Diversity

There is significant evidence to show that not only does culture play a significant role in terms of how we understand health and illness, but that different cultures perceive these differences and that these differences can play a key role in terms of how illnesses are managed. One aspect of difference across cultures relates to what we perceive the cause or nature of disease or illness to be. This can vary from notions of possession by spirits, yin/yang imbalances, the ‘evil eye’, black magic, or the breaking of taboos (and perceptions change with time, for instance, homosexuality, which was identified as a disorder in the DSM-II until 1974). Views of illness, causality range across the individual, the natural world, and the social world, and every cultural group may see this differently. Knowledge of the range of culturally informed understandings should provide avenues for the practitioner to explore further, to come to a clearer appreciation of the issues.

Culture changes our coping styles or how we cope with everyday problems and to more extreme types of adversity. Not only are there cultural variations in the stressors that people experience, but the assessment of stressors also varies, as do the choice of responses to stressors. The US Department of Health and Human Services noted such differences in coping styles when reporting that children in Thailand were two times more likely than children in the US to report reliance on covert coping methods, such as ‘not talking back’, as against overt methods such as ‘screaming’ and ‘running away. Treatment-seeking patterns vary across cultures. People from ethnic minorities are less likely to seek mental health treatment and also more likely to present in crisis compared with the majority community in Western countries. Some of these patterns can be examined in how culture and the history of that culture change, how therapeutic systems, interventions, and therapists are viewed or trusted. As an example, in countries like Australia, where minority groups such as Aboriginal and Torres Strait Islander people have historically struggled with oppression and dispossession, we may view mental health professionals as part of the problem.