12.4 Culturally specific and universal factors in mental health.

Substance disorders are strongly implicated in mental illness including the abuse of alcohol and illegal drugs ubiquitous in nearly all societies. Some societies have had no historical experience with alcohol including some American Indians tribes and the Aborigines of Australia, and do not metabolize alcohol in the same way as people of European descent leading to early alcohol dependence, especially when associated with desperate socioeconomic circumstances (Baxter, 1998).

The DSM recognizes a number of mental illness syndromes as culturally specific patterns of aberrant behavior not connected to existing diagnostic categories in the DSM that we discussed above. These syndromes appear only in distinct cultures and those societies that are related culturally or geographically supporting the cultural context as a determinant of mental disorder. The symptoms of some culturally framed mental disorders do not appear to have an organic cause, but are nevertheless recognized as an aberration by a specific cultural society. Although a given mental disorder may in some cases appear to be related to a diagnostic category in the DSM the cultural context create local features. In some cases the disorder may lack distinct symptoms associated with the illness in the West. A culturally specific mental illness may not be recognized in DMS such as Kuru disorder in New Guinea, a progressive psychosis thought to be the result of protein malfunction. Some illnesses may occur in several cultural settings, but are only recognized as disorders in some cultural contexts and not in other situations. Aberrant behavior is linked in some traditional societies to superstitious beliefs in witchcraft or being in a state of trance brought on by spirit possession. These behaviors and beliefs would be taken as evidence of psychoses in Western medicine. Some mental disorders appear to be just local cultural varieties of the more common diagnostic syndromes found in the West. Nevertheless, the culturally specific interpretation is helpful by bringing culturally related beliefs from in religion and superstition to the attention of the clinician and contributes to the understanding of the etiology of mental illness in some societies (Simons & Hughes, 1985).

Culturally specific disorders reflect cultural values in different parts of the world. They include Zar, a common belief in Africa of being in the possession of spirits and a disorder characterized by involuntary movements (Grisaru, Budowski, & Witztum, 1997). Ataque de nervios have been diagnosed in Latin groups and symptoms include extreme emotion manifested by trembling, crying, and shouting (Febo, San Miguel, Guarnaccia, Shrout, Lewis-Fernandez, Canino, & Ramirez, 2006). Pfeiffer (1982) suggested that such culturally specific syndromes arise from culturally unique family, social and ecological sources of stress. The specific manifestation of aberrant symptoms develops out of societal expectations that encourage certain ways of responding to stress. Researchers in these areas argue that it is important to understand cultural values and beliefs in determining how to help victims of these disorders.

Anorexia nervosa is an illness diagnosed initially in Western affluent societies. The disorder produces distorted perception of body image so that even very skinny patients see themselves as fat. The fear of becoming fat produces serious and in many cases life-threatening loss of weight as the patient refuses to eat, or in the case of bulimia purges food after eating. The ideal of female beauty has varied across centuries and in different cultures. However, in the last decades the image of the super thin model has been promoted as the ideal for women in the Western world and transported overseas via the media. Since the image is impossible to reach for most women, and is in fact very unhealthy, most women fail to achieve the unreasonable weight loss required to become super thin and some become anorexic. Today along with globalization and the spread of Western models women all over the world are now bombarded with similar pressures to become and stay thin. Anorexia that once was thought culturally specific to Western countries has now been diagnosed in many other urban cultural areas (Gordon, 2001; Tareen, Hodes, & Rangel, 2005).

An overall conclusion of the research results lends support to the presence of universal symptoms in the diagnosis of some mental disorder categories including depression and schizophrenia. There is also evidence for some culturally specific syndromes shaped by cultural values and expectations. Culture and the presence or lack of social support determines the prognosis of a given disorder. Although both culturally specific as well as universal mental health diagnoses are supported in the literature, there is no way to predict the outcome of globalization on mental health. However, with globalization social structures and cultural influences are becoming more homogenous all over the world and that may influence how mental illness is viewed in the future (Guarnaccia & Rogler, 1999).