Learn how social factors promote mental health, influence the onset and course of mental illness, and affect how mental illnesses are diagnosed and treated. This course explores how our understanding of mental health and illness has been influenced by social attitudes and social developments in North America and around the world. The course begins by situating our contemporary mental health practices in historical context, then looks at different aspects of mental health, mental illness and mental health services and their connections to what’s going on in our social environment.
4.5 an example of intersections between culture and mental health
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From the course by University of Toronto
The Social Context of Mental Health and Illness
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From the lesson
Culture, mental health and mental illness
Meet the Instructors
Charmaine WilliamsAssociate Professor
Faculty of Social Work
>> So I said, as I said, we are going to be talking about one of your assigned
readings, social determinants of health among internally displaced persons in
Northern Uganda. And I'm using this as an example of
intersections between culture and mental health practice in the global context.
So the first think you need to know is a bit of context about international mental
health. There have been, unfortunately, many
incidents in recent years where there have been populations dealing with natural
disasters, man-made disasters, war, conflict, genocide, all kinds of things.
And now it's very common for there to be international responses to this.
So people will be sent over from Canada, for example, the U.S., the U.K., all kinds
of other countries to go in and do relief work, and some of that work is to deal
with mental health issues. So one of the things that they found out
pretty quickly was they went over there and they thought, well these people have
obviously been through a trauma, so what we need to do is get in there and deal
with their post traumatic stress disorder. And so they came in armed with cognitive
behavioral therapy and discovered that actually the people they were seeing did
not look like they had post traumatic stress disorder, and those interventions
were not very helpful to them. And what I think people have come to
understand and have become better at doing is, is finding ways to, to collaborate
with existing services and, and ways of healing within these contexts.
And really people are putting a lot of work into trying to understand what are
appropriate interventions in these circumstances and how can we collaborate
more effectively with local people. And a lot of the international relief work
you see now is to try to support local and indigenous strengths and resources as part
of building sustainable responses to these kinds of natural disasters and other
things. So, in this paper it's a research paper.
So I'm just going to take a minute talking about the research because I know not all
of you will necessarily be familiar with, with what they're describing.
So the team that went in conducted qualitative interviews.
And qualitative interviews are interviews where people are not using a questionnaire
per se. What they're doing is interviewing people
in a more conversational way about things that are going on in their lives.
So there are particular areas that they want to cover, and here you see that they
had started with hol, this holistic definition of health.
What they wanted to do was talk to people about what had happened to them, what they
understood to be health, and how, how these things had, had an impact on it, and
then also what they were doing. So the, so they did these interviews with
I think about 21 people. I wrote that down somewhere.
Don't have it here that, where they asked them about these issues.
The article reveals the following social determinants of health for
internationally, sorry, internally displaced persons in Uganda.
I'm hoping you recognize that we've talked about these in our lecture on social
determinants. They are largely issues that are located
in the social context, with some that you could also identify as being part of the
environmental context. These are commonly issues that you see
facing populations in the aftermath of war, disaster, civil unrest.
And I'm sure you won't be surprised that they are associated with the development
of both physical and mental health problems.
Certainly from a social determinants perspective, they, they seriously
undermine people's physical and mental health.
So this article through its use of qualitative interviewing gives us a
glimpse into what are the idioms of distress in this context.
I've mentioned idioms of distress a few times in this lecture, and I apologize
because I don't think I've given them a proper definition before now.
Idioms of distress refers to the specific ways that people express the distress,
distressing feelings that they're having. And these are always terms and ways of
behaving that make sense within their specific context.
And that might be a cultural context, but that also can be a family context, a
professional context, basically within any kind of, you know, social environment
they're in. This is the way that people express this
type of distress. For the people interviewed in Uganda, the
idioms of distress that were described included overthinking, madness, and
physical sickness, and of course we have to bear in mind that in trying to
communicate this to us as an English language audience, these may not, these
are undoubtedly not the precise terms that people used, but this is how they've been
translated. So overthinking seems to refer to sadness,
rumination, and obsessive thoughts that we would probably associate with depression.
Madness seems to refer to post trauma effects, although in this context, there
was the additional and very specific component of being affected by the
presence of vengeful ghosts and spirits. And certainly if you consider that part of
this conflict involved people being involved in the killing of other people in
the community, that makes sense. And then finally, the physical sickness
that they described was recognized as being a physical manifestation of the
social and emotional pain that many of them were experiencing.
There were also some indigenous components of this experience that are not as easily
translated into North American idioms. Because these were people who had worked
the land for their livelihood and survival, the separation from the land was
an important component of their suffering. It had tangible consequences in terms of
not having any resources and living in poverty, but it also had emotional
consequences, because separation from the land made people feel unwell, inadequate,
and negative about themselves. Another indigenous component was the
rendering of the social fabric. The loss of people in the community and
the aftermath of an experience in which people once known to you became people who
could harm or kill you was that the social connections that had once been in place
were broken. Without that community in place, without
that social fabric intact, people felt lost and unsupported, and this had
consequences for mental health as well. I'm hoping that as you think about this,
it's reminding you of the indigenous approaches to mental health that were
described in an earlier segment. Clearly the loss of connections between
individuals, families, communities, and nature were causing high levels of, of
distress among the survivors of this conflict.
So because we've been talking earlier about what is universal versus indigenous
in our understandings in mental health, I've created a table here where we can
look at what is described by these displaced perpens, persons in Uganda and
how it corresponds to what we in North America would call a post traumatic stress
experience. Clearly there are points of overlap, ways
in which we can take the idioms of distress in Uganda and translate them into
idioms of distress that we see in North America.
But there are other places where there is not a correspondence, and it may be that
these reflect the influence of culture-specific elements.
Although the experiences that trigger these reactions could be similar, they are
interpreted through a cultural matrix that makes them manifest differently, in
different cultural contexts. Another thing we learned from this paper
is that it is possible to merge the indigenous with other modes of helping to
promote mental health. The people interviewed talked about their
use of doctors, counselors, healers, religion, family and friends, and at times
isolation to engage in healing. Here we see a real demonstration of the
way in which a biopsychosocial approach to mental health can work.
And we see additional dimensions of spiritual and cultural that can be part of
the healing process. In our last segment, we are going to try
to bring these things together to think about how an understanding of the
intersections between culture, mental health, and mental illness might influence
the way we think about providing care in multicultural contexts like North America,
and the U.K., and the U.S., and so many other places.
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