Cross-Cultural Approaches to Mental Health: How Does Culture Affect Our Understanding?

We tend to approach physical and mental health as an objective concept – governed by evidence and science. With medical research, we have identified and classified various mental illnesses, laid out their symptoms, and developed evidence-based treatments.

But beneath the surface of this “objective” understanding lies an often overlooked dimension: cultural identities. Culture shapes our understanding of the world, including how we perceive and navigate the realm of mental health.

In the United States, the study, assessment, diagnosis, and treatment of mental illnesses have predominantly been influenced by our shared Western culture. However, this prevailing approach must encapsulate the rich diversity of perspectives and beliefs of different cultural communities. Our cultural identities profoundly influence our attitudes toward emotional well-being and the approaches we adopt when faced with mental health challenges.

Today, we’ll examine how culture affects our understanding of mental health and discuss what we can learn from a multicultural perspective.

Cultural identity and mental health perspectives

Culture refers to a group’s shared beliefs, customs, values, etc. Although we often think of culture as being related to one’s nationality – and the country you grew up in undoubtedly makes up a part of your cultural identity – it’s about much more. Culture can be defined by your neighborhood, friends, religion, educational or socioeconomic background, and even music taste.

Everyone is impacted by their cultural identity – there are no exceptions. Though we may not tend to recognize our culture when we’re surrounded by others who share it, everyone has a cultural identity, and culture impacts the way we all understand mental health.

Our cultural identity provides a unique lens through which we interpret our emotions and mental well-being. This worldview is deeply ingrained in our upbringing, family traditions, spiritual beliefs, and societal norms. These factors profoundly shape our attitudes toward mental health and influence how we seek help from the medical system.

For example, in many cultures, mental health challenges are seen as a communal issue, addressed collectively within the family or community. Others (like the U.S.) may prioritize individual autonomy and professional treatment.

How do different cultural groups understand mental health?

There are so many different cultural groups that exist in the world it would be futile to try to delineate how every single one of them affects our understanding of mental health. For example, on top of different countries and ethnic groups’ cultures, there exists:

• Youth culture
• Different music culture (such as the electronic dance music culture)
• Drug Culture
• Culture of the LGBTQ+ community, including subcultures within this group
• Internet culture
• Cultures around specific interests (like anime culture)
• Political countercultures

Each of us exists at the intersection of many different cultures, and it’s essential to take all of your various identities into consideration when thinking about how your “culture” affects your understanding of mental health.

Recognizing the diversity within cultural groups is crucial as well. People from the same cultural background can hold different perspectives on mental health; no cultural group is a monolith. You may very well have different beliefs about mental health than your cultural groups or even your family, and that’s okay.

How the West has shaped the mental health conversation

It is essential, however, to recognize much of the “mainstream” understanding of mental health in the world has been shaped by Western culture.

In places like the United States, the dominant approach to mental health has been rooted in Western theories and practices. We lean toward the medical model, which is often focused on diagnosing and treating mental illnesses with medication and therapy. While these approaches have been effective for many individuals, they may not resonate with everyone.

The Western-centric approach prioritizes individualism, direct communication, and symptom-based diagnosis, but many cultures value collectivism, indirect communication, and holistic well-being. People from other cultural backgrounds could find it challenging to relate to the Western model of mental health and be less likely to seek help because of this.

How does culture impact mental health treatment?

Because culture has such a significant impact on our understanding of mental health, it also affects whether or not we receive treatment that is helpful for us. Especially in places like the U.S., which have a Western-centric view of mental health, it’s important to realize people who don’t share these Western cultural values may feel uncomfortable seeking help in our healthcare system.

Here are some of the specific cultural factors that can affect mental health treatment^[1].

How symptoms are perceived

Culture can impact the way the symptoms of mental illness are perceived. Many cultural groups make no distinction between physical and psychological health and may be inclined to treat mental health symptoms just like they would any physical discomforts. For example, someone might feel mildly depressed one day and innately understand what they need – rest, a nourishing meal, social connection – instead of going to a medical professional for intervention.

How symptoms are presented

People also vary in how they present or describe their symptoms to providers. For example, people of some cultures could tell somatic issues like frequent headaches because that’s what they notice first (above other symptoms like depressed mood).

Emotion expression

Cultural groups also vary in how they express emotions. Some cultures may believe in expressing deep and innermost feelings to other people, while others may value keeping their genuine emotions hidden, and so forth.

How trauma is understood

Culture can affect the way people view and process traumatic and other difficult experiences. For example, some cultural groups may feel it’s best to try to forget and move on without dwelling. Others may want professional medical assistance to process or feel like they need a period of mourning, and so on^[2].

Power imbalances in medicine

In some cultures, there is a vast inherent power imbalance between medical providers and their patients. All medical professionals, including mental health therapists, may be thought of as “doctors,” and people may feel little to no autonomy within the relationship.

Willingness to trust medical professionals

Similarly, some cultures and communities have an understandable mistrust of medical professionals. This could be especially true if the medical professional doesn’t share your culture; you might feel they won’t understand.

Spirituality and religion

Religion is often tied to culture and can influence the way we think about mental health and treatment. For example, many cultures historically have regarded mental illness as a sign of possession by evil spirits. Some people may prefer a spiritual guide or pastor for advice and healing rather than a Western healthcare professional.

Social worlds

Culture can also affect the amount of social support we have in our lives. Some cultures value social connection with similar people, while others appreciate the nuclear family. Many cultures value large families and regular gatherings. Social connection is a crucial protective factor against mental illness, so this is important.

Coping strategies

Cultures cope with difficulties in different ways. Two people could feel the same symptoms of anxiety, but depending on their culture, one could want medication to cope with their symptoms while another person could cope by getting more rest. People of one cultural group may feel they must be left alone to manage well, while others want to be surrounded by people^[3].

Treatment methods

Similarly, people of different cultural groups may request other treatment methods. The combination of medication and talk therapy may only resonate with some cultural groups. Although it’s essential to explore all of your treatment options (especially ones that research has found effective), choosing treatments that you feel comfortable with and that align with your cultural values is also essential.

Cultural shame

Unfortunately, every culture feels shame about some aspect of life – and some cultures feel shame around having mental health issues. Some cultural groups may have shame around being seen as “crazy” or “weak” by their community, while others may have shame around talking to outsiders about personal problems and more.

Historical/generational trauma

Lastly, many cultural groups have experienced historical trauma, and the effects of this trauma may have been passed down for generations. To be clear, it’s not culture itself that causes trauma but rather the oppression and discrimination that society places on certain cultural groups. Generational trauma can harm mental health.

Holistic and culturally competent mental health care

There is no way to detangle your cultural identity with the way you view mental health. It’s critical to find a mental health provider who listens to your concerns and helps to create a treatment plan that’s tailored to you.

The Center • A Place of HOPE uses a unique Whole Person Care approach to mental health treatment. This means we consider every aspect of your well-being – mental, physical, spiritual, social, financial – and cultural. We want to understand how you view your mental health and offer culturally competent care consisting of many different holistic treatment methods.

1 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018386/
2 – https://www.ncbi.nlm.nih.gov/books/NBK44249/
3 – https://focus.psychiatryonline.org/doi/10.1176/appi.focus.20200049