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Do you consider that contemporary theories of mental health ignore the cultural values of 'others'?

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Do you consider that contemporary theories of mental health ignore the cultural values of 'others'? Word Count: 2509 Interest in the relationship between culture and mental illness is not new (Kluckhohn 1944). However, in recent years, there has been a greater recognition and realization of cultures' influence over individual expression of mental distress, in psychiatric diagnosis and treatment, and in the delivery of mental health care community-wide. It is clear that cultural values shape the way in which mental symptoms are expressed and how individuals and their families respond to such distresses. Thus dictating when a cluster of symptoms and behaviours are labelled 'normal' or 'abnormal'. Cultural values also determine the accessibility and acceptability of mental health services. Consequently, effective mental health care cannot be separated from the cultural context in which the formation and expression of psychiatric distress occurs. Nonetheless, diagnosis of mental illness is still by and large taken from peoples' behaviour, often received via second-hand accounts or self reports of emotional state and cognitive processes, which may be inaccurate. Furthermore, there are very few objective, scientific tests that can be carried out to help with this diagnosis or to monitor treatment effectiveness. Therefore, even though a medical model is usually adopted, in many cases there is no real distinction between the symptoms and the hypothesised underlying disease. Despite these contradictions, the process of diagnosis aims to go beyond a mere description of symptoms and attempts to identify a (hidden)


In addition, it is a common feature of economically motivated migration from third world to first world countries that the social class distribution of the first generation of migrants is skewed downwards so the incomers are likely to be exposed to harsh working conditions, economic uncertainty, substandard and overcrowded housing and other forms of social deprivation. Depending upon context, these experiences will, themselves, have mental health implications which may mistakenly be attributed to ethnicity. Nonetheless, these potential factors will reduce, but not disappear entirely, as a greater and greater proportion of minority ethnic groups are born into this country. One factor which is common for all generations of South Asian and African ethnic minorities in Britain is their exposure to racism. Racism, in so far as it is manifested in discrimination and economic disadvantage, may well affect both physical and mental health, as poverty and low socioeconomic status are among the best predictors of risk for many forms of morbidity. Furthermore, in contrast to physical conditions, further manifestations of racism, such as prejudice, will also impact upon psychological well-being. Whereby experiences of verbal disrespect, social rejection, denial of humanity, stereotyping and assumptions that skin colour is associated with a whole range of problems from academic underachievement to serious criminal activity, have all had considerable influences on self-esteem and mental health. The health impact of racism, previously sidelined as a focus in research and policy, has recently gathered momentum as a subject of legitimate study.


It is clear that traditional views of mental health have in the past ignored cultural values of 'others', conversely, research in this area has boomed in recent years, and although putting these theories into practice has been slow, contemporary approaches have made distinct progress which incorporate alternative cultural values. Fernando (1991) believes that if we are to progress to a new definition and understanding of mental illness, this will have to be as part of a general move towards greater understanding between people. Where, for an understanding of this unity, a realistic approach must be taken to the problems arising from differences in culture and the divisions arising from racism. The paradox that mental health is different because of culture and race and yet the same irrespective of culture and race, is a reality that we have to face up to. In conclusion then, although there is still a significant gap in knowledge in transcultural mental health, future research will be advantaged by the availability of sophisticated research designs and statistical techniques that were unavailable two decades ago. Despite a slow start, progress over the next decade will likely outdistance the totality of what has been learned to date. It is possible that aspects of Western psychiatry may be useful if they are integrated into indigenous systems of 'psychiatry' and vice versa. However, if Western psychiatry is to participate fully in the promotion of mental health, it must break free from ethnocentrisms and racism, and reach out into the world it has so far ignored.

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