Global Perspectives on Mental Health: Bridging Cultures, Diagnoses and Care
Global Perspectives on Mental Health: Bridging Cultures, Diagnoses and Care
By Charlotte Hajer
NAPA VALLEY, Calif. — Did you know that psychiatrists in Morocco still diagnose patients with hysteria? Or that people in India who hear voices tend to think of them as positive – even divine – whereas their counterparts in the United States typically experience them as threatening? Did you know that Brazil is the country with the highest prevalence of bipolar disorder in the world and that countries with a higher GDP also tend to see higher rates of anxiety? How interesting is it that Finland has once again been rated as the happiest country in the world but also has one of the highest rates of depression?
Just like almost any other disease, mental illness occurs on every continent on this planet, but there are curious variations in the way it is diagnosed, treated and experienced. Studying these trends can tell us more about how mental illness operates inside the human body and brain. I would argue, actually, that thinking about global mental health and illness means exploring much deeper questions about what parts of human experience are universal and in what ways individuals on opposite sides of the planet are different. It means grappling with what can really be defined as “normal” when we talk about feelings and emotions and who gets to decide what’s normal, anyway.
I’ve studied global mental health and illness for many years. And what it has shown me is that human experience (and definitions of “normal”) across the world are both different and universal in ways that are each important to understand and embrace.
Every category of mental illness (anxiety, depression, psychosis, personality disorders and so on) occurs around the world. In other words: Psychological suffering is a human universal. Sure, our environment might shape the way we express and experience symptoms of mental illness (remember the difference between Indian and American voice-hearers?). And absolutely, a community that considers sadness to be a normal part of human experience may be less likely to diagnose someone with depression, while a society with a weaker social safety net may see higher rates of anxiety.
But in every part of the world there are individuals who experience a level of suffering that interferes with their ability to function – to work, to socialize, to take care of themselves and others. And in every part of the world there are practitioners whose job it is to help those people resolve that suffering. I think it is important to recognize this universality because it shows that mental illness is real – as real as something like diabetes or a broken leg – and just as worthy of treatment by trained professionals.
At the same time, it’s important not to lose sight of the variations that can exist within that reality. Culture and language shape the way we experience our emotions and psychological struggles in significant ways – ways that can impact the success of treatment if they’re not taken into account. A well-known example in the field of global mental health is the way people in many cultures tend to express symptoms of depression in physical ways: They’ll complain of stomach aches, fatigue or dizziness, for example.
A primary-care doctor who is unaware of these cultural factors may not consider the fact that these could be signs of a psychological rather than physical issue, leaving their client without the correct referral. (The same is true of any medical illness. Imagine a patient who is at risk for a heart attack but comes from a community that has taught them to be “tough” and therefore tells their doctor that their chest pain barely bothers them. A doctor who forgets to consider this cultural environment might underestimate the patient’s risk level, which might then lead the latter to miss out on life-saving tests or preventive measures.)
But it's about more than correctly recognizing symptoms. It’s also about understanding that not all treatments work for everyone. Just as different patients with diabetes will prefer different methods of administering insulin due to variations in lifestyle, so not every patient with depression or anxiety will prefer or respond to the same kind of treatment. A religious individual might appreciate a therapist who can infuse spirituality into their work. Someone who identifies as part of the LGBTQIA community might benefit from a practitioner who understands the experience of coming out. And someone who grew up in a French-speaking household might prefer to work through their childhood trauma with a therapist who speaks that language.
This is why it is so incredibly important that diverse communities like ours have access to a diverse range of medical and mental-health practitioners. In honor of this year’s World Mental Health Day (on Oct. 10), let’s appreciate the universals that connect us all as humans, let’s celebrate the differences that make us all unique, and let’s work to make sure that everyone has access to the psychological supports and wellness tools that work for them.
If you or someone you love is experiencing a mental-health crisis, call or text the 988 Suicide and Crisis Lifeline.
If you or someone you love needs mental health or wellness support, please visit our Mentis Community and Youth Resource Database. Mentis is one of Napa’s oldest nonprofits and provides bilingual, affordable mental health services to people of every age and income level.
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Charlotte Hajer is Mentis’ development director. She holds a Ph.D. in medical anthropology with a focus on cross-cultural mental health. She lived in Morocco for two years, where she conducted research on women, hysteria and borderline personality disorder at a psychiatric hospital. Originally from Amsterdam, the Netherlands, she now lives in Sonoma with her husband and two children. She loves to write about the way individuals experience and navigate the social and cultural world around them.
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Ye, mental illness can be subtle and needs different perspectives.