[MUSIC] How does culture affect mental health? [MUSIC] What are the major challenges for us is to look at how patients see their experiences of illness. [MUSIC] Anthropologists have argued that there is a very clear distinction between disease and illness. Disease is literally dis ease, which means that we are looking at pathology. When patients experience those phenomena of distress and it stops them from working, stops them from eating, it stops them from interacting with others, disease becomes illness. Doctors are interested in disease because that's what we're trained to identify, diagnose, and manage. Patients are interested in illness because it's stopping them from functioning, it's stopping them from going for a job, making money, paying their rent, looking after the family. [MUSIC] Sickness, on the other hand, is defined by the society. Society decides how much sick leave an individual is allowed, and how that is defined and who issues the certificate for that. It's the culture which constructs, which allows us to develop, express and share our experiences and distress. [MUSIC] Culture affects all aspects of the illness by generating symptoms, by perpetuating them, by creating the experience that patients may go through, may choose to share, may seek help for. Cultures also determine how healthcare systems are developed and where people go for looking at specific help seeking and port of call and expressing their distress and looking for help. [MUSIC] It can have a pathogenic effect, which means that it can cause symptoms, for example, it may produce culture conflict, which may lead to some common mental disorders. It may create new conditions which had not been seen before. [MUSIC] Culture may affect groups of people in specific ways, for example, symptom contents of delusions may vary across cultures and even historically, in the 1930s and 1940s, 1940s, people had delusions about mustard gas. Then it changed to the contents that they were being shadowed by the KGB or CIA then it changed to other impact of Facebook, etc. In some cultures, these delusions may be to do with something that they had done in the previous life and in others, it may be what they're experiencing now. Cultures also mould symptoms. In clinical depression, for example, in some cultures you will see much more of somatic symptoms, physical symptoms rather than psychological ones. Many languages do not have words for depression, but the experience of joylessness, of sadness, of not being able to concentrate can be universal, but it's also worth recognising that cultures do allow people to elaborate their pathology, what they're experiencing, and some conditions, for example, may not be pathological, but just allowed to be elaborated by the cultures. An example would be running amok. Originally, it will describe in Malayan Peninsula and it was seen as very much a culture bound exotic syndrome. The British rulers deemed it to be a crime as people were going around hitting others when they were feeling distressed so this meant that a common expression of distress, which the cultural allowed people to elaborate became a crime. Cultures can also facilitate expression of certain kinds of distress. We know that in many cultures, rates of suicides are much greater than others, rates of alcohol use and substance use are much greater and some of these variations can be explained on the business of culture. Of course, it is quite likely the genetic factors may be at play but these factors also tend to be affected by cultures and what that means is that, the way people are brought up, for example, in the Mediterranean countries, children are allowed a sip of wine at quite a young age, so you do not see, high rates of alcohol abuse, alcohol dependence or alcohol use, whereas in others, because there is no model, they may be binge drinking and there may be additional problems. Cultures affect people's beliefs and what they feel that they are going through and they may cause variation in help seeking and variations in outcomes. In many cultures, people will present with possession states or with, conversion disorders and what that does is that, as a clinician, you need to look out, what that means to the patient, what the significance is, and how the society and patient's families and carers deal with it. When you are in doubt whether something is culturally explicable, whether it can be explained by the culture or not, ask the patient's family, ask the carers, they will tell you whether in their micro-culture in their culture group, these things are acceptable or not, whether these are abnormal or deviant.
