Culture and Mental Health
How culture affects psychological health
Cultural Influences on Mental Health
1. Should we focus on race, ethnicity, and culture in therapy?
2. Cross-cultural research
a. Two causal models of cultural influence
b. A research example: Jamaica vs. U.S.
3. Implications for clinical intervention
Should we focus on
race, ethnicity, and culture in therapy?
Three good reasons not to:
1. We are all fundamentally the same
2. Each of us is a unique person with unique life experiences
3. Race/ethnicity/culture is only one type of group
difference. Why focus on this particular difference and
not on gender, class, and/or sexual orientation?
The role of culture
 Zeitgeist



Drapetomania (out)
Homosexuality (out)
Pathological gambling (in)
 Cultural relativity (emic vs etic)
 Cultural influences on prevalence
Cross-Cultural Research Methodology
Etic perspective
•Emphasis on universals among human beings by using examination and
comparison of many cultures from a position outside those cultures.
•The usual etic imposed is white, middle-class, Anglo-American.
•The original norms on the original MMPI (1972) described a 35-year-old
white, married, semi-skilled man with an 8th-grade education
Emic Perspective
Examines behavior from within a culture, using culture-specific criteria
Causal Models of Cultural Influence
(Weisz, 1987)
Problem Suppression-Facilitation Model
• Culture suppresses (via punishment) some behaviors
• Culture facilitates (via modeling, reinforcement) other
behaviors
Adult-Distress-Threshold Model
• Culture determines adult thresholds for different types of
child problems
A research example: Jamaica vs. U.S.
Jamaican Society:
•
Descendants from British-owned slaves from West Africa (became
fully independent state in 1962).
•
Cultural customs reflect a combination of
• British values (e.g., respect for authority)
• African values (e.g., respect for elders)
•
Child-rearing often done by extended family
•
Non-related adults have “permission” to address a child’s behavior
U.S. Society:
•
•
Two types of childhood disorders
 Externalizing disorders: problems in conforming to
expected norms; often cause problems for others.





Rule violations
Negativity, anger & aggression
Impulsivity
Hyperactivity
Deficits in attention
 Internalizing disorders: experience of subjective distress;
others often unaware of their difficulties.



Separation anxiety
Depression
Phobias
Cultural Differences in Child Behaviors
Given your basic knowledge of
• how the Jamaican and U.S. societies are different
• the two major categories of child problems
• Internalizing
• Externalizing
Can you make any predictions about how the prevalence of
these two types of problems may differ in Jamaican vs. U.S.
children?
Lambert & Lyubansky, 1999
Parents’ reports of boys ages 6-11
10
8
6
4
2
0
Ext *
Int *
U.S.
Jamaica
Parents’ reports of boys ages 12-18
10
8
6
4
2
0
Ext *
Int *
U.S.
Jamaica
Lambert & Lyubansky, 1999
Parents’ reports of girls ages 6-11
10
8
6
4
2
0
Ext *
Int
U.S.
Jamaica
Parents’ reports of girls ages 12-18
10
8
6
4
2
0
Ext
Int *
U.S.
Jamaica
Lambert & Lyubansky, 1999
Self-reports of boys ages 11-18
20
16
12
8
4
0
Ext *
Int *
U.S.
Jamaica
Self-reports of girls ages 11-18
20
16
12
8
4
0
Ext
Int *
U.S.
Jamaica
Presenting problems of clinic-referred African-American
and Jamaican youths, ages 4 to 18
2
1.5
1
0.5
0
Ext
Int
U.S.
Jamaica
Lambert et al., 1999
Research Conclusions
1. The data indicate that there are, in fact, cultural influences in child
problems, lending support to the two models of cultural influence.
2. Jamaican children tend to have more internalizing problems and U.S.
children tend to have more externalizing problems, regardless of age,
gender, or reporter.
3. Adolescents report more internalizing problems than parents, regardless of
their gender or culture. Do we know why?
4. Understanding cultural differences is necessary to a) understand human
behavior and b) to work effectively with people
5. Cultural differences exist, and are likely to become more pronounced with
age, as the effects of socialization become more ingrained.
Clinical Implications
 Consider all clients as individuals first, but recognize that a
person’s racial/ethnic group membership is often part of his/her
personal identity. Note separately the degree of involvement with
both the culture of origin and the new culture.
 Never assume that a person's race/ethnicity tells you anything
about his or her cultural values or patterns of behavior (see Cross
article on Black racial identity).
 Treat all "facts" you have ever heard or read about cultural values
and traits as hypotheses, to be tested anew with each client. Turn
“facts” into questions.
 Remember that all members of racial/ethnic minority groups in this
society are bicultural. The percentage may be 90-10 (in either
direction), but they still have had the task of integrating two value
systems that may be in conflict. The conflicts involved in being
bicultural may override any specific cultural content.
Clinical implications (continued)
 Do not prejudge which aspects of a client's cultural history, values,
and lifestyle are relevant to your work with the client. Engage your
client actively in the process of learning what cultural content
should be considered.
 Identify strengths in the client's cultural orientation which can be
built upon. Assist the client in identifying areas that create social or
psychological conflict related to bi-culturalism and seek to reduce
dissonance in those areas.
 Know your own attitudes about cultural pluralism, and whether you
tend to promote assimilation into the dominant society or stress
the maintenance of traditional cultural beliefs and practices.
 Identify cultural explanations for the individual’s illness. Also,
identify the associated beliefs and attitudes regarding the illness
(e.g., temporary vs. permanent)
 Be aware of cultural elements in the clinician-client relationship