Concepts of mental health, distinctions between mental health and mental illness, and distinctions between mental and physical illness are highly variable across cultures. Lefley examines the cultural context of defining mental health and mental illness. The first part of the chapter explores the relationship between culture and the experience of stress. The second part of the chapter turns to international research and provides an integration of its empirical findings. The third part focuses on cultural diversity in mental health service systems and describes the important role played by social stressors, ethnicity, and minority and refugee status. It contrasts the traditional and biomedical healing systems and describes the Italian experiment to improve the quality of life of persons with mental illness. Self-help groups and the consumer movement have also emerged internationally, and the chapter examines some of these movements. The chapter concludes by considering the future of mental health services and the merging of Western concepts with those of the developing world. Is there a universal or optimal way to describe mental health and illness? Students should consider variability among meanings attached to mental health and illness.
In this chapter, we deal with culture as a major variable in the conceptualization, development, and administration of mental health systems. The study of culture has typically referred to the beliefs, values, symbolic meanings, and normative behavioral practices of a specific human group. But in social science research today, cultural groups are usually categorized and compared along axes such as Western versus non-Western or modern versus traditional. In recent years, there has been increasing attention to differentiating individualistic cultures, which give primacy to individual rights, from collectivist or sociocentric cultures which focus on group loyalties and social role obligations (Triandis, 1995). These respective modes of categorization in many ways tend to distinguish the wealthier, industrialized nations from the developing world. Thus, they represent differences not only in worldview and norms, but in resources available for the provision and structure of health care. Within nation states, modal cultural attitudes as well as intergroup differences may shape the accessibility, appropriateness, and effectiveness of services for population subgroups such as racial or ethnic minorities (Substance Abuse and Mental Health Services Administration, 2015b; Takeuchi, Uehara, & Maramba, 1999).