Cultural specificity

Cultural determinants of ‘reality’

Across the globe, culture and language heavi­ly influence the way we deal with health issues. This is particularly true in the case of mental health. When making a diagnosis, health professionals must consider the patient’s cultural and linguistic background to reach an unbiased assessment.
Dealing with psychological problems is strongly dependent on culture. Short/picture-alliance Dealing with psychological problems is strongly dependent on culture.

Our native language guides our actions and thoughts in many subtle ways. Indeed, language determines the ground rules of communication itself. For example, a child whose native language is German learns to put him- or herself at the centre when expressing a thought. An Iranian child, in contrast, learns to say “we” instead of “I”, downplaying the individual’s role. Similarly, many languages use the words “yes” and “no” differently from German. Many Asian languages have a weaker form of “yes” – and have no word to convey a firm “no”. The reason is that an emphatic negation could feel offensive.

Differences in the way words are used can give rise to misunderstandings. Two people from different cultures may believe they have expressed themselves clearly – and yet they may not have understood each other at all.

Such cultural misunderstandings can carry over into medical and especially psychological evaluations. For example, cultures that prioritise saving face and protecting one’s group give little scope to admitting that an individual suffers mental distress. As entire families are involved in issues of health and illness, it might be considered a disgrace to admit to that a family member is not well. That leaves people who are mentally distressed with only the option of pointing to a physi­cal problem. People in such cultures might say things like “my heart is liquefied”, “my liver is burning”, or “my skin is on fire” to describe what is in fact mental distress.

This phenomenon explains why physical illnesses with no identifiable organic cause appear more frequently in some cultures than others. If admitting to a mental issue is un­avoidable, some cultures might deal with the problem by “externalising” the cause, viewing the affected person as possessed by a ghost, a demon, a devil or some other evildoer.

Cultural standards

Personality is influenced by many factors, including a person’s biology, learning style and life circumstances. The social and cultural context matters too. The terms and concepts used in the study of personality are themselves strongly influenced by the cultures the researchers belong to. Cultural differences between researcher/clinician and patient – including differences in basic social values – should be taken into account to avoid misunderstandings and incorrect diagnoses (see box).

Moreover, individual variations within cultures should be considered. When discussing a nation’s cultural characteristics, experts often portray the values, thinking processes and perceptions of the majority as applying to everyone in a given culture. For example, in country X punctuality may be described for everyone as a sign of compulsiveness and lateness as a sign of self-confidence. The possibility of exceptions to these rules is often left out of the picture. Such stereotyping can be harmful.

The ongoing global blending of cultures should also be taken into account. Nowadays it is not uncommon, for example, for a young woman to be self-confident in public affairs, religiously devout, politically progressive and still have a traditional view of sexuality. The lines of national cultural identities have been blurring at least since the 1970s, and the internet has recently been accelerating the trend dramatically.

Interpersonal interactions within cultures have thus become more complex and multi-layered. This causes stress, psychological instability and mental overload – factors that should be considered when making individual psychological evaluations. Above all, a discerning attitude towards oneself as an observer and close questioning of one’s own cultural precepts, can help to improve understanding and communication worldwide.

Solmaz Golsabahi-Broclawski directs the Medical Institute for Cross-Cultural Competence in Bielefeld. She specialises in psychiatry and psychotherapy.

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