Culture refers “to the ideas, customs, and social behaviour of a particular people or society.” “the way of life, especially the general customs and beliefs, of a particular group of people at a particular time.”

1. MENTAL HEALTH AND CULTURAL
RESPONSE
Dr. Kingsley Mayowa Okonoda
Consultant Psychiatrist and Medical
Director,
Netwealth Centre For Addiction
Management and Psychological
Medicine.
State Low Cost, Rantya, Jos.

2. MENTAL HEALTH
Mental health is defined as a state of well-
being in which every individual realizes his or
her own potential, can cope with the normal
stresses of life, can work productively and
fruitfully, and is able to make a contribution to
her or his community.

3. The positive dimension of mental health is
stressed in WHO's definition of health as
contained in its constitution:
"Health is a state of complete physical, mental
and social well-being and not merely the
absence of disease or infirmity."

4. The World Health Organization (WHO)
relates mental health to the "promotion of
well-being, the prevention of mental disorders,
and the treatment and rehabilitation of people
affected by mental disorders."
And in 2005, the WHO endorsed mental
health as a universal human right.

5. WHAT ARE MENTAL ILLNESSES?
Refer Definition.
Mental illnesses are health conditions involving
changes in thinking, emotion or behavior (or a
combination of these).
Mental illnesses are associated with distress
and/or problems functioning in social, work or
family activities.

6. CULTURE AND MENTAL HEALTH
Culture refers “to the ideas, customs, and social
behaviour of a particular people or society.”
“the way of life, especially the general customs
and beliefs, of a particular group of people at a
particular time.”
Cambridge Dictionary

7. DIFFERENT CULTURAL GROUPS AND BELIEFS?
Particular People:
Racial
Ethnic
Religious
Particular Time:
Previous Centuries
This Century
This Decade
Now

8. CULTURAL BELIEFS: AETIOLOGY OF MENTAL
ILLNESSES
What are the beliefs about the causes of Mental
Illnesses?
Demonic Possessions?
Spiritual Attack?
As a result of weak character? (Weakness, Laziness,
Greed)?
As a result of sin?
Suicide: Honour? Shame?

9. In a recent study when surveyed on their thoughts on the
causes of mental illness, over a third of Nigerian
respondents (34.3%) cited drug misuse as the main cause.
Divine wrath and the will of God were seen as the second
most prevalent reason (18.8%), followed by
witchcraft/spiritual possession (11.7%).
Very few cited genetics, family relationships or socio-
economic status as possible triggers.

10. Pathogenic effects – Culture is a direct causative
factor in forming or generating illness
Patho-selective effects – Tendency to select
culturally influenced reaction patterns that result in
psychopathology
Patho-plastic effect – Culture contributes to
modeling or shaping of symptoms

11. Patho-elaborating effects – Behavioral
reactions become exaggerated through
cultural reinforcements
Patho-facilitative effects – Cultural factors
contribute to frequent occurrence
Patho-reactive effects – Culture influences
perception and reaction.

12. CULTURAL MANIFESTATION OF ILLNESS
Delusions: Themes of delusions have been found to
be related to patients' social background, cultural
beliefs, and expectations. Religious delusions are
common in Christian societies, whereas these are
rarer in Hindu, Muslim, or Buddhist societies. Magical
religious delusions have also been found to be
greater in rural societies, especially in women >30
years of age.

13. The first large-scale cross-cultural evaluation of hallucinations
found that visual hallucinations were more common in Africa.
Another study found higher occurrence of auditory and visual
hallucinations in non-European patients than in European patients.
The International Study on Psychotic Symptoms (ISPS) showed
that auditory hallucinations were commonest in all cultures and
that visual hallucinations were the commonest in Africa and the
rarest in Pakistan. The cultural content of hallucinations also recurs
in future psychotic episodes.

14. Low rates of religious delusions, grandiose delusions,
and delusions of guilt were found in Pakistan, the
only pure Islamic country in the study.
In contrast, religious grandiosity was more common
in African countries.
The cultural content of the delusions recurs in future
episodes of psychosis.

15. CULTURAL BELIEFS: ATTITUDES TO THE MENTALLY ILL
Mental illness is a taboo subject that attracts stigma in much of
Africa.
Social stigma has meant that in much of Africa mental illness is a
hidden issue equated to a silent epidemic.
Many households with mentally ill persons hide them for fear of
discrimination and ostracism from their communities.
Girls from homes known to have mental illness are
disadvantaged due to the fact that a history of mental illness
severely reduces their marriage prospects.

16. CULTURAL BELIEFS: ATTITUDE TO TREATMENT
Presentation to the traditional healers.
Presentation to the churches and mosques
Prayer and fasting
Deliverance
Delay in presentation to mental health
professionals

17. Poor funding for health.
Funding for mental health is even worse :Most
developing countries dedicate less than 2% of
government health budgets to mental health care.
According to a study by the Grand Challenges in Global Mental
Health Initiative the biggest barrier to global mental health care is
the lack of an evidence-based set of primary prevention intervention
methods.
It may be a reflection of the cultural beliefs of the people.

18. CULTURAL BELIEFS AND THERAPY
Understanding the sociocultural beliefs of the clients
The roles of family members are very different
transculturally.
They play a more significant role in treatment in an
Nigerian setting.
Communicating with patients and families regarding
diagnosis, illness, and care is an art that needs to be
attuned to individual cultural frameworks.

19. The family remains an important resource for the support of
patients with mental health problems. You must therefore
understand the dynamics of the family.
Although most families are willing to care for their sick relatives,
severe mental disorders may deplete the resources of even the
most willing and able families.
Involvement of the family in therapy

20. Communicating with patients and families regarding diagnosis, illness,
and care is an art that needs to be attuned to individual cultural
frameworks.
In addition, the nature of expressed emotions and life events differ
between cultures.
Traditional healing practices
Motivational factors to follow traditional healing practices include
cultural faith, inadequate recovery with allopathic treatment, economic
factors, social stigma, and easy approachability

21. It is important to understand the concepts, classification, and management
of other health systems to have effective liaisons with them.
Concomitant use of traditional therapies may enhance the acceptance and
adherence of modern treatments.
Psychotherapy
Cultural values are important to determine psychotherapeutic needs and
interventions. There are cross-cultural differences in personality
configurations which have to be taken into account. The Western-model
psychotherapy in its usual form may not be suited for a diverse culture like
Nigeria

22. Some proposed modifications to suit the need of Indian patients are as
follows:
Use of religion or spirituality – Religious beliefs can be used for the
benefit of the patient if used carefully
Family involvement – Unlike in the West, many Nigerian subjects might
want active family involvement. The need for confidentiality may not be as
high
Lower emphasis on individual responsibility and autonomy – Nigerian
culture fosters dependence and dependability

23. Superior class of the therapist and paternalistic approach –
In Nigerian societies, the doctor (or therapist) is considered
superior and the patient becomes submissive. This may be
used for patients' benefit.
Greater active participation by the therapist – Unlike the
Western-style therapist, the Nigerian therapist has to be
more active and direct suggestions might be particularly
useful
Single session therapy may be useful for the poor and
underprivileged.

24. CONCLUSIONS
Cultural sensitivity and competence in assessment, and
management are as important as other aspects.
The use of cultural factors in a positive way will improve
coping with symptoms and illness, as well as recovery. It is
also important to consider other cultural, traditional, and
folk methods for understanding and management of
mental illnesses.

25. SEEK PROFESSIONAL HELP
Netwealth Consult Ltd
 Mental Health Promotion
 Peak Performance Training
 Personal Development
 Management Consulting
Netwealth Medical Services& Rehabilitation Centre Before Mining
Gate, State Low Cost, Rantya, Jos
Mindwealth Academy
Mindwealth for Life and Living
netwealth.consult@yahoo.com, netwealthconsult30@gmail.com
08036770092 (CEO/MD), 08107717419 (Front Desk)
Netwealth Rehabilitation Initiative Netwealthrehab.ngo@gmail.com
12-Mar-22 25

26. 12-Mar-22 26

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http://www.who.int/features/factfiles/mental_health/en/ Accessed 21st November, 2017
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Arboleda-Florez, J. (2002). 'What Causes Stigma?' World Psychiatry 1 (1): 25-6.
Amuyunzu-Nyamongo M. The social and cultural aspects of mental health in African societies.
Commonwealth health partnerships. 2013:59-63.
Kala AK, Wig NN. Delusion across cultures. Int J Soc Psychiatry. 1982;28:185–93.
Tateyama M, Asai M, Hashimoto M, Bartels M, Kasper S. Transcultural study of schizophrenic
delusions. Tokyo versus Vienna and Tübingen (Germany) Psychopathology. 1998;31:59–68.
Stompe T, Bauer S, Ortwein-Swoboda G. Delusions of guilt: The attitude of Christian and Islamic
confessions towards Good and Evil and the responsibility of men. J Muslim Ment Health.
2006;1:43–56.

28. Murphy HB, Wittkower ED, Fried J, Ellenberger H. A cross-cultural survey of
schizophrenic symptomatology. Int J Soc Psychiatry. 1963;9:237–49.
Ndetei DM, Vadher A. A comparative cross-cultural study of the frequencies of
hallucination in schizophrenia. Acta Psychiatr Scand. 1984;70:545–9.
Chaturvedi SK, Sinha VK. Recurrence of hallucinations in consecutive episodes of
schizophrenia and affective disorder. Schizophr Res. 1990;3:103–6.