This document discusses key concepts relating to culture and mental health. It defines culture and related terms, and explains how culture can influence various aspects of mental health, including definitions of normality and abnormality, symptom presentation, help-seeking behavior, and response to treatment. It also discusses culture-bound syndromes and how non-biological factors like cultural beliefs, traditional medicine use, and patient compliance can impact psychopharmacology.

2.  A pattern of beliefs, customs, and behaviors
which a people acquire socially and
transmit from one generation to another
through symbols and shared meanings.
 It provides the tools by which people of a
given society adapt to their physical, social
environment, and to one another.
 It is an organized group of ready made
solutions to the problems and challenges
which a people face.

3.  Culture: is the External expression of
people’s mental life in the form of
language, beliefs , customs, technology,
human relationship, and many other
factors.
 Society: is A population which is separated
from surrounding populations and has a
distinctive culture.
 Race: is the classification of people
according to biological and physical
factors e.g skin color, blood group.

4.  Ethnicity: is the Classification of people
based on race, culture, and language.
 Anthropology: is It is the study of human
beings. Medical anthropology is the study
of beliefs and behavior concerning health
and disease in different cultures.
 Cross-Cultural Psychiatry: is the, study of
cultural aspects of mental health and
mental illness.

5.  Physical (tangible): can be directly
observed through the five senses and/or
through items collected in a museum or
recorded on film. The physical level of
culture yields more easily to change and
to adaptation than does the ideological
level.

6.  Ideological (intangible): the beliefs and
values of the people, the reasons for
holding some things sacred and others
ordinary and the things , events of which
they are proud or ashamed, Religion,
philosophy, psychology, literature, and
the meanings which people give to
symbols) of culture which must be
observed in directly, usually through the
behavior people.
 Without some understanding of the
ideological aspect of culture, it is difficult
to understand the meaning of things at
the physical level

7.  Cultural identity: Ethnic or cultural
references and the degree to which an
individual is involved with their culture of
origin and host culture are important.
Also, attention to language abilities and
preference must be addressed.

8.  Cultural explanations: How an individual
understands distress or the need for
support is often communicated through
symptoms (nerves, possessing spirits,
somatic complaints, and misfortune);
therefore, the meaning and severity of
the illness in relation to one's culture,
family, and community should be
determined.
 This "explanatory model" may be helpful
when developing an interpretation, a
diagnosis, and a treatment plan.

9.  Psychosocial function: Cultural factors have
a significant impact on the psychosocial
environment and on function. Cultural
interpretations of social stress, support, and
one's level of disability and function must be
addressed. It is the physician's responsibility
to determine the level of disability.

10.  The relationship between the clinician and
the patient: cultural differences and their
impact on the treatment must not be
ignored. Language difficulties, difficulty
eliciting symptoms or understanding their
cultural significance, negotiating the
appropriate relationship, and determining
whether a behavior is normal or
pathological are common barriers.

11.  Normality and abnormality: Definitions of
normality vary widely throughout the
world. Even within a single society, the
social definition of normality is not
uniform or static. It varies for different
genders, age groups, occupations,
social ranks and cultural minorities.

12.  Illness behavior (The social process of
becoming ill): the way that illness is
recognized, labeled, explained and
treated within any particular society. The
process of labeling oneself as "ill" and
seeking help is a very complex one and
at each stage it is heavily influenced by
culture.

13.  Stage one: Identifying experiences as
abnormal.
 Stage two: Seeking explanations for
abnormal experiences.
 Stage three: Initial help seeking
behaviour.
 Stage four: Triggers to seeking
"professional" help.
 Stage five: The decision to seek medical
help.

14.  May be relevant in all patient groups.
 Often not readily admitted by the patient,
fearing it to be unacceptable to the
doctor.
 Knowledge of all therapies a patient is
receiving is important in assessment.
 Many complementary therapies may be
very helpful.
 A few have dangers or may interact.
 Compliance compromised if advice
conflicts with that of traditional healer.

15.  The clinical features of any given mental
disorder may vary from one cultural group
to another and this is referred to as the
"pathoplastic" effect of culture.

16.  The incidence and prevalence of mental
disorder varies considerably between
different cultures and social groups,
suggesting that cultural factors play a part
in the etiology of mental disorder.
 e.g.: mental illness in migrants. The rates of
mental illness in migrant populations are
often greater than those of the host
population in which they reside (and/or
from which they originate).

17.  The selection hypothesis: suggests that
mental illness may cause people to
migrate to another culture.
 The stress hypothesis: suggests that
migration itself may cause mental stress
and that this may precipitate mental
illness in susceptible individuals.
 A combination of both of these factors
may be responsible.

18.  Culture-bound syndromes are classified on the
basis of common etiology (magic, evil spells, or
angry ancestors), so clinical pictures vary.
 Sleep paralysis (amafufanyane) :occurs in
normal people, in patients with narcolepsy, and in
psychiatric syndromes caused by witchcraft (as in
young females in the Zulu population of southern
Africa; it often contains sexual content and
symbols). The somatic symptoms include
abdominal pains, paralysis, blindness, hysterical
seizures, shouting, sobbing, and amnesia
(conversion-dissociation).

19.  Sudden mass assault (amok/benz): to
engage furiously in battle, the syndrome is
seen in Malaysia, Indonesia, Laos,
Philippines, Polynesia.
 It is associated with a sudden, unprovoked
outburst of wild rage, causing the person to
run madly about with a weapon and
attack or kill people and animals before
being overpowered or committing suicide.
 Amok is often preceded by a period of
preoccupation, brooding, and mild
depression. Afterwards, the person feels
exhausted and amnesic. An attack can last
for a few hours, and may be precipitated
by magical possessions by demons and evil
spirits.

20.  Non-biological Issues Affecting Psychopharmacology:
 Cultural beliefs: Culturally shaped beliefs play a major role in
determining whether an explanation and treatment plan will
make sense to a patient:-
› Egyptians have Concerns about addictive and toxic effects
of psychiatric medications.
› Upper Egyptians prefer treatment with injectable forms of
medications.
 Traditional and/or alternative methods. Asians, Hispanics, and
African-Americans continue to use herbal medicines. Some
herbal medicines interact with psychotropic medications.

21.  Patient compliance: Compliance may
be affected by poor therapeutic
alliance, and a lack of community
support, money, or transportation,
Language issues.
 Other factors affect psychopharmacology:
Misdiagnosis of a psychiatric condition, a
placebo response, mistrust of the health
care system all may affect drug response
and compliance.

22.  On Pharmacokinetic level: may be
influenced by genetics, age, gender, total
body weight, environment, diet, toxins,
drugs and alcohol, and other disease
states. Environmental factors include
medications, drugs, herbal medicines,
steroids, sex hormones, caffeine, alcohol,
constituents of tobacco, and dietary
factors.

23.  On Pharmacopdynamic Level: Affinity to
receptors, actions on Cyclic AMP or G
protein and synthesis of Transcription factors
are all related to protein and proteins are
different from ethnic group to another.
That's why drugs can give a different
response in different ethnic groups