2. General Information
● Cognitive Tolerance -- embracing both traditional health methods
and modern medical practices
● Somatization -- express emotional distress somatically
○ well documented in some Arabian Gulf countries as well as
Eastern Asian countries
○ excessive somatization used as metaphor to convey state of
mind
■ e.g. "sinking of the heart" or "broken heart"
■ reflect cultural conceptualization and understanding of mental
process, not deficit in emotional expression
■ may relate to using spirit possession as
metaphor/conceptualization in other cultures
■ e.g. spirit catches you
● Idiom of Distress -- most commonly accepted way of
communicating stress/distress in various cultural settings, which
may not be common in other cultural settings
○ "playing the sick person"
○ helps remove stigma of being diagnosed with mental illness
3. Arabic Countries
● Arabic denotes common language, geography, history, and
shared values/characteristics
● Treatment for Arab patients primarily includes
pharmacotherapy
○ using psychiatrist/psychologist viewed as personal
weakness and disgrace of family
○ prefer using general healer and refrain from disclosing
family information
■ family hires companion to accompany family member to
therapy
■ they grow close and in many cases the companion
takes on traits of the client
● Somatization found in Arabic countries
● No distinctive boundaries between self and body
● Certain Doctor/Patient role expectations
○ doctor seen as omnipotent, omniscient, mysterious
4. Egypt
● Cairo is center of mental health research and teach in Arab world
○ 70% of professionals in Arab world are Egyptian
○ treatment in hospitals is free, but stigma associated with so most
people prefer private practitioners
● Cultural belief in "Zar Cult" or belief in evil spirits that possess a
person, causing unhappiness, misfortune, and mental/physical
illness
○ possess certain people who are vulnerable to envy and jealousy
of others
○ can never remove, only appease spirits
● family often have negative attitudes towards mental health
professionals because they are resistant from making relationships
outside family/cultural background and they feel guilty, frustrated,
alienated, and helpless when communicating with them
● "maalesh" or "never mind" attitude toward mental illness and
bizarre behavior
● varying beliefs in causation ranging from evil eye to heredity
● fear of treatment, especially ECT, often family organizes and
structures the persons life, which is thought to help
5. Ghana
● often lack of agreement on how to understand mental illness
in low-income, developing countries
● greater reliance on culturally specific, traditional explanations
of mental illness in rural areas
● degree of stigma is influenced by how much blame is
attributed to the person
○ traditional views remove blame from the person and
places it on social and spiritual forces beyond their control
● more acceptance and support of strong traditional belief
systems in general
● greater acceptance of biomedical model in urban centers
● Conclusion:
○ develop more integrated mental health services to reflect
different beliefs and include more traditional views
6. Southern India
● Diversity in beliefs in causes of mental illness related to
severity of stigma
● Patients and relatives often hold multiple and contradictory
beliefs about mental illnesses
○ not static, but dynamic and adaptive to situation
● Patient beliefs tended to focus on biomedical and karma/evil
spirits causes
○ family relatives tended to focus on karma/evil spirit beliefs
● Almost all believe in treatment of doctor, while also holding
faith in other treatments such as traditional healers and
religious cures
●
7. Japan
● people are more reluctant to use psychiatric labels to
describe mental disorders, unless they are the more extreme
forms
● Japan places greater emphasis on hospital care
● less likely to discuss mental health issues outside of the
family and close friend
● more likely to endorse the helpfulness of private information
sources
○ e.g. books, internet
○ Despite the stigma associated with seeking outside help,
there is a general belief that professional help is beneficial,
especially psychotropic medication
○ however, not optimistic about full recovery
● The predominant view in Japan is that trait neuroticism is a
major risk factor for depression
○ seen as a sign of weakness of character and highly
stigmatized
8. Japan continued
● The stigma attached to mental health may also be related to
a stigma against expressing negative emotions
● Collectivistic cultures tend to focus less on their internal state
and cognitions
○ would affect Japan's bias against expressing negative
emotions because focusing on one's negative emotions is
asserting themselves over the importance of the group
● A large part of Japanese culture that may be strongly
influencing the personal and perceived stigma is the
"tatamae" and "honne" culture
● Tatamae = things people say in order to maintain positive
relationships, but may not actually believe
● Honne = what the person is truthfully thinking and believing
● While people still hold negative attitudes towards mental
disorders (especially more mild cases), they overrate the
attitudes of the community as being more negative they they
actually
9. Fiji Islands
● Urban areas associated with acceptance of Western model
○ positive views toward hospitals and medication (majority
view)
● Rural areas associated with acceptance of traditional etiology
views
○ e.g. witchcraft and use of traditional healers
● Majority do not view witchcraft or heredity as causes of
mental illness
○ lack of belief in witchcraft causes likely due to increasing
Western influence
○ lack of belief in heredity causes likely due to locus of
control would shift from individual to family -> indicating
"bad genes"
● Health workers more positively disposed toward those with
mental illness
○ contact with those with mental illness
10. Australia
● Japan and Australia share a common belief that personal
vulnerability factors contribute to each disorder, but different
kinds
● In Australia, there is an emphasis on genetic predisposition
as a risk factor for developing mental illness
● Greater emphasis on community care
11. General Findings
● Factors associated with positive attitudes toward mental
illness:
○ direct contact with persons with mental illness
○ younger age
○ higher education
○ more prestigious occupation
● Urban areas tend to favor biomedical model and treatment
methods
○ rural areas tend to favor traditional model and treatment
methods
● Several studies conclude that education/health education
have the potential to help reduce stigma
○ several also indicate integrating traditional views into
mental health services
