Knowledge base

Baza wiedzy

important books :

  • "Depresja u dzieci.", Rola, J.
  • "Depresja. Modele kliniczne i techniki terapeutyczne.", Hammen, C.
  • "Udręka życia. Jak ludzie radzą sobie z lękiem przed śmiercią.", Łukaszewski, W.
  • "Standardy leczenia farmakologicznego niektórych zaburzeń psychicznych.", Jarema, M.
  • "Kryzys. Punkt zwrotny w życiu.", Kreppold, G.

List of articles :

List of articles multimedialnych:

Intercultural depression

The issue of illness or mental health standards can't be considered in isolation from a particular culture. What in one culture will be the norm, in another could be regarded as a deviation from it. Without a doubt, culture affects the way society talks about emotions and the difficulties which it experiences. All diagnoses of mental condition concern human behavior, which is assessed by social rules, so it depends on the culture.

Most mental disorders appear in many cultures, suggesting their universal nature. However, it should be noted that human behavior is modified by various social norms that may be the source of countless tensions and stress of an individual.  And how it is with depression?  Does it occur in all cultures?

Depression or rather melancholy, because this is how affective disorder was previously determined, was known even in ancient times. Hippocrates described the symptoms as early as the fifth century BC, mentioning: an aversion to food, affliction, sleeplessness, irritability and anxiety. Does it have the same symptoms everywhere?

 

Mood disorders in different cultures

The frequency of occurrence of mood disorders in different societies varies - in some the more common is mania, in the other - depression. However, due to different methodologies and diagnostic criteria, as well as the relationship between depression and cultural factors, it is difficult to provide accurate statistics.

Even incidence rates vary among cultures. It is estimated that in the U.S. 10-25% of women and 5-12% of men experienced in their lives two depressive episodes lasting about six months.  Research conducted by Manson, Shore, and Bloom (3) showed that the rates are up to six times higher in the population of North American Indians. On the other hand, many researchers suggest that a group of symptoms associated with depression in Western culture, is very rare in other societies. According to studies conducted by different researchers in the 1960s and the 1970s, the concept of depression was unknown to Nigerians, Chinese, Canadian Inuits, Japanese and Malaysians. (3)

Carothers (1) was interested, in turn, in residents of East Africa. His research conducted in the 1940s and the 1950s showed relatively low incidence of depression and high incidence of manic disorders - a reverse trend compared to that observed in the United States. A low incidence of depression among Africans the scientist explained by the fact that in traditional African cultures there is no tendency to blame an individual for a failure.  In such societies, the individual is highly dependent on the group, there is no problem of self-sufficiency and responsibility so common in Western culture. Africans don't experience personal disappointments and failures, because they don't set unit objectives that are difficult to achieve, are submissive to harsh environmental conditions in which they live. In this kind of culture the blame for the failure is attributed to external factors, which removes the responsibility of the individual and prevents them from lowering their self-esteem. Similarly, in Kaluli - a primitive tribe living in New Guinea, where there are no leaders, everyone is equal. In this community, depression, suicide, and in general the feelings of despair and hopelessness are unknown. In their culture there is a phenomenon of compensation - if someone would cause someone harm, they can demand amends. According to Seligman (1), this effectively protects from a sense of helplessness and hopelessness, thereby preventing depression.

African culture, however, is developing and changing, and over time it is getting closer and closer to the Western culture, which makes the data become outdated. It's not difficult to get the impression that the more the culture of low-developed societies comes closer to the West, the more its members are exposed to mood disorders typical to Western societies.

 

Cultural specificity of depression

Even if the concept of depression is not unfamiliar to the given cultural environment, its understanding may be completely different. There are also specific symptoms of depressive disorders in different societies. Marsella (1) noticed that the Chinese people lack the psychological symptoms of depression. Also Kleinman (3) in his study in 1986 observed a lower sense of guilt and lack of lower self-esteem among Chinese people with depression compared with those of the West. Similar results were also among Filipinos and the Senegalese. (3) These symptoms are replaced by somatic disorders, such as: sleep disorders, eating disorders and lack of interest in sex. Some cultures even lack psychological components of depression to be able to compare it to the West. There are no signs of mental depression, such as the feeling of guilt and self-accusation, so common in depression in developed countries. Australian Aborigines, not only don't experience these destructive emotions, they also don't know the concept of suicide. In their culture, there was no suicide attempts. According to the researchers, this may be due to a strong fear of death and conditioning activities aimed at the enemy in a threatening situation. (1)

Another peculiarity was observed among the Hopi Indians (3). They distinguish five separate accidents describing them with symptoms attributed to western depression. Each of them: worrying, feeling of misery, madness (similar to alcohol intoxication), and disappointment, has its own symptoms and specific forms of therapy. From the perspective of this tribe, the western definition of depression including all these states would be too general and vague.

During the study conducted in the 1960s, depressive symptoms in thirty countries were examined.  In most of them, because in twenty-one countries, there were symptoms such as depressed mood, mood swings, lack of interest in the world and insomnia. In the remaining nine countries, most of which didn't belong to Western culture, symptoms of depression were somatic in nature. They were: fatigue, anorexia, weight loss, decreased libido. Similar results were obtained by repeating the study 20 years later.

Rare occurrence of psychological symptoms of depression in different cultures is explained by scientists by cross-cultural differences in developing ways of interpreting feelings. In non-Western cultures, individuals tend to blame the failure on external factors. This is probably related to the orientation on the unit (individualism) or group (collectivism) occurring in a given society. The Western culture puts a strong emphasis on individualism and individual responsibility for their actions. On the other hand, in collectivist cultures, such as Asian, people attribute successes and failures to the group to which they belong, for example, family or colleagues. Such transfer of failures to external factors helps to maintain high self-esteem and protects from guilt.

So does mental disorders such as depression may be culturally determined? Many things seem to suggest that the culture of society has an impact on the emotionality and the way of living the reality by individuals, which in turn can affect the experience of the disease. But it's not only a place of residence, but cultural factors such as language, the structure of society and its norms. Therefore, diagnosis, and later also therapy should include not only the somatic and psychological aspects of disorders, but also these cultural factors.