Ethno-Cultural Variations in the Experience and Meaning of Mental Illness and Treatment: Implications for Access and Utilization

Abstract

We conducted a study to investigate how understandings of mental illness and responses to mental health services vary along ethno-racial lines. Participants were 25 African American, Latino, and Euro-American inner-city residents in Hartford Connecticut diagnosed with severe mental illness and currently enrolled in a larger study of a community mental health center. Data were collected through 18 months of ethnographic work in the community. Overall, Euro-Americans participants were most aligned with professional disease-oriented perspectives on severe mental illness and sought the advice and counsel of mental health professionals. African-American and Latino participants emphasized non-biomedical interpretations of behavioral, emotional, and cognitive problems and were critical of mental health services. Participants across the sample expressed expectations and experiences of psychiatric stigma. Although Euro-Americans were aware of the risk of social rejection because of mental illness, psychiatric stigma did not form a core focus of their narrative accounts. By contrast, stigma was a prominent theme in the narrative accounts of African Americans, for whom severe mental illness was considered to constitute private "family business." For Latino participants, the cultural category of nervios appeared to hold little stigma, whereas psychiatric clinical labels were potentially very socially damaging. Our findings provide further empirical support for differences in symptom interpretation and definitions of illness among persons from diverse ethno-racial backgrounds. First-person perspectives on contemporary mental health discourses and practices hold implications for differential acceptability of mental health care that may inform variations in access and utilization of services in diverse populations.

Putting meaning into medicine: why context matters in psychiatry

“…Indeed, these narratives echo the experiences of urban, lowincome African-American participants with whom we have worked, many of whom felt that mental health providers 'do not care' and 'do not provide solutions. They are mainly concerned about you taking your medications' (Carpenter-Song et al 2010). With this information, people's reluctance to engage in professional treatment and their wariness towards providers is much more understandable.…”

“…Anthropological research has demonstrated that psychiatric conceptualisations of mental health problems often do not resonate with how individuals, families and communities understand problems (Jenkins, 1988;Carpenter-Song, 2009b, Carpenter-Song et al 2010. We have learned from urban, low-income participants from racial and ethnic minority backgrounds that mental illnesses are understood and experienced in relation to daily lives marked by the threat of violence, histories of trauma and the stresses of financial insecurity.…”

“…How problems are identified, conceptualised and explained by sufferers and the social meanings of maladies influence decisions about whether or not to seek help and what type of help is considered appropriate (Kleinman, 1980). For example, problems diagnosed as mental illnesses can be variously understood as arising from chemical imbalances, stress and trauma, interpersonal conflict, personal moral failure, or supernatural causes (Jenkins, 1988;Jenkins & Barrett, 2004;Carpenter-Song et al 2010). These diverse 'explanatory models' (Kleinman, 1980) of distress would each suggest a specific pathway for treatment (e.g., psychotropic medication for a chemical imbalance or a community ritual to mitigate social conflict).…”

Engendering cultural responsive care: a reflective model for nurse education

“…Similarly Carpenter-Song et al [13] found that Euro-Americans perceptions' of severe mental illness were aligned with professional disease-oriented perspectives and that they sought the advice and counsel of mental health professionals. In contrast African-American and Latino participants emphasised the non-biomedical interpretations of behavioural, , emotional, and cognitive problems.…”

Beliefs about Causes of and Risk Factors for Mental Disorders: A Comparison of Japanese and American College Students

“…The cultural effects on MHL should also be taken into account since research shows a strong cultural impact on the classification and treatment of mental disorders (Carpenter-Song et al, 2010;Courtis, Lauber, Trujillo Costa, & Cattapan-Ludewig, 2008;Good, James, Good, & Becker, 2003). The cultural differences in MHL can have negative impacts, including an individual with a mental disorder not being identified as needing mental health care, or as an individual not receiving needful help from a trained mental health care professional (Sartorius, 2007).…”