How Cultural Frames Shape our Experience of Mental Disorders

Leading researchers in cultural psychiatry explain how different cultural frames influence our perceptions, attitudes, and experiences of mental distress.

Ayurdhi Dhar, PhD
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In a new article published in Oxford Research Encyclopedias, G.E. Jarvis and Laurence Kirmayer of McGill University explore the role of cultural frames in informing and defining human experience, especially suffering and distress.

Cultural frames involve both the explicit norms and values of a culture and the more implicit (subtle) ways that the culture affects how individuals understand themselves and their experience. For example, these frames shape whether a person hearing voices thinks their hallucinations are caused by a broken brain or a gift from the gods, which can alter the distress they experience. Most people are not consciously aware of these frames affecting their experience as they spontaneously shape our understanding of ourselves and our distress.

The meaning provided by cultural frames that shape individual experience exists within (and is reinforced by) our language, cultural narratives, social institutions, and communal practices. These frames change through time and are culturally specific ways of making sense of the world and navigating daily life. In this article, the authors explore how cultural frames “shape perceptions of, and attitudes to, behavior that are specifically linked to mental disorders.”

These frames operate at many levels. The authors write that:

“Cultural frames influence the experience of distress at the individual level, shape clinical practice in mental health at the professional level and determine societal attitudes that persist and evolve through time and loop back to the individual and professional levels to perpetuate historical patterns and reinforce established frames.”

In the face of an experience such as deep unending sadness, frames can conjure certain ways of thinking, feeling, and being in people. Often, they may do so using metaphors, analogies, or common narratives, which then transform the individual’s experience. This experience then begins to conform to the original frame.

Extensive literature has noted that cultural frames influence people’s concept of psychopathology. These could take the form of local theories of illness but also include the everyday knowledge shared among people; the exchange is not one-way, and individuals and socio-cultural contexts shape each other.

Research in anthropology, transcultural psychiatry and cross-cultural psychology has documented how culture affects distress and influences how disorders are perceived, understood, and treated. For example, anthropologist Tanya Luhrmann found that people in Ghana and India have a vastly different experience of hearing voices when compared to those in the US. Similarly, others have found that the content and frequency of delusions are dependent on the prevalent cultural beliefs and themes.

Culture also shapes our understanding of ourselves (as an individual first or a relational/communal entity first) which influences how disorders are interpreted. Further, culture shapes what we pay attention to and remember (our memory). The fact that certain disorders appear for short periods in human history only to mostly vanish in later periods also points to their cultural dependency.

Jarvis and Kirmayer highlight two issues that crop up when we export diagnostic categories from one culture to another.

The first issue is that of ‘category fallacy.’ Using foreign categories to understand symptoms among people might lead to missing the actual problems specific to that place. This can cause a diagnostic error as every experience is seen through the lens of that diagnostic category.

Second, there is the possibility of the ‘looping effect,’ where categorizing people in certain ways (especially when done by powerful cultural actors like doctors) leads to a change in peoples’ experiences of themselves and their symptoms. For example, they might come to see issues they earlier called “life problems” as “depression” after being diagnosed, which in turn shifts their experience, and they start feeling additional symptoms traditionally associated with depression. In this way, diagnostic categories can become self-reinforcing.

This change in self-definition can then further change the way the phenomena are categorized and studied since the relationship is multi-directional. The authors give the example of autism and how as the group of people identified as autistic changes (due to the efforts of advocacy groups), the study of genetic markers changes, and now more people are considered autistic.

The authors then go on to elaborate on how cultural frames of mental disorders operate at different levels. At the individual level, these frames influence our cognitive schemas, which are internal frameworks defining how we organize information and pay attention to some things while ignoring others. Cultural frames shape our schemas around illness, affecting our experience.

The authors use the case of Joseph Smith, the founder of The Church of Latter-Day Saints. Smith experienced commands from god and visions of angels. His family encouraged a belief in an enchanted universe (full of supernatural beings and angels). Thus, his experience, which, in another cultural frame, could be thought of as psychotic, was considered religious and spiritual. People in his community believed what he said and his claim of being a prophet, leading to the creation of a church and not a decades-long stay in a psychiatric institution. To now turn around and call his experience psychotic constitutes a category fallacy.

The cultural frames surrounding him allowed for a religious interpretation of his visions and voices. The authors note that in cultures with an enchanted view of the world, experiences of hearing voices and visions are shaped by the cultural frames of that time and place. Cultural frames also influence what we call schizophrenia, which came into being along with urbanization and industrialization and became a social problem because people who were labeled psychotic were not productive.

At the second level, cultural frames are about larger professional models which shape clinical realities and are shaped by the wider culture. Consequently, these professional models influence our understanding and experience of ourselves. The prevalent mental health professional frameworks, far from merely being about scientific progress, are equally influenced by cultural frames and common local theories about personhood and selfhood.

The authors give the example of the rise and fall of psychoanalysis in North America. The entry and acceptance of psychoanalysis were informed by a dominant cultural belief that America was witnessing cultural and moral decay. Also, during that time, the brain-centric somatic approach had failed to bring about any impressive changes.

Psychoanalysis, the version that entered the US, was seen as reinstating American values. It put the individual at front and center (especially ego psychology) and focused on autonomy and self-determination. It encountered unprecedented success, but by the 1970s, psychoanalysis was under critique for being non-scientific, and the medical model saw a re-emergence. This influenced clinical spaces and relationships:

“Psychoanalysis emphasized the common humanity of the clinician and the patient—psychological conflicts were inherent in the human condition—and blurred the distinction between mental health and illness: psychopathology was on a continuum with normal functioning,” the authors explain.
“The biomedically oriented neo-Kraepelinian psychiatry that replaced the psychoanalytic frame by the end of the 20th century views mental illness as a disease, rather than the result of intrapsychic conflict…. Patients are seen as different from the clinician because of the disorder or disease that characterizes them as objects of clinical attention.”

The authors point out that the current predominant narrative is one of “brainhood,” as people begin to understand themselves and experience their suffering and conflicts in terms of their brains.

Cultural frames operate at the level of broad social paradigms that influence our understanding of health and illness through different institutions in society. The authors give the example of different cultural frames in the US and the UK and how they interpret and theorize about findings of higher rates of psychosis among Black populations, in turn shaping people’s experience and influencing the type of research that is pushed and published.

In both countries, the cultural frame shapes how Black populations are seen and interpreted. In the US, the higher rates of psychosis among Black populations are explained by research and theories around clinical bias and misdiagnosis – that there is no higher rate of psychosis, and it’s only caused by clinical misdiagnosis and racial bias of the clinician. The focus is on the failure of mainstream services to understand context and experience.

Research in the UK also finds higher rates of psychosis among Black populations, but there is less concern about misdiagnosis. Instead, these discrepancies are seen as accurate, reflecting the fact that structural determinants (racism, discrimination, violence, poverty) lead to actual psychotic breaks.

Jarvis and Kirmayer end by noting that these three levels of cultural frames are deeply interlinked. Professional models in society depend on local theories of selfhood and other lay ideas, creating numerous looping effects for everyone involved.

 

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Jarvis, G.E. & Kirmayer, L. (2021). Situating Mental Disorders in Cultural Frames. Oxford Research Encyclopedias. (Link)

4 COMMENTS

  1. I do no know what “culture” means. To me it sounds like a made up word from the book of logic, written by the scribes of the God of Logic. “Culture” is apparently out there haunting me and imposing its will on me and so I had best listen up to advisors who tell me what signs of the cross I am to do to ward off steely-eyed culture, that spook thst has designs on my miniscule bank account and private shopping preferrences and even my semi permeable sub conscious. Yes, “culture” that spectre causing mass hysteria as if it is a new prop in a Salam’s Lot remake. Honestly, I am perplexed. Is it a mist? Is it a vampiric blood transfusion? Is it a moses basket that leaves indelible welts on a newborn?

    All I know is I have free choices. I either make those choices or I choose not to. Someone may try to butt in an influence my choice but if I let them then that is also my free choice to let them persuade me or act as a “culture”. If they try to influence me and it is not my free choice then they are just a Great Big Bully as a person. And that has to be banned just as all violence and cruelty must be banned.

  2. Dear author of the lovely smile, I hope my prior comment did not sound shirty or personal. I was saying it all abstractly and with amused excitement. Like spanner hoisting Scotty in the engine room of the Starship Enterprise. Your article is amazing. I love what you have made me ponder.

    For me I just think the prevailing focus on culture exonerates people from checking out their abusive behaviour. I dare say some misguided reactionaries once said the Uigur people had “the wrong culture” and that their “culture” perpetuated crimes against “humanity” and therefore a little Uigur boy needs turned into the correct “culture” by flogging him, if he remembers his mommy’s lullaby. Or how about the Rohinge “culture”?. Or could the Palestinian people be deemed a “culture” that might be in need of change? Or the Yazedee “culture”?. Or the Jewish “culture”?. Whatever word that is used to describe a group of people can easily slide into the saints and sinners categorizing that becomes a proxy meaning for any “them”. And when it does you suddenly have a million perfectly logical scholastic reasons for being a bully, since you can logically say how their hairstyle is a clue of “them” or their mommy’s lullaby is evidence of “culture” and so is causing the destruction of the planet. And everyone agrees a planet is way more important that any bleeding little boy on it.

    This is all very fascinating. I mean I suppose you could say that all “cultures” are highly suspect and evidence of mass hypnosis and therefore are a danger to “the public” but that too becomes “a culture”. It may be a gentle “culture” or a peace loving “culture”, if we have it that the word is just a fancy way of saying “they” or “them”, but any “them” who purport to be decent can be the worst nightmare for your village huts. I feel it is easier to call “them” “them”. That way you can see your own part in keeping “them” at arms lengths and hopefully ask the tough question of how do you make “them” an “us”…without…bullying them into being a “me”.

    As for the part about the content of delusions and psychosis being influenced by “culture” I suspect that is “a belief”. For how can one actually peer into someone elses psyche and follow the bread crumb trails through the mess and mayhem of exotic delusions to seize upon their original source with abiding rock solid confidence?

    I am rather jaundiced about my ghastly illness of schizophrenia being used as the wounded man of faulty “culture”, as if a crowd puller star attraction of a crippled man supposedly offended by “them”….a little boy’s lullaby.

    I will not have my own schizophrenia illness used to save the planet by destroying every scrap of love on it. It is like when people trot out the symbol of the refugee Somalian starving baby to prove why a local bakery should be daubed with hate speech. I think if one were to ever bother asking the baby what she wants it would be the milk of human kindness.

  3. What do we mean by “culture?” What *is* “culture?” How do we define “culture,” by what authority and standard, and why? According to whom, for whom, and by whom, and why? From where did culture stem, and what was the first cause and why? Why is there culture than no culture?

  4. I do agree, “The focus is on the failure of mainstream services to understand context and experience.” And I do agree with this author, that we in America are living in the midst of a “culture war.”

    https://books.google.com/books?id=xI01AlxH1uAC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false

    But that’s largely because my experience with a “holistic, Christian” Lutheran psychologist was that she believed a dream about being ‘moved by the Holy Spirit’ – which is one aspect of the Triune God, in which the Lutherans used to claim to believe – is “psychosis.” Apparently all who dream are “psychotic” now, according to the psychologists and psychiatrists? And I also had the misfortune of dealing with another Lutheran psychologist, who believed that the job of psychologists is to steal from those who believe in God and stand against child abuse.

    The first psychologist also eventually confessed to me, when I was picking up her medical records, that she believed distress caused by 9/11/2001, right after that distressing-to-the-entire-world event, was distress caused by a “chemical imbalance” in my brain alone. Who’s insane?

    I’m quite certain both these psychologists and psychiatrists, and the ELCA pastors and bishops also involved, should get out of the Holy Spirit blaspheming, systemic child abuse covering up, child abusing, anticholinergic toxidrome attempted murdering, pedophile aiding, abetting, and empowering business.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
    https://www.madinamerica.com/2016/04/heal-for-life/

    Since living in a “pedophile empire” is not really a “status quo” that should be maintained, as that second, attempted thieving, psychologist stated he believed. Although I would guess he and his now claimed to be “non-essential” pastor, question that belief system. And as the globalist banksters are working to implode all of the Western civilizations’ monetary systems, they may also question their worship in the American dollar?

    https://www.amazon.com/Pedophilia-Empire-Chapter-Introduction-Disorder-ebook/dp/B0773QHGPT
    https://www.youtube.com/watch?v=2VauMFaHJT0
    https://www.youtube.com/watch?v=5hfEBupAeo4
    http://thephaser.com/2021/05/the-most-obvious-criminal-banking-fraud-in-world-history-chris-marcus/

    We are living in the midst of a “culture war.” And the ELCA bishops, pastors I dealt with, and their systemic child abuse covering up, pedophile aiding, abetting, and empowering “mental health” industry, are the enemies within, as are the globalist banksters. And all this systemic child abuse covering up, by the DSM “bible” thumpers, is by DSM design.

    https://www.psychologytoday.com/us/blog/your-child-does-not-have-bipolar-disorder/201402/dsm-5-and-child-neglect-and-abuse-1

    There’s a good reason I painted the American flag as upside down and backwards 16 years ago. And why the psychologist I mentioned, who knows something about art, is now attempting to steal all profits from my “insightful” and “prophetic” work, not to mention the rest of my money. But satanic “pharmakia” forcing “mental health” sickos, truly, is all they are. And all the DSM deluded “mental health professionals” involved do truly need to repent and change from their evil ways.

    Since their DSM “bible” was debunked as scientific fraud in 2013. And the DSM deluded “mental health” system is murdering “8 million” innocent people EVERY YEAR, based upon their BS DSM belief system, and with their neurotoxic drugs.

    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis
    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2015/mortality-and-mental-disorders

    Truly, I hope and pray, we will bring about a better world for all. But I do believe it requires a proper judgement by God. Not a judgement by the “mental health” system.

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