>> Alright. So, let's start by talking about culture. We used to see definitions of culture that focused on things like language, symbols, artifacts, etc. This was a reflection of earlier associations of culture as something mostly associate with ethnicity and practice within ethnic groups. Now, you tend to see more inclusive definitions of culture. The focus on its role as a way of describing how groups of people live. Here I talk about the ways of living built up by a group that are socially transmitted between people. I think of culture as being like a guiding system that helps people to navigate their way though life. And as I say here, it is framework for the interpretation of experience. When we think about culture in the context of mental healthcare, we need to have an understanding of culture in mental healthcare, because so much of our decision making about mental health and illness depends on being able to interpret peoples' behavior appropriately. Knowledge of the cultural context helps us to make sense of whether the behavior we observe is appropriate or indicative of illness. A knowledge of culture is also necessary for being able to communicate effectively with people in ways that can facilitate a shared understanding of what's going on with them. And it's also necessary for building relationships that can be effective in providing help. In the same way that culture helps to make sense of everyday life, it also provides ways to make sense of unusual circumstances in life, like mental health and mental illness. Culture provides the means by which to express distress, to communicate it to others, and evoke helping responses. It's not possible to ask for help or receive it, if there's not some way of communicating the, the request and the need. A cultural context attaches meaning to these experiences and devices ways of supporting and providing solutions to the problems they create. In addition, the beliefs and expectations that the cultural context has about an experience like mental illness, has a powerful influence on how mental illness is experienced. Those beliefs and expectations can actually construct outcomes because people live out the experience of mental illness or disorder within the constraints and opportunities that the culture can provide for them. So, I know that those were some pretty heavy ideas. So, I want to take moment here to just pause and try to go over them, using an example. So, let's take the example of depression. Something that we know happens no matter where you are in the world, no matter what group you're from. We know that there are lots of people that experience depression. Now I remember, that we used to talk about how depression was experienced differently in different cultural groups. Referring to the fact that in the west or I'll say, North America, for example, when we were be talking about depression, we would normally talk about things like people having low self-esteem feelings of guilt, feelings of worthlessness, not having pleasure, not experiencing pleasure for things that they usually did. These are the kinds of things, it was very much about people's mood and their, and the way they were thinking, right? And this, I am going to suggest to you, was a reflection of the way the culture thought about how mental distress or how distress is experienced. Experiences, it's experienced as something that makes you feel poorly about yourself, makes you feel like you can't engage in the usual kind of activities, all that sort of thing, right? Now in contrast to that, we would discuss how in Asian cultures people somatized their depression. This was referring to the fact that when people from the cultural backgrounds that were Asian, mostly we're taking about East Asian, when they would experience what we call depression, they wouldn't talk about self-esteem and feelings of worthlessness and guilt and that sort of thing. Their description has more to do with things like feeling pain and feeling you know, stomach upsets and not being able to work, and that sort of thing, right? So, they had what we called different idioms of distress. And they would talk more about what was happening in their body rather than what was happening in their head. So, the interesting thing is that we now know because of brain research, that the neural, the neural pathways that are associated with depression affect both the way that you're thinking and feeling, and the way that you're physically feeling. So, depression is something that's happening with you mood and your thoughts but its also happening in your body. And it's interesting me, to me now to look back and think that actually in retrospect, the these Asian patients that we're talking about pain and stomach upset and migraines and all that, actually had an understanding of the illness that we did not have yet, right? But the thing is, in both situations patients were using the, the language and the idioms they had available to them to explain what was happening in their body. Something was happening in their body that was affecting the way they were feeling, emotionally, physically, whatever. And in an Asian context, the language that was available to you, the, the framework for understanding that was one that was based in physical and a physiological understanding. And in the West, in North America, the language that was available to you was one that was based more in an understanding of how one feels about their self and their self-esteem, and their self-efficacy and things like that. Very much a cultural difference. And the thing is that cultural difference that, of course, translates into different ways of responding. So, in an environment where depression is understood as something that affects the way you feel about yourself and your ability to engage in relationships and your feelings of being a worth while person, it makes sense that then the treatment for that would be some kind of talking cure that's focused on those issues of self-worth and guilt and feelings of worthlessness. In the East, where your depression was something that was, was causing problems with the way your body was functioning and the way that you were able to deal with pain and the way that you were able to work, it made sense that then the solution the people sought out had to do with trying to strengthen the body. Dealing with issues like diet, dealing with issues like supplements and other kinds of treatments that would help the body run more effectively. Now, both of these things probably helped people with depression and continue to help people with depression, but because they're in different cultural context, people respond to them differently. There are different people called in to help. There are different solutions available. Hopefully, part of what's happening as the world becomes more global is that we're able to take from all of these different, these different contexts, and bring it together to find solutions that can work across the spectrum. Or that give people more choice in terms of what they're able to do. But what we're going to be talking about as the lecture goes on, is how culture and cultural differences and cultural, culturally different ways of responding to mental health, mental illness, and mental disorder have actually played out internationally and in multi-cultural environments. And at the end, maybe we can think about is there the potential for us to have better systems, richer systems of mental healthcare because we have all these different ways of thinking about what constitutes mental health and how you deal with mental illness.
