Challenges and Rewards of a culturally-informed approach to mental health | Jessica Dere | TEDxUTSC

Thank you, it is truly an honor to be here. I would like to start my talk today with a little exercise by introducing you to a person named Pat. Pat is 31 years old and lives at home with a brother and his parents. Pat has always lived in the family. He is getting married and would not consider moving out to live alone except after getting married. Pat's parents always play an important role in making decisions about all aspects of Pat's life, including educational decisions, career decisions, friendships, and Pat's romantic life. This has been the case since Pat was a child.

He rarely makes decisions without consulting family members and rarely expresses disagreement with others for fear of disapproval or loss of support. Pat feels very uncomfortable when alone and tends to cling to others for fear of being abandoned. Now take a moment to imagine Pat, is that you? When imagining a young man or young woman, are you imagining a person of a particular ethnic or cultural background, perhaps similar to or different from your own? Consider for a moment whether such information would make a difference in how you think about Pat and whether or not you think about her. that Pat might have some type of

mental

health

issue now, what if I added the following information specifying that Pat is Patricia Lee and that she and her family immigrated to Canada from China when she was 5 years old or the following where Pat is Patrick Smith, whose maternal and paternal grandparents immigrated to Canada from the United Kingdom and whose parents grew up in the Toronto area.

Judging by some faces, I can see that this information really makes a difference in the way you think about Pat. Simply adding basic demographic information can significantly change the way we think about the same behaviors This exercise has elicited similar responses in my class when I have used it in teaching about personality disorders, offering a particularly striking example of the need to consider cultural factors when defining

mental

illnesses, since they themselves are defined by patterns. of behavior that deviate from cultural expectations. I used it as an exercise to introduce the role of cultural factors in thinking about mental

health

and illness and to introduce the central idea that culture matters in my experience.

Once introduced to this idea, people seem to intuitively know that culture makes a difference when we think about mental health and mental illness without specifically talking about cultural differences in things like parent-child relationships. Independence and interdependence or assertiveness, it seems that we just know that it makes a difference if we talk about Patricia or Patrick, but not only Culture matters when it comes to mental health is fundamental. Many people, including myself, argue that a

culturally

informed

approach

is really critical to effective healthcare and that only by including cultural factors in our discussions about this field will we truly make progress. and social scientists writing in one of the world's most prestigious medical journals stated: The systematic abandonment of culture in health and medical care is the greatest barrier to the advancement of the highest level of health throughout the world. world, a pretty powerful statement, so this is Great, I see several of you nodding and seem to agree that reflecting on Pat illustrates to you, at least on a basic level, the importance of considering cultural issues when it comes to mental health, but stopping here would be problematic for many.

First of all, I still have 15 minutes and 52 seconds left on the clock, but more importantly, stopping here could serve to reinforce certain cultural stereotypes that contrast the frontman with The Smiths and wouldn't really leave you with any idea how to view it. cultural factors or worse, could leave you with an overly simplistic idea of ​​how to do this, perhaps suggesting that simply knowing a person's ethnicity or immigration history provides enough information to truly understand the meaning of their behaviors and relationships, for example. The crucial initial step is like the first piece of a puzzle, but we need to go much further, so if knowing Pat's cultural background is like having a first piece of the puzzle, it is necessary to recognize that culture matters. learn a lot more before we even get close to a complete picture, for example.

Based on common cultural ideas, you may have had the feeling that the description of Pat's behavior became somehow more acceptable when it involved Patricia, a young woman of Chinese-Canadian origin, compared to Patri, a young man. and second-generation Canadian of British descent. Harmony are more commonly endorsed values ​​among people of Chinese origin compared to those from Western Europe. Is it necessarily the case that Patricia's parents are happy with her level of dependence on them? Perhaps her migration to Canada was driven in part by her own independent traits and she is really quite concerned that her daughter has not developed greater autonomy or self-confidence, perhaps Patricia has never felt like she fits in among her peers and really feels feels unable to achieve the level of independence that his parents encourage him, on the other hand, although independence and autonomy. are commonly endorsed values ​​in North America, perhaps it is normative within Patrick's family to defer to parents and view life decisions as communal efforts.

These examples illustrate that we cannot simply make sweeping assumptions about people based solely on their cultural background nor can we make simple comparisons. or distinctions between people simply because they come from different contexts, this might suggest to them that cultural information is not very useful and that we should simply focus on the individual and their unique experiences, but this would also be problematic and incomplete. Complete because to truly understand Patricia Lee's experience we must know that her parents' level of emphasis on independence may be relatively uncommon, uncommon within her cultural community, and on the other hand, or similarly, the experience of Patrick Smith about his level of dependence on his family would probably have a different meaning if he and his family were from a cultural community that particularly emphasized family ties;

In other words, to truly develop a full understanding of mental health we must develop an understanding of individuals in their context, so this discussion illustrates one of the key

challenges

of a

culturally

informed

approach

to mental health and in teaching this field. to university students. I have the privileged opportunity to work with them as they struggle with these same types of

challenges

. The path I often see my students take is one of initial enthusiasm. As they engage with the idea that culture matters and often tend to appreciate in-depth discussion of a topic that tends to be missing or downplayed in mental health teachings, this initial enthusiasm, though later often turns into a certain level of feeling of overwhelming when they start.

Really grappling with the complexity of culture and beginning to recognize the number of different factors to consider and questions to ask to help my students navigate these questions has helped me distill my own thinking about this field and how best to teach it. I recognize that dealing with cultural issues can be really daunting and I also worry that feeling overwhelmed can sometimes lead to avoiding new ideas or experiences, so with that in mind I propose two related suggestions that I think can help people engage in a A culturally informed way to approach mental health rather than avoid it is to take a stance of informed curiosity and ask different questions and ask questions differently, so a stance of informed curiosity contrasts with some models of culture and mental health that suggest that one needs to be an expert in a particular cultural group in order to work with or understand the experiences of a member of that group, for example, many articles and book chapters talk about working with Asian clients or working with Hispanic clients, although that guy has good intentions.

This type of approach can inadvertently lead to the perpetuation of cultural stereotypes. There is an assumption, at least at some level, that members of a given group share values, beliefs, and experiences simply based on group membership, although that may be the case. It's certainly not necessarily true for a working doctor. From that perspective, I could have easily assumed that Patricia Lee's level of dependence on her family was encouraged or supported. I also always found the more experience-based approach problematic from a personal perspective as the daughter of a Chinese Canadian father and an Anglo-Canadian mother born and raised in Montreal bilingual with English as a first language, it is unlikely that there will ever be a book chapter dedicated to working with people of my particular culture.

Cultural composition. I believe my own lived experience as a person of mixed cultural heritage informs my thinking about culture and how it plays a role in mental health and my experience also plays a role in my emphasis on a stance of informed curiosity rather than experience. I think such a stance promotes an attitude of humility and actually encourages one to develop hypotheses and questions rather than making assumptions. So one of the key ways I work to promote a posture of informed curiosity among my students is by helping them ask different questions and ask questions differently about mental health.

My own passion for the area of ​​culture and mental health really began when I took an introductory medical anthropology course in the second year of my undergraduate studies. This course turned out to be a key turning point in my academic journey and, Looking back, I think one of its last effects was that it forced me to ask different questions about Health and Mental Health Questions that I hadn't been exposed to previously in my psychology courses. Working with a different discipline with its own set of theories and frameworks also instilled in me the value of asking questions differently in many ways.

That course forced me to re-evaluate ideas I had previously taken for granted, and that kind of experience is often at the center of cultural discussions about mental health. The interdisciplinary nature of my early experience also corresponds to the interdisciplinarity that often characterizes discussions of culture and mental health. image of the complex set of puzzle pieces A cultural approach to mental health truly benefits the integration of different perspectives, each offering their own sets and types of questions, now adopting a stance of informed curiosity in no way minimizes the importance of developing in-depth knowledge in cultural matters, rather the emphasis is on how to engage with this knowledge with a focus on really gaining awareness of the wide range of cultural differences that exist in the human experience to be equipped to ask informed questions that we know By research in cultural psychology, significant cultural differences exist across the spectrum of psychological domains, including cognitive and perceptual processes consi

dere

d basic and therefore often assumed to be universal.

For example, we know that there are significant cultural differences in how people perceive the world, such as how much they concentrate. Based on background information when examining a photograph versus focusing on the central figure in the photograph, we also know that there are significant differences in how people think about the world, such as the extent to which they use contextual information when grouping different objects. These types of differences suggest that some of you may be viewing the slide behind me as a single holistic image, while others may be more focused on specific constituent parts more directly relevant to mental health.

We also know that cultural context plays a profound role in the types of emotions people value and desire most. feel and how and with whom they express those emotions in some cultural contexts feeling proud is closely associated with feeling good in general, while in other contexts the individual focus involved in pride makes it less desirable and there is a large literature demonstrating important cultural differences In how people define the very notion of the self, for some the self is truly an autonomous and individual entity, while for others their ideas about the self include close interpersonal connections, so cultural differences in domains like these should directly inform our thinking about mental health and illness.

Culture plays such a profound role when things go well, surely it must play a similar role when things go wrong. The way peopleexperience profound changes in their emotional life is deeply influenced by their values ​​and beliefs about emotions and when and with whom it is appropriate to do so. Share your emotions In some cultural contexts the physical symptoms of major depression tend to be more emphasized compared to the psychological symptoms and this may be related to cultural differences in values ​​about emotions, so at this point I have probably convinced you of several of the challenges of taking a culturally informed approach to mental health and I have offered some suggestions on how to address these challenges, but I hope I have at least also planted the seed that there are also

rewards

to be had, not surprisingly I personally believe that the The

rewards

at the level of research, clinical care, and teaching about mental health are numerous and profound and ultimately far outweigh the challenges at the research level.

In order to build a comprehensive understanding of mental illness, we must integrate cultural factors as the quote near the beginning of my talk suggests. We neglect culture at our own peril, if what it means to be sad and share this sadness with others is deeply affected by our values ​​and beliefs about emotions, then we will never develop a full understanding of sadness or severe depression without a cultural approach. from a cultural point of view. A clinical perspective that integrates cultural factors into our assessment of a person's distress is crucial to truly understanding their experience and can help improve treatment.

We know from research that treatments that integrate a person's own cultural beliefs about the causes of their distress are more effective than treatments that do not integrate them better. Cultural factors in treatment are an area of ​​ongoing research and debate, but it begins with the argument that culture makes a difference and, thirdly, at the level of learning about mental health for students and the general public, The rewards of a culturally informed approach include greater openness. Mindset Greater understanding of experiences different from one's own and less stereotyping This approach also offers new perspectives on ideas already learned about mental health These are all rewards that my own students have specifically talked about when discussing the benefits of learning about this field, so I hope So, for today, you'll walk away with some of this heightened curiosity, open-mindedness, and an interest in asking different questions about mental health, all rooted in the core premise that culture matters, thank you.