Historical context

Cultural relativists believe mental illness must be understood within social and cultural
contexts. In contrast, universalists argue that mental illness has a biological basis that
transcends culture. Each perspective guides how mental illness is diagnosed, researched, and
treated. While cultural theories support the idea that definitions of mental illness change over
time (social construction), biomedical views see mental illness as a constant human
condition, with changing definitions reflecting growing knowledge.

The Cultural Perspective

Cultural relativists believe mental illness must be understood within social and cultural
contexts. In contrast, universalists argue that mental illness has a biological basis that
transcends culture. Both agree culture plays a role in how mental illness is seen, but they
differ on its cause and expression. Each perspective guides how mental illness is diagnosed,
researched, and treated. While cultural theories support the idea that definitions of mental
illness change over time (social construction), biomedical views see mental illness as a
constant human condition, with changing definitions reflecting growing knowledge.

Cultural theorists criticized psychiatry’s focus on biology (Fabrega, 1995). Szasz (1960) said
mental illness is socially constructed. Foucault (1957, 1965) argued that mental illness lacks
clear biological proof and is shaped by social and political forces. For example, behaviors
seen as "madness" vary across cultures and history.

In Medieval and Renaissance Europe, madness was linked to religion and supernatural forces.
People were seen as caught in battles between good and evil and were often left to wander or
locked up. With economic changes, madness came to be seen as moral failure, leading to the
rise of mental institutions (Foucault, 1965).

Before the 1800s, Americans didn’t use the term "mental illness." People showing emotional
distress were called "distracted" and treated through religion. As the U.S. became industrial,
madness was blamed on sin and bad habits like laziness or masturbation. Some believed
insanity was inherited. Poor people were sent to asylums, while the rich got private care,
showing how class shaped treatment (Manning & Zucker, 1976).

Social constructionist views, which saw mental illness as a social reaction rather than a
disease, were labeled “antipsychiatry” and lost influence (Fabrega, 1995). Theories like
labeling and symbolic interaction shifted focus from individuals to how society defines and
reacts to mental illness.

Anthropologists helped shape the cultural relativity movement from the mid-1900s. They
studied mental illness in non-Western, preindustrial societies. However, their findings were
rarely applied to ethnic minorities in Western countries like the U.S., limiting their broader
relevance. Examples: In some African communities, hearing voices might be seen as
spiritual communication rather than a symptom of schizophrenia, showing cultural
differences in understanding mental health.

Biomedical View of Mental Illness

In the 20th century, psychiatry adopted a medical model to gain scientific credibility, using
terms like diagnosis and treatment (Jimenez, 1988; Pilgrim & Rogers, 1993). Brain disorders
like encephalitis and syphilis supported links between biology and mental illness (Grob,
1983). With popular drugs like Prozac, biological views became widely accepted. Today,
psychiatry focuses on genetics, often ignoring cultural and social causes (Fabrega, 1987;
Kleinman, 1988).

Certainly. Here's a concise yet critical summary of Frantz Fanon's work, focusing on how
colonial psychology and psychiatry viewed mental illness, particularly in Africa:

Frantz Fanon: Colonialism, Mental Illness, and the Racist Gaze of Psychiatry

Frantz Fanon, a Martinican psychiatrist and anti-colonial thinker, critically examined how
colonialism shaped the understanding and treatment of mental illness. In his seminal works
Black Skin, White Masks (1952) and The Wretched of the Earth (1961), Fanon argued that
colonial psychiatry was not a neutral science—it was complicit in reinforcing the belief that
colonized people were inferior.

Fanon exposed how European colonial psychology pathologized African behavior through a
racist lens. The "colonial gaze" saw the African as primitive, irrational, and emotionally
unstable. Psychiatry, as practiced in the colonies, often treated African culture, religion, and
behavior as signs of mental deficiency or inferiority, rather than as different ways of being.
For example, traditional healing practices or spiritual beliefs were often labeled as
"delusional" or "psychotic" under European psychiatric standards.

In colonial Algeria, where Fanon practiced psychiatry, he observed that mental health
services were segregated and that native Algerians were often overdiagnosed with psychosis
or treated with violence. He saw mental illness not only as an individual condition but as a
direct consequence of colonial violence, racism, and dehumanization. For Fanon, colonial
oppression created a "colonized mind" marked by internalized inferiority, self-hatred, and
psychological trauma.

Fanon also critiqued how psychiatry failed to recognize the political roots of suffering. He
called for a revolutionary psychiatry that would understand the psychological impact of
colonization and aid in the liberation of the oppressed. His work remains foundational in
postcolonial psychology, cultural psychiatry, and the decolonization of mental health care.

MENTAL HEALTH AMONG ETHNIC AND SOCIAL MINORITIES IN INDIA

India is a highly diverse country with many caste, tribal, religious, and linguistic
communities. This social diversity greatly influences mental health experiences. However,
while India’s population and health care systems continue to evolve, mental health issues
among marginalized and minority communities remain under-researched and often
misunderstood (Srinivasa Murthy, 2017).

Demographic Diversity and Mental Health

In India, social groups such as Scheduled Castes (SCs), Scheduled Tribes (STs), Other
Backward Classes (OBCs), and religious minorities like Muslims form a large section of the
population. According to the Census of India (2011), SCs and STs make up around 25% of
the population, and Muslims are the largest religious minority at over 14%. These
communities often face social exclusion, economic hardship, and discrimination, all of which
are linked to poor mental health outcomes (Kumar & Mohanty, 2021).

Recent surveys show that Muslims and SCs report significantly higher levels of sadness and
anxiety compared to upper-caste Hindus, even when income, education, and urban/rural
status are controlled for (Deshpande & Ramachandran, 2020). Such findings indicate that
mental health disparities are strongly influenced by social status and discrimination.
Mental Health Among Scheduled Tribes

Tribal populations in India face a severe burden of mental health challenges. A field study by
the Indian Council of Medical Research (ICMR) found that more than 70% of people in tribal
communities showed symptoms of common mental disorders, including depression and
anxiety (ICMR, 2016). The causes include poverty, lack of access to healthcare, dislocation
from traditional lands, and cultural alienation.

Gender and Marginalization

Women from marginalized communities are particularly vulnerable to mental health

problems. In several rural areas, lower-caste or tribal women are sometimes accused of
witchcraft, leading to social exclusion, abuse, and trauma (Nongkynrih & Venkatesan, 2020).
These forms of gendered violence are deeply connected to caste-based discrimination and
patriarchal control, which can cause long-lasting psychological harm.

Cultural Beliefs and Underutilization of Mental Health Services

Cultural attitudes strongly influence how mental illness is perceived and treated in India.
Mental health issues are often associated with stigma, spiritual causes, or supernatural
explanations, leading to a preference for traditional or religious healers over clinical care
(Kermode et al., 2009). This contributes to the low rates of mental health service use,
especially among marginalized groups, despite evidence that mental illness prevalence is
similar to or higher than national averages (Uba, 1994; Sinha et al., 2019).

Regional Variations in Prevalence

Kerala, a southern Indian state known for high literacy and healthcare access, reports higher
lifetime prevalence of mental illness than the national average (Srinivasan et al., 2022). Rapid
modernization, family breakdown, and migration stress may contribute to this trend,
suggesting that mental health issues are shaped not only by deprivation but also by social
transition.

The Importance of Inclusive Mental Health Approaches

To address the mental health needs of India’s diverse population, we must:

 ●​ Develop culturally sensitive mental health programs that understand the local
beliefs, languages, and traditions of minority communities.
●​ Train community health workers to recognize and respond to mental health
symptoms with empathy and without bias.
●​ Combat stigma and discrimination through awareness campaigns focused on
schools, workplaces, and community centers.
●​ Improve data collection and research to include within-group differences (e.g.,
among subgroups of STs or religious minorities).

Understanding Group Differences in Mental Health

Mental health differences across racial and ethnic groups are often explained using broad
labels like race or acculturation, but cultural factors are rarely studied directly (Vega et al.,
1984; Abe & Zane, 1990; Padilla et al., 1986). While some research links acculturation to
distress, recent studies show immigrants may have better mental health than native-born
individuals. Still, how acculturation truly affects mental health remains unclear. Many studies
assume all members of a group are similar, ignoring within-group differences (Takeuchi,
Uehara, & Maramba, 1997). The traditional model of research overlooks culture’s direct role,
while the elaborated model encourages examining both cultural and social factors together.

Mental Illness in a Multicultural Context: An Indian Perspective

Mental health issues do not exist in isolation—they are deeply influenced by the social and
cultural context of the people who experience them. Two key factors shape how people from
different ethnic or cultural backgrounds express psychological distress: structural factors
(like the way society is organized) and cultural factors (like values, beliefs, and traditions).
These factors not only affect the prevalence of mental health conditions but also influence
how symptoms are understood, talked about, and treated.

Structural factors include things like the level of social stress, family expectations, gender
roles, caste dynamics, economic hardship, or political instability. These factors shape what
kinds of emotions or behaviors are acceptable, and how distress is expressed. For example, in
a collectivist society like India, where community and family are given priority over the
individual, people may suppress personal struggles in order to avoid burdening others or
bringing “shame” to the family.
Hutterites, a religious community in North America that lives in isolated, close-knit groups.
Despite their peaceful, religious way of life, studies found high rates of depression among
them. Researchers realized that the strict communal lifestyle may discourage the open
expression of negative emotions like anger or frustration. Over time, this emotional
suppression, especially of anger, may lead to inward-directed emotions like guilt and
depression.

Culture shapes not just how we feel distress but also how we talk about it—or whether we
talk about it at all. In some cultures, people are more comfortable expressing emotional
suffering through physical symptoms. For example, research in China has shown that people
with depression often report body aches, fatigue, or sleep problems rather than feelings of
sadness. Instead, "neurasthenia" remains a common diagnosis in China, including symptoms
like fatigue, insomnia, and palpitations (Beard, 1880; Cheung, 1989). Though removed from
the DSM, it persists in Chinese psychiatry, reflecting cultural norms around expressing
distress (Lin, 1982; Ming-Yuan, 1989).

In India, something similar happens. Many people, especially in rural areas or among older
generations, express emotional distress as “gas problems,” “weakness,” “tension,” “heat in
the head,” or “weight on the chest.” Women, in particular, may talk about "body pain" or
"feeling faint" when they are actually struggling with anxiety or depression. These somatic
expressions are often more socially acceptable than openly discussing mental health, which
may still carry stigma

Conclusion

Many large-scale mental health studies overlook culture, using broad labels like race or
immigration status without examining how cultural beliefs shape mental illness (Rogler et al.,
1989). Future research should directly measure cultural values and practices.

A key framework is individualism vs. collectivism (Triandis, 1993). In collectivist cultures,

people often turn to family or community rather than professionals for support (Tracey et al.,
1986; Kashima & Triandis, 1986). This helps explain lower service use among some ethnic
groups.

Concepts like "loss of face" also influence help-seeking, especially in Asian cultures, where
seeking help may bring shame (Zane, 1993; Ja & Aoki, 1993). Western diagnostic categories
may not fit all cultural expressions of distress—terms like susto (Mexico) or neurasthenia
(China) may be more accurate (Kleinman, 1977; Vernon & Roberts, 1982).

Culture also affects symptom expression by gender—e.g., Mexican American women may
show distress as depression, men as substance use or aggression (Fabrega et al., 1967;
Aneshensel et al., 1991).

Thus, a culturally informed, person-in-environment approach is needed—one that considers

biology, culture, and social context (Lemert, 1951; Waxler, 1974; Good & Good, 1986).
Mixed methods, including interviews and ethnography, can provide richer insights than
surveys alone