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Sociology of Depression - Effects of Culture

Rashmi Nemade, Ph.D.

Sociologists study how people get along together in groups. They study culture, social groups and how they affect individuals. The sociology of depression looks at the cultural context in which people live. It also looks at the social stresses that people encounter as a part of life. The sociological aspects of depression are both influenced by and also influence the other biological and psychological aspects of people's lives.

The Effects of Culture

people around worldCulture and the ethnic group that people come from are important aspects of health and illness. A new branch of medicine, known as ethnomedicine, focuses on the role of culture, perception, and context in shaping someone's physical and mental health.

Previously, it was thought that depression primarily affected people in developed "Western" nations and that other cultures did not suffer from this condition. Ethnomedical studies suggest that this idea may have more to do cultural perceptions of what symptoms become labeled as a depressive disorder. It also has to do with how occurrences of depression are recorded for statistical purposes and how depression is thought of within particular cultures.

For example, in India, a wide range of distress disorders are categorized as depressive disorders.  But in Japan, the very idea of mental illness is unacceptable and few people will admit to having it. Without knowing this, someone might conclude that Indian people have very high rates of depression.  They might also think that people from Japan rarely develop this condition. Even within the United States, the numbers of people experiencing depressive disorders can be influenced by cultural context. For example, black women have lower rates of depression than white women. In addition, recent immigrants to the U.S. tend to have lower rates of depression than others who are presumably more "Western" in attitudes and behavior.

Ethnomedical research suggests that cultural differences in focusing on oneself and one's place within the social group are linked to the amount of depression that occurs. Some of this difference comes from the individualistic vs. collectivistic orientation of a particular culture. In Western cultures, individuals are ideally viewed as independent, separate people striving for individual achievement and success. In contrast, other cultures view the family or society as being of more importance than the individual. Many times, personal happiness is sacrificed for the good of the larger group in such cultures. Very little thought is given to particular individuals within such cultures. For example, in traditional Asian cultures it is common for one member of the family to work hard and share a paycheck with the entire extended family. Some authors suggest that because people from collectivistic cultures are not encouraged to place much importance on personal gratification, they do not spend time feeling frustrated about their failure to achieve personal success. As a result, the lack of focus on the self can lead to a decrease or absence of the development of depressive disorders.

Our rules about our specific responsibilities and obligations (to ourselves, to others, and to the institutions we live with) are also shaped by our culture. For example, a person who comes from a culture where family obligations are demanding and required may feel restricted, powerless and limited. On the other hand, a person from the same culture may view family obligations as a way to feel needed, useful and competent. Feelings and thoughts concerning powerlessness and usefulness shape people's self-concept and mood.

Some cultures have rigid gender roles that define expected behavior. Men's lives exist primarily outside the home, while women's roles are specifically in the home. In these cultures, women may not even leave their homes unless escorted by a male family member and men may never enter the kitchen. If someone from this type of culture encounters a social stressor which forces a change in roles or a challenge to this typical set-up (such as the death of a spouse), this stress can cause this person to become depressed. For instance, if a husband (from a culture with rigid gender roles) loses a wife, he will not know how to care for his children's day to day needs such as feeding, bathing, etc. Similarly, if a wife loses her husband, she will not know how to provide financial support for her family and additionally, may be prevented from even trying. Both people may start to think of themselves as worthless or useless if they cannot meet the needs of their children.

Cultural identity often influences the degree to which a particular individual shows physical symptoms of depression. In other words, some cultures are more comfortable reporting depressive symptoms that are physical in nature rather than mental. For example, many Chinese people with depression complain of bodily discomfort, feelings of inner pressure, and symptoms of pain, dizziness, and fatigue. Similarly, Japanese individuals with depression often complain of stomach, headache, and neck pain symptoms. Even within Western countries where depressive disorders are more "acceptable", researchers have theorized that some chronic conditions (chronic pain, fibromyalgia, chronic fatigue syndrome) may be more physical forms of a mood disorder rather than actual physical problems. Some researchers have even suggested that fibromyalgia (a condition characterized by widespread pain, tenderness, and fatigue) should be characterized as a "depressive disorder spectrum ". At the same time, it is important to note that the depressive disorder may result from the condition of fibromyalgia.

Some cultures may view symptoms of depression as normal emotional responses to particular life events. For example, some cultures may expect the grief process to last longer than the roughly one-year period which is acceptable in the West. Individuals from these cultures might find it odd that a Western psychologist would think that two years spent mourning for a lost spouse was a sign of a mental health problem.

Still other cultures may recognize that symptoms of depression are problematic.  However, the causes that they believe for these symptoms happening doesn't make sense to people from other cultures. For instance, patients may reject explanations for symptoms that are commonly acceptable to clinicians in favor of ones that are accepted within the patient's culture. For instance, a patient from China seen in a Western country might reject the idea that a chemical imbalance in the brain is causing symptoms of depression. Instead, they might accept an explanation in terms of energy flows or similar concepts drawn from traditional Chinese medicine. These patients may respond best to mental health professionals who are able to use culturally-sensitive language to describe the cause of symptoms and related suffering.

Cultural differences in help-seeking behavior may influence the treatment of depression. For example, non-Western individuals frequently use practitioners from their own culture for treatment of "illness" and Western-trained physicians for treating "disease". If emotional disturbances are not considered within the area of disease, people with depression might not seek out mental health care for depressive symptoms. It is more socially acceptable to have a depressive disorder in Western societies, and more people from these cultures are willing to seek help. In contrast, mental illness is often more stigmatized in other cultures. As a result, people and their families may deny mental illness out of shame of being identified as "crazy". Others may find the label "major depressive disorder" morally unacceptable, shameful, and meaningless. Treatment for depressive disorders may be actively resisted by someone who comes out of this sort of culture.

Cultures also vary in the degree to which they rely on or incorporate complementary and alternative medicine practices such as herbs, meditation, yoga, or other approaches into their prescribed treatments for depression. Individuals from some traditional cultures may reject Western antidepressant medications while embracing prescriptions for herbs, acupuncture or exercise.

A person's cultural background can also influence their biological makeup. People from different parts of the world have different patterns of genes and, often, different patterns of disease to which they are vulnerable. These genetic differences can influence whether people get depression when stressed. People's genetic background can also influence their response to antidepressant medications.

Reader Comments

Suicide in Japan - Andrew Grimes JCP, JSCCP, M. Sci. Pth. - Nov 19th 2009

Western media reports on suicide and mental health care in Japan rarely get it right. I am a psychologist and psychotherapist working in Japan for over 20 years and so like all of my colleagues in the mental health care field here share with them the view that copycat suicides have a lot more to do with press and media copy than western misconceptions about relatively more group oriented societies in Asia.

I would like to put forward a perspective on some of the main reasons behind the unacceptably high suicide Japan from Japan and so will limit my comments to what I know about here in Japan but would first like to suggest that western media reports on suicide rates in Asian countries should try harder to get away from the tendency to orientalize the serious and preventable problem of increased suicide rates here over the last 10 years by reverting to stereotypical ideas of Asian people in general. People here do not wake up one day and say, "Hey, let's commit suicide today because I hear it is all the rage in Shanghai and Tokyo and the word is that even the Changs and Suzukis are doing it!" In other words Asians are real people too and not lemmings and it is more than every before the time the world wide media puts aside its mystical cliches, anciently outdated and jaded misconceptions on the hundreds of thousands of men and women who take their own lives every year in Japan and other countries throughout Asia.

Mental health professionals in Japan have long known that the reason for the unnecessarily high suicide rate in Japan is due to unemployment, bankruptcies, and the increasing levels of stress on businessmen and other salaried workers who have suffered enormous hardship in Japan since the bursting of the stock market bubble here that peaked around 1997. Until that year Japan had an annual suicide of rate figures between 22,000 and 24,000 each year. Following the bursting of the stock market and the long term economic downturn that has followed here since the suicide rate in 1998 increased by around 35% and since 1998 the number of people killing themselves each year in Japan has consistently remained well over 30,000 each and every year to the present day.

The current worldwide recession is of course impacting Japan too, so unless very proactive and well funded local and nation wide suicide prevention programs and initiatives are immediately it is very difficult to foresee the governments previously stated intention to reduce the suicide rate to around 23,000 by the year 2016 being achievable. On the contrary the numbers, and the human suffering and the depression and misery that the people who become part of these numbers, have to endure may well stay at the current levels that have persistently been the case here for the last ten years. It could even get worse unless even more is done to prevent this terrible loss of life.

The current numbers licensed psychiatrists (around 13,000), Japan Society of Certified Clinical Psychologists clinical psychologists (16,732 as of 2007), and Psychiatric Social Workers (39,108 as of 2009) must indeed be increased. In order for professional mental health counseling and psychotherapy services to be covered for depression and other mental illnesses by public health insurance it would seem advisable that positive action is taken to resume and complete the negotiations on how to achieve national licensing for clinical psychologists in Japan through the Ministry of Health, Labour and Welfare and not just the Ministry of Education as is the current situation. These discussions were ongoing between all concerned mental health professional authorities that in the ongoing select committee and ministerial levels that were ongoing during the Koizumi administration. With the current economic recession adding even more hardship and stress in the lives its citizens, now would seem to be a prime opportunity for the responsible Japanese to take a pro-active approach to finally providing government approval for national licensing for clinical psychologists who provide mental health care counseling and psychotherapy services to the people of Japan.

During these last ten years of these relentlessly high annual suicide rate numbers the English media seems in the main to have done little more than have someone goes through the files and do a story on the so-called suicide forest or internet suicide clubs and copycat suicides (whether cheap heating fuel like charcoal briquettes or even cheaper household cleaning chemicals) without focusing on the bigger picture and need for effective action and solutions. Economic hardship, bankruptcies and unemployment have been the main cause of suicide in Japan over the last 10 years, as the well detailed reports behind the suicide rate numbers that have been issued every year until now by the National Police Agency in Japan show only to clearly if any journalist is prepared to learn Japanese or get a bilingual researcher to do the research to get to the real heart of the tragic story of the long term and unnecessarily high suicide rate problem in Japan.

I would also like to suggest that as many Japanese people have very high reading skills in English that any articles dealing with suicide in Japan could usefully provide contact details for hotlines and support services for people who are depressed and feeling suicidal.

 

Useful telephone numbers and links for residents of  Tokyo and Japan who speak Japanese and are feeling depressed or suicidal and need to get in touch with a mental health professional qualified in Japan: 

Inochi no Denwa (Lifeline Telephone Service):

Japan: 0120-738-556

Tokyo: 3264 4343

AMDA International Medical Information Center:

http://amda-imic.com/

 

Tokyo Counseling Services:

http://tokyocounseling.com/english/

http://tokyocounseling.com/jp/

 

http://www.counselingjapan.com

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