It has been widely reported that people with mental illness, who come from more traditional cultures have a better outcome than Anglo American patients, but up until now no one knew why. A new study points to levels of hostility and criticism in different cultures, as a determining factor in the prognosis of patients suffering from mental illness, and proposes culturally sensitive therapies to improve their prognosis.
Starting in the 1970s the World Health Organization did a series of studies in different countries around the world and found counter intuitively that while the prevalence of the disease was pretty stable worldwide, the course was much more benign in traditional cultures, said Amy Weisman de Mamani, professor at the University of Miami Psychology Department and the studys principal investigator.
“Since family attitude plays an important role in patient outcome, we looked at what happens within the families in these cultures that may provide a more adaptive course for the illness” Weisman de Mamani said. “While all cultures value family, what is seen as most important in different societies comes thru in the way that family members react towards a relative with mental illness.”
According to the study, criticism and hostility towards a mentally ill relative is significantly higher among Anglo American families, than among Latinos and Asians and more detrimental than for African Americans in the United States.
Family members of a person with mental illness become impatient, when an ill relative fails to live up to culturally desired behaviors and values, the study says. When this occurs, there is a breakdown in communication between family and patient, and the harsh and disapproving attitudes that emerge makes the ill person more vulnerable to the disease.
Since Anglo American cultural values emphasize independence and responsibility, they are much more likely to be critical about a relative not being able to hold a job, or act independently, the study says.
“Among Anglos in the United States, there is this notion that with hard work you can overcome anything. In the context of mental illness, this attitude can lead to more criticism of the individual that, because of the illness, does not act in an independent and productive manner” Weisman de Mamani said.
On the other hand, Latino and Asian families emphasize interdependence and family connectedness. Thus criticism arises less frequently, usually, when family unity and harmony is disrupted.
“We found that Latinos are more likely to criticize patients for not taking a shower, not interacting, or not showing their emotions,” Weisman de Mamani said. “This sense of interconnectedness, may encourage a more supportive environment.”
Interestingly, criticism of the mentally ill among African American families is as frequent as in the Anglo community however, it is not as harmful. What people in other cultural groups may consider criticism may not be perceived as such by African Americans, said Jennifer A. Kymalainen, co-author and post doctoral fellow at the Edith Nourse Rogers Memorial Medical Center, Bedford Massachusetts.
“Black patients do not appear to take criticism from family members as personally,” Kymalainen said “Although communication tends to break down around some of the same issues as other groups, blacks may interpret the criticism as a sign of family concern,”
Weismann de Mamani explained that spiritual values also play a role, so that families that have a belief system to fall back on helps them make sense of the illness in a way that helps them bear the adversity more easily and helps both the patient and the families cope, and they may have more of a buffer and support system in place at church, for example.
The study concludes that understanding cultural patterns for patients with Schizophrenia can predict relapse and stabilization of the affected individual, and suggest that clinicians and researches focus family interventions on specific issues related to the patients cultural norms to greatly improve the patients outcome.
It has been widely reported that people with mental illness, who come from more traditional cultures have a better outcome than Anglo American patients, but up until now no one knew why. A new study points to levels of hostility and criticism in different cultures, as a determining factor in the prognosis of patients suffering from mental illness, and proposes culturally sensitive therapies to improve their prognosis. 
