The steady rise of diversity in America has and continues to shape the nation; however, it poses several problems for mental health professionals as well. A great concern is the inability of psychologists to effectively diagnose and treat patients of an ethnic minority due to a lack of cultural consideration. Even greater complications arise when the patient identifies with a minority group whose beliefs greatly differ from the beliefs of the dominant, Western culture. With respect to these issues, individuals from collective cultures are prime candidates for psychological misinterpretation. Though the biopychosocial model is the one of the most widely accepted methods of explaining psychological maladies, many of its compounding approaches to diagnosing and treating disorders are intended for the dominant white, Christian society. Appropriate cultural knowledge can help psychologists appropriately adjust their methods to fit the needs of a diverse population.
In contrast to the individualistic views of the West, which emphasize individual thought, achievement, and well being, Eastern cultures operates on collectivism, which focuses on the group and the interdependency of its members rather than any one person. The collectivistic view of the self is that it can only be understood through one’s social relationships and affiliations. These relationships and affiliations make up a network where the nuclear family shares the closest bonds, followed by the extended family and close friends.
Although the collectivism of Eastern cultures creates a strong support system for the group, it produces many stressors that can lead to depression and anxiety. For example, the overwhelming focus on the group rather than the individual can result in feelings of a lost individual identity and sense of self. Identity issues such as these are historically linked with depression. Moreover, many more rules and social norms exist in collective cultures than in individual cultures to maintain the harmony of the group. This combined with the cohesiveness of the group can make social mistakes very public and result in feelings of shame and embarrassment by the individual at fault. Research indicates that these feelings are associated with social anxiety within collectivistic societies. A bigger mistake that affects an individual’s reputation or results in the loss of honor has more severe consequences because of the stress associated with maintaining that honor.
The process of acculturation involves adjusting one’s values, attitudes, and cultural practices in to order to effectively adapt to a new culture. Acculturation is difficult for most immigrants, but especially so for Eastern immigrants since the Western and Eastern cultures differ greatly. The biggest challenges Eastern immigrants must face when they travel to America are the sudden loss of a support system, childrearing, and limited knowledge about the American way of life. Coming from a collectivistic culture that places great emphasis on relationships, immigrants may mourn the loss of their friends and family. The likelihood of suicide and depression tends to increase as acculturative stress, such as this loss, increases. Tensions within the nuclear family may also arise as children assimilate to the mainstream culture and language and identify less with their immigrant parents. Adolescents whose families strictly follow traditional culture are at a high risk for depression and suicide. A lack of knowledge about the American culture can increase the cultural gap between parents and children.
As is true in Western societies, depression is much more prevalent in women than in men in collective cultures. However, women from collective cultures also tend to experience more gender discrimination than Western women. They are traditionally expected to protect their honor at all costs and fulfill domestic roles. The stresses of these tasks alone are often overwhelming. Due to their inferior positions in the culture, women may also experience domestic violence, poverty, and blatant inequality that can greatly contribute to depression.
Considering the stigma associated with mental illnesses in the Arab culture, it is not surprising that many Easterners express depression and anxiety through somatic complaints. This is especially true with Eastern women, who may feel symptoms of depression as a result of inequality, but are taught not to express personal feelings. Instead, they complain of headaches, numbness, breathlessness, and chest pains to receive some form of medical attention. Somatization is also common among individuals with little knowledge of mental health who have no linguistic way to express their symptoms.
In many other non-Western societies, a stigma is associated with mental disorders despite high prevalence of depression and anxiety. Many Easterners believe that symptoms of depression and anxiety are simply a part of life and do not require medical attention. Also, individuals from collective societies tend to be extremely careful in maintaining their reputations, and mental distress is usually interpreted as a weak faith in God and/or a weak self. Therefore, they do not seek treatment for their symptoms in order to avoid shame and gossip. This stigma stems in part from the limited knowledge many Easterners have about depression and anxiety. Multiple studies reveal that the majority Easterners do not know the names of mental illnesses. Instead, they describe their symptoms through series of physical complaints.
The Arab American Institute Foundation estimates that there are over 3.5 million individuals with Arab-speaking ancestry residing in the United States, with thousands more arriving from the Middle East every year. As these numbers increase, so does the importance of psychologists to understand the Arab culture. Arab American immigrants make for an interesting case because they face additional discriminatory stressors associated with the events of 9/11 and political tensions in the Middle East.
The causes of depression and anxiety in Arabs and Arab Americans are a combination of biological factors and psychological and social factors that are greatly influenced by the Arab culture and immigration. Research indicates that biological markers of depression are consistent between Arab and Western populations, as are many psychological factors.
Arabs who seek psychological help are much more confident about the effectiveness of medication over therapy. But since many Arabs either refuse to meet with mental health professionals or do not have any knowledge of them, traditional treatment methods are still commonly used. Islamic therapy, for example, involves Quran recitation by an imam to repel moral deviance from the soul of the individual. The imam may also suggest old Islamic remedies, such as ice baths and herbal antidotes. Using Islam to simply cope with psychological distress is a more widely used method of treatment that is supported by research. A study completed on depressed Pakistani patients also reported that the participants believed that medicine could rid them of their symptoms but had little to no knowledge of psychotherapy.