5 Ways Culture Impacts Acceptance of Mental Health Problem

5 Ways Culture Impacts Acceptance of Mental Health Problem

Cultural Factors in the Road to Recovery

We often expect people with mental health problems to accept themselves. We underestimate the effects of our broader culture on the process of acceptance of a mental health problem. In this post, I describe the ways that culture can impact this process based on research in my book, Acceptance of Mental Illness: Promoting Recovery Among Culturally Diverse Groups. Here, you will see that culture offers a number of challenges and resources to the acceptance process.

1. Cultural stigma. Most of us are familiar with the exacting toll that a culture can take with regard to stigma. One Jewish American woman I interviewed described this phenomenon in the U.S. She stated, “In America you're not supposed to be depressed, and, if you are, you're supposed to snap out of it, and pull yourself up by your bootstraps.” While some empowerment can be found in Western cultural values of autonomy and self-reliance, these expectations can also make it difficult to accept a mental health problem and seek help.

 2. Explanatory models.  The medical anthropologist and psychiatrist Arthur Kleinman went around the world listening to people’s stories about their medical and mental health problems. He learned of the explanatory models that their health narratives revealed – cultural explanations for the origin of a mental health problem. It’s not surprising that these explanatory models would have an effect on acceptance, posing risk and/or resilience. Risk could result from a cultural view of mental illness as the effect of demon possession requiring banishment from the group. In turn, resilience could result from a cultural view of mental illness as a connection to a higher power, elevating the person’s social status.

3. Cultural isolation versus cultural supports. As a result of stigma, people may feel a sense of isolation within their cultural group. One interviewee in my book spoke to feeling that members of his cultural group “don’t accept people who have mental illnesses. A lot of cultures understand it, but they… don’t want to understand it.” He identified this lack of support as a key barrier to accepting his mental health problem. On the other hand, another woman described her depression advocacy group for women of color as a source of cultural support that was central to her acceptance process.

4. Cultural pride. Some research has found that cultural and ethnic identity pride can buffer against the mental health effects of racism and prejudice. One African American woman spoke to the centrality of cultural pride to her acceptance process. She stated, “When you meet people that are doing good in your cultural identity, it makes you want to good, too. It makes you want to say, ‘Well, they can do it, I can do it.’ It gives you a broader outlook than the stereotypes that people have about people.” Cultural pride can buffer against not only racism and prejudice, but also foster acceptance of a mental health problem.

An important topic to close with is the issue of public versus personal acceptance. We can teach individuals to accept themselves until we are blue in the face. But ultimately, more effort is needed among the general public to accept mental health problems in order to prevent the cultural stigma that blocks the self-acceptance of others. 

Reference

Mizock, L., & Russinova, Z. (2016). Acceptance of mental illness: Promoting recovery among culturally diverse groups. Oxford University Press. 

 

Five Obstacles Men Overcome to Accept Mental Health Problems

Five Obstacles Men Overcome to Accept Mental Health Problems:
How traditional masculinity affects mental wellness

Previously posted on Psychologytoday.com

Acceptance of a mental health problem is one of the most critical and difficult stages of recovery. In my book, Acceptance of Mental Illness, I use the term acceptance to refer to the process of recognizing and actively managing a mental health problem. One of my research findings is that the process of acceptance is particularly affected by gender. In my last post, I described the unique experiences of women in the acceptance process. In this post, I describe the obstacles men overcome to accept a mental health problem.

1. Hegemonic masculinity. One of the central obstacles men overcome to accept a mental health problem is hegemonic masculinity—the pressure men feel to conform to traditional gender norms such as toughness, fearlessness, and invulnerability to pain. Men I interviewed described suffering in silence because a mental health problem might be a sign of weakness or vulnerability. One woman I interviewed spoke to this difference: “Sometimes I think it’s easier for women to have mental illness than men, because at least we’re used to being told we can cry, and we can be emotional…I can’t imagine being a man and having so much bottled up. I don’t know how they’re living and walking.”

Men navigated these rigid notions of masculinity by working within the confines of traditional gender socialization. One man I interviewed described his version of acceptance: “I have a symptom, and I'm going to go through life with this symptom. I’m going to make the best out of it, and I'm just going to roll with it.” Like this participant, other men worked within pressures of traditional masculinity by constructing acceptance as a sign of courage, strength, and flexibility.

2. Help-seeking avoidance. Another key challenge to acceptance involves men’s socialization to avoid help. Seeking help through professional means or peer support can foster acknowledgement and understanding of a mental health problem. I read stories describing the physical pressures of hegemonic masculinity (Charmaz, 1995; Courtenay, 2000), including those of prisoners who belittled inmates seeking medical treatment for pain. Or a man with diabetes in a wheelchair who skipped lunch rather than get help with a cafeteria tray, risking a coma. Or an executive who took great efforts to conceal his dialysis appointments to his employees to avoid being seen as weak.

On the other hand, many men overcame help-seeking avoidance by resisting rigid notions of masculinity and engaging in treatment. At times this involved the recruitment of women into their care. Women sometimes act as health mediators to men in managing their mental and physical well-being, helping them to detect and respond to the symptoms they may ignore. Women can give permission to accept professional help when needed in the face of these rigid gender norms.

3. Emotional suppression. In my research, I found that men may be conditioned to dismiss and repress emotions that are integral to recognizing and responding to a mental health problem. I’ll never forget running an anger management group at a veteran’s hospital and initially worrying whether anyone would come. I was shocked when I saw a room packed to the brim — all the men in the unit had come to the group. I learned that anger was one of the few difficult emotions that was socially appropriate for men to express. Painful feelings might be funneled through anger, rather than manifesting as sadness or loss. Alternatively, the conditioning to repress emotions can be surmounted through accepting and expressing feelings, supporting acceptance of the mental health problem through which these emotions may take shape. 

4. Substance abuse. What happens when emotional expression is constrained? Substance abuse can become a way to numb the pain. One man I interviewed spoke to converting his pain into substance abuse: “I was just feeling like crap, so I picked up the bottle and started drinking.” After drinking 40 or 50 beers, he was rushed to the hospital, where the mental illness he had tried to drown out was acknowledged and attended to. Many men overcome this obstacle to acceptance through addiction recovery, where they may find valuable sources of social support and a space where denial is actively overcome.

5. Destructive health behaviors. In my research on men and mental illness, I was shocked to learn about the ways in which we have taken for granted something as major as the difference in average age of death between men and women. Courtenay (2000) attributed this to issues as dramatic as the aforementioned addiction or homicide, to health behaviors as seemingly trivial as seat belt use. “Left unquestioned,” he argued, “men's shorter life span is often presumed to be natural and inevitable” (p. 1387).

One of the men I interviewed spoke to the mental health nature of this problem: "If I believe I don't have an issue, then I won't take my medicine...I think if I don't accept it, then I won't do what I need to do for my health." Self-care and healthy intervention can serve as alternatives to these barriers to acceptance of a mental health problem.

Overall, it is incredible that men facing these obstacles to acceptance are able to overcome them. It is important to remember in these discussions of gender that differences can abound across men with different racial/ethnic, sexual, and gender-diverse identities. Discussions of gender differences risk essentialist and binary categorizations of gender. We can understand the social construction of gender as a category that privileges those identified as men, but also comes with a number of challenges and losses. To put it plainly, traditional gender categories can be toxic to everyone. Developing more fluid notions of categories like masculinity can be a healthy direction for the mental health and acceptance process of all.

References

Charmaz, K., 1995. Identity dilemmas of chronically ill men. In: Sabo, D., Gordon, D.F. (Eds.), Men's Health and Illness: Gender, Power and the Body. Sage Publications, Thousand Oaks, CA, pp. 266-291.

Courtenay, W. J. (2000). Constructions of masculinity and their influence on men's well-being: A theory of gender and health. Social Science & Medicine, 50, 1385-1401.

Mizock, L., & Russinova, Z. (2016). Acceptance of mental illness: Promoting recovery among culturally diverse groups. Oxford University Press. 

Five Tools that Help Women Accept a Mental Health Problem

Five Tools that Help Women Accept a Mental Health Problem:
Sources of Resilience to Misogyny and Mental Illness

Previously posted on Psychologytoday.com

Women face unique mental health challenges, including more diagnoses of depression, longer hospitalizations, and higher rates of abuse. However, women also bring particular resources to their mental health experiences, including advantages in detecting and accepting a mental health problem. In my book, Acceptance of Mental Illness: Promoting Recovery Among Culturally Diverse Groups, I define acceptance as actively recognizing and managing the symptoms of a mental health problem. In this post, I will draw from the research in my book to identify the strengths that women often bring to the process of accepting a mental health problem.

1. Stigma awareness. Women with mental health problems face double stigma - both the stigma of having a mental health problem as well as the effects of misogyny and sexism. Women often face particular challenges that are magnified by the presence of a mental health problem. These effects can range from an increased risk of violence to the gender pay gap. However, women’s mistreatment at individual and systemic levels can lead to a heightened awareness of how oppression operates. As a result, women may be more likely to understand mental illness stigma, and deflect this barrier to acceptance. Why accept a mental health problem when there may be so much stigma attached? Women’s understanding of how stigma operates can help us to recognize and resist stigma – a key obstacle to accepting a mental health problem.   

2. Emotional expression. In my research, I have found that women with mental health problems feel they are advantaged in being socialized to detect and express their emotions. One woman put this to words: “Sometimes I think it’s easier for women to have mental illness than men because at least we’re used to being told we can cry and we can be emotional.” As women, we are allowed to feel our feelings, which can help to work through them and notice if there is a problem with our emotional experience.

3. Accessing services. Women are more active users of mental health services than men, and not necessarily due to need.  Women are taught that it is acceptable to reach out for help when they need it, attend medical appointments, and form relationships with providers for ongoing care. This proclivity for accessing services helps women to engage in the self-care required to acknowledge and accept their mental health problem, aided by the help of professionals.

4. Social support. Women are also oriented around relationships, encouraging them to seek out and sustain relationships with peers and providers. In my research, women have spoken to the value of their relationships with friends, family members, and partners in helping their recovery and management of mental health problems, as well as adding meaning to their lives. This prevents some of the isolation that can come from having a mental health problem – having someone by your side so you don’t have to face mental health challenges on your own.  

5. Helping role. Women have been often culturally designated as nurturers and helpers to others, whether in their families or professions. Hence, women with mental health problems often describe their roles as mothers or supporters in their families as key sources of meaning. Many women with mental health problems become traditional providers, peer specialists, activists, and advocates for others with mental health problems. The opportunity to transform suffering into the service of others surely reflects an acceptance of a mental health problem, and allows women to aid in the acceptance process of others.

I want to mention a few caveats in closing this discussion of women’s strengths in the acceptance process. When we talk about gender differences in mental health, it is important to focus on the effects of gender socialization rather than essentialist notions of gender. Essentialism constructs gender as a fixed category holding universal characteristics, and attributes gender differences solely to biology or evolution. Eschewing essentialism also means not assuming all women are the same. There are major within-group differences among a category as broad as gender. Women’s mental health experiences can differ dramatically across race-ethnicity, sexual orientation, gender nonconformity, ability, and history. Ultimately, we can acknowledge the effects of gender socialization on women and affirm the strengths and resources we have developed in navigating mental health challenges and the acceptance process.

Wondering about men’s experience in accepting a mental health problem? Stay tuned, as I’ll be discussing my research on men in my next post.

Reference

Mizock, L., & Russinova, Z. (2016). Acceptance of mental illness: Promoting recovery among culturally diverse groups. Oxford University Press.

Eight Common Challenges to Accepting a Mental Health Problem

Eight Common Challenges to Accepting a Mental Health Problem:
Overcoming Obstacles to Recovery

Previously published on PsychologyToday.com

A family member is in a funk and hasn’t seemed himself in a long time. Or you haven’t been able to get on a crowded train all week due to breaking into a sweat. Maybe your friend keeps canceling plans and hasn’t gotten out of bed in several days. It might be clear to some that there is a mental health problem at hand. But there’s something inside the person that fosters doubt and delays taking action.

These examples speak to the challenging process of accepting a mental health problem. In my book on acceptance of mental health problems, I define acceptance as the process of recognizing and actively dealing with the symptoms and related challenges associated with a mental health problem.

In a previous blog post, I described the different facets of the acceptance process, and tips to accepting a mental health problem.

Here, I highlight the common challenges to acceptance in my research from my book, and how they can be overcome to bring a greater sense of recognition and self-care. These barriers can be internal (emotional, cognitive, behavioral, identity-related), relational, or more cultural-systemic.

1. Feelings can get in the way of acceptance.
The first barrier to acceptance is at the emotional level. In my research with people with mental health problems, many people described difficult feelings like shame and despair that get in the way of accepting a mental health problem. On the other hand, feelings like hope, pride, or even fear could motivate recognition of a mental health problem.

2. Certain actions or inactions might block acceptance.   
Another obstacle to acceptance can happen at a behavioral level. People I spoke with described avoidant and maladaptive behaviors that only led to greater denial. These inactions might include skipping appointments or social activities that bring a sense of wellness and connection. Scheduling positive activities and committing to them often helped with accepting and managing a mental health problem.  

3. Thoughts and beliefs can pose barriers to acceptance.
Cognitive challenges in acceptance can include things like a lack of clarity or negative thinking. Other cognitive processes that promote acceptance might include a sense of awareness and self-reflection. One person I interviewed spoke to this experience, seeing acceptance as, “Just thinking about what’s going on with me. Just knowing my issues, just knowing my problems, just knowing how I act on a regular basis, [helps] accept it.”

4. Ideas about your identity or sense of self may interfere with acceptance.    
I learned in my research that acceptance can be a process of identity development, involving integrating a new sense of oneself as a person with a mental health problem into one’s identity in a positive way. But if you have negative associations of people with mental health problems being inferior, then this can be a challenge to overcome. However, having a mental health problem can also lead to positive identities. These could include being a strong and resilient person for making it through. Or, serving as a role model or advocate for others with mental health problems.

5. Some relationships may not support acceptance.
Perhaps a key problem to accepting a mental health problem is a lack of acceptance and support from other people. “When other people don’t accept you as you are, it’s really hard to accept depression,” was how one person described this experience. People can engage in relationships with others who support recognizing and dealing with a mental health problem. This relational obstacle to acceptance also speaks to the need of the broader society to promote acceptance and eliminate stigma as a community, rather than expecting people with mental health problems to do the work of acceptance on their own. 

6. Cultural factors can inhibit acceptance.
Stigma can be particularly prominent depending on cultural values, beliefs, and practices. Take American culture, for example, where there are cultural stereotypes that people with mental health problems are violent. Or given our individualistic, productivity-oriented culture, beliefs can prevail that people with mental health problems are a “drain” on society. One woman described this in my book: “In America you’re not supposed to be depressed, and if you are, you’re supposed to snap out of it, pull yourself up by your bootstraps.” However, there might be other cultural supports or beliefs that offer resources and support that foster acceptance, like some biomedical treatments, or an emphasis on education and learning about mental health problems to spread awareness.

7. Religious beliefs might impede acceptance.
Depending on their religious and spiritual backgrounds, some people might feel they are being punished by God for their mental health problems, or that they could be cured through spiritual practices that might be ineffective or even harmful. In other cases, one’s religious community and practices might be a source of inclusion, encouragement, and healing that can be extraordinarily helpful to acceptance.

8. Systemic factors can also hinder acceptance.
Lastly, it’s important to note that institutional factors at the systemic level can interfere with acceptance. People might be ostracized at work or school for their mental health problem. They may be failed by the policies in health care or local politics in their region. Access to adequate resources in these contexts can be transformative to boosting acceptance of a mental health problem and offering the right tools to do so.

The process of acceptance can be complex, involving a number of challenges that arise at different times for different people. But with each barrier can come an adjacent facilitator to the acceptance process, whether emotional, behavioral, relational, cultural, or otherwise.

Reference

Mizock, L., & Russinova, Z. (2016). Acceptance of mental illness: Promoting recovery among culturally diverse groups. New York, NY: Oxford University Press. 

Five Tips to Accept a Mental Health Problem

Five Tips to Accept a Mental Health Problem:
Develop Self-Awareness with Lessons from the Research

(Originally published on PsychologyToday.com)

"Understanding is the first step to acceptance, and only with acceptance can there be recovery,” Dumbledore, the headmaster wizard once said in the Harry Potter series.  With this quote, author J.K. Rowling tapped into a core truth in the acceptance of a mental health problem… acceptance is key to managing mental health challenges. 

My research has found that acceptance is not a simple outcome that is either there or not there. Instead, acceptance is a dynamic process that involves several factors that develop over time. This process requires moving from a passive state of denial to an active position of agency.

How is it done? Here are some central lessons based on research on acceptance.

1. Develop an awareness of the mental health problem and beliefs that support it.The process of acceptance of a mental health problem includes a cognitive piece. Insight is needed to understand that a mental health problem is taking place. Symptoms can get in the way of thinking clearly about what is happening, and they could be lessened through treatment. Or if denial is a problem, it is important to understand what beliefs might add to it. That you can’t live a life of hope and meaning in the face a mental health problem? That you won’t be able to pursue your dreams or feel accepted by others? These beliefs can be challenged in order to better recognize the problem.

2. Create a positive sense of self in the face of a mental health problem. Research has shown that acceptance is also a process of identity development that involves moving past stigma. Why would you accept a mental health problem if you feel society might shun you for having one? Stigma needs to be disputed to allow for a new sense of self to emerge. You can still be a fantastic worker, parent, friend, or community member even with a mental health problem. A mental health problem doesn’t need to define a person, or become central to your identity. However, it does need to be integrated as a part of who you are.

3. Engage in activities that support acceptance. There is also a behavioral aspect to this process. Engaging in certain activities can reflect and reinforce acceptance of a mental health problem. These might be treatment-oriented activities, like taking medication or attending therapy. You might also keep an active schedule and build in positive activities to look forward to during the week. A range of behaviors can keep the mental health problem from taking over and make accepting the problem easier.

4. Focus on relationships that promote acceptance. Supportive relationships are particularly helpful to accepting a mental health problem. Some people may not accept the mental health problem because of their own stigmatizing beliefs. Some people might also benefit from ignoring the problem, or simply be unprepared to accept it. On the other hand, many friends, providers, family members, and others might recognize the presence of a mental health problem and support the management of it. They might offer non-judgmental listening, company to appointments, or general encouragement. Acceptance can be supported by relationships with people who acknowledge the mental health problem.

5. Pursue emotional experiences that boost acceptance. Research shows that people also describe the process of acceptance as an emotional experience. This might involve making room for grief and pain and moving past shame. On a positive side, acceptance can also involve sustaining a sense of happiness and hope. The acceptance process can certainly involve some work, but it can also be a joyful experience that leads to a greater sense of peace.

These tips include a number of aspects of acceptance that take place within the individual. However, acceptance shouldn’t be seen as the sole responsibility of the person, but a process that includes the effort of the general public to overcome stigma and foster mental wellness in our communities. Acceptance is a process that can’t and shouldn’t be done alone.

Reference

Mizock, L., & Russinova, Z. (2016). Acceptance of mental illness: Promoting recovery among culturally diverse groups. New York, NY: Oxford University Press.