Cultural differences affect diagnoses of disorders


art by Hyelee Won

Afsah Khan

art by Hyelee Won
art by Hyelee Won

While flu season infects anywhere from five percent to 20 percent of the U.S. population, some diseases aren’t spread through viral or bacterial means. Some diseases and conditions are spread through cultural boundaries set by societies around the world.
The interpretation of such diseases in American culture is different from how they are interpreted in foreign countries, according to sophomore Sohae Park. As a foreign exchange student from South Korea, she found herself immersed in different viewpoints and opinions while at RBHS, but she gradually got used to most of them.
Slowly, she began to see a big distinction in the mentality people have on the subject of illnesses between South Korea and the United States.
Park thinks people with certain illnesses are treated much differently in American culture than what she has seen in her home country. She believes Americans tend to overemphasize the seriousness of certain disorders compared to the other countries of the world who do not recognize some of the diseases diagnosed in the United States.
Some, like Michael Bednar, assistant professor of history at the University of Missouri-Columbia, believe diseases like ADHD, anorexia, bulimia or depression can be considered solely American illnesses. Bednar said he believes “many people in the United States … feel that ADHD, depression and anxiety do not exist or else are being overdiagnosed.”
Even though Park does not deny the existence of mental illnesses around the world, she believes there are several factors that come together to suppress these illnesses in other countries. The definition of mental illnesses might be different in other countries, Park said.
“I’m sure there’s a lot of people who have a mental illness in Korea, but they’re just hiding themselves from the others because they’re scared [of] bullying,” Park said. “[Mental illness] is not common.”
Mental illnesses are, indeed, uncommon in foreign countries when compared to American statistics. For example, mood disorders are significantly more prominent in the United States than in South Korea. According to the 2006 Epidemiologic Survey on Psychiatric Illness, three percent of Korean adults suffer from mood disorders. Comparatively, an estimated 26.2 percent of American adults suffer from mood disorders, according to the National Institute of Mental Health.
Park recognizes there is a clear difference between the people in terms of cultural priorities and expectations as well, and it is possible for this difference to make its way into the debate of mental illnesses and how they are viewed in the respective countries.
“I think it’s a difference of culture,” Park said. “Asian people really think about their [image], that’s really important to them. In my opinion, for Americans, they don’t really care about [image], but [what’s on] the inside, so I think that’s one reason that Asians aren’t wanting to show their mental illness to others, and just hide it, because [image] is the biggest thing in their life.”
A study published in 2003 counters Park’s opinion. Conducted by researchers Stephen Faraone, Joseph Sergeant, Christopher Gillberg and Joseph Biederman and titled “The worldwide prevalence of ADHD: is it an American condition?”, the study focuses on ADHD specifically. It states ADHD is not specifically an American disease and that it does indeed exist in other countries.
“In all studies, descriptions of being restless and distractible formed a coherent factor corresponding to hyperactivity, which was distinct from antisocial behaviors such as defiance and aggressiveness,” according to the study. “When the scores on this hyperactivity factor were compared from the different studies, they were found to be similar across the seven studies. Taylor [the researcher] thus suggested that the prevalence of such hyperactive behavior is probably similar across these different countries.”
Additionally, they said the reason ADHD and other such mental illnesses are not diagnosed properly in many areas around the world is because there is no set definition for the disorder that is applicable in all countries and cultures. Such a disease does exist in other countries, therefore, but is not recognized.
“Over the years, the diagnostic criteria for the condition now known as ADHD have evolved as research has furthered our understanding of the distinctive characteristics of the disorder,” according to the study. “This move towards a consensus for the definition of ADHD should facilitate the development of a clear picture of the worldwide epidemiology of the condition.”
The definition of diseases such as ADHD is indeed unclear, especially for several foreign countries, in Bednar’s opinion. He agrees that there are many reasons why such diseases aren’t widely diagnosed, probably because of “social stigma” or because of the difficulty of leading a normal life after a diagnosis. Being most familiar with India and Pakistan, Bednar said the two countries are perfect examples for explaining why certain illnesses are a taboo topic.
“Neither [Pakistan nor India] has a welfare program as advanced as the United States. If someone is depressed, but cannot afford medical care, then the condition goes undiagnosed and untreated,” Bednar said in an email interview. “People with severe depression often times are unemployable. Again, since there is no welfare program for the unemployed, they remain untreated. This cycle of unemployment and depression leads to a downward spiral.”
A study conducted by the World Health Organization in 2004 supported the notion that some illnesses are not as prevalent in foreign countries. It showed that the United States saw 218 deaths from eating disorders such as anorexia nervosa, which contributes to its first place ranking in such deaths.
Researchers from the W.H.O. and Harvard Medical School conducted a study in 2004 which showed that 9.6 percent of the United States population experiences bipolar disorder, chronic minor depression or major depressive disorder over the course of a year. However, there was a much lower rate in Nigeria at only .8 percent, showing how the United States sees more cases of such illnesses than other places around the world.
Junior Mubinah Khaleel, who has family from Nigeria, sees a clear difference between the mentality of Americans and residents of foreign countries as well. She agrees with Park and thinks the United States sometimes emphasizes mental illnesses too much compared to other countries and cultures around the world.
“Here, they make everything look like a really big deal when someone has a problem with something,” Khaleel said. “Then in other places, just like the really big things like cancer and stuff there will be diagnosed.”
Khaleel thinks the method of diagnosis for illnesses in the United States is much better because it is broader and more in-depth than in other parts of the world, as well as more understanding and accepting than elsewhere. She has personally seen several examples of illnesses that are often overlooked during diagnosis and not looked into as much as they should be.
“In Nigeria, some people have what they call the jinn inside them, and I think it’s just depression or something, or multiple personality disorder,” Khaleel said. “We’ve dealt with it, but it’s just weird because the people [with the illness] just come out of nowhere and they’re yelling stuff at you, and you’re like, ‘What’s happening?’ and … nobody knows if it’s something different, because [Nigerians] just categorize it into one thing, multiple personality disorder.”
Bednar acknowledges that several foreign countries have their own ways of coping with illnesses, including many home remedies. Although he has seen many people follow these remedies, he is still hesitant of accepting their efficiency.
“Much of this [idea of home remedies] comes from Asian medical practices that seek to restore the body’s balance, whether it is Chinese Qi or Indian ayurveda,” Bednar said. “Some practices have been shown to be effective based on scientific studies and patient surveys, although I am somewhat skeptical about all of their claims.”
While there is a notable difference in the treatment process of these diseases, the difference between everyday life and the lifestyle in these different countries could be a prominent factor in the overwhelming number of cases of depression and anxiety in the United States as opposed to a country such as Nigeria, Khaleel said.
“I know in Nigeria, everyone’s really nice to people, everybody’s nice to everybody, and you’re like a huge family,” Khaleel said. “Here, people are secluded, and people will straight up say that they don’t like you and just be mean to you, and you’ll get bullied. It’s not as big of a deal in other countries.”
A study sponsored by the W.H.O. as part of their World Mental Health Survey Initiative found that 19.2 percent of people surveyed in the United States said they had an extended period of depression at some point in their lives. Even though such studies suggest the United States has more people diagnosed with mental illnesses such as depression than in other regions of the world, Khaleel and Park both believe that the American system of dealing with people who suffer from mental illnesses is much more understanding and effective.
“I feel like it’s actually better here because you can get over the disease, with the proper medication,” Khaleel said. “You don’t have to live with it all your life and then eventually you just get over it.”
Park agrees with Khaleel because she has seen how patients are dealt with in her home country of Korea. When she considers the treatment they get in the United States, she appreciates it much more because of its effectiveness.
“I think American culture is better, they have an open mind to [people with mental illnesses],” Park said. “It’s obvious because they can join the society and can just have a normal life with others. They just need some cure, just take some pills, and that’s it.”
By Afsah Khan