Mental phenomena in health and cultural variation

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It is not surprising that the identification and classification of the phenomena of mental illness is a difficult task as there is no consensus concerning what would be acceptable as normal healthy experiences. Health has been regarded as a state of complete physical, mental, and social well-being; (3) mental illness has variously been considered as the products of a diseased brain, the symptoms that doctors treat, or a statistical variation from the norm carrying biological disadvantage, and mental illness often has legal implications. It is best to retain the use of the word 'normal' in a statistical sense; thus a phenomenon, such as hypnagogic hallucination, may be statistically abnormal but in no way an indicator of ill health or mental disease. Similarly, it is unwise to extrapolate from a population of mentally ill people and make assertions about the origins of behaviour in those who are not mentally ill.

It is important to recognize the effect of culture on subjective experience, the expression of psychological symptoms, and their manifestation in behaviour. In some cultures the very expression of subjective experience and emotion is discouraged and censored, in others feelings tend to be somatized, and in yet others the subjective experience of the individual tends to be subjugated to the sense of well being of the immediate social group. There are specific culture-bound expressions of subjective distress concerning body image in those who suffer from anxiety disorders. For delusions of passivity, although the psychopathological form remains relatively constant, the description of content will vary according to culture; for example, 'the djinn made me do it', 'my thoughts are controlled by the television'. Similarly, for possession state, although the psychopathological description remains similar, the actual cultural expression is very different for a member of a fundamentalist sect in the American Appalachian Mountains and a Buddhist girl in Sri Lanka.

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