Situating Mental Disorders in Cultural Frames

Culture and society shape the symptoms, course, and outcome of mental disorders. Cultural frames—including conceptual models, values, norms, attitudes, and practices—influence the experience and expression of psychological distress. These frames reflect community history, ethnicity, religion, gender, politics, and the identity of individuals in specific social contexts. While some aspects of cultural frames are conveyed through explicit norms, values, ideologies, and practices, much remains implicit in a way of life and social environment that shape beliefs and practices through cultural affordances. Over time, cultural frames evolve, such that the expression of psychological disorders changes as new narratives and categories gain credibility and dominance. Understanding the dynamic impact of these frames on behavior and experience in illness and health requires a systemic or ecosocial approach. Category fallacies may occur when the observer interprets symptoms exclusively through categories derived from one cultural frame that preclude discovering local ways of characterizing distress. By failing to consider local meanings and modes of expression, category fallacies can result in diagnostic error. Looping effects result from the tendency for social categories to reshape human experience and behavior, as well as social institutions and practices, so that they conform to the category. In this way, cultural categories and constructs become self-vindicating social realities and contribute to the creation and maintenance of cultural frames. Cultural frames may be understood at multiple levels: (a) individual cognitive models or schemas that shape illness experience, (b) professional models and modes of practices that shape clinical interactions, and (c) broader societal paradigms, derived from cultural-historical institutions, that influence general attitudes to illness and suffering. Cultural frames invoke particular ontologies to explain illness, ascribing causal efficacy or agency to material (biological or social), psychological, or spiritual entities or forces . Cultural frames may focus on historical, political, or economic structures to explain the causes and forms of mental disorders (e.g., colonial ideologies). Cultural framings of concepts of mental disorder are readily identified in historical and contemporary settings. At the individual level, Joseph Smith, the American Prophet (1805–1844), exemplifies how intense religious experiences could be interpreted as revelation or as psychotic symptoms, depending on the cultural frame. At the professional level, the rise and fall of American psychoanalysis from 1909 to 2000 represents a paradigm, or cultural frame, shift such that the way that mental health professionals understand distress has changed from a focus on the inner theatre of the mind, accessed through intimate personal inquiry and talking therapy, to a focus on disordered machinery of the brain, in which the pathology requires treatment with medication. At the societal level, research on rates of psychosis among Black people in the United States and United Kingdom has been approached differently owing to differences in history, demography, and cultural frames, with U.K. studies emphasizing elevated rates among Black immigrants and U.S. studies focusing on diagnostic bias. These three levels influence each other through looping effects that give rise to new, hybrid forms of disorder that challenge standard psychological theories.