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Mental ill-health is a growing public health concern, it is not only prevalent in the UK, but all across the globe. It has been estimated that 1 in 4 people will experience a mental health issue at some point in their life. The 2014 update of the Commonwealth Fund rankings placed the UK National Health Service (NHS) first out of 11 Western healthcare systems. [1] Despite this, it is widely acknowledged that the NHS has been inadequate in some areas, particularly in mental health and for Black, Minority and Ethnic (BME) communities. [2]
Social psychology has a large part to play when we look to understand what the wider global implications of mental health are. Essentially, understanding how people think and what they choose to believe is the first step in this process. Prominent social representations theorist, Serge Moscovici, believed that our system of beliefs, practices and values can be produced and reproduced by groups of individuals to make sense of their social world. [3] Within society, social representations have the ability to create shared meanings that can impact an individual’s sense of self and how they perceive and interact with their social environment. They also have the ability to impose social norms and cultural rules that shape the way in which we conduct ourselves, not only within our own communities, but in society at large. This can have huge consequences for the way individuals perceive mental health.
In the past, and even recently, mental health representations that exist have, more often than not, been associated with negative connotations such as stigma. Defined as an attribute or behaviour that is undesirable and rejected by society, it differentiates the stigmatised individual from other members of society, or the community that they belong to. It demonstrates an ‘us’ versus ‘them’ outlook and confirms the negative representations attached to mental health. This has not only been seen in the UK, but also on a more global level. The work of Denise Jodelet is a clear example of this, who studied the representations linked to mental illness, and to those considered mentally ill, within rural France. [4] Her results confirmed that those with mental illness were considered to be threatening and invoked fear.
These representations of mental health and the narrative that comes with it can have serious implications on global mental health. The way individuals choose to understand mental health, through social and cultural norms, can have an overall detrimental impact. Acculturation theory, this idea of cultural change, demonstrates that these representations may not always remain static but can move across the vast global space. [5] Not only can acculturation theory predict and describe cultural change but it can also bring about the very cause for concern, mental ill-health. For instance, when an individual or group of individuals migrate – moving and settling into a new culture – especially one which contrasts with previous experiences and the culture in which one is brought up, individuals may often find this change a stress-inducing ordeal, which can ultimately affect one’s mental health. Adopting the host culture therefore presents challenges to the newly arrived immigrant, which can come in the form of: food, dress, climate, education and language.
If we take the British Muslim community as an example, research shows that cultural beliefs around mental health being caused by spiritual influence, such as jinn possession, and evil eye are highly prevalent. This has been demonstrated not only in the UK but also in the immigrant’s ancestral country where many of these ideas originate. [2] We can appreciate that the migrant might choose to hold on to the values and ideals they have grown up with. This might mean that normative cultural and religious beliefs tend to get passed on over time from one generation to the next, even if it does not necessarily ‘fit’ with the normative beliefs of the host country. These ideas around mental health are often confirmed by those that a devout British Muslim might closely align with from a faith point of view, the local imam or faith healer. [6] This shows how important religious leaders are in this context and that they have key roles in shaping the representations of mental health within the British and global Muslim communities.
Since the role of the family and gendered roles are large parts of Muslim culture, especially for health and well-being, cultural expectations and pressures from family and community members can be a burden. Issues of openness, preserving reputation and denial are considered ways in which the British Muslim community deal with the negative representations of mental health. In addition, fear and shame can be added barriers to accessing mental health care. [7] It is evident from this that there is concern with negative perceptions by the community or family members as opposed to religious repercussions. Ideas around female marriageability, patriarchal systems, arranged marriage systems and maintaining family reputation are all examples of the cultural norms still in play amongst British Muslims today.
Identifying what can create social change for one community, such as British Muslims, can indicate the possible impact it can have upon the rest of society at large where there may be similar cultural norms that dictate such perceptions.Approaches to challenge the cultural stigma perceived to be the issue could come from education on a national level. For example, introducing mental health into the school curriculum from a young age and increasing awareness through the religious institutions from which many of these cultural influences derive. In addition, incorporating media efforts into dispelling the myths of mental health and Muslims in general, continues to be integral to the reconstruction of these harmful representations. These could all be a positive start to addressing these concerns for members of the British Muslim community, which could in turn inform global mental health policies.
Farah Ahmad recently completed her MSc in Social and Cultural Psychology at the London School of Economics and is currently working for an educational charity called IntoUniversity, which supports young people from disadvantaged backgrounds to aspire and achieve their full potential.
References
Davis, K., Stremikis, K., Squires, D., & Schoen, C. (2014). Mirror, mirror on the wall, 2014 update: how the US health care system compares internationally. The Commonwealth Fund, 16.
Rethink (2007). Our voice: The Pakistani community’s view of mental health and mental health services in Birmingham. London: Islamic Human Rights Commission.
Moscovici, S. (1973). Foreword. In C. Herzlich (Ed.), Health and illness: A social psychological analysis (pp. ix–xiv). London/New York: Academic Press.
Jodelet, D. (1991). Madness and social representations. Hemel Hempstead: Harvester Wheatsheaf.
Berry, J. W. (2005). Acculturation: Living successfully in two cultures. International journal of intercultural relations, 29(6), 697-712.
Abu-Ras, W., Gheith, A., & Cournos, F. (2008). The Imam’s role in mental health promotion: A study at 22 mosques in New York City’s Muslim community. Journal of Muslim Mental Health, 3(2), 155-176.
El-Islam, M. F. (2008). Arab culture and mental health care. Transcultural psychiatry, 45(4), 671-682.
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