WEBVTT 00:00:00.000 --> 00:00:06.156 [Music] 00:00:06.352 --> 00:00:07.813 {Applause.} 00:00:07.851 --> 00:00:10.201 Thank you. It's truly an honor to be here. 00:00:11.092 --> 00:00:14.802 I would like to start my talk today with a little exercise, 00:00:14.802 --> 00:00:17.432 introducing you to a person named Pat. 00:00:18.843 --> 00:00:24.003 Pat is 31 years old and lives at home with one sibling and their parents. 00:00:24.643 --> 00:00:26.853 Pat has always lived in the family home. 00:00:26.853 --> 00:00:29.513 And would not consider moving out to live alone. 00:00:29.513 --> 00:00:31.423 Except after getting married. 00:00:32.130 --> 00:00:35.130 Pat's parents always play a significant role 00:00:35.130 --> 00:00:39.700 in making decisions about all aspects of Pat's life 00:00:39.700 --> 00:00:45.010 including education, work decisions, Pat's friendships and romantic life. 00:00:45.644 --> 00:00:48.164 This has been the case since Pat was a child. 00:00:48.664 --> 00:00:52.664 Pat rarely makes decisions without consulting family members 00:00:52.664 --> 00:00:55.434 and rarely expresses disagreement with others 00:00:55.434 --> 00:00:58.774 out of fear of disapproval or loss of support. 00:00:59.691 --> 00:01:02.011 Pat feels very uncomfortable when alone 00:01:02.011 --> 00:01:06.251 and tends to cling to others out of fear of being abandoned. 00:01:07.926 --> 00:01:10.026 Now take a moment to picture Pat. 00:01:11.448 --> 00:01:13.868 Are you picturing a young man? 00:01:13.868 --> 00:01:15.228 A young woman? 00:01:15.770 --> 00:01:19.770 Are you picturing a person of a particular ethnic or cultural background. 00:01:19.770 --> 00:01:22.560 Maybe similar to your own. Or different. 00:01:23.230 --> 00:01:25.910 And consider for a moment whether such information 00:01:25.910 --> 00:01:29.110 would make a difference in how you think about Pat 00:01:29.110 --> 00:01:34.142 and whether or not you think that Pat might have some kind of mental health concern. 00:01:35.714 --> 00:01:38.214 Now what if I added the following information. 00:01:38.585 --> 00:01:40.895 Specifying that Pat is Patricia Lee 00:01:41.347 --> 00:01:44.527 and that she and her family immigrated to Canada from China 00:01:44.527 --> 00:01:46.357 when she was five years old. 00:01:47.657 --> 00:01:48.767 Or the following. 00:01:48.767 --> 00:01:53.087 Where Pat is Patrick Smith whose maternal and paternal grandparents 00:01:53.087 --> 00:01:58.887 immigrated to Canada from the United Kingdom and whose parents grew up in the Toronto area. 00:01:59.925 --> 00:02:02.405 Judging from some faces that I can see, 00:02:02.405 --> 00:02:06.635 this information indeed makes a difference in how you think about Pat. 00:02:06.940 --> 00:02:09.800 Simply adding some basic demographic information, 00:02:09.800 --> 00:02:13.800 can significantly shift how we think about the very same behaviors. 00:02:14.935 --> 00:02:18.545 This exercise has elicited similar responses in my classroom 00:02:18.545 --> 00:02:21.975 when I have used it in teaching about personality disorders, 00:02:21.975 --> 00:02:25.005 which offer a particularly striking example 00:02:25.005 --> 00:02:29.005 of the need to consider cultural factors when defining mental illness, 00:02:29.005 --> 00:02:35.405 since they are themselves defined by patterns of behavior that deviate from cultural expectations. 00:02:37.677 --> 00:02:42.037 I use this exercise to introduce the role of cultural factors 00:02:42.037 --> 00:02:44.962 in thinking about mental health and illness 00:02:44.962 --> 00:02:49.062 and to introduce the central idea that culture matters. 00:02:50.544 --> 00:02:53.184 In my experience, once introduced to this idea, 00:02:53.184 --> 00:02:55.584 people seem to intuitively know that culture 00:02:55.584 --> 00:02:59.584 makes a difference when thinking about mental health and mental illness. 00:02:59.883 --> 00:03:02.993 Without specifically talking about cultural differences 00:03:02.993 --> 00:03:07.433 in things like parent-child relationships, independence and interdependence, 00:03:07.433 --> 00:03:08.843 or assertiveness, 00:03:08.843 --> 00:03:13.993 we seem to just know that it makes a difference if we're talking about Patricia or Patrick. 00:03:15.053 --> 00:03:19.803 But not only does culture matter when it comes to mental health, it is fundamental. 00:03:20.176 --> 00:03:22.626 Many people including myself argue 00:03:22.626 --> 00:03:27.236 that a culturally informed approach is really critical to effective healthcare. 00:03:27.713 --> 00:03:31.713 And that only by including cultural factors in our discussions of this field 00:03:31.713 --> 00:03:33.703 will we truly make advances. 00:03:34.912 --> 00:03:37.882 Recently a group of medical and social scientists 00:03:37.882 --> 00:03:41.052 writing in one of the world's most prestigious medical journals, 00:03:41.052 --> 00:03:42.402 stated the following: 00:03:43.240 --> 00:03:47.610 That the systematic neglect of culture in health and healthcare 00:03:47.610 --> 00:03:54.320 is the single biggest barrier to the advancement of the highest standard of health worldwide. 00:03:54.932 --> 00:04:00.562 A pretty powerful statement. So this is great. 00:04:00.562 --> 00:04:03.742 I see a number of you nodding and you seem to be in agreement 00:04:03.742 --> 00:04:07.742 that reflecting on Pat illustrates for you at least at a basic level 00:04:07.742 --> 00:04:12.532 the importance of considering cultural questions when it comes to mental health. 00:04:13.218 --> 00:04:16.918 But stopping here would be problematic for a number of reasons. 00:04:17.207 --> 00:04:21.917 First of all I still have 15 minutes and 52 seconds left on the clock. 00:04:22.658 --> 00:04:24.018 But more importantly, 00:04:24.018 --> 00:04:28.418 stopping here could serve to reinforce certain cultural stereotypes. 00:04:28.418 --> 00:04:30.958 Contrasting the Lees versus the Smiths. 00:04:31.500 --> 00:04:34.040 And would not really leave you with any idea of how to actually 00:04:34.040 --> 00:04:37.060 go about considering cultural factors. 00:04:37.654 --> 00:04:41.944 Or worse, it might leave you with an overly simplistic idea of how to do this. 00:04:41.944 --> 00:04:45.604 Suggesting perhaps that simply knowing a person's ethnic background 00:04:45.604 --> 00:04:49.044 or immigration history provides enough information 00:04:49.044 --> 00:04:53.044 to really understand the meaning of their behaviors and relationships. 00:04:53.873 --> 00:04:57.873 So acknowledging that culture matters is a crucial initial step, 00:04:57.873 --> 00:04:59.973 sort of like the first piece of a puzzle. 00:04:59.973 --> 00:05:02.623 But we need to go much further. 00:05:04.980 --> 00:05:06.970 So if knowing Pat's cultural background 00:05:06.970 --> 00:05:09.770 is like having a first piece of the puzzle, much more 00:05:09.770 --> 00:05:13.770 needs to be learned before getting even close to a complete picture. 00:05:14.329 --> 00:05:17.739 For example, based on common cultural ideas, 00:05:17.739 --> 00:05:21.529 you may have had the sense that the description of Pat's behavior 00:05:21.529 --> 00:05:24.959 became somehow more acceptable when it was Patricia. 00:05:24.959 --> 00:05:28.589 A young woman of Chinese-Canadian background. 00:05:28.589 --> 00:05:33.959 Compared to Patrick, a young man and second generation Canadian of British descent. 00:05:34.939 --> 00:05:38.049 However, although interdependence and social harmony 00:05:38.049 --> 00:05:42.499 are values more commonly endorsed among people of Chinese background 00:05:42.499 --> 00:05:44.509 compared to western European background, 00:05:44.509 --> 00:05:51.629 is it necessarily the case that Patricia's parents are happy with her level of dependence on them? 00:05:52.197 --> 00:05:57.587 Maybe their migration to Canada was driven by their own traits of independence. 00:05:57.587 --> 00:05:59.977 And they are really quite concerned that their daughter 00:05:59.977 --> 00:06:03.907 has not developed greater autonomy or self-reliance. 00:06:04.435 --> 00:06:07.925 Maybe Patricia has never felt that she fits in among her peers 00:06:07.925 --> 00:06:13.605 and really feels incapable of attaining the level of independence as encouraged by her parents. 00:06:14.368 --> 00:06:17.668 On the other hand, although independence and autonomy 00:06:17.668 --> 00:06:20.798 are commonly endorsed values in North America, 00:06:21.317 --> 00:06:23.647 maybe it's normative within Patrick's family 00:06:23.647 --> 00:06:28.597 to defer to one's parents and to view life decisions as communal endeavors. 00:06:29.982 --> 00:06:33.622 These examples illustrate that we cannot simply make sweeping assumptions 00:06:33.622 --> 00:06:36.982 about people purely based on their cultural background, 00:06:37.527 --> 00:06:41.337 nor can we make simple comparisons or distinctions between people 00:06:41.337 --> 00:06:44.277 simply because they're from different contexts. 00:06:45.305 --> 00:06:51.415 Now this might suggest to you then that cultural information is of not much use at all 00:06:51.415 --> 00:06:55.975 and that we should simply focus on the individual and their unique experiences. 00:06:56.774 --> 00:07:00.274 But this would also be problematic and incomplete 00:07:00.274 --> 00:07:03.724 because to truly understand Patricia Lee's experience 00:07:03.724 --> 00:07:09.754 we must know that her parents' level of emphasis on independence may be relatively uncommon -- 00:07:09.754 --> 00:07:12.514 uncommon within their cultural community. 00:07:13.733 --> 00:07:16.383 And on the other hand, or similarly, 00:07:16.383 --> 00:07:20.983 Patrick Smith's experience of his level of dependence upon his family 00:07:20.983 --> 00:07:24.153 would likely carry different meaning if he and his family 00:07:24.153 --> 00:07:28.913 were from a cultural community that particularly emphasized family bonds. 00:07:29.554 --> 00:07:34.684 So in other words, in order to really develop a full understanding of mental health, 00:07:34.684 --> 00:07:39.784 we must develop an understanding of individuals in context. 00:07:41.329 --> 00:07:47.699 So this discussion illustrates one of the key challenges of a culturally informed approach to mental health. 00:07:47.699 --> 00:07:50.679 And in teaching this field to undergraduate students 00:07:50.679 --> 00:07:56.819 I have the privileged opportunity of working with them as they wrestle with these varied types of challenges. 00:07:57.750 --> 00:08:02.670 The path that I often see my students take is one of initial excitement 00:08:02.670 --> 00:08:05.624 as they engage with the idea that culture matters 00:08:05.624 --> 00:08:09.314 and often tend to appreciate the indepth discussion of a topic 00:08:09.314 --> 00:08:13.314 that tends to be lacking or minimized in teachings about mental health. 00:08:14.355 --> 00:08:20.125 This initial excitement, though, then turns often to some level of feeling overwhelmed 00:08:20.125 --> 00:08:23.625 as they begin to really grapple with the complexity of culture 00:08:23.625 --> 00:08:29.205 and begin to recognize the number of different factors to consider and questions to pose. 00:08:30.460 --> 00:08:33.400 In helping my students to navigate these questions 00:08:33.400 --> 00:08:36.780 it has helped me to distill my own thinking about this field 00:08:36.780 --> 00:08:38.450 and how best to teach it. 00:08:39.197 --> 00:08:43.727 I recognize that dealing with cultural matters can indeed be daunting. 00:08:44.207 --> 00:08:50.947 And I also have the concern that feeling overwhelmed can sometimes lead to the avoidance of new ideas or experiences. 00:08:51.913 --> 00:08:52.903 So with that in mind, 00:08:52.903 --> 00:08:58.063 I propose two related suggestions that I believe can help people to engage 00:08:58.063 --> 00:09:01.073 with a culturally informed approach to mental health 00:09:01.073 --> 00:09:07.503 rather than avoid it. And these are to take a stance of informed curiosity, 00:09:08.366 --> 00:09:12.366 and to ask different questions and ask questions differently. 00:09:13.900 --> 00:09:17.260 So a stance of informed curiosity stands in contrast 00:09:17.260 --> 00:09:19.930 to some models of culture and mental health 00:09:19.930 --> 00:09:24.190 which suggests that one needs to be an expert in a particular cultural group 00:09:24.190 --> 00:09:29.170 in order to work with or understand the experiences of a member of that group. 00:09:29.601 --> 00:09:32.421 For example many articles and book chapters 00:09:32.421 --> 00:09:36.421 talk about working with Asian clients or working with Hispanic clients. 00:09:37.243 --> 00:09:40.183 Although well intentioned, that type of approach 00:09:40.183 --> 00:09:44.183 can inadvertently lead to the perpetuation of cultural stereotypes. 00:09:44.183 --> 00:09:47.303 There's the assumption, at least at some level, 00:09:47.303 --> 00:09:50.153 that members of a given group share values, 00:09:50.153 --> 00:09:54.153 beliefs and experiences simply based on group membership. 00:09:54.572 --> 00:09:58.572 Though that can be the case, it is certainly not necessarily true. 00:09:58.892 --> 00:10:01.252 A clinician working from such a perspective 00:10:01.252 --> 00:10:04.682 may have easily assumed that Patricia Lee's level of dependence 00:10:04.682 --> 00:10:08.192 upon her family was encouraged or supported. 00:10:09.528 --> 00:10:13.238 I have also always found the more expertise based approach 00:10:13.238 --> 00:10:16.328 problematic from a personal perspective. 00:10:16.328 --> 00:10:20.028 As the daughter of a Chinese-Canadian father and Anglo-Canadian mother, 00:10:20.028 --> 00:10:23.688 born and raised in bilingual Montreal with English as a first language, 00:10:23.688 --> 00:10:26.908 there is unlikely to ever be a book chapter devoted 00:10:26.908 --> 00:10:30.208 to working with people of my particular cultural makeup. 00:10:30.805 --> 00:10:34.805 I think my own lived experience as a person of mixed cultural heritage, 00:10:34.805 --> 00:10:39.965 informs my thinking about culture and how it plays a role in mental health. 00:10:40.611 --> 00:10:43.891 And my experience also plays a role in my emphasis 00:10:43.891 --> 00:10:47.891 on a stance of informed curiosity rather than expertise. 00:10:48.646 --> 00:10:52.326 I believe that such a stance promotes an attitude of humility 00:10:52.326 --> 00:10:55.206 and really encourages one to develop hypotheses 00:10:55.206 --> 00:10:58.586 and questions rather than make assumptions. 00:10:59.536 --> 00:11:03.526 So one of the key ways that I work to promote a stance of informed curiosity 00:11:03.526 --> 00:11:07.526 among my students is by helping them to ask different questions 00:11:07.526 --> 00:11:10.686 and ask questions differently about mental health. 00:11:11.897 --> 00:11:15.697 My own passion for the area of culture and mental health really began 00:11:15.697 --> 00:11:19.697 when I took a course, an introductory course in medical anthropology 00:11:19.697 --> 00:11:22.407 in the second year of my undergraduate studies. 00:11:23.132 --> 00:11:25.282 This course proved to be a key turning point 00:11:25.282 --> 00:11:27.862 in my academic path and looking back, 00:11:27.862 --> 00:11:29.852 I think that one of its lasting effects 00:11:29.852 --> 00:11:34.512 was that it forced me to ask different questions about health and mental health, 00:11:34.512 --> 00:11:39.022 questions to which I had not previously been exposed in my psychology courses. 00:11:39.840 --> 00:11:41.330 Working with a different discipline, 00:11:41.330 --> 00:11:47.920 with its own set of theories and frameworks also instilled in me the value of asking questions differently. 00:11:48.542 --> 00:11:53.752 In many ways that forced me to re-evaluate ideas I had previously taken for granted. 00:11:54.394 --> 00:11:59.754 And that type of experience is often at the heart of cultural discussions about mental health. 00:12:01.427 --> 00:12:07.417 The interdisciplinary nature of my early experience also corresponds to the interdisciplinarity 00:12:07.417 --> 00:12:11.265 that often characterizes discussions of culture and mental health. 00:12:11.449 --> 00:12:15.389 Thinking back to that image of the complex set of puzzle pieces, 00:12:15.389 --> 00:12:21.539 a cultural approach to mental health truly benefits from the integration of different perspectives. 00:12:21.703 --> 00:12:25.703 Each offering their own sets and types of questions. 00:12:27.202 --> 00:12:30.042 Now taking a stance of informed curiosity 00:12:30.042 --> 00:12:35.722 by no means minimizes the importance of developing indepth knowledge in cultural matters. 00:12:35.722 --> 00:12:39.492 Rather, the emphasis is on how to engage with this knowledge 00:12:39.938 --> 00:12:42.588 with a focus really on gaining awareness 00:12:42.588 --> 00:12:47.778 of the wide range of cultural differences that exist in human experience. 00:12:47.778 --> 00:12:52.348 So as to be equipped to pose informed questions. 00:12:52.795 --> 00:12:55.145 We know from cultural psychology research 00:12:55.145 --> 00:12:57.575 that there are significant cultural differences 00:12:57.575 --> 00:13:00.265 across the spectrum of psychological domains. 00:13:00.951 --> 00:13:04.021 Including in cognitive and perceptual processes 00:13:04.021 --> 00:13:08.021 regarded as basic and therefore often assumed to be universal. 00:13:08.835 --> 00:13:12.195 For example, we know that there are significant cultural differences 00:13:12.195 --> 00:13:17.785 in how people perceive the world such as to what extent they focus on background information 00:13:17.785 --> 00:13:22.625 when examining a photograph, versus focusing on the photograph's central figure. 00:13:23.227 --> 00:13:25.397 We also know that there are significant differences 00:13:25.397 --> 00:13:30.517 in how people think about the world such as to what extent they use contextual information 00:13:30.517 --> 00:13:32.757 when grouping different objects together. 00:13:33.624 --> 00:13:37.084 These types of differences suggest that some of you may be viewing 00:13:37.084 --> 00:13:40.104 the slide behind me as a single wholistic image 00:13:40.814 --> 00:13:44.984 whereas others may be more focused on specific constituent parts. 00:13:46.682 --> 00:13:48.792 More directly relevant to mental health, 00:13:48.792 --> 00:13:52.392 we also know that cultural context plays a profound role 00:13:52.392 --> 00:13:55.162 in what types of emotions people most value 00:13:55.162 --> 00:14:00.122 and want to feel and how and with whom they express those emotions. 00:14:00.781 --> 00:14:02.161 In some cultural contexts, 00:14:02.161 --> 00:14:06.161 feeling proud is closely associated with generally feeling good. 00:14:06.555 --> 00:14:10.945 Whereas in other contexts the individual focus that pride entails 00:14:10.945 --> 00:14:18.095 makes it less desirable and there is a large literature demonstrating important cultural differences 00:14:18.095 --> 00:14:21.105 in how people define the very notion of the self. 00:14:21.812 --> 00:14:27.382 For some, the self is truly an autonomous and individual entity whereas for others, 00:14:27.382 --> 00:14:31.892 their ideas about the self include close interpersonal connections. 00:14:32.804 --> 00:14:35.474 So cultural differences in domains such as these 00:14:35.474 --> 00:14:39.474 should directly inform our thinking about mental health and illness. 00:14:39.474 --> 00:14:43.474 If culture plays such a profound role when things are going right, 00:14:43.474 --> 00:14:47.474 it must surely play a similar role when things go awry. 00:14:48.086 --> 00:14:52.086 How people experience profound shifts in their emotional life 00:14:52.086 --> 00:14:56.786 is deeply influenced by their values and beiefs about emotions 00:14:56.786 --> 00:15:00.786 and when and with whom it is appropriate to share their emotions. 00:15:00.786 --> 00:15:05.136 In some cultural contexts, physical symptoms of major depression 00:15:05.136 --> 00:15:09.568 tend to be more strongly emphasized compared to psychological symptoms. 00:15:09.568 --> 00:15:14.698 And this may be linked to cultural differences in values about emotions. 00:15:16.777 --> 00:15:21.257 So at this point, I have likely convinced you of a number of the challenges 00:15:21.257 --> 00:15:24.367 of taking a culturally informed approach to mental health 00:15:24.367 --> 00:15:28.367 and I have offered some suggestions about how to engage with these challenges. 00:15:29.156 --> 00:15:34.396 But hopefully I have also at least planted the seed that there are rewards to be had as well. 00:15:35.206 --> 00:15:39.946 Not surprisingly I personally believe that the rewards at the level of research, 00:15:39.946 --> 00:15:44.596 clinical care and teaching about mental health are numerous and profound. 00:15:44.596 --> 00:15:48.086 And ultimately far outweigh the challenges. 00:15:49.453 --> 00:15:54.893 At a research level, in order to build a comprehensive understanding of mental illness, 00:15:54.893 --> 00:15:57.073 we must integrate cultural factors. 00:15:57.884 --> 00:16:00.524 As suggested by the quote near the start of my talk, 00:16:00.524 --> 00:16:03.144 "We neglect culture at our own peril." 00:16:03.802 --> 00:16:07.802 If what it means to be sad and to share this sadness with others, 00:16:07.802 --> 00:16:11.802 is profoundly impacted by our values and beliefs about emotion, 00:16:11.802 --> 00:16:15.952 then we will never develop a complete understanding of severe sadness 00:16:15.952 --> 00:16:19.242 or depression without a cultural approach. 00:16:21.168 --> 00:16:22.918 From a clinical perspective, 00:16:22.918 --> 00:16:27.328 integrating cultural factors into our assessment of a person's distress 00:16:27.328 --> 00:16:33.598 is crucial to really understand their experience and can contribute to improved treatment. 00:16:34.173 --> 00:16:39.513 We know from research that treatments that integrate a person's own cultural beliefs 00:16:39.513 --> 00:16:44.713 about the causes of their distress are more effective than treatments that do not. 00:16:45.974 --> 00:16:49.324 How best to integrate cultural factors into treatment 00:16:49.324 --> 00:16:52.564 is an area of ongoing investigation and debate 00:16:53.057 --> 00:16:57.467 but begins with the argument that culture makes a difference. 00:16:58.728 --> 00:17:01.998 And thirdly at the level of learning about mental health, 00:17:01.998 --> 00:17:05.218 for students and the general public more broadly, 00:17:05.218 --> 00:17:10.296 the rewards of a culturally informed approach include greater open mindedness, 00:17:10.870 --> 00:17:16.290 increased understanding of experiences different from one's own and less stereotyping. 00:17:16.763 --> 00:17:22.873 This approach also offers new perspectives about ideas already learned about mental health. 00:17:23.612 --> 00:17:27.392 These are all rewards that my own students have specifically talked about 00:17:27.392 --> 00:17:30.932 when discussing the benefits of learning about this field. 00:17:32.122 --> 00:17:37.142 So my hope then for today is that you walk away with some of this increased open mindedness, 00:17:37.142 --> 00:17:42.332 curiosity, and an interest in asking different questions about mental health, 00:17:43.166 --> 00:17:47.766 all rooted in the central premise that culture matters. 00:17:48.132 --> 00:17:48.942 Thank you. 00:17:48.942 --> 00:17:53.412 {Applause.}.