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Sociology of Depression - Effects of Culture

Rashmi Nemade, Ph.D., edited by Kathryn Patricelli, MA

Sociologists study how people get along together in groups. They study culture, social groups and how they affect individuals. The sociology of depression looks at the cultural context in which people live. It also looks at the social stresses that people encounter as a part of life. The sociological aspects of depression are both influenced by and also influence the other biological and psychological aspects of people's lives.

The Effects of Culture

Culture and the ethnic group that people come from are important aspects of health and illness. A new branch of medicine, known as ethnomedicine, focuses on the role of culture, perception, and context in shaping someone's physical and mental health.

Previously, it was thought that depression primarily affected people in developed "Western" nations and that other cultures did not suffer from this condition. Ethnomedical studies suggest that this idea may have more to do cultural perceptions of what symptoms become labeled as a depressive disorder. It also has to do with how occurrences of depression are recorded for statistical purposes and how depression is thought of within particular cultures.

For example, in India, a wide range of distress disorders are categorized as depressive disorders.† But in Japan, the very idea of mental illness is unacceptable and few people will admit to having it. Without knowing this, someone might conclude that Indian people have very high rates of depression.† They might also think that people from Japan rarely develop this condition. Even within the United States, the numbers of people experiencing depressive disorders can be influenced by cultural context. For example, black women have lower rates of depression than white women. In addition, recent immigrants to the U.S. tend to have lower rates of depression than others who are presumably more "Western" in attitudes and behavior.

Ethnomedical research suggests that cultural differences in focusing on oneself and one's place within the social group are linked to the amount of depression that occurs. Some of this difference comes from the individualistic vs. collectivistic orientation of a particular culture. In Western cultures, individuals are ideally viewed as independent, separate people striving for individual achievement and success. In contrast, other cultures view the family or society as being of more importance than the individual. Many times, personal happiness is sacrificed for the good of the larger group in such cultures. Very little thought is given to particular individuals within such cultures. For example, in traditional Asian cultures it is common for one member of the family to work hard and share a paycheck with the entire extended family. Some authors suggest that because people from collectivistic cultures are not encouraged to place much importance on personal gratification, they do not spend time feeling frustrated about their failure to achieve personal success. As a result, the lack of focus on the self can lead to a decrease or absence of the development of depressive disorders.

Our rules about our specific responsibilities and obligations (to ourselves, to others, and to the institutions we live with) are also shaped by our culture. For example, a person who comes from a culture where family obligations are demanding and required may feel restricted, powerless and limited. On the other hand, a person from the same culture may view family obligations as a way to feel needed, useful and competent. Feelings and thoughts concerning powerlessness and usefulness shape people's self-concept and mood.

Some cultures have rigid gender roles that define expected behavior. Men's lives exist primarily outside the home, while women's roles are specifically in the home. In these cultures, women may not even leave their homes unless escorted by a male family member and men may never enter the kitchen. If someone from this type of culture encounters a social stressor which forces a change in roles or a challenge to this typical set-up (such as the death of a spouse), this stress can cause this person to become depressed. For instance, if a husband (from a culture with rigid gender roles) loses a wife, he will not know how to care for his children's day to day needs such as feeding, bathing, etc. Similarly, if a wife loses her husband, she will not know how to provide financial support for her family and additionally, may be prevented from even trying. Both people may start to think of themselves as worthless or useless if they cannot meet the needs of their children.

Cultural identity often influences the degree to which a particular individual shows physical symptoms of depression. In other words, some cultures are more comfortable reporting depressive symptoms that are physical in nature rather than mental. For example, many Chinese people with depression complain of bodily discomfort, feelings of inner pressure, and symptoms of pain, dizziness, and fatigue. Similarly, Japanese individuals with depression often complain of stomach, headache, and neck pain symptoms. Even within Western countries where depressive disorders are more "acceptable", researchers have theorized that some chronic conditions (chronic pain, fibromyalgia, chronic fatigue syndrome) may be more physical forms of a mood disorder rather than actual physical problems. Some researchers have even suggested that fibromyalgia (a condition characterized by widespread pain, tenderness, and fatigue) should be characterized as a "depressive disorder spectrum ". At the same time, it is important to note that the depressive disorder may result from the condition of fibromyalgia.

Some cultures may view symptoms of depression as normal emotional responses to particular life events. For example, some cultures may expect the grief process to last longer than the roughly one-year period which is acceptable in the West. Individuals from these cultures might find it odd that a Western psychologist would think that two years spent mourning for a lost spouse was a sign of a mental health problem.

Still other cultures may recognize that symptoms of depression are problematic.† However, the causes that they believe for these symptoms happening doesn't make sense to people from other cultures. For instance, patients may reject explanations for symptoms that are commonly acceptable to clinicians in favor of ones that are accepted within the patient's culture. For instance, a patient from China seen in a Western country might reject the idea that a chemical imbalance in the brain is causing symptoms of depression. Instead, they might accept an explanation in terms of energy flows or similar concepts drawn from traditional Chinese medicine. These patients may respond best to mental health professionals who are able to use culturally-sensitive language to describe the cause of symptoms and related suffering.

Cultural differences in help-seeking behavior may influence the treatment of depression. For example, non-Western individuals frequently use practitioners from their own culture for treatment of "illness" and Western-trained physicians for treating "disease". If emotional disturbances are not considered within the area of disease, people with depression might not seek out mental health care for depressive symptoms. It is more socially acceptable to have a depressive disorder in Western societies, and more people from these cultures are willing to seek help. In contrast, mental illness is often more stigmatized in other cultures. As a result, people and their families may deny mental illness out of shame of being identified as "crazy". Others may find the label "major depressive disorder" morally unacceptable, shameful, and meaningless. Treatment for depressive disorders may be actively resisted by someone who comes out of this sort of culture.

Cultures also vary in the degree to which they rely on or incorporate complementary and alternative medicine practices such as herbs, meditation, yoga, or other approaches into their prescribed treatments for depression. Individuals from some traditional cultures may reject Western antidepressant medications while embracing prescriptions for herbs, acupuncture or exercise.

A person's cultural background can also influence their biological makeup. People from different parts of the world have different patterns of genes and, often, different patterns of disease to which they are vulnerable. These genetic differences can influence whether people get depression when stressed. People's genetic background can also influence their response to antidepressant medications.

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