Clinical Review

ABC of mental health: Mental health in a multiethnic society

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7106.473 (Published 23 August 1997) Cite this as: BMJ 1997;315:473
  1. Simon Dein

    Introduction

    People from ethnic minorities comprise just over three million people or 5.5% of the British population. Their geographical distribution is highly uneven, with most living in greater London, the West Midlands, and other metropolitan counties.

    Doctors in Britain increasingly encounter patients whose values and beliefs differ substantially from their own. Without a knowledge of other cultural beliefs and practices, doctors can easily fall prey to errors of diagnosis, resulting in inappropriate management and poor compliance. For example, a delusion is a false belief not amenable to reason and out of context with a person's cultural and religious beliefs: diagnosing someone as deluded must take into account cultural and religious factors.

    Culture refers to the categories, plans, and rules that people use to interpret their world and act purposefully within it. These rules are learned in childhood while growing up in society. Cultural factors relate to mental illness in several ways. In the first instance, culture determines what is seen as normal and abnormal within a given society.

    View this table:

    Ethnic composition of Great Britain in 1991*

    “Culture is that complex whole which includes knowledge, beliefs, art, morals, law, customs, etc”

    Definition of culture, Tyler 1874

    Culture relates to mental illness in several ways, especially its mode of presentation and response to treatment

    Normal and abnormal behaviour

    Definitions of what constitutes normal and abnormal behaviour vary widely from culture to culture and, within any given group, are dependent on demographic factors such as age and sex, social class, and occupation. Behaviours that may be perceived as abnormal at one time may be regarded as normal at other times, such as during carnivals. At these times it is culturally acceptable for men to dress as women or animals.

    However, it seems that there is no culture in which men and women remain oblivious to erratic, disturbed, threatening, …

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