Mental Health Definitions Across Cultures: US, Japan, Asia & More

Defining Mental Health: Japan Versus the United States

Even within a single culture, the definition of what constitutes "sanity" or "insanity" can be extremely controversial. Where should we draw the line between eccentricity and quirkiness on one hand, and full-blown mental illness on the other? In Western culture, definitions of mental illness have changed significantly over time. For example, during the 19th century, a woman who did not want to get married or engage in sexual activity within marriage might have been considered deranged. Today, being gay is not considered a mental illness, but fewer than 50 years ago homosexuality was officially classified as an abnormality.

Given the subjective nature of mental illness, it is not surprising that every culture has a different definition of what constitutes deviance. In Japan, for example, a condition called hikikomori — meaning "pulling in" or "withdrawal" — has been identified as a distinct mental disorder (Grisafe, 2012). Hikikomori usually affects young men who "withdraw entirely from society and stay in their own homes for more than six months, with onset by the latter half of their twenties, and for whom other psychiatric disorders do not better explain the primary causes of this condition" (Grisafe, 2012). Most of these young men are middle-class and come from households able to support them financially. They spend their days watching television, playing video games, and pursuing other activities that do not require social interaction. While some have reported self-destructive behaviors such as cutting or obsessive-compulsive cleaning, their most distinguishing feature is complete social isolation.

One cause of hikikomori is thought to be Japan's famously rigid social system. If a young person does not gain admission to a good school and find stable employment immediately upon graduation, few opportunities remain available. While women have the possibility of marriage as an alternative path, men have little else to look forward to, as society regards them as failures. The condition was first identified during Japan's great recession of the 1990s, when the formerly stable and booming economy began to unravel.

Of course, the phenomenon of young people struggling to find work after graduation is not confined to Japan. In the wake of the 2008 recession, many young American graduates were forced to return home. "The number of young adults ages 20 to 34 who lived with their parents jumped from 17% in 1980 to 24% in 2007–09" (Nasser, 2012). Young male returnees are also reported to face fewer domestic demands from their parents, such as cooking and cleaning (Nasser, 2012). However, the sense of complete emotional stasis and failure that afflicts Japanese men is not sufficiently characteristic of American graduates to be regarded as a mental illness. Although some graduates undeniably experience depression and frustration, American society tends to take a more permissive view of taking time to "find one's feet" after graduation — an attitude that likely has a more positive emotional impact on graduates who are unable to be financially independent. Additionally, unlike in Japan, American colleges tend to be prohibitively expensive, and the need to alleviate debt burdens forces many young graduates to take some form of employment — and therefore to leave the house — in contrast to the Japanese hikikomori.

Perhaps most importantly, although the United States does recognize depression as an illness, it does not specifically classify the condition of a young person who is searching for direction, living at home, and feeling adrift as a mental illness in itself. In fact, this is generally regarded as a normal developmental stage. In Japanese culture, where finding a job and a vocational identity is critically important — particularly for males — the hikikomori are regarded as profoundly deviant.

Response to this post: I am not certain I agree with your conclusion about the lower reported rates of mental illness in Asian cultures. You suggest that it must be the result of a collectivist culture that suppresses the individual, making it less likely for individuals to engage in help-seeking behaviors. This seems like a plausible explanation, but it certainly does not appear to be the only one. It seems equally possible that in collectivist cultures, where there is less emphasis on the individual, mental health may actually be better on average. Therefore, the differences may not be due to a cultural bias against help-seeking, but to actual culture-based differences in the incidence rate of mental health problems.

American and Asian Cultural Perspectives on Mental Health

Mental health refers to the level of psychological well-being a person possesses. That level can be good or poor depending on the absence or presence of a mental or psychological disorder, as well as how that disorder is treated and managed. Generally, poor mental health constitutes a psychological disorder — a mental state in which emotions, thoughts, and behaviors are "typically maladaptive, distressing to themselves, and different from the social norm" (Barlow & Durand, 2005, as cited in Matlin, p. 385, 2010). Good mental health, by contrast, means that someone is free of these issues and without a diagnosis. In American culture, this framing is broadly accurate. In the United States, the stigma around mental illness has increasingly diminished while education and public awareness of diagnoses and disorders have grown substantially. American culture is one of labels and titles, so having a diagnosis or disorder has become more common and more accepted in the eyes of society. Greater education has enabled people to understand that mental illness is widespread and can be treated successfully with professional help. American culture does not regard a person as deviant unless the disorder is extreme (e.g., psychosis), and it increasingly encourages therapy and pharmaceutical treatment.

This may not be true in other cultures, particularly in Asian cultures. Because of the collectivist nature of many Asian societies, mental health is not perceived in the same way. Men are typically the powerful members of Asian households, which creates a significant gender inequality gap. Other family members are often expected to be passive and subordinate, especially women (Root, 2005). Asians are significantly less likely to seek mental health services or receive either psychotherapy or pharmacotherapy. Two reasons may explain this pattern. First, Asians may be less likely to recognize poor mental health in themselves, because the cultural mentality prioritizes group harmony and meeting the needs of others before one's own. This orientation may reduce the degree of individual introspection and self-awareness common in more individualistic cultures. Second, even if an individual does recognize something is wrong, the group-harmony mentality makes seeking help feel like a violation of the important cultural value of honoring one's family. Seeking mental health services implies that one has failed or is somehow defective, which would reflect poorly on the entire associated group and bring shame to the family — something strongly discouraged in Asian cultures, unlike in American culture (Hall & Barongan, 2002). Seeking a therapist is typically not publicized in American culture, but it is certainly not stigmatized the way it is in Asian cultures. As a result, far more Americans seek help for mental health than people in Asian cultures. In the United States, because individual accountability is valued and one's actions are seen as one's own, seeking therapy is not taboo — if anything, it is encouraged. This is not the case in Asian cultures. Even though Asians are just as likely to experience mental health problems as European Americans, the impact of cultural values changes how people respond to their psychological needs (Lee & Mock, 2005).

Response to this post: I think that many of us are taking an idealistic approach to mental health care in the United States when we suggest that there is no stigma to seeking mental health services. I do not believe that is true, and I think the stigma associated with some mental illnesses has actually grown alongside the general population's increasing willingness to seek help for other conditions. The easy access to treatments for illnesses like depression — which is highly responsive to medication — may have created an atmosphere in which people believe mental illness should always be easily treatable and readily responsive to chemical intervention. That is not the case for all mental illnesses, and the stigma attached to those less treatable conditions has not abated.

The culture chosen for this comparison is Botswana in Africa, set against American culture. Drawing on Sabone's (2009) article, mental health can be defined as "a condition whereby an individual feels a sense of self-appreciation and sense of belonging to a social group, has the capacity to use resources at his or her disposal to meet his or her basic needs, is productive and resourceful to self and the community, and has the capacity to adapt to change and cope with adversity" (Sabone, 2009, p. 777, citing HealthTalk.com; Frisch & Frisch, 2002). This definition describes the treatment process and recovery stages a mental health patient may go through to maintain his or her mental health and lifestyle with professional guidance.

Several ways American culture influences this definition of mental health include: (1) American culture and its practitioners seek to restore the individual to mental health across all areas of life; (2) practitioners refer and assist clients in acquiring the resources needed to live productively and to become productive members of society; and (3) through training, education, and encouragement, practitioners help clients build the capacity to cope with life's circumstances as they arise.

The American definition of mental health differs from Botswana's in important ways. First, the American definition has been derived from a broad base of empirical data and research studies. Second, Botswana's definition of mental health stems from traditional spiritual and religious beliefs, including the concept of "altered emotional states that deteriorate into mental illness and/or the possession of spirits" (Sabone, 2009, p. 782).

Botswana and American Approaches to Mental Health

A behavior that is considered normal in American culture but would be abnormal in Botswana culture is the expectation of payment — the "demand for fees" (Sabone, 2009, p. 781) — for mental health services rendered. In Botswana culture, the Kgotla system functions as "an open participative community forum, [where] Chiefs and members set values, develop rules of conduct, members air their concerns, and conflicts are resolved to maintain emotional and social stability important to mental health" (Sabone, 2009, p. 781), at no cost to participants.

Response to this post: It was not entirely clear whether you viewed the American approach to mental health — which is structured around the client-healthcare provider relationship rather than community member and community leader — as more or less conducive to appropriate mental health outcomes. I found it particularly interesting that you focused on a behavior that would be considered abnormal not because a person with an alleged mental illness was exhibiting it, but because someone in the surrounding society — the treatment provider — was exhibiting it. In other words, you focused on the normalcy of the treatment provider rather than the patient. This was a thought-provoking approach to the normal/abnormal labeling process in mental health.

Mental health is a term that can be difficult to define given the cultural variation in what is considered good or poor mental health. With that said, a working definition of good mental health would include a state of well-being in which an individual can manage daily life, stresses, and emotions while remaining free of psychological disorders. Poor mental health, conversely, would be an individual's inability to manage daily life, stresses, and emotions, with or without the presence of a diagnosed psychological disorder. Culture influences personal definitions of mental health through the socialization process: families teach children what behaviors are acceptable and what are not. Laws also play a role, setting the standards by which society functions and protecting individuals with and without mental health issues.