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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
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The Influence of Culture on the Expression of Depression

Allan N. Schwartz, LCSW, Ph.D. Updated: Jul 16th 2008

 A study conducted by the Center for Addiction and Mental Health (CAMH) in Toronto, Canada, compared groups of people, one in Canada and the others in Asia, as to how they handled depression. The findings revealed what many in the mental health community already guessed was true. Chinese subjects in the study talked about physical symptoms, such as tiredness, low energy and headaches while the Canadians talked about feeling sad, guilty and worthless.

The reason for the differences is that in China and many Asian cultures, depression continues to be stigmatized. Subjects do not want their families and friends to know that they may have depression. Only when the interviewers in the study assured subjects that their information would be kept strictly confidential were they willing to talk about things such as sadness and hopelessness.

For these Asian subjects, there is no shame in having physical symptoms while there is terrible shame in having psychological problems. In fact, it is not only that depression or emotional problems bring shame to the individual but to their family as well.

These attitudes among Asian people do not stop when they emigrate to the west. Instead, they dearly hold onto the notions that it is terribly stigmatizing to admit to anything psychological that is bothering them. This makes it extremely difficult for doctors treating these patients to do an accurate diagnosis.

What I want to emphasize is what I believe to be the fact that here, in the west, huge numbers of people cling to similar attitudes towards mental health problems. For example, one of findings in out patient clinics and family doctor offices, is that their patients report somatic symptoms but fail deny emotional problems. Even here, in the west, many continue to feel ashamed of admitting to having mental problems.

During the many years of my mental health practice I learned that it was much easier, on the whole, for women to seek psychotherapy than men. When there were marriage difficulties, I found that, most often, the wives were "dragging their husbands, very reluctantly," into marriage therapy. In other words, it is my suggestion that American males share a lot in common with Asian attitudes towards mental health with one exception:

I doubt that American men are fearful of casting shame on their families simply because familial bonds are no longer as strong as they are in Asia. Rather, for American males, mental health, or depression, is more bound up with issues of masculinity than anything else.

Whether from the Eastern or Western world, it is important for people to be able to admit to psychological problems in order to relieve suffering and prevent suicide.

Your comments are welcome and encouraged.

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at for details.

Reader Comments
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Solution - - Jul 28th 2008
Admitting something is not right with me mentally is the easy part it is seeking treatment is difficult .Mental care in my country is expensive .

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