In behavioral health, culture and ethics are often connected. Practicing ethically requires empathy, awareness, and sensitivity for the patient as a person, including their cultural beliefs and values. Cultural competence in healthcare requires practitioners to have a welcoming patient experience while achieving the needs of behavioral healthcare (Putulrt et al., 2018). Thus, cultural competence demonstrates compliance with the ethical principles of justice, respect for persons, non-maleficence, and beneficence (Subudhi et al., 2014). The five ethical principles are the foundation of modern biomedical ethics. Furthermore, ethical principles indicate an expression of moral values and ideas, which are the outcome of human cultural values. Since values are influenced by cultures, clinicians may face various challenges if their personal, cultural heritage and development do not reflect their patient's values ( Nemade, Reiss, & Dombeck, 2015) . It is essential to critically analyze the influence of culture and ethics on behavioral health.
Summarization of Concepts
The research paper will analyze the complex relationship between ethics and culture in behavioral health. Also, it will use peer-reviewed articles that highlight the topic. Due to diverse cultures, behavioral healthcare must incorporate ethical principles, cultural competence, and multiculturalism so that they can achieve favorable health outcomes.
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Impact of Culture
Ethnicity and culture are essential aspects of illness and health. Previously, it was believed that mental illness mainly affected western countries and that non-Euro-American cultures were not affected by the condition ( Nemade, Reiss, & Dombeck, 2015) . However, the perception is highly influenced by cultural perceptions and how people in particular cultures perceive behavioral health. For instance, the topic of mental illness in Japan is a serious, and few people admit to experiencing the condition. On the other hand, in India, many different types of distress disorders are diagnosed as depressive disorders. Without evaluating the entire story, people will generally believe that Japanese people rarely develop the condition while Indians have a high rate of depression. Even in the US, the prevalence rate of depression among white women is higher than that of black women ( Nemade, Reiss, & Dombeck, 2015) . Furthermore, recent immigrants tend to have a lower prevalence rate of depression in comparison to their descendants who are perceived to be ‘westernized’ in behavior and attitude (Collazos, 2005).
Various researches indicate that cultural differences that highlight a person’s focus on oneself and their role in their social hierarchy is related to the prevalence of mental illness. The differences could be associated with the collectivistic or individualistic concept within different cultures. For instance, Western cultures view individuals as autonomous and independent entities that should strive for individual success and achievement ( Nemade, Reiss, & Dombeck, 2015) . On the other hand, non-western cultures view society and family as being of greater significance than an individual. In most cases, individual happiness is sacrificed for the success and happiness of the entire family or society. Due to such collectivistic cultures, people have less emphasis on personal gratification. Ultimately, they spend less time being depressed or frustrated because they did not achieve individual success. Due to little or lack of focus on personal gratification, it can cause an absence or a decrease in the development of some mental issues.
Human norms regarding specific obligations and responsibilities to the institutions, oneself, and others are influenced by culture (Putulrt et al., 2018). For instance, an individual from a culture that states that family obligations are non-negotiable, compulsory, and demanding may feel limited, restricted, and powerless. On the contrary, a person from that culture may perceive family obligations as a way of feeling competent, needed, and useful. Such feelings influence mood and self-concept. Moreover, some cultures have rigid gender roles and expected behavior. In such cultures, men’s work is providing for their families while women are confined to their homes. Additionally, men should not enter the kitchen while ladies can only leave their homes with a male family member. The rigid gender roles may have an adverse impact on a family if there are changes such as the death of a spouse. After the death of a spouse, a woman may lack the financial support for the children while men may not know how to take care of their children ( Nemade, Reiss, & Dombeck, 2015) . The affected individuals may feel useless or worthless if they cannot take care of their families.
Also, some cultures may perceive particular depressive symptoms as usual or normal emotional responses to certain life events (Putulrt et al., 2018). For instance, some culture may allow the bereavement and grief process to extend beyond the expected time, about one year in western cultures. Therefore, people from such cultures may find it strange that a western psychologist would believe that mourning for two years is a symptom of mental issues. Additionally, people may attribute the symptoms of mental illness to other issues that may not be realistic to people or psychologist from other cultures. For example, a Chinese patient in the US may reject the idea the fact that biochemical imbalances may cause depression in favor of the perception of energy flows and other concepts that are common in traditional Chinese culture. Such patients are more likely to respond favorably to psychologists who understand their culture (Collazos, 2005).
Cultural variations regarding help-seeking behavior may affect the treatment of mental illness. For instance, most non-western cultures use western trained healthcare professionals to treat ‘serious diseases' while using indigenous practitioners to treat ‘illnesses’ ( Nemade, Reiss, & Dombeck, 2015). If the physicians do not identify emotional disturbances that could have caused disease, depressed people are less likely to seek mental health or psychiatric care for symptoms of mental illness such as depression, anxiety, and substance abuse. Furthermore, there is a great difference between how different cultures perceive depression and their willingness to seek assistance. For instance, in Western cultures, it is socially acceptable to experience mental illness, and many people are willing to seek mental health or psychiatric care. On the contrary, mental illnesses are stigmatized in non-Western cultures ( Nemade, Reiss, & Dombeck, 2015) . Ultimately, families and people may fail to seek help and deny mental illness due to the shame and fear of being called ‘crazy.’ Also, some may perceive the label ‘depression’ as experientially meaningless, unacceptable, and shameful.
Notably, culture varies in the level that they incorporate or rely on alternative and complementary medicine practices such as yoga, meditation, herbs, and other approaches into the mental illness treatment (Putulrt et al., 2018). People from particular traditional cultures may embrace prescriptions for exercise, herbs, or acupuncture while rejecting western antidepressant medications ( Nemade, Reiss, & Dombeck, 2015) . Furthermore, people’s cultural background may influence or affect their biological makeup. For instance, people from different regions in the world have different gene patterns and diseases that they may be vulnerable. The genetic differences may affect how an individual may succumb to mental illness, such as depression if they are stressed. Additionally, it may influence how individuals respond to anti-depressant medication.
Ethical Issues in Behavioral Health
In behavioral health, ethical dilemmas may occur because of differences between a patient’s personal beliefs and values and those of the clinician even if they have a similar cultural heritage. Clinicians and patients often differ in the value and meaning they attach to various psychiatric diagnoses, such as their beliefs regarding the utility of psychotherapy and/or psychotropic medication. Some of the cultural/ethical dilemmas include:
Maintaining Therapeutic Boundaries
Behavioral health practitioners have an ethical duty to offer high-quality care according to the core principles of non-maleficence and beneficences (Hoop et al., 2008). Furthermore, competent care involves not only diagnosis but also the treatment of illness. Health providers must find a healthy balance between a patient’s cultural heritage and a physician’s professional diagnosis. A patient’s cultural heritage should not override a physician’s need to offer competent care.
Treatment Choice
In western medicine, treating mental illness involves psychoeducation, pharmacotherapy, and individual therapy. Various researches support, and they offer adequate guidance that allows healthcare providers to achieve their ethical duties of providing high-quality care (Hoop et al., 2008). However, western medicine has historically believed that the use of traditional or native treatments as unethical. Nevertheless, the need to provide culturally pluralistic care, there is need to respect a patient’s cultural heritage according to the core principle of non-maleficence that involves creating a safe environment that acknowledges divergent cultural practices and beliefs (Abbot and Chase, 2008).
Informed Consent and Confidentiality
Ethical principles of respect and non-maleficence support confidentiality. Confidentiality encourages patients to disclose shameful information so that it can be addressed therapeutically. Clinicians are legally and ethically responsible for respecting patients’ privacy and confidentiality. However, they are only permitted to reveal confidential information without patient consent if the information is a danger to others such as elder abuse, child abuse, or when the patient threatens another individual’s safety (Hoop et al., 2008). Additionally, they can release confidential information if the patient requests them to reveal it to a third party such as a consultant or insurance company.
Justice and Diverse Populations
In the US, there are racial disparities in healthcare delivery. Justice is a core principle that involves treating everyone fairly according to their needs. Contrary to the principles of respect for autonomy, non-maleficence, and beneficence, justice is important to public health. Distributive justice dictates that burdens and benefits should be distributed in a community in an impartial manner (Hoop et al., 2008).
Conclusion
The paper has analyzed the h istory, ethics, and influence of culture on behavioral health. Cultural differences between clinicians and patients is a critical issue because western populations are becoming more diverse. Understanding the cultural differences highlights the role of ethics in behavioral health and how cultural competence is essential in quality care. Clinicians should be empathetic, sensitive, and knowledgeable regarding cultural differences.
References
Abbot, P., & Chase, D. M. (2008). Culture and substance abuse: Impact of culture affects the approach to treatment: Psychiatric Times , 25 (1), 43-43.
Collazos, F. (2005). Cultural competence in the mental health treatment of immigrant and ethnic minority clients: Diversity in health and social care , 2 , 307-17.
Hoop, J. G., DiPasquale, T., Hernandez, J. M., & Roberts, L. W. (2008). Ethics and culture in mental health care. Ethics & Behavior , 18 (4), 353-372.
Nemade, R., Reiss, N., & Dombeck, M. (2015). Sociology of Depression – Effects of Culture. Retrieved from https://www.mentalhelp.net/articles/sociology-of-depression-effects-of-culture/
Putul, M., Kahua, T. D., Choudhury, M. K., & Shobhana, M. (2018). The Influence of Culture and Society on Mental Health: Medico-Legal Update , 18 (2).
Subudhi, C., Bama, S., Panneer, S., Nabeesa, S. B., & Arivanandan, A. (2014). Culture and mental illness: Social Work Practice in Mental Health: Cross .
