Culture, Diversity, and Mental Health: 7 Powerful & Eye-Opening Reasons Why Your Mind Doesn’t Exist in a Vacuum

Introduction: The Strangest Therapy Session You’ve Never Heard Of

Let me tell you about a tribe you’ve probably never encountered.

They’re called the Nacirema and according to anthropologist Horace Miner who studied them in the 1950s, they have some fascinating beliefs. They believe the human body is ugly and prone to weakness. They perform elaborate daily rituals in special shrines built right in their homes, shrines with charms and potions they believe will keep them from falling apart. They have “holy-mouth-men” who drill holes in their teeth to ward off decay. And when someone’s really struggling? They visit a “listener.”

Here’s how Miner described it:

“The patient simply tells the ‘listener’ all his troubles and fears, beginning with the earliest difficulties he can remember. The memory displayed by the Nacirema in these exorcism sessions is truly remarkable. It is not uncommon for the patient to bemoan the rejection he felt upon being weaned as a babe and a few individuals even see their troubles going back to the traumatic effects of their own birth.”

Sounds pretty strange, right? Almost… primitive?

Here’s the thing I didn’t tell you. Spell “Nacirema” backwards.

Go ahead. I’ll wait.

…

American.

Miner was writing about us. About American culture in the 1950s. About how our own rituals, brushing teeth, going to the dentist, lying on a therapist’s couch, would look absolutely bizarre to an outsider.

I think about this study a lot. Because it reminds me of something we forget constantly: the way we understand mental health, the way we experience distress, the way we heal, none of it is universal. None of it is just “the way things are.” It’s all filtered through culture. Through assumptions so deep we don’t even see them as assumptions.

By the end of this piece, I want you to see what I’ve been slowly learning for years: that your mind doesn’t exist in a vacuum. That the emotions you feel, the way you express them, even what you consider “crazy” or “normal”, all of it is shaped by the world you grew up in. And if we don’t understand that, we end up doing damage without meaning to.

Quick disclaimer before we dive in: I’m Maryam, a digital journalist with a background in psychology and counseling. This newsletter is just me, no corporate sponsors, no agenda, just someone obsessed with understanding why people are the way they are. What I’m sharing here comes from my research and my psychological lens. It’s an interpretive framework, not the final word. But I hope it gives you a new way to see.

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What Is Cultural Psychology? (Or: Why Your Mind Has a Passport)

I want you to think about the last time you felt really sad. Not just a little down, the kind of sad that sits in your chest and won’t move.

Now ask yourself: where did that sadness come from?

If you’re like most people in Western cultures, you probably looked inward. Maybe something happened in your life. Maybe there’s something wrong with your brain chemistry. Maybe you’re just wired that way.

But here’s a question that might not have occurred to you: would you feel the same sadness if you’d grown up somewhere else? Would it feel the same? Would you express it the same way? Would it even be the same emotion?

This is what cultural psychology studies. One of its founders, Richard Shweder, defines it as:

“The study of the way cultural traditions and social practices regulate, express and transform the human psyche, resulting less in psychic unity for humankind than in ethnic divergences in mind, self and emotion.”

Let me translate that into regular human language: culture doesn’t just put a different coat on the same universal human experiences. Culture shapes the experiences themselves. Shweder puts it even more simply: “Culture and mind make each other up.”

This has two big goals:

Pluralism – Documenting the incredible diversity of what counts as “normal” functioning across different communities. Not to say “anything goes,” but to recognise that normal in Tokyo looks different from normal in Toronto.

Decentring – Developing a way of understanding that helps us actually get the mental lives of people different from us. Not just tolerating difference, but genuinely appreciating it.

This isn’t about saying “everything is relative and nothing is real.” It’s about recognising that we all see the world through cultural lenses, including the people who wrote the DSM.

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The DSM and the Problem of Pretending to Be Universal

Let me tell you about a revolution you probably never heard about.

In 1980, the third edition of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-III, was published. And it changed everything.

Before the DSM-III, psychiatry was kind of a mess. Different therapists in different places used different categories. There was no shared language. Research was hard to compare.

The DSM-III promised to fix all that. It would be atheoretical, not committed to any one school of thought. It would use clear, specific criteria so that any two clinicians would arrive at the same diagnosis. It would put mental health on a scientific footing.

And in many ways, it worked. The DSM became the bible of mental health. Insurance companies require a DSM code to pay for therapy. Research studies use DSM criteria to select participants. Medical students memorise its categories.

But here’s the thing no one talked about at the time: the DSM wasn’t actually universal. It was built in a particular place (the United States), by particular people (mostly white, mostly male, mostly Western-trained), at a particular moment in history.

The assumptions baked into the DSM are worth naming:

Assumption 1: Mental health problems belong to the field of medicine. They’re illnesses, not… something else.

Assumption 2: Mental illnesses can be discovered in disordered biology. There’s a physical cause underneath.

Assumption 3: Research should rely primarily on statistical inference. If the numbers say it’s real, it’s real.

Assumption 4: We need standardised concepts. Everyone should use the same categories.

Assumption 5: Discrete disorders can be identified with explicit diagnostic criteria.

None of these are wrong exactly. But they’re not neutral either. They reflect a particular way of thinking about distress, one that prioritises biology over meaning, standardisation over context, categories over continuums.

Here’s the problem: when you take a tool built in one culture and export it everywhere, you get… problems. Ethan Watters, in his book “Crazy Like Us” (link to Watters), documents some of the disastrous results of exporting Western mental health categories to non-Western cultures. In some cases, we’ve actually taught people to experience distress in new ways, ways that fit our categories.

Some scholars, like Fernando (2003) (link to Fernando, 2003), have argued that this is simply another form of colonialism. Less obvious than the old kind, but just as damaging. We export our categories and call it “education.” We pathologise local ways of understanding distress and call it “science.”

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When Symptoms Speak Different Languages: Idioms of Distress

Imagine you’re feeling overwhelmed. Life is too much. You can’t cope.

What do you say?

If you’re in North America, you might say “I’m so stressed” or “I’m depressed.” If you’re in the UK, you might say “I’m knackered” or “I’m proper gutted.” If you’re in Nigeria, you might describe your head spinning. If you’re in Haiti, you might talk about feeling like zombies are after you.

These aren’t just different words for the same thing. They’re different ways of experiencing distress.

Psychologists call these idioms of distress.

An idiom is a culturally-bound way of saying something. “It’s raining cats and dogs” doesn’t mean actual animals are falling from the sky. It means it’s raining hard. But if you didn’t grow up in an English-speaking culture, that phrase would be baffling.

The same thing happens with distress. Different cultures have different idioms, different accepted ways to express suffering. These idioms determine:

• How symptoms are expressed (physical complaints vs. emotional language)
• What the symptoms mean to the person experiencing them
• How severe the symptoms seem (to the person and to others)
• What kind of help seems appropriate

Think about the phrase “nerves” or “nervous breakdown.” These aren’t medical terms with precise definitions. They’re cultural idioms. They mean something real, but what they mean depends on who’s saying them and where.

Or consider “burnout.” That’s a relatively new idiom and it’s built on a specific cultural metaphor: the person as machine. You’ve been running too hard, too long, without refueling. Now you’ve run out of energy. You’ve burned out. That metaphor makes perfect sense in a culture that values productivity and sees people as resources to be optimised. But would it make the same sense somewhere else? Somewhere with a different relationship to work, to the body, to the self?

Probably not.

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Healing Across Cultures: What Does “It Works” Even Mean?

Here’s a question that seems simple but gets complicated fast: what makes healing work?

If you’re a doctor trained in biomedicine, the answer might seem obvious: healing works when the patient gets better. When the symptoms resolve. When the disease is gone.

But here’s the thing: every culture has healing practices. And they define “success” differently.

Research on healing across cultures suggests that all healing systems share certain elements:

• They identify certain forms of affliction (not everything is a problem)
• They define roles, patient and healer, with clear expectations
• They create specific places and times for healing rituals
• They use symbolic acts that mean something within that culture
• They create expectations for recovery

But here’s where it gets interesting: the logic that connects illness to healing varies. And that logic is shaped by cultural metaphors.

Take burnout again. If burnout means you’re a machine that’s run down, then healing means refueling. Rest. Boundaries. Self-care. That logic makes perfect sense within the machine metaphor.

But Kirmayer (2007) (link to Kirmayer, 2007) points out that we can define successful healing in at least three different ways:

1. The sick person recovers. This is what biomedicine focuses on. Symptoms go away. Function returns.

2. The person doesn’t recover, but the family or community is healed. Maybe someone has a chronic condition that won’t go away. But the family learns to accept it, to support them, to integrate the condition into their lives. That’s a kind of healing too, just not individual cure.

3. The healing system itself is affirmed. Sometimes the intervention doesn’t change the outcome, but it reinforces everyone’s belief in the system. Think of a ritual that doesn’t cure the disease but reaffirms community bonds and shared meaning. That counts as success in some frameworks.

The point isn’t that one definition is right and others are wrong. The point is that how we define success depends on what we value. And what we value depends on culture.

This has real implications. If you’re a therapist trained in one tradition working with someone from another, you might think you’re failing when you’re actually succeeding, or vice versa. You might be aiming for the wrong goal entirely.

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The Self: Individualist, Collectivist and Everything In Between

I want you to finish this sentence: “I am…”

How would you complete it?

If you’re like most people in Western cultures, you probably described personal qualities. I am kind, curious, anxious, creative. I am a therapist, a writer, a daughter. The “I” at the center, the self, is the thing that has these qualities.

But that sense of self, the autonomous individual with a stable inner core, is not universal.

Psychotherapy, as we practice it in the West, requires something called psychological mindedness. The ability to reflect on your own thoughts, feelings and motivations. To see yourself as an object of inquiry.

But here’s the thing: the self takes different forms in different cultures.

In North America and much of the West, the dominant model is individualism. The self is autonomous, worthy of pursuing its own goals. There are actually two flavors:

• Expressive individualism: The self is defined by its ability to articulate its unique inner experience. “I need to express who I really am.”
• Utilitarian individualism: The self is an agent that maximizes its own well-being. “I need to make choices that work for me.”

Cognitive Behavioral Therapy (CBT) fits neatly into utilitarian individualism. It’s about helping the individual identify unhelpful thoughts and change them to achieve better outcomes.

In China and many other cultures, the dominant model is collectivism. The self is defined by relationships. The Chinese word for personality is ren, which also means “a social being.” The individual expresses their unique qualities through mature commitment to family or social group.

Think about what this means for therapy.

If your sense of self is fundamentally relational, then “self-improvement” doesn’t mean becoming more authentic as an individual. It means becoming better at fulfilling your roles. Better at relationships. Better at contributing to the group.

A therapy that focuses only on individual goals might miss what actually matters. It might even do harm by encouraging someone to prioritise their own needs in ways that damage the relationships that define them.

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A Postpartum Story: When Therapy and Culture Collide

Let me make this real with an example.

A young Egyptian woman, born in Canada to immigrant parents, comes to therapy with postpartum depression. She’s exhausted, overwhelmed, struggling to bond with her baby.

As she talks, a conflict emerges. She feels torn between two demands. Her in-laws expect her to be a devoted step-daughter, to care for them, to be present, to fulfill family obligations. But she also needs to care for her newborn. She can’t do both. She feels guilty no matter what she chooses.

Now imagine two different therapists.

Therapist A is trained in classic Western individualist therapy. She helps the client explore her own needs. She encourages her to set boundaries with the in-laws. She frames self-care as essential, not selfish. She helps the client see that she can’t pour from an empty cup.

Therapist B takes a different approach. She asks about the client’s values, her family structure, her cultural context. She explores what it means to be a good daughter, a good mother, a good wife in this family. She doesn’t assume that “setting boundaries” is the answer, maybe the answer is finding ways to integrate roles or enlisting family support or redefining what “devotion” means in a way that includes caring for the baby.

Which therapist is right?

There’s no simple answer. But here’s what I know: a therapy that aims to support the client’s “individualised self-actualisation” might actually increase her distress. It might pull her away from relationships that matter to her. It might make her feel like a failure for not being able to achieve the individualist ideal.

This doesn’t mean individualist therapy is always wrong. For some clients, in some contexts, it’s exactly what they need. But the therapist has to notice. Has to see that the “self” they’re working with isn’t a universal given, it’s shaped by culture, by family, by history.

And if they don’t notice, they can do damage without meaning to.

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Do We All Feel the Same Emotions? (Spoiler: No)

Here’s a question that psychologists have argued about for decades: are emotions universal?

Paul Ekman famously argued that there are basic emotions, happiness, sadness, anger, fear, disgust, surprise, that are recognised across cultures. His research showed that people in different parts of the world could identify these emotions from facial expressions.

That seemed to settle it. Emotions are biological. Universal. Hardwired.

Except…

The more researchers looked, the messier it got. A 3rd century Sanskrit text called the Rasadhyaya listed eight basic emotions, and they’re not the same as Ekman’s. The Sanskrit list includes:

1. Sexual passion, love or delight
2. Amusement, laughter, humor
3. Sorrow
4. Anger
5. Fear or terror
6. Perseverance, energy, dynamic energy or heroism
7. Disgust or disillusion
8. Amusement, wonder, astonishment or amazement

“Heroism” is a basic emotion? “Wonder”? That doesn’t fit our Western list at all.

Salzen (2001) (link to Salzen, 2001) reviewed nearly 100 distinct and conflicting theories of emotion. A hundred. If emotions were simply biological, we’d expect more agreement.

Here’s what the evidence actually suggests: emotions are both biological and cultural. Culture doesn’t just put a different label on the same universal feelings. Culture shapes the feelings themselves.

Mesquita and Walker (2003) (link to Mesquita & Walker, 2003) identified several ways culture matters:

1. Differences in the social production of events. Cultures promote different kinds of events. Some actively create situations that elicit happiness. Others create situations that elicit shame or honor. If you’re surrounded by events that make you happy, you’ll feel happier. If you’re surrounded by events that make you anxious, you’ll feel more anxious.

2. Differences in the significance of events. The same event means different things in different cultures. Uncertainty, not knowing what will happen, is experienced very differently in cultures that value certainty versus cultures that are comfortable with ambiguity. Cultures high on “uncertainty avoidance” see more situations as threatening. More actions become potential norm violations. More opportunities for shame and anxiety.

3. Differences in experience: valence. Valence just means how pleasant or unpleasant something feels. One study asked American, Japanese and Taiwanese students to rate their emotional experiences daily for a week. Americans rated their experiences as more positive. Japanese and Taiwanese students rated theirs as neither particularly positive nor negative. Pleasant and unpleasant experiences were negatively correlated for Americans, more good stuff meant less bad stuff. But for Japanese students, pleasant and unpleasant were positively correlated, if you had more of one, you had more of the other.

Think about what that means. The structure of emotional experience differs. In some cultures, people maximize positive and minimize negative. In others, balance is preferable. Both positive and negative are part of a full life.

4. Differences in appraisal. Appraisal means interpretation. Cultures differ in how much they emphasise personal agency, the sense that you control what happens to you. In individualist cultures, success and failure are attributed to the individual. In more collectivist or fatalist cultures, events are seen as multiply determined. Fate, context, other people, environment, all play a role.

This has mental health implications. More personal agency means more anger when things go wrong. If it’s your fault, you’re angry at yourself. If it’s someone else’s fault, you’re angry at them. But if things just… happen… anger might not be the dominant response.

5. Differences in expression. Different cultures have different rules about which emotions can be shown. Some encourage emotional expression. Some discourage it. Some encourage certain emotions and discourage others. Happiness is expressed less frequently in cultures that value relational harmony, because too much happiness might make others feel bad.

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Anger and Shame in Nepal: A Lesson in Politics and Feelings

Let me tell you about two groups of people in Nepal. They live in the same country, sometimes in the same villages. But they feel emotions completely differently.

The Tamang are a minority group, Buddhist, with values of compassion and tolerance. They emphasise harmony, obedience and conciliation.

The Brahman are an upper-caste group, majority, with values of pride and independence.

Researchers Cole, Tamang and Shrestha (2006) (link to Cole et al., 2006) studied how children in these groups experience and express anger and shame.

Here’s what they found:

Tamang children are taught to discourage the expression of anger. Anger disrupts harmony. It’s not okay. But shame? Shame is acceptable. Shame acknowledges that you’ve violated a norm and signals your commitment to doing better.

Brahman children are taught something different. They’re encouraged to express anger appropriately, toward younger people, for example, but not toward parents or others above them. And shame? Shame is discouraged. It undermines pride and independence.

Same country. Same emotions, anger and shame. But different responses, different expressions, different meanings.

And here’s what makes it political, not just cultural: the Tamang are a minority group. Their values of harmony and conciliation make sense when you’re not in power. They’re survival strategies. The Brahman are the dominant group. Their pride and independence reflect their position.

Emotions aren’t just personal. They’re shaped by power, by history, by who gets to feel what.

This has huge implications for mental health. If you’re a therapist trained to see “appropriate anger expression” as healthy, you might pathologise a Tamang client who suppresses anger. But that suppression isn’t a pathology, it’s a cultural value, a survival strategy, a way of being in the world.

Conversely, if you see shame as always unhealthy, you might miss its function in cultures where shame maintains social bonds and signals moral awareness.

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What This Means for How We Help

So where does this leave us? If mental health isn’t universal, if emotions aren’t universal, if the self isn’t universal… how do we actually help people?

The old answer was “cultural competence”, learning about different cultures so you could work with them effectively. That’s not wrong, but it’s incomplete. You can’t learn a checklist for every culture you might encounter. And “competence” can become another form of stereotyping, assuming all members of a group are the same.

Castillo and colleagues (2019) (link to Castillo et al., 2019) outline a more sophisticated approach. They talk about several components:

Cultural awareness – Being sensitive to a person’s values, beliefs and context. Not assuming yours are universal.

Cultural knowledge – Actually learning about different worldviews. Not to stereotype, but to understand what might be relevant.

Cultural encounter – Direct engagement with people from different backgrounds. You can’t learn this from books alone.

Cultural skills – Being able to gather relevant cultural information from clients and use it in treatment.

Cultural desire – The motivation to engage in this process. Not because you “should,” but because you genuinely want to understand.

But here’s what I think is most important: humility. The recognition that you don’t know. That your way of seeing is one way, not the way. That the person in front of you is the expert on their own experience, including their cultural experience.

This isn’t about abandoning everything we know. It’s about holding it lightly. About being willing to learn. About recognising that every therapy session, with every client, is a cross-cultural encounter, because even two people from the same background have different cultures, different families, different stories.

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Conclusion: Seeing Our Own Rituals

I keep coming back to the Nacirema.

What Miner did with that article was brilliant: he made the familiar strange. He took American rituals, brushing teeth, going to the dentist, lying on a therapist’s couch, and described them as an outsider would. And suddenly they looked… weird. Arbitrary. Cultural.

We need that. We need to make the familiar strange, because otherwise we mistake our way for the only way. We mistake the DSM for universal truth. We mistake individualist therapy for the natural way to heal. We mistake our emotions for the only emotions.

But here’s the thing: making the familiar strange doesn’t mean rejecting it. It means seeing it clearly. It means recognising that therapy, for all its insights, is also a cultural ritual. It has its own logic, its own metaphors, its own assumptions. That doesn’t make it wrong. It makes it specific.

And when we understand that specificity, when we see that our minds are shaped by culture just as much as by biology, we can finally do what good therapists have always done: meet people where they are, not where we assume they should be.

Small action: challenge one “obvious truth” you hold about mental health this week.
Next read: Culture, Diversity, and Mental Health: Why Your Mind Doesn’t Exist in a Vacuum

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