Running head: MENTAL HEALTH OVERVIEW IN IRAQI AND CHINESE CULTURES 1

Mental Health Overview in Iraqi and Chinese Cultures

Jenna Mazur

Loras College
MENTAL HEALTH OVERVIEW IN IRAQI AND CHINESE CULTURES 2

Introduction

The World Health Organization (WHO) explains mental health as a “a state of well-being in

which every individual realizes his or her own potential, can cope with the normal stresses of

life, can work productively and fruitfully, and is able to make a contribution of her or his

community” (Mental health: A state of well-being, 2014). When these factors are compromised,

affecting the individual’s life, is when we see a mental health diagnosis. Some examples of

mental health disorders diagnosed worldwide include anxiety, mood, psychotic, and eating

disorders (Types of Mental Illness, n.d.). Many factors affect and individuals mental health

status, one of the more prominent ones being cultural factors. While it is difficult to put one

definition on culture, it is most commonly known as the customary beliefs, social forms, and

material traits of a racial, religious, or social group (Culture, n.d.).

While different cultures have different views of mental health disorders, it is important to

note that historically, many cultures had the same original ideas as to the origins or causes of

mental health disorders. In 1550 BC, Egyptians believe that mental illness was caused by

possession or punishment from the Gods; this is also the case for many other ancient civilizations

(Gold & Gold, 2014). Another thing that has persisted through time is stigma associated with

mental health disorders (Mehraby, 2009). Stigmatization of a mental illness, which can come

from either the general public or the individual’s friends and family, includes devaluing,

disgracing and disfavoring the individual based on their mental health status (Abdullah &

Brown, 2011). Despite some commonalities, there are still many cultural factors that affect the

individuals with mental health disorders differently including diagnosis, treatment, and familial

response. In this essay, I will examine Iraqi and Chinese cultures prospective on mental health.

Iraq
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Iraq is located in ancient Mesopotamia and is Muslim nation with strong religious ties to

almost all aspects of their culture. In terms of mental illness, Muslim cultures have strong beliefs

that mental illness is a either a test or punishment from their God, Allah (Ciftci, Jones &

Corrigan, 2013). This idea has persisted through time, as the ancient Mesopotamians believed

that mental illness had a divine origin and that it was their God punishing the individual (Gold &

Gold, 2014). In a study observing Muslim perceptions of mental illness, participants explained

that “God… is the ultimate doctor. He is the one that brought down the disease. He is the one

that brought down the cure” (Padela, Killawi, Forman, DeMonner & Heisler, 2012). Another

trait Muslims display is pride in their family. This can be extremely helpful or extremely

detrimental to the suffering individual. On one hand, Muslim families are very supportive and

can serve as a shield against certain stressors. On the other hand, Muslim families also value

their social reputation. An individual with a mental illness could fear that seeking help would

being shame to the family and damage their reputation (Mehraby, 2009).

Before the 1980s, mental health services were developing hospitals, education programs for

professionals, and awareness movements. However, since then there has been a major decline.

Many citizens, including many psychiatrists, have fled the country due to poor work conditions,

healthcare shortages, lack of educational opportunities, and ongoing war and conflict. Unlike

other countries, Iraq has experienced many years of war and conflict that have created several

scars on the country. Some of these scars include political, economic, cultural and humanitarian

consequences (Frontieres, 2013). All of these stressors can ‘trigger’ or heighten an individual’s

likelihood of being diagnosed with a mental illness. However, because of the many wars, mental

health care is so limited. Now, the WHO has taken initiative in rebuilding the mental health care

system in Iraq (Sadik & Al-Jadiry, 2006).

In the WHOs efforts of strengthening the mental health care system in Iraq, representatives

have been able to collaborate with government and nongovernment organizations, humanitarian

agencies, and private sectors to make mental health care more prevalent. Due to years or war and

conflict, it has become extremely difficult for individuals suffering from a mental illness to see a

clinician to even receive the appropriate diagnosis. In 2005, there were approximately 1.6 mental

health professionals per 100,000 population (Sadik and Al-Jadiry, 2006). Due to limited number

of mental health professionals and facilities, there is limited data as to how an individual receives

a diagnosis. However, due the involvement of WHO it is appropriate to assume that the

International Classification of Diseases 10th edition (ICD-10) as a guideline in diagnosing mental

health illnesses, as WHO implements it to its member states (International Classification of

Diseases Information Sheet, 2015). Most recently, in the WHOs efforts to provide mental health

care, they have donated nearly 70 mobile clinics for individuals to seek professional support,

diagnosis, and in some cases, treatment (Eastern Mediterranean Region, (n.d.).

Due to lack of mental health professionals in Iraq, treatment options are extremely limited;

outpatient treatment options like counseling or therapy are essentially impossible. As a result,

many individuals turn solely to prescription drugs contributing to the fact that prescription drug

abuse if the leading substance abuse problem in Iraq (Fadel, 2010). One prescription drug

frequently used is Artane, commonly known as the “pill of courage” for its strong sedative effect

(Fadel, 2010). Before the WHO stepped in, the main form of treatment was long-term

institutionalization. Since the fall of the regime, there are only 2 remaining facilities in Iraq: Al-

Rashad and Ibn Rushid. Both facilities are in Baghdad, making them difficult to access for those

outside this area (Sadik & Al-Jadiry, 2006). Along with this, these facilities are operating on

scarce equipment, staff, and medication (Sadik & Al-Jadiry, 2006).

Overall, there is limited data and knowledge surrounding the concept of mental health. What

we are certain of is psychological illnesses need to have equal priority as physical illnesses.

Culture and religion are a large part of the Iraqi people’s lives. Perhaps we should start to

implement treatment options involving religion in this area.

China

Present day China is home to about 1.4 billion individuals who all contribute to the Country’s

culture and identity. Some values that have a great influence on the Chinese mental health

include harmony, benevolence, righteousness, courtesy, wisdom, honesty, and loyalty (Lihua,

n.d.). Like many other places around the world, mental illness is often associated with severe

psychosis and the individual being a threat to society. Unlike the Iraqi family dynamic discussed

previously, the familial response to mental illness is mostly negative. This is due to the fact that

in Chinese society, there is great emphasis on interfamilial relationships and the idea the family

is known as the ‘great self’. In other words “the individual is obligated to do whatever it takes to

maintain a well-functioning family” (Hsiao et al., 2006). As a result, it is common for individuals

suffering to present their symptoms as physical symptoms such as pain or fatigue which makes it

difficult to diagnose a mental illness (Hsiao et al., 2006).

However, many times when the family realizes they are not the best resource in treating the

family member’s mental illness, many individuals are seen by a psychiatrist or another clinician.

In China, practitioners use the Chinese Classification of Mental Disorders (CCMD) as a standard

reference for a mental illness diagnosis (Chiang, 2015). The CCMD is comparable to the ICD-10

created by the WHO. Many psychiatrists also reference the ICD-10 when diagnosing mental

disorders.
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In the 1980s, Chinese mental illness treatment facilities were flourishing; they utilized work-

rehabilitation centers to establish a sense of purpose, and family-based therapy to apply cultural

values in the treatment process. However by 2004, the number of mental illness treatment

facilities decreased by 62% due to economic reforms (Liu et al., 2011). In an interview, Dr

Yong, the direction of Education and Training and the Shanghai Mental Health Center, stated

that in the past institutionalization and pharmacological treatment methods were primarily used.

This was due to the fact that there simply were not enough clinical psychologists, social workers

or therapist available to provide other forms of treatment. However, cognitive behavior therapy

is now being integrated into education and training courses are much more prominent

(Szymanski, 2012). However, less 6% of individuals suffering fromm a mental illness in China

actually seek professional help, presumably due to the cultural factor of keeping it within the

family.

Overall, Chinese cultural puts high priority on fulfilling the family’s needs and expectations;

potentially being a psychological stressor bringing guilt and shame to the individual. This idea

has persisted through time while many economic and political changes occurred in the country.

Conclusions

As an outsider to both of these cultures, it is hard to judge which would be more

beneficial for the person experiencing the mental illness. Both Iraqi and Chinese cultures

emphasize the importance of the family over the individual which brings their own stressors on

the individual. In addition to this, both cultures seem to have made progress in terms of diagnosis

and treatment methods only to be set back; now, although in different magnitudes, both cultures

are in the rebuilding phase of mental health care. However, there are still more mental health

resources that are more easily accessible in China compared to Iraq. From an outside perspective,
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I would say that this sets the two cultures apart, making China the more ideal location and

culture for an individual suffering a mental illness.

Overall, there were more similarities between these two cultures than expected. Familial

relationships and reputations are of great importance to both of these cultures. As we have

discussed in class, this can be both hindering and helpful; the individual can either feel they are

bringing their family shame or they could feel much supported by their family. Both cultures are

also experiencing a transitional phase in treatment. However, when resources become available,

in order to best utilize cultural values treatment should include family therapy. Awareness and

empathy towards mental illness is the key to progressing in the mental health care field in both

Chinese and Iraqi cultures.

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