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IN MODERN Western cultures, conceptual models of mental illness are interwoven with value systems of individualsm, agency, internal locus of control, and fear of dependency. These values have translated into psychological theory and practice, affected families' relationships with the professional, legal, and consumer communities and have often exacerbated family burden. Culturally patterned attributions of individual accountability also affect family-patient interactions and may have an effect on relapse and prognosis. The family and consumer movements are discussed in terms of their orientations, services, social impact, and influence on epistemology, particularly with reference to the different effects of protective paternalism and individualistic autonomy. Questions are raised regarding cultural values and differential prognoses in modern and developing countries and whether the process of recovery may be shaped by different cultural introjects. It is suggested that the era of family and consumer empowerment may be heuristic in discovering parameters of mental illness and potential for recovery, and ideas are offered for future crosscultural research.
This article poses some hypotheses regarding the conceptualization and course of major psychiatric disorders in different cultural settings and explores how cultural values may affect families' relations with their mentally ill members and their interactions with practitioners. In contrast to the copious and wide-ranging literature on culture and mental illness, which has largely explored non-Western conceptualizations of psychopathology, the focus here is on Western value systems and their influence on treatment of patients and their families. In exploring putative correlates of the course of illness and process of recovery, we suggest the mediating influence of different values and value orientations in modern and traditional cultures. Cultural worldviews regarding man-nature relationships, modes of activity, locus of control, and concepts of personhood have influenced our theoretical paradigms and modes of treatment. Social organization, family structure, and kinship roles may determine how caregivers and patients view their intrafamilial obligations. These overarching variables may influence both societal and familial treatment of persons afflicted with major psychotic disorders, and their correlative self-concept, acknowledgment of dysfunction, and views of appropriate remedies.
A major thesis of this paper is that families' relations with their mentally ill relatives, with agents of the treatment system, and with other social groups are informed by their society's basic definitions of mental illness. The form and...