Fortunately, in this country, mental health awareness is on the rise. Although we have a very long way to go, and services surely lag behind demand, the stigma of mental health treatment and the conversations around it have started to improve. This begs the questions of what exactly does “mental health” mean, does it mean the same to everyone, and could there possibly be cultural differences that influence beliefs and expressions of psychological distress? If so, are we doing enough to stay educated and aware, especially those of us that treat mental health disorders on a daily basis?
In the early 1990s, I was moonlighting in the emergency room at a prominent Massachusetts medical hospital. We received a call that a 60-year-old woman had collapsed outside of a funeral home and a bystander had called 911. It initially appeared that she had fainted and was having an uncontrolled seizure. She appeared unconscious, was frothing at the mouth and was shaking uncontrollably. When EMS arrived, they found her to be tachycardic, hyperthermic and unresponsive. She was restrained in the ambulance, administered intravenous anticonvulsant and antianxiety medication and was placed on oxygen.
Upon her arrival to the ER, her condition remained unchanged. She was put on a heart monitor, placed in a cooling blanket and medication continued to be administered. We were able to locate her ID, contact her next of kin, and request that they come to the ER immediately, as her condition appeared life-threatening. When her brother arrived, he was rushed into her room and informed of what had happened. After watching his sister for several seconds, he assured us that she would be fine, as she was experiencing a culturally appropriate reaction to stress called "ataque de nervios." All medical interventions were stopped, and the patient recovered uneventfully within 15 minutes.
Cultural concepts of distress refer to ways that cultural groups experience, understand and communicate suffering, behavioral issues and any other types of emotional distress. Ataque de nervios, literally translated in English as “Attack of the Nerves,” is commonly observed in individuals of Hispanic-Latino heritage from the Caribbean region and North and South America. This usually occurs due to a stressful event in one’s family or close social circle, such as death, trauma, conflict or divorce. Ataque de nervios can manifest as alarming psychiatric symptoms such as uncontrollable shaking, crying, tachycardia, physical and verbal aggression, seizures, fainting and chest pain. In severe cases, it may also include auditory hallucinations and suicidal gestures. Often, the person does not recall the event when it is over. In Western culture, this may be diagnosed as a panic attack, depression, bipolar disorder or a manifestation of a psychotic disorder. Making it more confusing, as with many culturally related syndromes, is that there may be some overlap with diagnosable mental health disorders. Cultures that normalize such symptoms may not seek treatment.
Clinicians need to be sensitive to that expressions of mental health symptoms may vary from culture to culture. Not understanding this may lead to misdiagnosis, and unnecessary or improper treatment. Clinicians need to appreciate that there is a clear link between cultural definitions of mental health and the expressions of distress. This fact always needs to be considered when evaluating and treating patients, in order to provide them with the best, and most culturally appropriate, care possible.