2.4: The Sociocultural Model

Section Learning Objectives

• Describe the sociocultural model.
• Clarify how socioeconomic factors affect mental illness.
• Clarify how gender factors affect mental illness.
• Clarify how environmental factors affect mental illness.
• Clarify how multicultural factors affect mental illness.
• Evaluate the sociocultural model.

Outside of biological and psychological factors on mental illness, race, ethnicity, gender, religious orientation, socioeconomic status, sexual orientation, etc. also play a role, and this is the basis of the sociocultural model. Next, we explore a few of these factors.

Socioeconomic Factors

Low socioeconomic status has been linked to higher rates of mental and physical illness (Ng, Muntaner, Chung, & Eaton, 2014) due to persistent concern over unemployment or under-employment, low wages, lack of health insurance, no savings, and the inability to put food on the table, which can then lead to feeling hopeless, helpless, and dependent on others. This situation places considerable stress on an individual and can lead to higher rates of anxiety disorders and depression. Borderline personality disorder has also been found to be higher in people in low-income brackets (Tomko et al., 2014).

Gender Factors

Gender plays an important, though at times, unclear role in mental illness. It is important to understand that gender is not the cause of mental illness, though differing demands placed on males and females by society and their culture can influence the development and course of a disorder. Consider the following:

• Rates of eating disorders are higher among women than, men, though both genders are affected. In the case of men, muscle dysphoria is of concern and is characterized by extreme concern over not be muscular enough.
• OCD has an earlier age of onset in boys than girls, with most people being diagnosed by age 19.
• Women are at greater risk for developing an anxiety disorder than men.
• ADHD is more common in males than females, though females are more likely to have inattention issues.
• Boys are more likely to be diagnosed with Autism Spectrum Disorder.
• Depression occurs with greater frequency in women than men.
• Women are more likely to develop PTSD compared to men.
• Rates of SAD (Seasonal Affective Disorder) are four times greater in women than men.

Consider this…

In relation to men: “Men and women experience many of the same mental disorders but their willingness to talk about their feelings may be very different. This is one of the reasons that their symptoms may be very different as well. For example, some men with depression or an anxiety disorder hide their emotions and may appear to be angry or aggressive while many women will express sadness. Some men may turn to drugs or alcohol to try to cope with their emotional issues.”

https://www.nimh.nih.gov/health/topics/men-and-mental-health/index.shtml

In relation to women: “Some women may experience symptoms of mental disorders at times of hormone change, such as perinatal depression, premenstrual dysphoric disorder, and perimenopause-related depression. When it comes to other mental disorders such as schizophrenia and bipolar disorder, research has not found differences in rates that men and women experience these illnesses. But, women may experience these illnesses differently – certain symptoms may be more common in women than in men, and the course of the illness can be affected by the sex of the individual.”

https://www.nimh.nih.gov/health/topics/women-and-mental-health/index.shtml

Environmental Factors

Environmental factors also play a role in the development of mental illness. How so?

• In the case of borderline personality disorder, many people report experiencing traumatic life events such as abandonment, abuse, unstable relationships or hostility, and adversity during childhood.
• Cigarette smoking, alcohol use, and drug use during pregnancy are risk factors for ADHD.
• Divorce or the death of a spouse can increase the risk of developing an anxiety disorder.
• Trauma, stress, and other extreme stressors are predictive of depression.
• Malnutrition before birth, exposure to viruses, and other psychosocial factors are believed to contribute to the risk of developing schizophrenia.
• Seasonal Affective Disorder (SAD) occurs with greater frequency for those living far north or south of the equator (Melrose, 2015). Horowitz (2008) found that rates of SAD are just 1% for those living in Florida while 9% of Alaskans are diagnosed with the disorder. This is due to differences in exposure to sunlight in these regions.

Source: https://www.nimh.nih.gov/health/topics/index.shtml

Multicultural Factors

Racial, ethnic, and cultural factors are also relevant to understanding the development and course of mental disorders. Multicultural psychologists assert that both normal behavior and abnormal behavior need to be understood in relation to the individual’s unique culture and the group’s value system. Racial and ethnic minorities must contend with prejudice, discrimination, racism, economic hardships, etc. as part of their daily life and these stressors can increase vulnerability to a mental disorder (Lo & Cheng, 2014; Jones, Cross, & DeFour, 2007; Satcher, 2001), though some research suggests that ethnic identity can buffer against these stressors and protect mental health (Mossakowski, 2003). To address this unique factor, culture-sensitive therapies have been developed and include increasing the therapist’s awareness of cultural values, hardships, stressors, and/or prejudices faced by their client; the identification of suppressed anger and pain; and raising the client’s self-worth (Prochaska & Norcross, 2013).

Evaluation of the Model

The sociocultural model has contributed greatly to our understanding of the nuances of diagnosis, prognosis, course, and treatment of mental disorders for other races, cultures, genders, ethnicities. In Chapter 3 we will discuss diagnosing and classifying abnormal behavior from the perspective of the DSM 5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition). Important here is that specific culture- and gender-related diagnostic issues are discussed for each disorder, demonstrating increased awareness of the impact of these factors. Still, the sociocultural model suffers from issues with the findings being difficult to interpret and not allowing for the establishment of causal relationships due to a reliance on more qualitative data gathered from case studies and ethnographic analyses (one such example is Zafra, 2016).

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Chapter Recap

In Chapter 2, we first distinguished uni- and multi-dimensional models of abnormality and made a case that the latter was better to subscribe to. We then discussed biological, psychological, and sociocultural models of abnormality. In terms of the biological model, neurotransmitters, brain structures, hormones, genes, and viral infections were discussed as potential causes of mental disorders and several treatment options were described. In terms of psychological perspectives, behavioral, cognitive, humanistic and existential perspectives were discussed. Finally, the sociocultural model indicated the roles that socioeconomic status, gender, environmental, and multicultural factors can play in abnormal behavior.