Exercise #47
Cultural Stigma of Mental Health
Authors: Emilia Burbela, PhD
30-40 min
Description
An individual self-reflection exercise in which students analyse a clinical case involving a family from a closed religious community resisting psychiatric intervention. Through structured journal prompts, students develop cultural humility, identify personal biases, and apply ethical frameworks to a real-world scenario of cultural stigma and mental health.
Methodological Guide
Objectives
1. Develop cultural humility and the ability to analyse one’s own biases regarding mental health in different cultures.
2. Apply theoretical knowledge to analyse a hypothetical clinical situation involving cultural stigma.
3. Identify ethical dilemmas arising from patient autonomy, beneficence, and cultural beliefs.
4. Develop a culturally sensitive communication and action plan for working with resistant families.
2. Apply theoretical knowledge to analyse a hypothetical clinical situation involving cultural stigma.
3. Identify ethical dilemmas arising from patient autonomy, beneficence, and cultural beliefs.
4. Develop a culturally sensitive communication and action plan for working with resistant families.
Expected Outcomes
1. Students will identify personal cultural biases that could influence their clinical judgement in the presented case.
2. Students will be able to articulate the ethical tensions between autonomy and beneficence in the context of cultural stigma.
3. Students will propose a culturally sensitive communication strategy that respects the family’s beliefs while advocating for the patient’s medical needs.
2. Students will be able to articulate the ethical tensions between autonomy and beneficence in the context of cultural stigma.
3. Students will propose a culturally sensitive communication strategy that respects the family’s beliefs while advocating for the patient’s medical needs.
Exercise Procedure
1. Introduction (5 min): The teacher introduces the topic of cultural humility and mental health stigma, explaining the purpose of the reflective journal.
2. Case reading (5 min): Students read the clinical case carefully.
3. Individual journalling (30–40 min): Each student responds to all four reflection prompts below in writing.
4. Optional group debriefing (10–15 min): The teacher facilitates an anonymous discussion of key themes, enhancing collective learning.
2. Case reading (5 min): Students read the clinical case carefully.
3. Individual journalling (30–40 min): Each student responds to all four reflection prompts below in writing.
4. Optional group debriefing (10–15 min): The teacher facilitates an anonymous discussion of key themes, enhancing collective learning.
Mode of Implementation
Individual activity
Role of the Teacher
The teacher assigns the exercise and allows individual reflection time (30–40 min). After completion, the teacher conducts an optional group debriefing session, anonymously sharing key themes from student responses to deepen collective learning. The teacher evaluates depth of introspection and theoretical concept application, not ‘correct’ answers.
Theoretical Basis
The exercise is grounded in the concept of cultural humility (Gottlieb, 2021; Lekas et al., 2020) — an ongoing process of self-reflection and self-critique that acknowledges power imbalances and promotes partnerships with communities. It also draws on research on cultural competence in diverse healthcare interactions (Reeves et al., 2024) and on mental health assessment in the Ukrainian context (Korniiko et al., 2024). The case reflects real tensions between collectivist cultural values, religious stigma of mental illness, and the duty of the healthcare professional to intervene.
Practical Application
Students practise navigating a real-life ethical conflict: a patient who remains silent and cannot advocate for himself, a family actively blocking treatment, and a professional duty to act while respecting patient autonomy as a right. The exercise builds skills in building trust with resistant families, integrating cultural and spiritual needs into a medical intervention plan, and recognising the role of shame and stigma as barriers to care.
Knowledge Transfer
Knowledge transfer occurs through applying abstract ethical and intercultural concepts (autonomy, beneficence, ethnocentrism, cultural integration) to a concrete clinical narrative. Structured reflective journalling promotes deep processing and prepares students for similar situations in professional practice.
Reinforcement & Reflection
After individual journalling, the instructor conducts a general debriefing session where main themes that emerged during individual reflections are discussed anonymously to enhance collective learning. The instructor is not assessing the ‘correctness’ of answers, but the depth of introspection and quality of concept application.
Required Resources
Clinical case (embedded in this exercise)
Assessment / Evaluation
The instructor evaluates the depth of introspection, the ability to identify personal biases and ethnocentric tendencies, and the quality of application of theoretical concepts (cultural humility, autonomy, beneficence, cultural integration) to the case. Correctness of answers is not assessed — honest self-reflection is the goal.
Practical Tips
1. Create a psychologically safe environment: assure students that responses are confidential and will not be judged.
2. Encourage depth over brevity: prompt students to revisit their initial reactions and go beyond surface-level responses.
3. During debriefing, present student insights anonymously to model that self-awareness is more important than having the ‘right’ answer.
2. Encourage depth over brevity: prompt students to revisit their initial reactions and go beyond surface-level responses.
3. During debriefing, present student insights anonymously to model that self-awareness is more important than having the ‘right’ answer.
Discussion Topics
1. How can a healthcare professional build trust with a family whose cultural or religious beliefs directly conflict with medical recommendations?
2. Where is the line between respecting cultural autonomy and the duty to protect a patient who cannot advocate for themselves?
3. How might your own cultural background or biases influence your response to this case?
2. Where is the line between respecting cultural autonomy and the duty to protect a patient who cannot advocate for themselves?
3. How might your own cultural background or biases influence your response to this case?
Further Resources
1. Gottlieb, M. (2021). The Case for a Cultural Humility Framework in Social Work Practice. Journal of Ethnic & Cultural Diversity in Social Work, 30(6), 463–481. https://doi.org/10.1080/15313204.2020.1753615
2. Lekas, H. M., Pahl, K., & Fuller Lewis, C. (2020). Rethinking Cultural Competence: Shifting to Cultural Humility. Health Services Insights, 13, 1178632920970580. https://doi.org/10.1177/1178632920970580
3. Reeves, K., et al. (2024). Provider cultural competence and humility in healthcare interactions with transgender and nonbinary young adults. Journal of Nursing Scholarship, 56(1), 18–30. https://doi.org/10.1111/jnu.12903
4. Korniiko, Y. et al. (2024). Mental health assessment during the full-scale invasion within the general Ukrainian population. European Psychiatry, 67, S332–S333. https://doi.org/10.1192/j.eurpsy.2024.688
5. Shahait, M. & Buchholz, N. (2023). The Dilemma of Multiculturalism and Multinationalism in Medical Practice. Société Internationale d’Urologie Journal, 4, 244–245. https://doi.org/10.48083/GAHF2202
2. Lekas, H. M., Pahl, K., & Fuller Lewis, C. (2020). Rethinking Cultural Competence: Shifting to Cultural Humility. Health Services Insights, 13, 1178632920970580. https://doi.org/10.1177/1178632920970580
3. Reeves, K., et al. (2024). Provider cultural competence and humility in healthcare interactions with transgender and nonbinary young adults. Journal of Nursing Scholarship, 56(1), 18–30. https://doi.org/10.1111/jnu.12903
4. Korniiko, Y. et al. (2024). Mental health assessment during the full-scale invasion within the general Ukrainian population. European Psychiatry, 67, S332–S333. https://doi.org/10.1192/j.eurpsy.2024.688
5. Shahait, M. & Buchholz, N. (2023). The Dilemma of Multiculturalism and Multinationalism in Medical Practice. Société Internationale d’Urologie Journal, 4, 244–245. https://doi.org/10.48083/GAHF2202
Additional Remarks
This exercise was developed in the context of Chapter 3: Globalization and Multiculturalism in Medical Education. The case reflects documented challenges in providing mental health care in communities with strong religious and collectivist values.