Expressed emotion across cultures

Dinesh Bhugra is Professor of Mental Health and Cultural Diversity and heads the Section of Cultural Psychiatry at the Institute of Psychiatry (Health Services Research Department, PO Box 25, De Crespigny Park, London SE5 8AF. E-mail: d.bhugra{at}iop.kcl.ac.uk). His research interests include cultural psychiatry, spirituality, sexual dysfunction and diversity. Kwame McKenzie is a senior lecturer in psychiatry at the Royal Free & University College School of Medicine, London, and an honorary consultant psychiatrist with Barnet Enfield and Haringey Mental Health NHS Trust. His research interests include public health impact of mental illness, discrimination and social capital.

Expressed emotion has been used as a construct in understanding the interaction between patients and their carers and families. A considerable amount of data from Western cultures suggests that high expressed emotion can lead to relapse in vulnerable individuals, even when they are on medication. However, the data from other cultures are less solid. This paper reviews some of the existing findings and recommends that various components of expressed emotion must be seen in the cultural context and embedded in the normative data of the population before the concept can be considered in association with the pathogenesis of relapse.