Does Cultural Bipolarity Create Barriers to the Delivery of Quality Mental Health Care?

Melody Moezzi

Melody_MoezziWhat would it be like if your clinician didn’t understand your culture or treated you as something other than “normal” because of your ethnicity, religion, or gender?  Would you receive appropriate, effective treatment? Attorney, author and mental health activist Melody Moezzi talks with Care For Your Mind about how her religion influences her mental health and why the mental health care system should become more culturally competent.

Does Cultural Bipolarity Create Barriers to the Delivery of Quality Mental Health Care?

CFYM:  In your book, Hadol and Hyacinths: A Bipolar Life, you write about your experience living with and recovering from both clinical and cultural bipolarity. Can you expand on how you experienced cultural bipolarity?

MM: Well, I can’t say that I “recovered” from either in any literal sense. Rather, I’ve learned to see the beauty in both, which has helped me accept the fact that they’ll be with me in one way or another throughout my life. As for the cultural part, it’s a matter of birth, something I’ll never escape, and honestly wouldn’t want to—and I should say the same applies (for the most part) to the clinical side.

Being an Iranian-American Muslim living in the US today isn’t easy, but it gives me a really useful perspective that I don’t think I would have otherwise. Because I never feel quite at home anywhere—in fact, when I’m in the US I feel more Iranian, and when I’m in Iran, I feel more American—I have had to construct a life that works for me regardless of outside forces.

I am learning that home isn’t as much a place as it is a set of people—and in my case, a couple cats and some orchids thrown in as well. I’ve learned to treasure my uniqueness, as it’s helped me relate to other minorities and persecuted groups, including fellow survivors of serious mental illness and suicide. As much pain as it has caused me, it has also led me to seek out some pretty amazing people with similar experiences in terms of representing a minority, whether it’s because of their mental health status or sexual orientation or race or gender identity or whatever. I relate to the “other” because that’s who I am, and I wouldn’t change that.

CFYM:  What role has Islam played in your ability to cope with mental illness?

MM: My faith has helped save me on many occasions, but as with most faiths, the Muslim community is also full of people who simply don’t understand the fact that a mental illness is just that and that it’s not some moral failing. Nevertheless, my connection with the Divine has been integral to my healing. I find refuge in prayer, and I consider my activism a type of prayer. The concept of jihad is highly misunderstood in much of the Western world. Unfortunately, the media has adopted the extremists’ interpretation, rather than that of the vast majority of Muslims. In fact, jihad simply means struggle. It signals a struggle to maintain faith in a world where it’s easy to lose it and a struggle to fight injustice in the world.

In my eyes, these are two sides of the same coin. The more you work toward worldly justice, the more peace you find spiritually, and the more peace you find spiritually, the more able you are to pursue worldly justice. Being an activist and writing about and speaking out in defense of the rights of others who experience oppression and injustice—whether they be Muslims or Jews or Hindus or Baha’is or Atheists or anyone else—is a duty that is impressed upon me as a Muslim, and I don’t take that lightly. It is what drives me to speak out for those suffering from mental illness and others who experience discrimination of any sort.

CFYM: Do you think the medical community could have done a better job helping you circumvent cultural barriers that delayed the onset of a path to recovery and wellness?

MM: Yes! The idea of cultural proficiency just doesn’t seem to be important to many health care providers, yet it presents a serious barrier to wellness for many of us who come from different cultures. I think the medical community—and particularly the mental health community—needs to start taking such things seriously. Of course, they can’t be familiar with every culture, but it’s important that they take culture seriously, that they not be afraid to ask questions, that they try to understand at least.

Your Turn

  • Ms. Moezzi shares that being “other” is who she is. Have you experienced being “other”? Do you think it affected the mental health care you received?
  • How would you recommend the medical community move from doctor-centric to people-centric or, even “other-centric” treatment models?

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I  met  with a  psychiatrist (who was my doctor at the time), I was breaking down, symptomatic ,traumatized, and stressed out  from my job as a child welfare worker.  I  was describing what I was experiencing and said I needed time away from work and he said  sarcastically, "what  are you going to do go on SSI,"?

I  was so offended.  I  have worked since 1976 and paid more into the system to be eligible for SSDI. As a working class African American woman I  found him to be disrespectful and have not seen that psychiatrist again.  I find some of  the mental health professionals do not think it is necessary to acknowledge their own  socioeconomic and racist bias, perceptions, whether conscious or unconscious.


I routinely experience being the "other" in terms of being a member of the LGBT community, though by outward appearance I do not look like the "other". I am fair-haired and blue-eyed and grew up in America as the child of a doctor. As such, I was part of a dominant cultural group and routinely exposed to messages regarding conformity, though in reality, I have always been part of a minority cultural group. I went in to treatment for chemical dependency in the 1980's. At that time, I was routinely exposed to counseling that conformed to the dominant standards I most knew. "Other" cultures were definitely expressed as very different. For that reason, I did not do well within mental health and medical communities that did not relate to the fact that I interpreted experiences based within my own frame of reference from growing up as a lesbian. I continued to focus on the fact that I fell outside the norms of social behavior and this continued to give me a negative perception of myself. I did not improve much until the 1990's, when I attended counsel with a lesbian therapist who understood my values and perceptions. Later however, I was able to improve with other counselors, even when they knew little about my own culture, if I focused on what we had in common, such as the importance of family, the importance of marriage and the importance of getting my needs met psychologically and spiritually. At minimum, I would suggest that if providers in the medical community and the mental health community do not know about varying cultures, they should focus on what can be identified across all cultures in terms of basic emotions and feelings we all have, though it is vital that counselors learn more about how those feelings are expressed in varying cultures. Clearly, they must also hold a respect for human diversity and continue to be educated. 



Dear Kim,  I would be enthusiastic about pivoting off your final thought--"At minimum, I would suggest that if providers in the medical community and the mental health community do not know about varying cultures, they should focus on what can be identified across all cultures in terms of basic emotions and feelings we all have, though it is vital that counselors learn more about how those feelings are expressed in varying cultures. Clearly, they must also hold a respect for human diversity and continue to be educated"--for a group discussion.

Thank you for sharing.


BM Psychology Notes
BM Psychology Notes

cultural barriers can be extremely decisive in treatment effectiveness, imho



Taking this opportunity to encourage everyone to reveal your life in this space. It's safe. I woke up this morning with a new resolve for my future, absolutely ready to shed more of the past.

I feel honored that Melody Moezzi has affirmed us two writers who were present yesterday, just as I have felt honored to receive Phyllis' affirmations since we started.

Everyone have a great day! I look forward to your responses to Melody Moezzi's assertions.



Thanks so much for your comments! Stephen, quite a story. It means the world to me that you found some of my words useful enough to tape up anywhere, and even more so that you would share your experiences here. Only by sharing our struggles--as you have done here--will we be able to improve the system. Ktcoll, thank you for sharing your wise words with us, and I agree, that sense of community can help enormously. My best to both of you!


First, colleagues, having cofounded and participated in a DBSA chapter for 10 years, I am privileged to have familiarity with Melody Moezzi. I have read every one of her columns in BP magazine, even cut out one and taped it eye level on a kitchen cabinet.

In that column, she sits on the floor and "raps" with us who--as she has more than once--tampered with our medications sans awareness of doctor. At the instant I concluded my reading of that column--in which she encounters an acquaintance in a cereal aisle whose external appearance and behaviors severely warn her to NEVER tamper with meds sans doctor awareness again--I was compelled to cut it out.

Rereading highlighted passages while doing kitchen tasks has reinforced my  "wisdom for the pain," as Helen Reddy sang in "I am Woman."

I am 53; if you are around my age, you might remember Ms. Reddy's 1970s anthem's refrain:

Yes, I am wise; but it's wisdom for the pain.

Yes I've paid the price, but look how much I've gained.

If I have to, I can do anything!

I am strong.

I am invincible.

I am womanl.

Perhaps you nod your head in agreement that can replace the last line of the refrain with, "I am a survivor of mental illness."

Question 1, Have I ever experienced being other, and do I think it affected the mental health care I received?

Yes, and yes.

Reasons for my answers: I was sexually abused when I was 5, 19, and 20. The trauma suffered shut down my emotional development until a month prior to my 53rd birthday when in CBT and the floodgates opened. Finally, I could start developing healthy, effective modes of expressing anger, of being assertive.

The issue of "otherness" connects to misperceptions of me as being homosexual. I was a child and teen prodigy--classical pianist and journalist. When. . .




Immediately commencing my "breather" on this beautiful college campus, with a cool breeze helping me stay calm and resolved about this step into transparency, I thought: "I AM GOING TO BEGIN MY COMPLETION OF TODAY'S RESPONSE BY ASSERTING THAT I ADAMANTLY DISAGREE WITH AGENTS OF INTAKE AT PSYCHOLOGIST/PSYCHIATRIST/INPATIENT HOSPITAL SPACES ASKING, "Are you attracted to men or women?"

Why? Labeling can be cruelly premature because of various "other" factors.

In the life of my family:

1. My father Charles Edward, who died in June, 2012, would regularly admit to our DBSA support group in the eight years that he participated as a co-facilitator that he suffered depression He was never officially treated.  Charles' father, Charles Anthony, exhibited extremely sad signs of untreated depression.

Charles Edward was the middle child of three of a poor share-cropper farm family in south Louisiana. Of the five, he was an intellectual. When Dad told me close to the end of his life that his parents--upon the completion of his bachelor degree in Civil Engineering (which he earned with the help of a buddy hitchhiking with him to the university 30 miles away) and his three years service in the Air Force. "Leave Louisiana, and don't come back. There's nothing for you here."

So my dad's profession in a worldwide construction company was of workaholic status; thus, I regard the primary factor that I suffered the "otherness" misperceptions of being homosexual when I left home at 18 is that I no longer had the security of family, same as him.

2. Mom. We can look at "otherness" dysfunction factors in her as well. Whereas he was French-American with some Scotch Irish in Cajun country, she was the second of four born to Mexican immigrants, Otila and Alfredo, who met and married in San Antonio, Texas. More than several times I heard Mom say that she did not feel comfortable being Hispanic in San Antonio in the 1950s.

There were four siblings in Mom's family--and a lot of turmoil. Her parents had tension. Her older brother committed suicide at age 49 because he vowed he would be a millionaire at 50. Her younger brother disappeared from the face of the earth in his late 30s/early 40s; he had served in Vietnam and was emotionally drowning. Her youngest brother was addicted to alcohol and drugs for over 20 years; finally, in a court case in which Carlos thought he was going to prison, the judge ordered him to treatment.

Praise God! Upon completion of treatment, Uncle Carlos earned a Ph.D., and for over 20 years has worked a career as a bilingual educational consultant specialist, traveling the world, specializing in science and math programs for "others" who have tremendous potential and deserve the opportunity.

I tell you all this because no life is simple.

Every life is precious; however, no life is simple.

I am angry about being asked "Are you attracted to men or women" in probably eight of my nine inpatient stays. I can see that the loneliness of growing up  was due to several factors: my dad not have the capacity to be a daddy, and my parents could not foster a family (there are four sons born within 4 1/2 years) that communicated about thoughts and feelings.

I am proud of the masculinity that exists within, and enormously grateful that I survived two suicide attempts. I am tremendously blessed to develop advocacy skills after the major break-through in my treatment.

Healing takes time. Every story unfolds ever so slowly. Please, healing profession, realize that because of the sexual revolution of the 1960s; the confliction of what it means to be a man, to be a woman; the terrible war between the lure of the "American Dream" and the stress suffered by lmmigrants, mental illness IS truly--as quoted in a recent issue of Esperanza--the LEPROSY of our times.



While being "other" has not affected the mental health care I've received, it has affected the way people who know we've experienced a mental health care diagnosis  in our family treat me. Many cannot even respond to the information, and since I know the importance of being as open as I would with any illness, I continue to speak informatively as possible in hopes of slowly but surely eroding the shame and stigma. that seems so difficult to eradicate. Being treated as "other" is part and parcel of this disease. But supporting one another through a mental  health diagnosis builds a likemindedness and sense of community that limits the sense of "other."



Dear Colleague,

I am going to pivot off your last sentence, "But supporting one another through a mental  health diagnosis builds a likemindedness and sense of community that limits the sense of "other."


I hear the voice of a consumer who, like me, immensely appreciates this CareForYourMind discussion opportunity, as well as DBSA support groups, Melody Moezzi and all the professionals whose expertise we read in BP and Experanza magazines. Then we have the plethora of books, both non-fiction and, more and more, engaging and instruments-of-healing first person stories.

Thank you for sharing!