Signs vs. Symptoms in Mental Health: A Culturally Responsive Approach
Understanding the difference between signs and symptoms is foundational in mental health work, yet these concepts are often shaped by cultural context.
Signs are observable indicators that others can see—such as restlessness, changes in speech patterns, appearing disheveled, or social withdrawal.
Symptoms are subjective experiences reported by the individual, such as feelings of sadness, intrusive thoughts, difficulty sleeping, etc.
Recognizing Cultural Expressions of Mental Distress
Western mental health frameworks tend to define these terms through a biomedical lens, but for many BIPOC individuals, Indigenous communities, neurodivergent individuals, and other marginalized groups, emotional distress is often expressed in ways that challenge these definitions.
For instance, individuals might report headaches or stomachaches—physical signs—rather than discussing feelings of depression or anxiety, which are framed as psychological symptoms in the mental health field.
I know that for myself, I often say, "My heart hurts" when feelings of sadness arise, especially when witnessing injustice.
Impact of Stigma on Symptom Reporting
Stigma surrounding mental health across marginalized communities—including BIPOC individuals, disabled communities, LGBTQIA+ folks, military culture, and more—often leads to underreporting of symptoms. Cultural wounding and systemic oppression have ingrained the idea that struggling should be hidden, minimized, endured in silence, or even worn as a badge of honor, rewarding individuals for how much they can endure.
Many hesitate to share their experiences due to fear of judgment, shame, a history of cultural practices being pathologized, or even a lack of awareness of what their bodies are trying to communicate. Research has shown that stigma and cultural barriers contribute to delayed mental health treatment, particularly in communities facing systemic discrimination (Corrigan et al., 2014).
Suppression as Survival: Navigating Systemic Barriers
For many of us, identifying and naming our emotional experiences was never something we were taught. Instead, we were conditioned—whether through cultural wounding, societal expectations, or systemic barriers—to suppress distress and prioritize survival and productivity in the face of struggle. Many are expected to quickly move past pain and discomfort, not because healing has taken place but because expressing that pain makes others uncomfortable.
Even grief has been pathologized in the latest edition of the DSM with the introduction of prolonged grief disorder, which dismisses the humanity of individuals and enforces an unrealistic expectation of quick recovery after loss.
This suppression not only disconnects us from our own emotions and communities but also leads to misdiagnosis, inadequate care, and further harm. When providers are not trained to recognize the unique ways different communities express distress, symptoms are either ignored, mislabeled, or forced into frameworks that do not fit.
Cultural Considerations: Who Gets Seen and Heard?
Colonial and white-centric approaches to mental health have historically ignored or pathologized the ways communities experience and express distress. Consider the following:
In many Indigenous traditions, mental well-being is interconnected with the land, ancestors, and collective balance. What the Western model might label as "hallucinations" could be understood within these communities as spiritual communication (Gone, 2010).
Many BIPOC individuals are socialized to manifest emotional pain somatically. Instead of saying, “I feel depressed,” someone might report persistent headaches, fatigue, or stomach pain. Without cultural competence, these physical expressions of mental health struggles may be dismissed or misdiagnosed (Hinton & Lewis-Fernández, 2011).
Neurodivergent individuals may have their coping mechanisms misunderstood as defiance rather than as responses to overwhelm (Kapp et al., 2019).
LGBTQIA+ individuals often have their mental health struggles pathologized rather than acknowledged as responses to systemic oppression (Meyer, 2003).
Black children are often diagnosed with behavioral issues rather than being these signs being seen as symptoms of depression, anxiety, or the impacts of intentional and persistent oppression.
Larger-bodied individuals navigating fatphobia frequently have their symptoms of depression and anxiety ignored or attributed to weight rather than being properly assessed (Mensinger et al., 2018).
Disabled individuals are often gaslit about their experiences, with medical professionals prioritizing physical health over mental well-being and a lack of connection made between both. (Mollow, 2022).
The mental health system, as it exists today, was not built for authentic, genuine connection—it was built to maintain order and productivity, not to foster healing. This is why insurance companies still dictate how much care individuals receive and whether care should even be offered.
If we are to truly address mental health disparities, we must acknowledge the diverse ways communities experience and express distress. We must push for mental health care that is rooted in cultural humility, accessibility, and liberation, ensuring that healing is defined not by conformity or productivity but by the wholeness of each individual and community.
Reimagining Mental Health Care: A Path Toward Liberation
How Do We Shift This?
To honor the lived experiences of communities, mental health practitioners must:
✅ Engage in Cultural Competency Training – Learn how distress manifests across cultures to avoid misdiagnosis (Gone, 2021).
✅ Use Culturally Validated Tools – Standard diagnostic measures often fail BIPOC communities. We need assessments designed with cultural nuance in mind (Hinton & Good, 2016).
✅ Center Community Voices – Healing is collective. Work with community leaders, elders, and culturally specific healers.
✅ Identify and uproot oppressive, patriarchal, hierarchical beliefs within ourselves.
Mental health cannot be decolonized without shifting how we define, assess, and respond to signs and symptoms. We must move beyond colonial frameworks and toward approaches that recognize the full humanity of the communities we serve and cherish.
- Alyssa Cedillo MA, LPC-S, RPT-S™, IP-CST
References
Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science in the Public Interest, 15(2), 37-70.
Hoge, C. W., Castro, C. A., Messer, S. C., McGurk, D., Cotting, D. I., & Koffman, R. L. (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351(1), 13-22.
Mensinger, J. L., Tylka, T. L., & Calamari, M. E. (2018). Mechanisms linking weight stigma to disordered eating in treatment-seeking women. Appetite, 125, 298-305.
Mollow, A. (2022). Disability studies and the future of fatness. Hypatia, 37(1), 187-207.
Kapp, S. K., Gillespie-Lynch, K., Sherman, L. E., & Hutman, T. (2019). Deficit, difference, or both? Autism and neurodiversity. Developmental Psychology, 55(12), 2733.
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, bisexual, and transgender populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674-697.
