Abstract Mental disorders affect approximately 450 million people globally, with a disproportionate burden in low- and middle-income countries where cultural and religious beliefs strongly influence illness perceptions and pathways to care. In such settings, symptoms are often interpreted through spiritual or supernatural frameworks, contributing to delays in accessing psychiatric treatment. This case series aims to illustrate how cultural and religious explanatory models shape symptom interpretation and help-seeking behavior, and to derive implications for culturally competent psychiatric care. This study was conducted in a tertiary care psychiatry setting in India. Four cases were purposively selected over a defined clinical period based on the presence of culturally mediated interpretations that significantly influenced care pathways. Data were obtained from clinical interviews, patient records, and collateral information from family members. The cases included obsessive-compulsive disorder misinterpreted as spiritual awakening, mania perceived as divine inspiration, dissociative disorder viewed as spirit possession, and psychosis following head injury attributed to supernatural causes. Cultural validation of symptoms contributed to delays in psychiatric consultation ranging from weeks to several months. Variations were observed in how different symptom types were interpreted, with some behaviors normalized or reinforced and others stigmatized or concealed. Cultural explanatory models play a significant role in shaping mental illness trajectories and delays in care. Clinicians should actively elicit and engage with patients’ cultural beliefs using culturally sensitive approaches. Training in cultural competence and collaboration with faith healers and community stakeholders may improve early identification and referral, thereby reducing delays and improving outcomes.
Usmani et al. (Wed,) studied this question.