Bipolar mental illness, along with schizophrenia, affects people in different cultures all over the world. These biologically based and possibly inherited tendencies are part of the human condition, it seems. Yet there are also regions of the planet, and cultural \u201cislands\u201d, where the bipolar tendencies toward depression and suicide are less common, or less severe. And then there are a few areas where they are more severe. So does culture matter in the prevention and care of bipolar spectrum disorders? Three core elements create some of the major differences between cultures in ways that may matter: location --where a culture is located and the environment from which it draws sustenance and meaning; food -- what foods a culture eats the most; and social structure --what kinds of relationships make up the community and how they structure the every day lives of the people of that culture.\r\nLocation\r\nIf lithium is implicated in manic depression, or bipolar dysfunction, and lithium is found naturally in higher doses in some places than others, does it matter where you live? Lithium is a naturally occurring element that shows up in soil, water, and certain plants. Doctors have used it successfully to treat bipolar mania for the last fifty years. Hirochika Ohgami and colleagues at Oita University analyzed the suicide rates in Japan\u2019s Oita Prefecture, and found that cities with higher levels of lithium in their drinking water experienced lower rates of suicide, as reported recently in the British Journal of Psychiatry. The amounts of lithium were still much lower than those in conventional medication, but there is a statistically significant difference that may be important for those with bipolar disorders. In a 1990 study of 27 Texas counties, researchers found an \u201cinverse association of tap water lithium content in areas of Texas with the rates of mental hospital admissions, suicides, homicides, and certain other crimes.\u201d It was also discovered that young men incarcerated for violent crimes in some parts of Texas had disproportionately low lithium levels. Schrauzer and Shrestha discovered that the negative correlation was confirmed, \u201c especially in the south-central region of the state where high suicide mortality rates correspond to low lithium concentrations.\u201d\r\nFood\r\nCould some cultures eat combinations of just the right lithium-rich foods and foods with omega three fatty acids to keep bipolar illness at bay? Foods rich in lithium include all kinds of dairy products, seaweed, potatoes, lemons, eggs, fish, grains, and vegetables. Natural mineral water and seawater also contain higher levels of lithium. While the amounts of lithium in these foods are far lower than clinical doses of lithium, a regular low dose of naturally occurring lithium may help to reduce bipolar illness. The Mediterranean diet, such as the traditional food eaten on the island of Crete, may provide an excellent combination of these foods. Likewise, the Japanese diets rich in fish and seaweed may also help prevent lithium deficiency. In a study titled, \u201cCross-National Comparisons of Seafood Consumption and Rates of Bipolar Disorders\u201d, scientists reported on the seafood consumption levels and rates of bipolar illness among nine countries. Their study showed the lowest lifetime prevalence rates of bipolar illness occurred in the countries with the highest levels of fish consumption, including Puerto Rico, Taiwan, Korea, and Iceland. Iceland had the highest rates of fish consumption \u2013 well above 200 pounds average per person per year\u2014and the lowest rates of diagnosed bipolar disorders. In Germany, where the consumption of fish is much lower, the lifetime prevalence rate was much higher \u2013 6.5 percent in Germany, versus 0.2 percent in Iceland. The authors concluded, \u201cThere is some evidence that eating a lot of fish, or at least those rich in the omega-three fatty acids, may be able to combat the depression of bipolar disorder.\u201d They note that it also may play \u201ca preventive and therapeutic role\u201d for depression.\r\nSocial Structure\r\nDo some cultures have social structures that promote better mental health? A series of well-known studies in the 1960s in the town of Roseto in Pennsylvania uncovered astonishing health statistics: no one was dying from heart attacks under age sixty-five, there were no suicides, no alcoholism, no drug addiction, and very little crime. Author Malcolm Gladwell notes, \u201cThe death rate from all causes in Roseto, in fact, was 30 to 35 percent lower than expected.\u201d Roseto was named after a town in Italy, and most people were immigrants from that town. They had brought their culture with them. Physician Stewart Wolf and sociologist John Bruhn found that the family structure in the homes, and culture of work and egalitarian ethics, as well as close connections with each other, was the answer. The family homes often had three generations living under one roof, and showed great respect for the elders. In the tight knit community, which stressed an egalitarian social structure, extended family clans, people spending time together, chatting in the streets, respect for elders and the calming effect of the Church, these factors combined to provide better health insurance than anything money could buy. With this study in mind, as well as many anthropological studies demonstrating the social strength of small face-to-face communities, it is possible to see another correlation in the nations showing lower rates of bipolar spectrum disorders. They are all island nations, or peninsular, and have numerous small tight-knit fishing communities. Because it takes years to learn to fish well on the ocean and even longer to gain the experience necessary to know where the fish will be, fishing is often a family business, with older generations teaching younger, and the younger family members showing respect, but also receiving support and direction. The community provides necessary support to the fishers and their families. Those who fish may be away from home for weeks at a time, plying a dangerous trade. Family members left behind build support networks in the community. Like Roseto, fishing communities with strong connections and generational family cohesion may provide an essential safety net that helps lessen the rates of bipolar spectrum disorders. It may be worth another study to find out. Culture apparently does matter. People with bipolar spectrum disorders and those supporting them might want to consider living in one of those places with a blue horizon --on an island or in a coastal community with access to lots of seafood, or in a desert community in Arizona or Chile or Bolivia where levels of lithium in the soil are high. They might want to choose a community where the pace of life is a little slower, relationships and work are constant over time, and people have time for talking \u2013 a face-to-face community where people really get to know each other. That supportive network may be the best \u2013 and cheapest\u2014investment people facing bipolar disorders can make. REFERENCES: Blade, Joseph C. and Gabrielle A. Carleson. 2007. \u201cIncreased Rates of Bipolar Disorder Diagnoses among U.S. Child, Adolescent, and Adult Inpatients, 1996-2004.\u201d Department of Psychiatry and Behavioral Science, Stony Brook State University of New York, published online 16 February, 2007. Gladwell, Malcolm. 2008. Outliers: The Story of Success. New York: Little, Brown and Company. Hirochika Ohgami, Takeshi Terao, Ippei Shiotsuki, Nobuyoshi Ishi, Noboru Iwata. 2009. \u201cLithium Levels in Drinking Water and Risk of Suicide.\u201d The British Journal of Psychiatry, 194: 464-465. Kessing, L.V. ,Sondergard, L., Kvist, K., & Anderson, P.K. 2005. \u201cSuicide Risk in Patients Treated with Lithium.\u201d Archives of General Psychiatry, Vol.162 (8), 860-866. Noaghiul, Simona, M.D., M.P.H. and Joseph R. Hibbely, M.D. 2003. \u201cCross-National Comparisons of Seafood Consumption and Rates of Bipolar Disorders.\u201d American Journal of Psychiatry 160 (12): 2222-7. Schrauzer, Gerhard N., PhD, CNS, FACN. 2002. \u201cLithium: Occurrence, Dietary Intakes, Nutrition Essentiality.\u201d Journal of the American College of Nutrition Vol 21, No.1, 14-21. Schrauzer, G.N. & Shrestha, K.P. 1990. \u201cLithium in Drinking Water and the Incidence of Crimes, Suicides, and Arrests Related to Drug Addictions.\u201d Biological Trace Elements Research 25, 105-113.