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Conventional approaches often frame low mental health help-seeking as a literacy deficit, viewing traditional beliefs merely as barriers. This overlooks the profound cultural and spiritual significance of local healing practices. Moving beyond the deficit model, this study explores the lived experience of cultural dissonance -the tension arising from navigating competing biomedical and traditional frameworks- and the resulting adaptive strategies. A 12-month integrated qualitative study, combining Critical Ethnography and Interpretative Phenomenological Analysis. Participants (N= 42) included patients, family caregivers, traditional healers (bomoh), and healthcare providers. Data were gathered through 1,200 hours of immersive observation, semi-structured interviews, and visual narrative elicitation.
Findings reveal three dimensions of cultural dissonance: Compartmentalized Compliance, where patients lead a double life by presenting a clinical self in biomedical settings and a spiritual village self at home; Semantic Dissonance, the reframing of diagnoses into culturally meaningful terms to preserve identity; and Silent Betrayal, where accepting biomedical treatment is perceived as a transgression of faith or filial loyalty. Resolution occurs primarily through cultural authorization, where trusted authorities (ustaz, bomoh, elders) legitimize medical care within a spiritual framework. Consequently, stigma and non-compliance are often expressions of unresolved dissonance. To be effective, mental health systems must shift from purely educational campaigns toward culturally embedded collaboration, partnering with traditional and religious authorities to create hybrid, acceptable pathways to care
