The relationship of culture to chronic mental illness is reviewed in a cross-national and cross-ethnic perspective. The author critically examines the argument, based on differential prognosis for serious mental illness in developing and industrial countries, that chronicity is a cultural artifact. Key questions include whether cultural beliefs and practices that minimize social stigma, self-devaluation, and patients' assumption of the sick role are linked to better prognosis. World view, religion, alternative healing resources, values of interdependence, extended kinship structure, family support, and professionals' willingness to work collaboratively with families are viewed as cultural strengths that may help to mediate the course of mental illness. Issues that are relevant to treatment of long-term psychiatric disability in ethnic patients in the United States include interetbnic differences in the distribution of cases and service utilization patterns, diagnostic and medication issues, and development of culturally relevant treatment modalities.