Transcript Culture and Psychopathology

CULTURE AND PSYCHOPATHOLOGY
PSYC 338
Case Study
Mr. and Mrs. Gomes, a first-generation Portuguese
American couple brought their 20-month-old son John to
the developmental-behavioural clinic because of his refusal
of food, inadequate weight gain and poor sleeping patterns.
Mrs. Gomes and her mother had taken to feeding John all
day long, following him around with food and a spoon as he
played. John looked thin, pale and weak to his mother and
grandmother and that image was reinforced by neighbors
and relatives.
Sleep subsequently emerged as a problem within a week of
the Gomes’s moving form the maternal grandparents’ home
to their own place where they had lived the first 9 months.
What do you need to consider when helping the family?
Culture permeates all aspects of
Psychopathology
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Experience
Expression
Explanation
Assessment
Treatment
Culture and Psychopathology
• What’s normal and abnormal ?
• Expression of Abnormal Behavior
• Assessment and Diagnosis of Abnormal
Behavior
• Explanations of Psychopathology
• Treatment
What’s normal?
Mental illness in a Laotian village
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Dangerous behavior
Disruptive and dysfunctional activities
Communication problems
Delusions
Inappropriate affect
Somatic symptoms
Case Studies
A Pakistani patient complains of pain and
weakness
“ I have pains in my head, I have a body ache”
“ I have lost all of my strength”
What’s your diagnosis?
Expression of Abnormal Behavior
Symptoms of depression as an affective disorder
Affect- depressed mood
Behavior- withdrawn
Cognitive- guilt, worthlessness
Somatic complaints
Is depression manifest the same way across cultures?
Studies of Depression
Kleinmann’s study in Taiwan:
• 88% complained of somatic symptoms
• 40% never admitted to depressed affect
• 28% rejected the notion they were
depressed
Cross-cultural study (Ulusahin et al., 1994):
• Turkish patients had higher scores for somatic
complaints
• British patients had higher scores for core psychological
complaints
Matsumoto’s cross-cultural study:
• Americans experiences more intense emotions for a
longer duration than Japanese
Feelings of Guilt
Guilt-based societies:
“I have done something wrong, and even if it is never
discovered and nobody else but me knows about it, I am
distressed and disgusted with myself.”
Shame-based societies:
“I have done something wrong in the eyes of other people.
People who matter to me are disgusted with my behaviour,
and therefore I am distressed because I cannot face them.
Assessment and Psychological
Testing
Chinese Personality Assessment Inventory
• Mental disorders are caused by malfunction
of the vital organs (SOM)
• I have to hide my homosexual orientation (SM)
• I feel indebted to people around me. (DEP)
Assessment and Psychological
Testing
American Indian Depression Scale
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Worry sickness
Unhappiness
Heart-broken
Drunken-like craziness
Disappointment
Explanations of Psychopathology
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Biological
Psychological
Social
Spiritual
Ecological
Treatment of Psychopathology
• Importance of matching treatment with
explanation
• Similarity of process across therapeutic
approaches
MODELS OF PSYCHOPATHOLOGY
UNIVERSAL MODELS AND CULTUREBOUND SYNDROMES
Models of culture and pathology
• Psychopathology as universal
• Psychopathology as culturally constructed
• Hybrid orientation to psychopathology
Assumptions of the Universal
Perspective
• Abnormal behaviors occur across cultures
• Principal categories of psychopathology occur
world-wide
• Incidence and prevalence of disorders in
diagnostic categories vary little across cultures
• Manifestation of various disorders are similar
Standardized Diagnostic
Systems
• International Classification of Disorders
(ICD-10)
• Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV)
Empirical Research
• Affective Disorders
• Schizophrenia
• Childhood Disorders
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Suicide
Alcoholism
Anxiety Disorders
Personality Disorders
WHO study of affective disorders
• Schedule for Standardized Assessment of
Depressive Disorders
• Switzerland, Canada, Japan, Iran
• Core symptoms present in 76% of cases
• Cultural variations in some symptoms and
in the expression of depression
Schizophrenia
• WHO pilot study
• Two year follow-up
• WHO prospective study
Pilot Study
• 1200 patients in 9 countries
• Nigeria, India, Taiwan, Czech Republic,
Denmark, Russia, U.K., Columbia, U.S.
• Core symptoms
Two year follow-up
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75% of original patients
Most positive symptoms absent
Cultural variation in negative symptoms
Cultural variation in prognosis
Cultural variation in predictors
Prospective Study
• 1300 patients in 10 countries
• Incidence of functional psychosis
comparable across cultures
• More acute onset in developing countries
Childhood Disorders
• Reactions to temperament differ
• Diagnosis of hyperactive and disruptive
behaviours of children appears to be
culturally variable: function of the
nationality of both the child and the
diagnostician
• Childhood Behaviour Checklist
Culture Specific Idioms of Disease
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Ataque de nervios
Nervios
Rootwork
Susto
Culture Bound Syndromes
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Amok
Koro
Latah
Anorexia nervosa
Does the DSM-IV provide an
adequate classification
scheme for mental disorders?