Type II Diabetes from Person to World

1
Type II Diabetes from Person to World

• Shoshana D. Kerewsky, Psy.D.
• 3/1/07
• CPSY 607
• Physiological Psychology from an Ecological Model

2
A Personal Narrative

• A history of my own body and symptoms
• 1990 2002
• Diagnostic mishaps
• Other generic symptoms subject to
  misidentification
• E.g., fatigue, depression, confusion

3
A Personal Narrative

• Iatrogenic issues
• Previous diagnoses
• Disinterest
• Lack of cultural information
• Effects of poverty
• Acupuncture
• Metaphor My Furnace Saga

4
Type II Diabetes Basics

• Etiology of Type II diabetes
• The cyclic trap of Type II diabetes
• Functional description of insulin/glucose
  problems
• Vectors for dysregulation
• Diet
• Lack of exercise
• Stress
• Medication
• Etc.

5
Type II Diabetes Basics

• Interventions
• Best practice is ecological and holistic
• Typical intervention is allopathic and small
  systems focused
• Cultural relevance
• Type II diabetes in the world
• Cultural salience
• Explanation and intervention must
• make sense in cultural context
• be feasible
• attend to all levels of the clients ecology

6
And yet

• Examine general diabetes and psychotherapy texts
• Examine cultural health texts
• What do you notice?

7
Cambodia

• Findings
• The expected rate of Type II diabetes is low
• The surveyed rate is higha quarter of adults in
  surveyed areas have at least impaired glucose
  metabolism
• Cambodians are not obese
• Hypotheses
• Cambodians (Khmer) have Indian genetic loading
  for higher diabetes
• Nutritional deprivation from the Khmer Rouge
  period may have caused susceptibility to diabetes

8
Vietnam

• Findings
• The prevalence of diabetes rose 2.8 from 1993 to
  2001
• Hypothesis
• Shift to Western/industrialized lifestyle
• Changes in eating patterns
• Changes in physical activity

9
y?u t? ngan ng?a
ví d?
y?u t? r?i ro
báo, phim, truy?n hình, lu?t, qu? c?u t?
ngu?i d?i, tôn giáo, van hoá
s?c kho?, tình t? tin, s? b?t tài
Ð?i M?i
s? liên quan
gia dình, b?n bè, b?n h?c, b?n ? vi?c làm
th?i gian
Kerewsky_at_uoregon.edu
10
Case Study

• I will use the case of a 45-year old rural woman
  with Type II diabetes to illustrate the uses of
  this model.
• Diabetes is a serious and widespread problem in
  developing countries (Wild et al., 2004).
• The rate of Type II Diabetes in Ho Chi Minh City
  is increasing rapidly (Duc Son et al., 2004).
• Most of the information on Type II Diabetes that
  is available to clients and counselors focuses on
  the clients willpower and medical compliance,
  and ignores the large systemic and cultural
  factors that influence a persons ability to
  change his or her health behavior.

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Case Study

• Self-care for diabetes requires attention to diet
  and exercise and, in some cases, significant
  changes in these behaviors.
• Because food and weight have personal,
  interpersonal, and cultural meanings, clients
  with diabetes may have difficulty making and
  maintaining new health-promoting habits.

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A 45-Year Old Rural Woman with Type II Diabetes
Kerewsky_at_uoregon.edu
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Using the Ecological Model

• Many people, policies, and beliefs influence this
  client.
• It is not effective simply to tell her to take
  her medicine, change her diet, and exercise.
• The counselor can talk about these conflicts with
  the client so that she can recognize these
  influences and make good decisions.

14

• Questions and discussion