Two Views on Culture & Psychopathology

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Two Views on Culture Psychopathology

• Chapter 9

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Definition

• Possible Models for Defining Disorders
• Mental disorder as a violation of cultural
  standards.
• Mental disorder as maladaptive or harmful
  behavior.
• Mental disorder as emotional distress.
• Mental Disorder Any behavior or emotional state
  that causes an individual great suffering or
  worry, is self-defeating or self-destructive, or
  is maladaptive and disrupts the persons
  relationships or the larger community.

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Diagnostic and Statistical Manual IV

• Axis I Clinical Syndromes
• other important conditions that could be the
  focus of clinical attention
• Axis II Personality Disorders or Mental
  Retardation
• Axis III General Medical Conditions
• Potentially relevant to the understanding of
  management of the individuals mental disorder
• Axis IV Psychosocial and Environmental
  Conditions
• Primary support group, edul/occupl problems,
  problems from health care services, housing
  economic legal problems
• Axis V Global Assessment of Functioning Scale

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Concerns About Diagnostic System

• The danger of overdiagnosis.
• The power of diagnostic labels.
• Confusion of serious mental disorders with normal
  problems.
• The illusion of objectivity

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5 Areas Where Culture Affects Psychological
Disorders

• Subjective experience
• Knowledge about psychological problems
• Idioms of distress
• Culture-based display rules general ways
  individuals explain express their symptoms
• Diagnoses
• Includes professional/nonprofessional judgments
• Treatment
• How psychopathological symptoms are overcome
• Outcome
• Principles for treatment evaluation
• (Castillo, 1997)

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Alternative Hypotheses

• Relativist perspective
• As humans develop ideas, establish behl norms,
  learn emotional responses on the basis of
  culture, they should understand psychological
  disorders differently
• Universalist perspective
• Due to humans sharing similar attitudes, values
  behavioral responses, their understanding of
  mental disorders should be universal

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Culture-Bound Syndromes I

• A set of psychological phenomena of particular
  interest to psychologists
• Psychopathological symptoms w/o organic cause
  recognized as an illness w/I a cultural group,
  but not in the West e.g., amok in Malaysia
• Psychopathological symptoms recognized in the
  West but lacking some of the symptoms and salient
  features of the West I.e., shenjing shaijo in
  China like depression w/o depressed mood I.e.,
  neurasthenia
• Discrete disease not recognized in the West e.g.,
  kuru I.e., progressive psychosis/dementia in New
  Guinea

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Culture-Bound Syndromes II

• An illness w/ similar symptoms in other cultures,
  but only recognized as an illness in one e.g.,
  koro I.e., fear of disappearing genitalia
• Culturally accepted explanatory mechanisms not
  matching Western idioms e.g., evil eye
• Set of behaviors like trance, possession,
  speaking w/ dead, or loss of soul
• Syndrome w/I a cultural setting that does not
  seem to exist e.g., cannibal obsession

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Environment, Culture, Mental Health

• Psychophysiological model holds that health
  problems begin w stressors I.e., environmental
  challenges, demands, threats (McAndrew et al.,
  1998)
• Illness poverty are linked cross-culturally
• Concepts of mental illness evolve
• Understanding change
• Attitudes toward change

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Projective Tests

• Projective Tests Psychological tests used to
  infer a persons motives, conflicts, and
  unconscious dynamics on the basis of the persons
  interpretations of ambiguous stimuli.
• Rorschach Inkblot Test A projective personality
  test that asks respondents to interpret abstract,
  symmetrical inkblots.

A sample inkblot
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Objective Tests

• Inventories Standardized objective
  questionnaires requiring written responses they
  typically include scales on which people are
  asked to rate themselves.
• Minnesota Multiphasic Personality Inventory
  (MMPI) A widely used objective personality test.

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Anxiety Disorders

• Anxiety and Panic
• Fears and Phobias
• Obsessions and Compulsions

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Anxiety and Panic

• Generalized Anxiety Disorder A continuous state
  of anxiety marked by feelings of worry and dread,
  apprehension, difficulties in concentration, and
  signs of motor tension.
• Panic Disorder An anxiety disorder in which a
  person experiences recurring panic attacks,
  feelings of impending doom or death, accompanied
  by physiological symptoms such as rapid breathing
  and dizziness.

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Posttraumatic Stress Disorder

• Posttraumatic Stress Disorder (PTSD) An anxiety
  disorder in which a person who has experienced a
  traumatic or life-threatening event has symptoms
  such as psychic numbing, reliving the the trauma,
  and increased physiological arousal.

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Fears and Phobias

• Phobia An exaggerated, unrealistic fear of a
  specific situation, activity, or object.

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Obsessions and Compulsions

• Obsessive-Compulsive Disorder (OCD) An anxiety
  disorder in which a person feels trapped in
  repetitive, persistent thoughts (obsessions) and
  repetitive, ritualized behaviors (compulsions)
  designed to reduce anxiety.

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Anxiety Disorders/Cross-Cultural Issues

• Material achievement anxiety is common in the
  West, but not in most other countries
• Middle Eastern women are reluctant to go to
  public places, but this is not agoraphobia
• Fear of spirits is normal in some countries, but
  if extreme, then it may reflect a phobia
• Repetitive praying is not OCD unless it
  interferes with social functioning
• Similarity of symptoms does not accompany
  similarity of severity cross-culturally

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Depression

• Major Depression A mood disorder involving
  disturbances in emotion (excessive sadness),
  behavior (loss of interest in ones usual
  activities), cognition (thoughts of
  hopelessness), and body function (fatigue and
  loss of appetite).

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Symptoms of Depression
DSM IV Requires 5 of these within the past 2 weeks

• Depressed mood
• Reduced interest in almost all activities
• Significant weight gain or loss, without dieting
  
• Sleep disturbance (insomnia or too much sleep)
• Change in motor activity (too much or too
  little)
• Fatigue or loss of energy
• Feelings of worthlessness or guilt
• Reduced ability to think or concentrate
• Recurrent thoughts of death

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Universal Core Symptoms

• Dysphoria
• Anxiety
• Tension
• Lack of energy
• Ideas of insufficiency
• Tanaka-Matsumi Draguns, 1997)

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Gender, Age, Depression

• Women are about twice as likely as men to be
  diagnosed with depression.
• True around the world
• After age 65, rates of depression drop sharply in
  both sexes.

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Clinical Diagnosis

• Impacted by
• Diagnostic practices
• E.g., women in Japan not diagnosed with
  depression because its viewed as a mental illness
  and will limit their chance to marry
• Understanding of the symptoms by the individual
• Disclosure of the symptoms

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Culture Suicide

• Every 15 minutes someone in U.S. takes their life
• Low rates in Muslim Catholic countries
• Higher rates in western Protestant countries
• Sri Lanka Hungary have highest rates
• Mexico has a lower rate than Puerto Rico
  Indigenous influence?
• Sometimes religious beliefs facilitate suicide
  i.e., 9-11

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ADHD

• Attention Deficit Hyperactivity Disorder
• Persistent inattention, hyperactivity,
  restlessness
• Higher incidence in China lower in England,
  but inconclusive
• Classroom size lower socioeconomics impact
  occurrenceas does education

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Personality Disorders

• Problem Personalities
• Antisocial Personality Disorder

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Problem Personalities

• Personality Disorder Rigid, maladaptive patterns
  that cause personal distress or an inability to
  get along with others.
• Narcissistic Personality Disorder A disorder
  characterized by an exaggerated sense of
  self-importance and self-absorption.
• Paranoid Personality Disorder A disorder
  characterized by habitually unreasonable and
  excessive suspiciousness and jealousy.

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Antisocial Personality Disorder

• Antisocial Personality Disorder (APD) A disorder
  characterized by antisocial behavior such as
  lying, stealing, manipulating others, and
  sometimes violence and a lack of guilt, shame
  and empathy.
• Sometimes called psychopathy or sociopathy

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Drug Abuse and Addiction

• Biology and Addiction
• Learning, Culture, and Addiction
• Debating the Causes of Addiction

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Learning, Culture, and Addiction

• Addiction patterns vary according to cultural
  practices and the social environment.
• Policies of total abstinence tend to increase
  addiction rates rather than reduce them.
• Not all addicts have withdrawal symptoms when
  they stop taking a drug.
• Addiction does not depend on the properties of
  the drug alone, but also on the reason for taking
  it.

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Debating the Causes of Addiction

• Problems with drugs are more likely when
• A person has a physiological vulnerability to a
  drug.
• A person believes she or he has no control over
  the drug.
• Laws or customs encourage people to take the drug
  in binges, and moderate use is neither tolerated
  nor taught.
• A person comes to rely on a drug as a method of
  coping with problems, suppressing anger or fear,
  or relieving pain.
• Members of a persons peer group use drugs or
  drink heavily, forcing the person to choose
  between using drugs or losing friends.

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Schizophrenia

• Symptoms of Schizophrenia
• Theories of Schizophrenia

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Symptoms of Schizophrenia

• Bizarre Delusions
• Hallucinations and Heightened Sensory Awareness
• Disorganized, Incoherent Speech
• Grossly Disorganized and Inappropriate Behavior

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Delusions and Hallucinations

• Delusions False beliefs that often accompany
  schizophrenia and other psychotic disorders.
• Hallucinations Sensory experiences that occur in
  the absence of actual stimulation.

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Positive and Negative Symptoms

• Positive Symptoms Cognitive, emotional, and
  behavioral excesses
• Examples of Positive Symptoms
• Hallucinations
• Bizarre Delusions
• Incoherent Speech
• Inappropriate/Disorganized Behaviors

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Positive and Negative Symptoms

• Negative Symptoms Cognitive, emotional, and
  behavioral deficits
• Examples of Negative Symptoms
• Loss of Motivation
• Emotional Flatness
• Social Withdrawal
• Slowed speech or no speech

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Theories of Schizophrenia

• Genetic Predispositions
• Structural Brain Abnormalities
• Neurotransmitter Abnormalities
• Prenatal Abnormalities

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Culture Schizophrenia

• Impacts 1 of worlds population
• Highest rates in Ireland
• Higher rates for Blacks than European Americans
• Treatment in U.S. involves drugs and incorporates
  family support