Lecture 5 Culture specific mental disorders Cross-cultural psychology Petra Chvojkova 2.4. 2015 Content u uClassification of mental diseases uPsychopathologies across culture uCulture-bound syndromes uCulture specific psychotherapy An example… Classification of mental diseases u uMENTAL DISORDER = “a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual [which] is associated with present distress…or disability…or with a significant increased risk of suffering.” u uPsychopathological symptom x culture norm u uDiagnostic and Statistical Manual of Mental Disorders DSM-V (by American Psychiatric Association) uToday DSM V has become the main system of classification of psychological disorders uInternational Classification of Diseases ICD 10 (by World Health Organization) u Psychopathological symptom Culture norm Biases in the classification system of mental disorders uThe goal - Reliable and valid classification system uExperience of mental disorder highly subjective -> highly subejctive its expression uDepends on The manner, in which the behavioural aspect expressed are acceptable or not in the society uChanges in professional knowledge uExample of homosexuality u removed from the category of psychopathology in 1973 in western world u X u abnormal behaviour + criminal offence in other countries (Uganda) u u== universal classification system difficult to achieve The link between culture and psychopathology u u u u u uHealth = „a state of complete physical, mental and social well-being, and not just the absence of disease or infirmity“ (WHO, 1948) u u uConcept of health differs across cultures Culture Mental illness MENTAL DISEASE uE. Kraepelin ustart of 20th century uComparative Psychiatry u= sub discipline in psychiatry to study cultural differences in psychopathology. uWestern illness perspective - Biomedical model of mental illness u„psychopathology essentially homogenous, with only superficial variation presentation across people“ u –>> position of extreme universalism Universalism of psychopathology u Prevalence of some mental health disorders across countries uStudy Goldberg and Lecrubier, 1995, Ustun and Sartorius, 1995) uPrevalence rate for Current Depression – 29,5% in Santiago, 2,3% in Nagasaki, 11,6% in Ankara. uPrevalence rate for Generalize Anxiety 0,9% in Ankara and 2,6% in Rio de Janierio u= psychopathology present in all societies + qualification what pathological and expression differ from society to society uKleinman – category fellacy - u impute the illness categories of their culture to other culture Psychopathologies across cultures u Schizophrenia uAprrox. 1% of the worlds population today is affected by schizophrenia ucultural practice may affect the apparent prevalence uIn US black have relatively higher rates of schizophrenia than whites uAcute and catatonic cases more prevalent in developing counties (compared developed ) uThe contents of delusions varied uReligious delusions and delusional guilt are primarily found in Christian traditions u=>Schizophrenia as moderate universal disorder recognizably present in all cultures, but respond to different cultural experience in prevalence rates and modes of expression, and prognosis u uHuge differences in prevalence and incidence rates across societies uPrevalence rate from 1,0% in Nigeria to 10,3% in the US uExplanation: research artefacts, differential use of diagnosis, variations in pathways to care, health care, attitudes towards physicians, different terminology in language for being depressed uDescriptions found in text of ancient civilizations as Egypt, China, in Ramayana u„depressed“ has no language equivalent among American Indians , some South Asian groups u u DEPRESSION DEPRESSION uCore symptoms uDysphoria, anxiety, tension, lack of energy, ideas of insufficiency uPeripheral uHeadaches in Latino, Mediterranean uWeakness, imbalance, tidiness in China and Asia uProblem of the „heart“ in middle Eastern u DEPRESSION uFear of stigmatization in some countries – other (somatic) diagnosis instead of depression uemotional disturbance not taken as mental illness , explained by situational factors (Zimbabwe ) uSome (affective and cognitive) symptoms underreported – more refer somatic complains uNon Western people tend to somatise their distress x Western cultures to psychologize uPhysical (somatic) symptoms such as headache more often in non-western countries uDisapproval of strong expression of negative emotions – directing emotional feelings into bodily –complaints is more legitimate uIn China neurasthenia (somatoform disorder x depression) Trauma uTraumatic events (terrorism, captivity, torture) produce similar behavioural responses in individuals of different national, cultural and religious backgrounds u ->posttraumatic stress disorder Culture and suicide uUS:India (suicide rate) = 2:1 uLow suicide rate: Syria, Egypt, Jordan and Kuwait uHigh rate: Japan, Singapore, Scandinavian, Central , East Europe uCauses such as alcoholism, group pressure, depressive disorder,… uSignificant relationship between societal complexity and frequency of suicide (Durkheim hypothesis) uSome religious beliefs may prevent from considering self-killing uCome cultural norms increase the social supportiveness among people Substance abuse uWide cultural variations in attitudes toward substance consumption, patterns of substance use, accessibility of substance and prevalence of disorder related to substance uHighest consumption : Argentina, Australia, Northern Hemisphere uLow consumption level : Africa, southern Asia, Indian Ocean uEuropeans consumes 50% alcohol on Earth Culture-bound syndroms u u= recurrent, locality-specific patterns of aberrant behaviour, and troubling experience (that may or may not be linked to a particular DSM-V diagnostic category) uAre found only in a particular cultural group uA collection of signs and symptoms which are restricted to a limited number of cultures primarily by reason of certain psychosocial features uCulturally unique or local expressions of some universal disorders uAll cultures have separate categories for normal and abnormal bahavior u uFound in the appendix of the DSM-IV, but not in the ICD-10 u u Psychotherapy across cultures u Psychotherapy u = alleviating the patients suffering due to a psychological problem or disorder u= special practice involving a designated healer (or therapist) and an identified client (or patient) with the particular purpose of solving a problem for which the client suffering or promoting the client's mental health. The practice may take various forms, and the fundamental orientation may be supernatural, natural, biomedical, sociophilosophical or psychological (Tseng, 2001) uCultural beliefs and practices usually enter into psychotherapeutic process u – part of the therapist's and patient's understandings of the problem Psychotherapy Indigenous psychotherapies uShared common culture uIndigenous healing practices produce psychotherapeutic effects – „folk psychotherapy“ uSeen as religious ceremonies or healing exercises related to supernatural or natural powers uThe mobilization of ones own resources through medico-religious practices that one believes in uIndigenous healers uMore accessible uAccept patient's description of problems uEmpathetic and charismatic – effective healing relationship uPlacebo effect Indigenous psychotherapies uExamples: religious healing practice, healing ceremony, shamanism, divination, fortune-telling, voodoo uMorita therapy and Naikan therapy in japan uhttp://en.wikipedia.org/wiki/Naikan uhttps://www.youtube.com/watch?v=StSqWdJfX8g u u Cross-cultural psychotherapy uacross international borders uwestern-based theory and method used to examine persons of other cultures uCommon core to psychotherapeutic practices but with different historical and cultural roots and highly varied cultural expressions uCan medical beliefs and practices from one culture be effective in the healing process in another culture? uGriner, Smith (2006) meta-analysis culturally adapted psychological intervention X traditional intervention uOverall positive effect of cult. Adapted therapy (d=0,3-0,6) u Multicultural psychotherapy uculturally sensitive and appropriate psychotherapeutic methods taking into consideration the cultural and ethnic backgrounds of the therapist and client and the acculturating context u=> incorporation of culture-relevant and culture-sensitive information into practice of psychotherapy with diverse clients uCultural adaptation of psychotherapeutic methods that have been proven scientifically to be effective uTherapist need to be aware of his own ethnic views and biases and how it may interact u u Resources uShiraev, E., Levy D. (2014). Cross-Cultural Psychology. Pearson. uBerry, J. W., Poortinga, Y. H., et al. (2011). Cross-cultural Psychology: Research and aplication. Third Edition. Cambridge university press. u Thank You