Two Views on Culture & Psychopathology

1. Two Views on Culture & Psychopathology Chapter 9

2. 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 person’s relationships or the larger community.

3. 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 individual’s mental disorder • Axis IV: Psychosocial and Environmental Conditions • Primary support group, edu’l/occup’l problems, problems from health care services, housing & economic & legal problems • Axis V: Global Assessment of Functioning Scale

4. 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

5. 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)

6. Culture & Diagnosis • 1.Thomas, A. & Sillen, S. (1979). Racism and psychiatry. Secaucus, NJ: the Citadel Press, page 2. " The Black man, it was repeatedly claimed, was uniquely fitted for bondage by his primitive psychological organization. For him, mental health was contentment with his subservient lot, while protest was an infallible symptom of derangement. Thus a well-known physician of the ante-bellum South, Dr. Samuel Cartwright of Louisiana, had a psychiatric explanation for runaway slaves. He diagnosed their malady as drapetomania, literally the flight-from-home-madness, ‘as much a disease of the mind as any other species of mental alienation.’ Another ailment peculiar to Black people was dysaethesia Aethiopica, sometimes called rascality by overseers, but actually due to ‘ insensibility of nerves’ and ‘hebetude of mind’, explained Dr. Cartwright. Whereas psychologically normal Negroes were faithful and happy –go-lucky, the mentally afflicted ones ‘pay no attention to the rights of property…slight their work…raise disturbances with their overseers.’ "

7. Alternative Hypotheses • Relativist perspective • As humans develop ideas, establish beh’l 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

8. 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

9. 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

10. 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

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

12. 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.

13. Anxiety Disorders Anxiety and Panic Fears and Phobias Obsessions and Compulsions

14. 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.

15. 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.

16. Fears and Phobias • Phobia: An exaggerated, unrealistic fear of a specific situation, activity, or object.

17. 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.

18. 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

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

20. 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

21. Universal Core Symptoms • Dysphoria • Anxiety • Tension • Lack of energy • Ideas of insufficiency • Tanaka-Matsumi & Draguns, 1997)

22. 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.

23. 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

24. 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

25. 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

26. Personality Disorders Problem Personalities Antisocial Personality Disorder

27. 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.

28. 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

29. Drug Abuse and Addiction Biology and Addiction Learning, Culture, and Addiction Debating the Causes of Addiction

30. 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.

31. 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 person’s peer group use drugs or drink heavily, forcing the person to choose between using drugs or losing friends.

32. Schizophrenia Symptoms of Schizophrenia Theories of Schizophrenia

33. Symptoms of Schizophrenia • Bizarre Delusions • Hallucinations and Heightened Sensory Awareness • Disorganized, Incoherent Speech • Grossly Disorganized and Inappropriate Behavior

34. 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.

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

36. 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

37. Theories of Schizophrenia • Genetic Predispositions • Structural Brain Abnormalities • Neurotransmitter Abnormalities • Prenatal Abnormalities

38. Culture & Schizophrenia • Impacts 1% of world’s population • Highest rates in Ireland • Higher rates for Blacks than European Americans • Treatment in U.S. involves drugs and incorporates family support