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 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 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Expression of Abnormal Behavior Symptoms of depression as an affective disorder Affect- depressed mood Behavior- withdrawn Cognitive- guilt, worthlessness Somatic complaints Is depression manifest the same way across cultures ?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 Worry sickness Unhappiness Heart-broken Drunken-like craziness Disappointment

Explanations of Psychopathology 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 CULTURE- BOUND 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 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 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 Ataque de nervios Nervios Rootwork Susto

Culture Bound Syndromes Amok Koro Latah Anorexia nervosa

Does the DSM-IV provide an adequate classification scheme for mental disorders?