1 Psychology 307: Cultural Psychology Lecture 23

2 ● For those students who did not write a paper, the exam is worth one-third of your final grade; for those students who did write a paper, the exam is worth one-quarter of your final grade. ● The exam will be scored out of 50 points: multiple choice questions (1 point each) Short answer questions (ranging in value from 2 to 8 points, totaling points) Exam: April 21, 3:30-6:00 PM, Hebb Theatre

3 ●In addition to questions related to lecture content, the exam will include questions related to chapters 7, 9, 10, and 12.

4 ● Bring a pencil, eraser, pen, and your student ID to the exam. ● All electronic devices must be put away before the start of the exam. ● Bags and backpacks should be left at the front of the room. Please do not bring valuables to the exam. ● Hats (e.g., baseball caps) should not be worn during the exam.

5 Office Hours I will hold my regular Friday office hours through to April 21 st. In the week prior to the final exam, I will hold additional office hours: Friday, April 15: 2:00-4:30 Tuesday, April 19: 1:00-3:00 Wednesday, April 20: 11:30-1:30

6 Reminder Please note that course evaluations are available online. If you have not received an directing you to the evaluations for this course, you may provide your evaluation at: Course evaluations will be available until April 10 th. Your feedback is extremely valuable—both to the Psychology Department and to me.

7 Health 1. What is a psychological disorder? 2.What psychological disorders are universally recognized? 3. What psychological disorders are culture-bound? 4. Are Western psychotherapeutic approaches effective for the treatment of psychological disorders among individuals living in non-Western cultures?

8 By the end of today’s class, you should be able to: 1. discuss cultural differences in rates of depression. 2. explain cultural differences in the symptoms of depression. 3. discuss cultural similarities in rates of schizophrenia. 4. discuss cultural differences in the symptoms and prognosis of schizophrenia.

9 6. describe “indiginous” forms of psychotherapy. 5. generate examples of culture-bound disorders.

10 What is a psychological disorder? A woman is in the midst of a group of people but seems totally unaware of her surroundings. She is talking loudly to no one in particular, is often using words that people around her find unintelligible, and is occasionally barking. When later questioned about her behaviour, she reports that she was talking with a man who had recently died and had briefly been possessed by the spirit of a dog.

11 ● Psychological disorders are typically described as states that: (a) are statistically rare. (b) cause subjective distress or impaired social functioning. ● Cognitive or behavioural patterns that are described as psychological disorders in one culture may not be described as psychological disorders in other cultures.

12 ● In recent years, researchers have become increasingly interested in examining differences in the occurrence of psychological disorders across cultures. ● Their research has demonstrated that there are psychological disorders that are universally recognized and psychological disorders that are specific to distinct cultural groups.

13 What psychological disorders are universally recognized? 1. Depression  According to the DSM, depression is characterized by a depressed mood, an inability to experience pleasure, fatigue, changes in appetite or sleep patterns, poor concentration, a sense of guilt or worthlessness, and suicidal ideation.

14  Across cultures, medical practitioners have identified individuals who display this pattern of symptoms, suggesting that depression is a universal psychological disorder.

15  Nevertheless, the prevalence of depression and the primary symptoms of depression vary across cultures. With respect to the primary symptoms of depression, psychological symptoms are most frequently reported in some countries (e.g., Canada, the U.S.), whereas somatic symptoms are most frequently reported in other countries (e.g., China, Mexico).

  Neurasthenia is a relatively common diagnosis among Chinese psychiatric patients, not found in the DSM. Neurasthenia is characterized by somatic symptoms: poor appetite, headaches, insomnia, inability to concentrate. Kleinman (1982) interviewed Chinese neurasthenia patients and concluded that a majority (87%) could be diagnosed as having depression, although only 9% of them reported depressed mood as a chief complaint.

17  Several theories have been proposed to account for cultural differences in the primary symptoms of depression: (a) Cultural differences in the stigma associated with a psychological versus physiological disorder. (b) Cultural differences in the tendency to attend to psychological versus somatic symptoms. (c) Cultural differences in the tendency to view the mind and body as distinct entities.

18 2. Schizophrenia  According to the DSM, schizophrenia is characterized by auditory and visual hallucinations, delusions, disorganized speech, flat affect, and disorganized or catatonic behaviour.  Across cultures, medical practitioners have identified individuals who display this pattern of symptoms, suggesting that schizophrenia is a universal psychological disorder.

19  Multinational studies (Colombia, Czechoslovakia, Denmark, England, India, Nigeria, the Soviet Union, Taiwan, US; WHO, 1973, 1919, 1981) indicate that the prevalence of schizophrenia is similar across countries and has remained relatively constant across time.  Across countries, males are more likely to develop schizophrenia than females.

20  Nevertheless, the primary symptoms of schizophrenia vary across cultures. Paranoid hallucinations and delusions (indicative of paranoid schizophrenia) are most frequently reported in some countries (e.g., England, the U.S.), whereas catatonic behaviour (indicative of catatonic schizophrenia) is most frequently reported in other countries (e.g., India, Nigeria).

21 3. Other disorders  There are several other psychological disorders identified in the DSM that are found across cultures: Social anxiety disorder Attention-Deficit/Hyperactivity Disorder (ADHD) Personality disorders (e.g., antisocial personality disorder)

22 What psychological disorders are culture-bound? 1. Amok  The most widely observed culture-bound syndrome, identified in several Southeast Asian countries (e.g., Malaysia, Indonesia, Thailand).  More common among males than females.

23  Characterized by wild, aggressive behaviour of limited duration in which there are attempts to kill or injure others. Brooding and withdrawal proceed the outburst. Exhaustion and amnesia follow the outburst.  Precipitated by a slight or insult; brought on by stress, sleep deprivation, and alcohol consumption.  Hypothesized to emerge in societies that encourage people to be passive and nonconfrontational; pent up frustrations erupt as rage.

24 2. Pibloktoq (Artic hysteria)  Identified among Arctic and sub-Arctic Inuit communities, such as the Greenland Eskimos.  More common among females than males.  Characterized by extreme excitement, physical violence, verbal abuse, and convulsions. Individuals flee from protective shelters, tear off their clothing, and expose themselves to the extreme temperatures. Individuals may imitate the cry of an animal or bird during the attack.

25  Brought on by environmental conditions (e.g., isolation, darkness) and dietary deficiencies. 3. Shinbyeong (Spirit sickness)  Identified among Koreans.  More common among females than males.

26  Characterized by a loss of appetite, weakness, insomnia, dizziness, fear, and gastrointestinal problems. The symptoms progress to include mental disturbances: Dreams of communication with God, hallucinations, dissociation, possession by ancestral spirits.  Brought on by a spiritual “calling” to become a shaman.

27 4. Witiko (Windigo psychosis)  Identified among the Algonquian Indians.  More common among males than females.  Characterized by an insatiable desire to eat human flesh even when other food sources are available. Individuals are thought to be possessed by the “witiko spirit.” If the condition cannot be cured, sufferers often request that they be executed in order to avoid harming others.

28  Brought on by starvation anxiety.  A highly debated disorder (is it a racist fabrication?).

29 5. Other disorders  The DSM recognizes a host of other culture-bound syndromes: Ataque de nervios, Brain fag, Dhat, Frigophobia, Koro, Latah, Locura, Mal deojo, Rootwork, Susto, Whakama, and Zar are among them.

30 Are Western psychotherapeutic approaches effective for the treatment of psychological disorders among individuals living in non-Western cultures? ● Two evidence-based psychotherapeutic approaches are frequently used in the treatment of psychological disorders in Western cultures: Cognitive-behavioural therapy: Modification of debilitating thoughts and behaviours. Interpersonal therapy: Interpersonal skills training.

31 ● Research has established the effectiveness of these approaches for treating North Americans of European descent. ● Moreover, the scant research (Miranda, 2005) that has examined the effectiveness of these approaches with other cultural groups suggests that they are effective.

32 ● Nevertheless, there has been an increased interest among researchers in indigenous therapeutic approaches. ● Several indigenous therapeutic approaches have been identified. These approaches are comparable to CBT and IPT in their effectiveness.

33 1. Morita therapy  Developed in Japan.  Goal of therapy: To have patients accept reality rather than attempt to bring reality in line with personal needs and desires.  Procedure involves 4 stages:

34 (a) total bed rest and isolation. (b) light work, maintenance of a diary, continued isolation with the exception of therapist visits. (c) heavier work, continued maintenance of a diary, participation in lectures on self-control and the evils of egocentricity. (d) return to full social life, continued out-patient contact with the therapist in group sessions.

35 2. Naikan therapy  Developed in Japan.  Goals of therapy: (a) The discovery of authentic guilt for having been ungrateful and troublesome to others in the past. (b) The discovery of gratitude towards individuals who have extended themselves to the patient in the past.

36  Procedure: The patient introspects from 5:30 a.m. to 9 p.m. for 7 days. The patient is instructed to look at her/his relationships from 3 perspectives: Care received, repayment, and trouble caused.  Interviews are conducted every 90 minutes. The interviews are conducted in “a boldly moralistic manner, placing the burden of blame on the client rather than on others” (Murase, 1982, p. 318).

37 3. Chinese Taoist cognitive therapy  Developed in China.  Goal of therapy: To regulate patients’ negative affect and correct maladaptive behaviour through the reinforcement of Taoist principles. Taoism “focuses on conforming to natural laws, letting go of excessive control, and the flexible development of personality” (Zhang et al., 2002).

38 (a) identify stressors that contribute to the patient’s illness. (b) examine the patient’s cognitive evaluations of the stressors. (c) analyze the patient’s primary coping styles.  Procedure involves 5 stages:

39 (d) have the patient read Taoist writings and reflect upon the writings in a diary. (e) assess the effectiveness of the treatment via patient self-reports and clinical assessments.