Culture and Mental Illness

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Culture and Mental Illness
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What is Mental Illness?

• Actually, the preferred term is Psychological
  Disorder. The problem with using Mental illness
  is that it implies a medical disorder which is
  not the case.
• A Psychological Disorder is defined as any
  psychological dysfunction associated with
  distress or impairment in functioning that is not
  typical or culturally expected.

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What Constitutes Abnormality?

• Defining Abnormality
• Statistical approach-define behavior as abnormal
  because its occurrence is rare or infrequent.
• Problem Not all rare behavior is abnormal.
• Whether an individuals behavior is associated
  with impairment or inefficiency, deviance, or
  subjective distress.
• Problem Using Social Norms.

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Most Common Types of Psychological Disorders

• Depression
• Depression is a mood disorder characterized by
  feelings of extreme sadness and dejection more
  than just the feeling of sadness we all
  experience at times!
• Depression is one of the most common mental
  disorders. Roughly from 15 to 25 will
  experience depression at some time in their life.
  

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Psychological Disorders (cont.)

• Bipolar Disorder
• Bipolar disorder, like depression, is a mood
  disorder. It is a new name for what used to be
  called manic depression. Bipolar disorder affects
  the functioning of the brain, causing exaggerated
  swings of mood from being high, over-excited and
  self-important to feeling extremely low and
  helpless, and having difficulty in making
  decisions.

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Psychological Disorders (cont.)

• Anxiety
• Anxiety disorders, of which there are several
  types, have in common an intense and paralyzing
  sense of fear or a sustained pattern of worrying
  when there is no real danger or threat.

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Psychological Disorders (cont.)

• Anxiety disorders include
• 1) panic disorders
• 2) phobias
• 3) obsessive-compulsive
• disorder (OCD)
• 4) post traumatic stress
• disorder PTSD)

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Psychological Disorders (cont.)

• Schizophrenia
• Schizophrenia interferes with the mental
  functioning of a person and limits our ability to
  think, feel and act.
• Symptoms include
• - delusions,
• - phobias,
• - hallucinations and
• - confused thinking.

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Psychological Disorders (cont.)

• An alarming fact
• Approximately one in a hundred people (1) will
  develop schizophrenia. Some may experience only
  one or more brief episodes, while for others, it
  remains a life-long condition.

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Psychological Disorders (cont.)

• Eating Disorder
• Anorexia and bulimia are the two most recognized
  and serious eating disorders. Each involves
  having a preoccupation with control over eating,
  body weight and food. People with anorexia are
  determined to control the amount of food they
  eat, while people with bulimia tend to feel out
  of control where food is concerned.

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Whats the Role of Culture?

• Two points of view
• 1. Culture and psycho-pathology are
  inseparableabnormal behaviors can only be
  understood within the cultural context in which
  they occur.
• This perspective is called CULTURAL RELATIVISM

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Cultures Role?

• 2. Basic psychological disorders are present
  in all cultures. (universality argument)
• Culture, however, plays a role in determining
  the exact behavioral and contextual manifestation

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Cross-Cultural Research

• International Pilot Study of Schizophrenia
• Discovered set of symptoms across cultures lack
  of insight, auditory and verbal hallucinations,
  ideas of reference (assuming one is center of
  attention).
• Also discovered course of illness easier for
  patients in developing countries (i.e. Colombia,
  India, and Nigeria vs. England, Soviet Union, and
  U.S.).
• Differences in symptom expression Patients in
  U.S., less likely to demonstrate lack of insight
  and auditory hallucinations than Danish or
  Nigerian patients.

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Cross-Cultural Research (cont.)

• Cross-cultural studies of depression
• World Health Organization Study
• Investigated Depression in Canada, Switzerland,
  Iran, and Japan
• 76 reported cross-culturally constant
  symptoms-sadness, joylessness, anxiety, tension,
  lack of energy, loss of interest, loss of ability
  to concentrate, and ideas of insufficiency.
• More than half reported suicide ideation.

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Cross-Cultural Research (cont.)

• Other studies report differences in expression of
  symptoms
• Some cultural groups less likely to report
  extreme feelings of worthlessness and
  guilt-related symptoms.
• Others are more likely to report somatic
• complaints.
• Cultures vary in communication of emotional
  terminology and hence, how they experience and
  express depression (Leff, 1977).

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Cross Cultural Research (cont.)

• Somatization
• Bodily symptoms/complaints as expression of
  psychological distress.
• Some studies indicate, certain cultural groups
  (Hispanics, Japanese, Arabs) somaticize more than
  Europeans or Americans.
• However recent studies, indicate that there is
  not much support that somatization varies across
  cultures (Kirmayer, 2001).
• Although previously considered culture specific,
  it is a universal phenomenon with culture
  specific meanings and expressions.

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Culturally Bound Syndromes

• Culturally Specific Syndromes
• Forms of abnormal behavior found only in certain
  cultures
• AMOK sudden rage and homicidal aggression
• - Found Parts of Asia (Malaysia, Philippines,
  Thailand)
• WITIKO (OR WINDIGO) possession by an evil
  spirit (witiko, a man-eating monster)
• - Can produce cannibalistic behavior
• - Found Algonquin Indians in Canada

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Culturally Bound Syndromes (cont.)

• ANOREXIA NERVOSA distorted body image, fear of
  getting fat, a serious loss of weight from food
  restraining or purging
• - Found Although at first limited to Western
  Europe and North America, the disorder is
  spreading to other cultures.
• ZAR involuntary movements, mutism,
  incomprehensible language
• - Found Africa (possession by Zar)

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Culture and Psychiatric Diagnoses

• Culture and Psychiatric Assessment
• The DSN (Diagnostic and Statistical Manual of
  Mental Disorders)
• First published in 1952, it is currently in its
  fifth edition, DSN-V
• This latest version, DSM-V-TR, claims to
  acknowledge the influence of culture.

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Developing Diagnostic Systems Across Cultures

• Diagnostic and Statistical Manual of Mental
  Disorders
• Adjustments were made to most recent version to
  include
• Incorporating information on how manifestations
  of symptoms can vary across cultures
• Including 24 culture bound syndromes in the
  appendix
• Adding in depth guidelines for including cultural
  backgrounds
• However, Even the most recent DSM Edition does
  not require an assessment of cultural elements.

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Developing Diagnostic Systems Across Cultures
(cont.)

• International Classification of Diseases
• 100 major diagnostic categories encompassing 329
  individual clinical classifications.
• Fails to incorporate culture.
• Chinese Classification of Mental Disorders
• Has culture specific features that do not exist
  in international systems

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Cross Cultural Assessment

• Traditional tools are based on a standard
  definition of abnormality and standard set of
  classification.
• Therefore having little meaning in cultures with
  varying definitions.
• The American Indian Depression Schedule
• Developed to assess depressive illness.
• Includes items not found in the Diagnostic
  Interview Schedule and the Schedule for Affective
  Disorders and Schizophrenia.
• Researchers have offered guidelines for
  developing measures.
• Examine socio-cultural norms of healthy
  adjustment and culturally based definitions of
  abnormality.

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Cross Cultural Assessment (cont.)

• Cultural backgrounds of therapist and client
  contribute to perception and assessment of mental
  health.
• 2 types of errors in making assessments (Lopez,
  1989)
• Overpathologizing-clinician incorrectly judges
  the clients behavior as pathological when in
  fact they are normal in that individuals
  culture.
• Underpathologizing-a clinician explains the
  clients behavior as cultural when in fact it is
  an abnormal symptom.

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Mental Health of Ethnic Minorities

• African Americans
• Reiger et al (1993)
• Studied over 18,000 adults from five US cities on
  the prevalence of a variety of disorders.
• Found that prevalence of mental illness was
  higher among African American than European
  American
• Lindsey and Paul (1989)
• African American more often diagnosed with
  schizophrenia than European Americans.
• Differences may be due to SES disparities
• When Regier controlled for SES, the prevalence
  difference disappeared.
• Differences in misdiagnosis may be due to biases

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Mental Health of Ethnic Minorities

• Asian Americans
• Some studies indicate a higher prevalence of
  mental disorders among Asian than European
  Americans
• However, other studies indicate a variation
  within Asian Americans depending on Ethnic
  Background, Generational Status, and Immigrant or
  Refugee Status
• I.e. Kuos study (1984) found that Korean
  Americans had higher rates of depression followed
  by Fillipino Americans, Japanese Americans, and
  Chinese Americans.

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Mental Health of Ethnic Minorities

• Latino Americans
• Fewer differences have been found between Latino
  Americans and European Americans in rates of
  psychiatric disorders.
• Canino et al. (1987) study of Puerto Ricans
• Reported similar lifetime and 6-month prevalence
  rates of disorders compared with there US
  communities.

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Mental Health of Ethnic Minorities (cont.)

• Also significant within group differences
  depending on specific Latino group.
• I.e. one study found Puerto Ricans have higher
  rates of major depression than Cubans and Mexican
  Americans. (Cho, 1993)
• US born Mexican Americans in California showed
  rates of mental disorders similar to US
  nationals, whereas Mexican-born showed lower
  rates. (Alderete et al. 2000)

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Mental Health of Ethnic Minorities

• Native Americans
• Few studies have included this group, but those
  that have suggest that Depression is a
  significant problem.
• Alcohol abuse, and rates of suicide significantly
  higher than US nationals.
• Migrants
• Experiencing stresses associated with
  acculturation may lead to poorer mental health
  (Berry and Sam, 1997)
• Findings are inconsistent
• Refugees
• Migrants forced to flee from their countries
  because of political violence, social unrest,
  war, etc.
• They report higher rates of PTSD, depression and
  anxiety.