The role of culture in the perception and expression of stress and distress: experience from Oman

1
The role of culture in the perception and
expression of stress and distress experience
from Oman

• Samir Al-Adawi
• Associate Professor
• College of Medicine Health Sciences,
• Sultan Qaboos University

2
Sultan Qaboos University
3
What is Stress?

• Pioneering studies by Hans Selye in the
  1960s laid foundation for modern conception of
  stress
• Stress refers to events that are perceived as
  endangering ones physical or emotional
  wellbeing

Selye H (1978) The stress of life (New York
McGraw-Hill)
4
Eustress (good stress)
Distress (unhealthy stress)
5
Interim Questions

• Could events that are perceived as
  endangering ones physical or emotional wellbeing
  lead to distress?
• The American Institute of Stress have
  reported that 75 to 90 of all hospital visits
  are stress-related.
• Could perception be shaped by socio-cultural
  factor?
• Could stress and distress be experienced in
  socio-cultural context?

6
AIMS

• This session will
• Focus on cultural patterning and social behavior
  in Oman
• Highlight how distress is narrated among Omanis
• Highlight good practice guideline relevant to
  Oman

7
Aim 1 Focus on cultural patterning and social
behavior in Oman

• QEUSTION How individual is socialized in Oman?

8
Cultural patterning and social behavior in Oman

• Parenting style
• ACTIVE
• PASSIVE
• UNINVOLVED

• Dwairy et al.(in press). Parenting styles,
  individuation, and mental health of Arab
  adolescents A third cross-regional research
  study. Journal of Cross-cultural Psychology.

9
Cultural patterning and social behavior in Oman

• Arab vs. Western societies

• Collective social orientation
• Oriented towards group affiliation and
  interdependence

• Individualistic social orientation

10
Cultural patterning and social behavior in Oman
11
Cultural patterning and social behavior in Oman
12
Aim 2 Highlight how distress is narrated among
Omanis

• QUESTION How stress and distress is experienced
  in Oman?

13
When confronted with negative emotions

• Some people isolate
• themselves and
• ruminate over the problem
• Some people distract
• themselves
• (e.g. by exercising)
• Some avoid the problem by resorting to
• harmful behavior such as excessive
• drinking

How effective is each of these behavior?
14
(No Transcript)
15
How stress and distress is experienced in Oman?

• Shame vs. Guilt

• When a social impropriety occurs in Oman
• - An individual feels ashamed," suggesting that
  his or her feelings are controlled by the
  perceptions of others.
• When a social impropriety occurs elsewhere
• - An individual will experience sense of "guilt
  resulting from intra-psychic conflict between
  one's behavior and one's self.

16
How stress and distress is experienced in Oman?

• The avoidance of self-disclosure
• Many colloquialisms suggest caution
  regarding verbal expression.
• Tour tongue is like your horse, if you watch
  over it, it will watch over you."
• Complaining to anyone other than God is a
  disgrace
• "The walk can hear"
• Avoidance associated with emotional material

17
How stress and distress is experienced in Oman?

• Depending on the level of education,
  distresses are attributed to sensate
  agents/external forces.

Wasta Magic Evil Eyes Hasad
18
Untimely death
Zombies in Oman The Mu Ghayeb belief
in Omani society involves a complete denial of
the loss for a relatively long period with the
expectation of the return of the dead. Al-Adawi
S, Burjorjee RN, Al-Issa I (1997). Mu Ghayeb A
culture-specific response to bereavement in Oman.
INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY, 43,
144-151.
19
Distress experienced in consistent with cultural
teaching
Active parenting within an collective culture
is not as harmful as within a liberal culture.
AL LAWATI J. et al. (2000). Psychological
morbidity in primary healthcare in Oman A
preliminary study. Journal for Scientific
Research Medical Sciences, 2, 10510. KOUSSOUS
KJ. AL-ADAWI S. (in press). Suicide in
sultanate of Oman descriptive study among Omanis
and expatriates. Journal for Scientific Research
Medical Sciences. Zaidan ZAJ. et al. (in press).
Hazardous and harmful alcohol consumption among
non-psychotic psychiatric clinic attendees in
Oman. International Journal of Mental Health and
Addiction. ZAIDAN ZAJ. ET AL. (in press).
Hazardous and harmful alcohol consumption among
non-psychotic psychiatric clinic attendees in
Oman. International Journal of Mental Health and
Addiction
20
Gender vulnerability to stress and distress

• Insignificant gender gap in education and
  social empowerment
• Over 30 of the labour force in the
  government sectors are females

21
Data suggest that females with lower educational
levels, married or divorced women have
significant risk factor for feeling burned out
at the workplace. On the whole, females do
better than males. Males are likely to develop
stress-induced physical illness than female
counterpart.AL-RIYAMI K. (2006). OCCUPATIONAL
STRESS IN OMAN. Unpublished Master Thesis,
Submitted to Business School, University of
Glamorgan, UK
Gender vulnerability to stress and distress
22
Work vs. Home stress
Home-stress

• Work-stress

23
Possible predisposing factors leading to distress
at occupational settings

24
Major changes in life circumstances

• Money from oil has brought Omanis progress
  through development in less than 20 years,
  development that took a thousand years in Europe
  
• Smith (Lancet, 1988)

25
CULTURAL CONSTRAINS AND MODERNITY
26
CHANGING GOALPOST

• Omanis tend to regard the ability to seek
  higher social .. as an acquired right
• (Skeet,1992)
• there are too many Ph.Ds and too few mechanics
• (Looney, 1994)

27
CHANGING GOALPOST
The 17-item Effort-reward Imbalance (Siegrist,
2002) on Omani sample suggests 35 perceived
themselves putting more and receiving less
AL-RIYAMI K. (2006). Occupational Stress in
Oman. Unpublished Master Thesis, Submitted to
Business School, University of Glamorgan, UK
28
Perceived threat
29
AIM 3 Highlight good practice guideline
relevant to Oman

• Question What can be done?

30
Organizational burdens due to stress

• 150 billion of revenue is lost to stress
  annually in poor decision making, stress related
  mental illness and substance abuse (National
  Occupational Research Agenda Priorities for the
  21st century. Washington DC, 200).
• Stress-related illnesses entail lower
  productivity
• Stress-related illnesses increase sick leaves
• Stress-related illnesses often result in early
  retirements
• Stress-related illnesses often result in huge
  staff replacement cost

31
Global Burden of Diseases

• World Health Organization
• World Bank
• NGOs

Years of life lost by premature death Years of
life lived with a disability of known severity
The World Health Organization estimates that
stress-related disorders will be one of the
leading cause of disabilities by the year 2020
32
GOOD PRACTICE GUIDELINE 1 Standardization of
taxonomy

• What is stress?
• 68 bad day
• 57 too much to do
• 64 an illness

• Burnout syndrome
• Adjustment vs. Maladjustment

Do not medicalize maladjustment at workplace
33
GOOD PRACTICE GUIDELINE 2 Identify and quantify
the magnitude of maladjustment

• Identify source of maladjustment within the
  organization
• Quantify magnitude of maladjustment at
  workplace
• Lack of validity of assessment measures
• Al-Adawi S et al, (2004). Apathy and Depression
  in Cross-Cultural Survivors of Traumatic Brain
  Injury. Journal of Neuropsychiatry Clinical
  Neurosciences, 16, 435-442.
• Al-Adawi S et al. (2002). A survey of anorexia
  nervosa using the Arabic version of the EAT-26
  and "gold standard" interviews among Omani
  adolescents. Eating and Weight Disorders, 7,
  304-311.

34
GOOD PRACTICE GUIDELINE 3 cease perpetuating
maladjustment

• Current focus on performance appraisal
  should be matched with art of living
• Rewarding those individuals whose
• lifestyles keep maladjustment away

35
GOOD PRACTICE GUIDELINE 4 Devise counseling at
workplace using trained experts
Anthrotherapist A person who is very well
acquainted with the social structure and use that
knowledge to mediate between the workplace and
individual's wellbeing
Traditional cultural identity Biculturally
well-integrated identity Bicultural
unintegrated identity COCONUT (Assimilated
-acculturated identity)
36
Conclusion

• Occupational health services were created in the
  19th century as part of social measures to
  counter-balance the negative effect of industrial
  revolution (Froneberg, 2006).
• Initial focus has been on work-related accidents
  and improving quality of life
• The disability caused by stress is just as
  serious as the disability caused by workplace
  accidents or traditional enemy such as
  malnutrition and infectitious diseases.
• Available view on maladjustment is derived from
  Euro-American population -20 of the world
  population.
• Culture-sensitive approach to occupational health
  services would be essential in this era of
  globalization and to promote pluralism within
  globalization
• Modern organization requires those who can work
  with others. Social behavior in Oman is
  congruent with such view.

37
Self-Evaluation Topography of Oman
Topographical features of Oman and stress

• Rock
• Sand
• Water

38
Topographical features of Oman and stress

• Rock-type
• As if writing your problems in the rock, you
  give way to problems and retain them for a long
  time
• Sand-type
• As if writing your problems in the sand, you
  give way to disappointment but the disappointment
  quickly passes away
• Fallaj/Wadi-type
• As if writing your problems in running water,
  always remains pure and undisturbed.

39
THANK YOU!
40
Acknowledgment

• AL-ADAWI S et al. (2005). Japanese Journal of
  Psychosomatic Medicine, 45, 933-941.
• AL-ADAWI S, BURJORJEE RN, AL-ISSA I (1997).
  International Journal of Social Psychiatry, 43,
  144-151.
• Al-Adawi S. et al. (2004). Journal of
  Neuropsychiatry Clinical Neurosciences, 16,
  435-442.
• AL-ADAWI S. et al. (2005). New Developments in
  Eating Disorders Research. New York Nova Science
  Publishers.
• AL-BUSAIDI ZQ (2005). Rethinking Somatisation
  The Attitudes and Beliefs about Mental Health in
  Omani Women and their General Practitioners.
  Unpublished PhD Thesis, School for Community
  Health, Division of Psychiatry, University of
  Nottingham.
• AL-HINAI SS. et al. (2006). College Students
  Mental Health and Coping strategies. New York
  Nova Science Publishers.
• AL-LAWATI J. et al. (2000). Journal for
  Scientific Research Medical Sciences, 2, 10510.
• AL-RIYAMI K. (2006). OCCUPATIONAL STRESS IN
  OMAN. Unpublished Master Thesis, Submitted to
  Business School, University of Glamorgan, UK.
• DWAIRY M VANSICKLE TD. (1996). Clinical
  Psychology Review, 16, 231-249.
• IVEY, AE SUE, DW (2006). Multicultural
  foundation of psychology and counseling. New
  York Teachers Colleges Press.