Culture and Mental Health (Abnormality)

Defining abnormality Psychopatalogy is believed to be related to culture and can be understood within the culture framework  this is called CULTURE RELATIVISM

Introduction This lecture highlights on a few things: what constitutes of being normal vs abnormal in traditional (mainstream) belief of psychology. Differences in abnormal behaviour across cultures. Treatment in abnormal behaviours across cultures.

Limitations in defining abnormality in traditional approach a. Statistical approach to due to rare occurances/infrequent b. Impairment/ inefficiency when carrying out customary roles - hallucinations might prevent people from performing normal roles  e.g. thought that being followed by somebody, always being scared of something, thus prevent from perform activities/duties. c. Deviance – behaviours that are against social norms  e.g. homosexuality is deviant in Malaysia, but not in most states in the USA. d. Subjective distress – depends on a person’s perception on how distress is viewed.

Cross-cultural research on abnormal behaviours Schizophrenia Depression Somatisation Cultural-bound syndrome

Culture and schizophrenia SCHIZOPHRENIA = a group of psychotic disorders featured by:  gross distortions of reality,  withdrawal from social interaction, and  disorganisation of thought, perception, and emotion (Carlson, Butcher, & Coleman, 1988).

The etiology (penyebab) of schizo is due to biological (excess of dopamine or biochemical imbalances) and environmental factors (e.g. hostility in family). Diathesis-stress model  those who are biologically predisposed to schizo, and living in hostile environment, have more chances to become one (schizoic). Culture and schizophrenia

The WHO research (1973, 1979, 1981) was conducted in comparing the prevalence and course of schizophrenia in several continents. - found that research assessment in diagnosing schizophrenia was reliable. - also, similar (universal) symptoms found for schizophrenia, i.e. lack of insight, auditory and verbal hallucinations, and ideas of reference ( that becoming the centre of attention). HOWEVER…… Culture and schizophrenia

People of developing countries (i.e. Colombia, India and Nigeria) recovered at faster rates than those of highly industrialised countries (e.g. USA, UK) These differences were attributed to cultural factors, such as the presence of kin networks (a lot of relatives to turn to for support) and the tendency to hurry back to work (no work, no money, no food on the table) Culture and schizophrenia

Murphy (1982) – Irish admitted for schizophrenia 4 times higher than the English and Welsh Sue & Morishima (1982) – Schizoic Japanese were more withdrawn and passive than their European counterparts  reflecting the Japanese culture. Culture and schizophrenia

Expressed emotion as a mechanism in identifying relapse cases in schizophrenia patients may raise a question as whether or not it is appropriate to be used amongst cultures that do not encourage verbal communication (Kleinman, 1988). Racial bias in diagnosis of schizophrenia may account for some cultural differences in the expression of symptomatology. Culture and schizophrenia

Depression Depression = “intense sadness, feelings of futility and worthlessness, and withdrawal from others” (Sue, Sue & Sue, 1990). Depression = characterised by physical changes, emotional and behavioral changes. Some cultures (e.g. Nigerians) are less likely to report extreme feelings of worthlessness. Others (e.g. Chinese) are more likely to rpeort somatic complaints. Rates of depression also vary from culture to culture.

Somatization Somatization – bodily complaints due to psychological distress. Japanese, and Chinese > somaticize more than Europeans/ Americans

Culture-bound syndrome Culture-bound syndrome – forms of abnormal behaviour observed only in certain sociocultural milieus.

Types of culture-bound syndrome 1.Amok – sudden rage and homicidal aggression; probably due to stress, less sleep, & alcohol consumption. 2.Witiko – (windigo) –amongst Alongquin Indians in Canada – man-eating monster  suicide to avoid cannibalistic urges. 3.Anorexia Nervosa – distorted body image, fear of becoming fat, serious loss of weight by food restraining or purging. Found in urbanised part of the world.

Types of culture-bound syndrome 4. Zar – an altered state of consciousness amongst Ethiopian immigrants to Israel. Believe to be possessed bu Zar spirit, expressed by involuntary movement, mutism, and incomprehensible language. 5. Sinking heart – condition of distress in the Punjabi culture, affecting heart or chest; probably due to excessive heat, exhaustion, worry, or social failure

Others: whakama (in New Zealand) Avanga – In Tonga Latah – amongst Malay women in South EastAsia, esp. in Malaysia. Koro – retracting of penis, in Southeast Asian man. Susto Types of culture-bound syndrome

Culture, assessment and treatment of abnormal behaviour In assessing abnormal behaviour, psychologist seek to classify abnormal behaviours into categories. There is limitation on DSM and ICD-10 (International Classification of Diseases 1oth ed.) in assessing abnormal behaviour. Cultural sensitive therapist should be knowledgeable in diverse cultures and lifestyles, skillful and comfortable in using innovative treatment method, and experienced in working with culturally diversified clients.