Culture And Psychopathology.docx

SELF-STUDY ASSSIGNMENT Culture and Psychopathology

Culture and psychopathology The word culture comes from the Latin word colo –ere, which means to cultivate or inhabit. Edward Burnett Tylor(1871) defined culture as, “That complex whole which includes knowledge, belief, art, morals, law, custom, and any other capabilities and habits acquired by man as a member of society.” According to UNESCO(2002) culture should be regarded as the set of distinctive, spiritual, material, intellectual, and emotional features of society, and that it encompasses, in addition to art and literature, lifestyles, ways of living together, value systems, traditions, and beliefs. Culture has many dimensions and it includes ethnicity, race, religion of the country, and many other features( Eshun and Gurung, 2009). Mental illness refers to a wide range of mental health conditions — disorders that affect your mood, thinking and behavior. Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors. According to WHO around 20% of the world's children and adolescents have mental disorders or problems, mental and substance use disorders are the leading cause of disability worldwide, and Over 800 000 people die due to suicide every year and suicide is the second leading cause of death in 15-29-year-olds. It has been well established now that Cultural dynamics play and important role in shaping the perceptions, beliefs and practises of people towards mental illness and its Treatment (Satcher,2001). Every society has its own culture and social norms which is distinct from others and these cultural and social norms define the person as normal or deviant ( Siewert, 1999). It has been seen that the Culture influences the Epidemiology, Phenomenology, outcome, and treatment of mental illness (Viswanath and Chaturvedi, 2012).

Theoretical Perspective To better understand how culture influences mental illness there are three theoretical perspectives explained by Berry in 1995, which are: 1. The absolutist view assumes that culture has no role in the expression of behaviour. This view implies that the presentation, expression, and meaning of mental illness are the same, regardless of culture. 2. Relativist view with the view that all human behaviour (including the expression of mental illness) ought to be interpreted within a cultural context. 3. The universalist view takes more of a middle position, with the assumption that specific behaviours or mental illnesses are common to all people, but the development, expression, and response to the condition is influenced by culture. A

study was done by Draguns in 1990 where it was confirmed that though sad mood, anxiety, lack of energy and tension was reported as the common symptoms of depression across cultures, the westerns reported guilt whereas non westerns somatic symptoms in addition to the common symptoms.

Different ways culture contribute to Psychopathology There are six different ways that culture can contribute to psychopathology (Tseng, 2001). 1. Pathogenic effects- refer to situations in which culture is a direct causative factor in forming or ‘generating’ psychopathology. Cultural ideas and beliefs contribute to stress, which, in turn, produces psychopathology. Stress can be created by culturally formed anxiety, culturally demanded performance, culturally prescribed restricted roles with special duties. The psychopathology that occurs tends to be a culturally related, specific syndrome; for instance,  The folk belief that death will result if the penis shrinks into the abdomen, inducing the Koro panic; or the popular anxiety over the ‘harmful’ leaking of semen, leading to the development of the semen-loss anxiety disorder, or Dhat syndrome. 2. Pathoselective effects- refer to the tendency of some people in a society, when encountering stress, to select certain culturally influenced reaction patterns that result in the manifestation of certain psychopathologies.  For example, in Japan, cultural influences lead a family encountering serious stress or a hopeless situation to choose, from among many alternative solutions, to commit suicide together, forming the unique psychopathology of ‘family suicide’ observed in Japanese society (Ohara, 1963). 3. Pathoplastic effects- refer to the ways in which culture contributes to the modeling or ‘plastering’ of the manifestations of psychopathology. Culture shapes symptom manifestations at the level of the content presented. The content of delusions, auditory hallucinations, obsessions, or phobias is subject to the environmental context in which the pathology is manifested.  For instance, an individual’s grandiose delusions may be characterized by the belief that he is a Russian emperor, Jesus Christ, Buddha, the president of the United States, or the prime minister of the United Kingdom, depending on which figure is more popular or important in his society. 4. Patho-elaborating effect-While certain behaviour reactions (either normal or pathological) may be universal, they may become exaggerated to the extreme in some cultures through cultural reinforcement (Simon, 1996).

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This is well illustrated by the unique mental phenomenon of latah, which is mainly observed in Malaysia. The phenomenon is characterized by the sudden onset of a transient dissociative attack induced by startling. The person is often provoked on social occasions and acts like a clown, providing social entertainment. Thus, culture supports the latah attack, and elaborates the function of this unique mental condition.

5. Pathofacilitative effects- imply that, although cultural factors do not change the manifestation of the psychopathology too much – that is, the clinical picture can still be recognized and categorized without difficulty in the existing classification system – cultural factors do contribute significantly to the frequent occurrence of certain mental disorders in a society. In other words, the disorder potentially exists and is recognized globally, yet, due to cultural factors, it becomes prevalent in certain cultures at particular times. Thus, ‘facilitating’ effects make it easier for certain psychopathologies to develop  A liberal attitude towards weapons control may result in more weapon-related violence or homicidal behaviour (Westermeyer, 1973); cultural permission to consume alcohol freely may increase the prevalence of drinking problems. 6. Pathoreactive effects- indicate that, although cultural factors do not directly affect the manifestation people’s beliefs and understanding of the disorders and mould their ‘reactions’ towards them.  An example of pathoreactive effects is susto. Susto is a Spanish word that literally means ‘fright’. The term is widely used by people in Latin America to refer to the condition of loss of soul (Rubel, 1964; Rubel et al., 1985). Susto is based on the folk belief that every individual possesses a soul, but, through certain experiences, such as being frightened or startled, a person’s soul may depart from the body. As a result, the soul-lost person will manifest certain morbid mental conditions and illness behaviour.

Culture Bound SyndromesThe term and the concept of "Culture-bound Reactive Syndromes" was introduced in the 1960s by Pow Meng Yap. Several hundred such conditions have since been cited in the literature under their indigenous names . Some were listed in a DSM-IV Glossary and in the ICD-10 Diagnostic Criteria for Research. Some culture bound syndromes are: 1. Amok- Malaysia A sudden, wild outburst of violent aggression or homicidal behaviour in which an afflicted person may kill or injure others, usually found in males. 2. Latah- Malaysia and Indonesia, Japan, Siberia

Hypersensitivity to sudden fright often occurring in middle aged women of low intelligence who are subservient and self-effacing. This disorder is precipitated by the word snake or by tickling. Characterized by echolalia and echopraxia. 3. Koro- Southeast Asia and China A fear or anxiety state in which a man fears that his penis will withdraw into his abdomen and he may die. This reaction may appear after sexual over indulegence or excessive masturbation. 4. Windigo- Algonquin, Indian hunters A fear in which a hunter becomes anxious and agitated, convinced that he is bewitched. Fear centres on his being turned into a cannibal by the power of the monster with an insatiable craving for human flesh. 5. Kitsunetsuki- Japan Victims believe that they are possessed by foxes and are said to change their facial expressions to resemble foxes. Entire families are often possessed and shunned by the community.

Indian Perspective India is culturally diverse country where it is believed that, in every twenty five miles we come in contact of people from a diverse culture( Srivastava, 2002). Srivastava(2002) has mentioned three different theories of causation of mental illness; 1. Supernatural theory- Possession of a evil/soul that causes a change in the psychology of person. These Psychological changes in the mind mark that person as mentally ill. 2. Shock theory- Sudden changes of the individual’s environment in which the individual is unable to cope with the situation, can lead to mental illness. 3. Biochemical theory- Shows that chemical imbalances occur in the brain and are causes of mental illness. So the treatment sought by the people depends on their beliefs about the cause of mental illness, people who believe in supernatural causes for mental illness prefer traditional healing practises to address mental illness. Upto about 70% to 80% of the population of mentally ill belong to rural areas and first visit religious places for their treatment( Trivedi and Sethi, 1979; Thara et al., 1998). People who have the knowledge of modern medicines prefer to consult with the Psychiatrist for their treatment.

Disorders- Prevalence, phenomenology and outcome 1.Schizophrenia .The prevalence of schizophrenia in “least developed” countries was significantly lower than in the “emerging” and “developed” countries. Indian studies have suggested that the prevalence of schizophrenia is lower in India than in the West. One reason for this difference could be underreporting. Indian studies have found FRS to be generally culture free. However, there is a lower occurrence of FRS in non-Western countries. FRS were present in 35% in India ( Avasthi, 2012).The Madras longitudinal study and the study of factors associated with course and outcome of schizophrenia demonstrated that two-thirds of schizophrenia patients in India have partial to full remission of symptoms (Thara, 2004). Kala and Wig, 1978 studied the content of delusions in paranoid schizophrenia in Indian patients and found that the common themes were of murder, assault, magic and religion. 2. Affective disorders The prevalence of affective disorders has been found to be lower in most Indian studies than the West ( Chandrashekhar, 2007). A comparison of depression in Western and non-Western societies noted that disorders of conduct and somatic complaints were more common in nonWestern cultures (Venkoba Rao, 1966).The outcome of affective disorders has been found to be favourable in India than in developed countries. In a 4-year follow-up of first-episode manic patients from Ranchi, 40% of the patients did not have any recurrences and 25% had one recurrence( Khess et al., 1997). 3.Obsessesive compulsive disorder

Religious and contamination concerns and repeating compulsions may be more common in Muslims than Christians due the emphasis on religious cleansing rituals and the practices of repeating religious phrases (to ward off sin and blasphemous thought) that forms an integral component of Islamic religion and culture(Okasha et al, 1996).

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