Abnormal Psychology - Classification Systems Bolton

Discuss the concepts of normality and abnormality

Pick 2 Studies to “Discuss the concepts of normality and abnormality

Bolton (2002) & Parker et al ;

Bolton is in cultural differences in definitions

Parker is using symptoms to define abnormality

Bolton (2002) 6 STEPS THAT WERE NECCESSARY FOR AN EMIC APPROACH IN DIAGNOSIS

1. Collection of data on local perceptions of mental health in the community.

2. Analysis of the data for evidence that they meet some of the Western indicators of mental problems thus making comparison possible.

3. Use these data to adapt and translate existing questionnaires that measure these indicators

4. Test the credibility of these questionnaires

5. Used the validated instrument in a community-based survey

6. Analyze the data to assess the local prevalnce and characteristics of the selected mental health indicators.

Bolton (2002) AIM

Was to investigate the local validity of Western mental illness concepts.

* Was a Western diagnosis of depression or PTSD accepted by the local community as a valid description of their response to trauma?

Bolton (2002) WHAT TYPE OF STUDY

A Case Study

Bolton (2002) WHERE WERE THEY STUDYING

2 rural areas in Rwanda

Bolton (2002) WHAT INTERVIEW STYLES DID THEY USED

• Free Listing

• Key informant interviews

• Pile sorts

Bolton (2002) WHAT IS FREE LISTING

• Provided local terms for mental symptoms and disorders

• Interviewers asked 40 local people to name all the problems that had resulted because of the Rwandian Genocide. Asked to briefly describe each one.

• Using Inductive content analysis, they pulled out symptoms that were related to mental health

Bolton (2002) WHAT WERE THE 2 LOCAL DISORDERS

• Guhahamuka

• Agahinda gakabije

Bolton (2002) SYMPTOMS FOR EACH DISORDER

Guhahamuka:

• Failure to sleep, hopelessness, anger, inability to pray, too many thoughts, acting like a crazy person, acting without thinking, and attempting suicide.

Agahinda gakabije:

• Isolation, lack of self-care, not working, drunkenness, feeling life is meaningless, sadness, difficulty interacting with others, and burying your cheek in your palm.

Bolton (2002) WHAT IS KEY INFORMANT INTERVIEWS

It provided more detailed information about these disorders.

* When mental health issues were identified, participants were asked the names of the people in the community who were knowledgeable about these problems.
* Further interviews were then carried out. 7 people were identified as knowledgeable (traditional healers and local leaders).

Bolton (2002) WHAT ARE PILE SORTS

These confirmed the relationships between symptoms and disorders.

A set of cards was created which included mental health symptoms that were identified (guhahamuka & agahinda gakabije) in the first interview.

• The healers were asked to sort the cars based on similarity.

• The healers and local leaders included 3 symptoms with the DSM diagnosis of depression:

  • Lack of trust in others

  • lower intellectual ability

  • mental instability

They then used these local symptoms as part of their questionnaire which they made to determine the majority depression levels in the community.

Bolton (2002) RESULTS

• The interviewees described the diagnostic symptoms of depression and PTSD as results of the genocide.

• They also described associated “local” symptoms not included in the established diagnostics criteria.

• They divided symptoms into a “mental trauma” syndrome that included PTSD symptoms and some depression and local symptoms of guhahamuka, also a grief syndrome that had other depression and local symptoms agahinda gakabiji.

After the questionnaires were made,

• 93 people were identified as having mental health issues within the community.

• When interviewed, 70 were diagnosed by local healers as they had showings of agahinda gakabiji.

• When given the new questionnaire 30 of those diagnosed tested positive for signs of depression.

• The relationship between agahinda gakabiji and depression was the same as that between grief and depression in the Western world.

• To a larger community; 18% met the DSM criteria for depression and 42% described themselves of having agahinda gakabiji.

Bolton (2002) WHAT DOES THIS SHOW

This shows the difficulty of measuring dysfunction and distress.

Depending where you are there are different words to similar things. DSM was used and only 18% met the criteria, but locally with their symptoms, 40% said they had it.

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It also shows the cultural differences in determining abnormality.

Bolton (2002) STRENGTHS

An emic approach makes use of local resources in order to help with the diagnosis of mental health issues.

• By adopting this approach, clinicians consider how the various components of culture have shaped an individual’s health and help to determine the appropriate treatment.

• This process is highly systematic; making use of data triangulation to strengthen the credibility of the findings.

• Back translation

Bolton (2002) WEAKNESSES

• The research is reliant on determining which Western disorder resembles the locally defined problems.

  • The diagnosis of depression is then based on local definitions of the symptoms, compared to the symptoms in DSM.

• There is no outside way to verify an actual diagnosis of depression.

• Emic approaches are also limited to the community that is studied.

  • This makes it have a low generalizability

• It fails to recognize that cultures are dynamic, complex social constructs which go against the simple definition of measurement. It is possible that the symptoms of the rural communities in Rwanda are a direct result of the genocide, which then these symptoms could be different in other parts of Rwanda.