Lesson 7 (Part 1): Culture and Abnormality: Definitions, Diagnoses and Treatment Across Cultures

Abnormality

It might, for instance, be equated with deviation from the statistical norm.

Minority Practice

Abnormality may also be in a form of _______. An example of this is being nocturnal, which is abnormal because hardly anyone does it.

Ability to Function Occupationally or Socially

Abnormality may also be in a form of _______. An example of this one is a person seen as abnormal because he can’t hold down a job or he hasn’t got any friends.

Transgressing the Moral or Behavioral Codes

Abnormality may also be in a form of _______. An example of this is when your behavior may be normal in some places, but not in other areas.

Psychopathology

It refers to the psychological state without normal functioning, requiring treatment.

Mental Health

It is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively, and is able to make a contribution to his or her community.

Abnormal Psychology

The history of ________ teaches us that what is deemed abnormal in one cultural or temporal context may be perfectly acceptable elsewhere.

Auditory hallucinations, possession trance, and glossolalia are universally classified as mental disorders across all cultures without exception

Which of the following statements regarding the cultural and historical context of psychopathology is NOT true according to the slide?

• Homosexuality ceased to be regarded as pathological in the US in 1973

• Homosexuality remains legally questionable in China

• Auditory hallucinations, possession trance, and glossolalia are universally classified as mental disorders across all cultures without exception

• Cultural context can allow certain psychological phenomena to be viewed as pathological in one setting yet part of a religious experience or therapeutic practice in another

Glossolalia

What term describes the phenomenon of (apparently) speaking in an unknown language, especially in religious worship?

In-basket decision making

Which of the following is NOT an example of a phenomenon whose pathologization depends heavily on cultural context?

• Auditory hallucinations

• Glossolalia (speaking in tongues)

• Possession trance

• In-basket decision making

Schizophrenia

It refers to a pattern of psychotic features including thought disturbances, bizarre delusions, hallucinations (usually auditory), disturbed sense of self, and loss of reality testing.

International Pilot Study of Schizophrenia (IPSS)

The aim of the ________ was to test culturally universal credentials of schizophrenia as a diagnostic label.

Growing concerns about the objectivity and reliability of diagnoses across different situations

Which of the following factors prompted the International Pilot Study of Schizophrenia (IPSS)?

• Decreasing global prevalence rates of schizophrenia symptoms

• Growing concerns about the objectivity and reliability of diagnoses across different situations

• Establishing a universal pharmacological treatment protocol for psychotic features

• Standardizing the definition of bizarre delusions in Western clinical trials

International Pilot Study of Schizophrenia

What does the abbreviation IPSS stand for in the context of global psychopathology research?

• Integrated Psychiatric Scale for Schizophrenia

• International Pilot Study of Schizophrenia

• Intercultural Pathology System for Schizophrenia

• International Psychological Survey on Symptoms

Theoretical Orientation

Which of the factor influences the objectivity of clinical interviews, which is described as contrasting humanistic psychiatry (more client-centered) with psychoanalysis (more prescriptive)?

Symptoms that straddle two or more established syndromes may be ignored because they threaten a syndrome's validity

According to Leff (1977a), how can established syndromes impact the diagnostic process during clinical interviews?

• Symptoms that straddle two or more established syndromes may be ignored because they threaten a syndrome's validity

• Symptoms matching established syndromes are routinely discarded in favor of unique individual traits

• Psychiatrists disregard established syndromes entirely when using client-centered approaches

• Diagnostic validity is enhanced whenever symptoms cross multiple established syndrome categories

US psychiatrists identified twice as many pathological symptoms as UK psychiatrists, suggesting UK psychiatrists have a higher diagnostic threshold

In the study by Sandifer et al. (1969), what cultural difference was observed after US and UK psychiatrists viewed the same filmed clinical interviews?

• UK psychiatrists identified twice as many pathological symptoms as US psychiatrists

• US psychiatrists identified twice as many pathological symptoms as UK psychiatrists, suggesting UK psychiatrists have a higher diagnostic threshold

• Both US and UK psychiatrists produced identical diagnostic ratings across all filmed interviews

• US psychiatrists refused to assign diagnoses without conducting physical medical examinations

Delusions are defined as beliefs at odds with the patient's culture, requiring cultural knowledge to evaluate accurately

Why does a lack of cultural knowledge impair a psychiatrist's ability to reliably identify delusions in patients from different backgrounds?

• Delusions are defined as beliefs at odds with the patient's culture, requiring cultural knowledge to evaluate accurately

• Delusions only occur in patients who share the exact cultural background as the diagnosing psychiatrist

• Cultural knowledge replaces the need to assess psychotic features during clinical evaluations

• Delusions are universally identical across all world cultures regardless of local beliefs

Automated Brain Scanning

According to Leff (1977a), factors that influence the objectivity of clinical interviews include all of the following, EXCEPT:

• Theoretical Orientation

• Established Syndromes

• Cultural Background

• Automated Brain Scanning

• Cultural Knowledge

Cultural Variations

_________ in communication styles prevented psychiatrists from arriving at reliable, culturally consistent diagnoses of psychological disorders.

Present State Examination (PSE)

Which standardized diagnostic tool was utilized in the research by Cooper et al. (1972) to ensure research psychiatrists applied identical diagnostic criteria across London and New York hospitals?

• Present State Examination (PSE)

• International Pilot Study of Schizophrenia (IPSS)

• Structured Clinical Interview for DSM (SCID)

• Diagnostic and Statistical Manual of Mental Disorders (DSM-I)

'Schizophrenic' labels were applied more commonly in New York than they were in London

What major discrepancy in diagnostic practices was identified by Cooper et al. (1972) prior to applying a standardized diagnostic instrument?

• 'Schizophrenic' labels were applied more commonly in London than in New York

• 'Schizophrenic' labels were applied more commonly in New York than they were in London

• UK psychiatrists diagnosed schizophrenia at twice the rate of US psychiatrists

• Both London and New York practitioners produced identical schizophrenia diagnosis rates

The subsequent use of a standardized diagnostic instrument reduced differences between US and UK practitioners

Which of the following findings emerged regarding diagnostic consistency between US and UK practitioners in the Cooper et al. (1972) study?

• The subsequent use of a standardized diagnostic instrument reduced differences between US and UK practitioners

• The introduction of standardized instruments widened the diagnostic gap between US and UK clinicians

• US practitioners refused to use standardized diagnostic instruments during the clinical trial

• Standardized diagnostic tools failed to improve agreement between London and New York hospital assessments

The subsequent use of a standardized diagnostic instrument increased the diagnostic discrepancies between US and UK practitioners

According to Cooper et al. (1972), all of the following statements are true regarding the cross-national comparison of schizophrenia diagnoses, EXCEPT:

• The study compared hospital diagnoses of patients in London and New York

• The Present State Examination (PSE) was used to ensure identical diagnostic criteria among research psychiatrists

• 'Schizophrenic' labels were applied more commonly in New York than in London

• The subsequent use of a standardized diagnostic instrument increased the diagnostic discrepancies between US and UK practitioners

Colombia, Czechoslovakia, Denmark, England, India, Nigeria, Soviet Union, Taiwan, US

Which nine countries were included in the International Pilot Study of Schizophrenia (IPSS; WHO, 1974, 1979) to broaden Cooper's transatlantic comparison across 1,202 patients?

• Colombia, Czechoslovakia, Denmark, England, India, Nigeria, Soviet Union, Taiwan, US

• Canada, France, Germany, Italy, Japan, Mexico, Soviet Union, UK, US

• Brazil, China, Egypt, England, India, Nigeria, Russia, Spain, US

• Australia, Colombia, Denmark, Greece, India, Nigeria, Soviet Union, Taiwan, US

There were close clinical similarities between patients being diagnosed as schizophrenic across the nine countries

What was the overall finding of the IPSS (WHO, 1974, 1979) regarding clinical presentation across the nine participating countries?

• Clinical presentations varied so widely that no common diagnostic criteria could be established

• There were close clinical similarities between patients being diagnosed as schizophrenic across the nine countries

• Patients in Western nations displayed entirely unique psychotic features unobserved in non-Western samples

• Schizophrenia was found to exist exclusively in industrialized urban populations

US and USSR

In the IPSS study, which two participating countries were excluded from the finding where the overwhelming majority of patients diagnosed in situ were similarly diagnosed by the WHO procedure?

• England and India

• US and USSR

• Colombia and Nigeria

• Denmark and Czechoslovakia

The incidence of US and USSR diagnoses for schizophrenia was marginally greater than elsewhere

Regarding diagnostic incidence rates across participating nations in the IPSS, which of the following statements is accurate?

• The incidence of US and USSR diagnoses for schizophrenia was marginally greater than elsewhere

• The incidence of schizophrenia diagnoses in India and Nigeria was significantly higher than in all Western nations

• England recorded the highest overall diagnostic incidence rate among all nine countries

• All nine countries exhibited identical diagnostic incidence rates without any variation

The PSE was administered exclusively in English across all nine participating nations

According to the IPSS (WHO, 1974, 1979) overview, all of the following statements are true, EXCEPT:

• The PSE was translated into the first languages of the nine countries

• There were close clinical similarities between patients being diagnosed as schizophrenic across the nine countries

• In seven of the participating countries, local in situ diagnoses aligned with the standardized WHO procedure

• The PSE was administered exclusively in English across all nine participating nations

• The incidence of US and USSR diagnoses for schizophrenia was marginally greater than elsewhere

Schizoid Symptoms

Overall, the IPSS showed that, especially with the use of standardized training with a single diagnostic instrument, there existed a common core of ________ in most countries.

True

Another cultural discrepancy shows recovery from schizoid conditions to be better in developing nations than in more affluent nations. Perhaps these differences were due to stronger community and extended family support networks in some regions.

True or False

Social and emotional withdrawal, delusions, and emotional flatness

Which set of symptoms was found to be commonplace virtually across the board among individuals diagnosed with schizophrenia in the IPSS?

• Visual hallucinations, grandiosity, and flight of ideas

• Social and emotional withdrawal, delusions, and emotional flatness

• Catatonia, severe amnesia, and language aphraxia

• Panic attacks, compulsions, and depersonalization

Auditory hallucinations

According to the local variations observed in the IPSS findings, which specific symptom was scored higher by Nigerian and Danish schizophrenic patients than by US patients?

Because the PSE was developed in the UK, using it in diverse cultural settings prevented projects from taking account of local meanings attached to psychosis

Which major limitation of standardized diagnostic instruments in schizophrenia research is highlighted by the use of the Present State Examination (PSE)?

• Because the PSE was developed in the UK, using it in diverse cultural settings prevented projects from taking account of local meanings attached to psychosis

• Standardized instruments like the PSE rely exclusively on self-report questionnaires rather than clinical observation

• The PSE requires extensive neuroimaging technology that was unavailable in developing countries

• Using the PSE caused clinicians to completely miss negative symptoms such as emotional flatness

Psychiatrists sometimes apply diagnostic labels differently when treating different racial groups

What did Loring and Powell (1988) demonstrate regarding the application of the 'schizoid' diagnostic label?

• Psychiatrists apply diagnostic labels with 100% objective consistency regardless of patient demographics

• Psychiatrists sometimes apply diagnostic labels differently when treating different racial groups

• Racial bias in psychiatric diagnosis only occurs when non-standardized interview techniques are used

• Female patients are diagnosed with schizophrenia at four times the rate of male patients across all racial categories