Week 3 Lecture 2 - Closing the loops

Cultural considerations in clinical practice

• Understanding the influence of culture on how psychological symptoms are expressed

• Understanding and being aware of cultural identity of individual clients and individual’s experiences (related to psychological experience and levels of functioning)

Ancient Greece - Hippocrates (~460-370 BCE)

• Father of Western empirical medicine

• Rejected supernatural theories of psychopathology

• Proposed biological, psychological and social/environmental factors key to mental illness, prevention and treatment

• Imbalance of ‘humours’ (bodily functions — blood, phlegm, black bile, yellow bile)

• Described mania, melancholy, phrenitis (delirium - inflammation), insanity, paranoia, panic, epilepsy, hysteria and more

Hysteria

A ‘female’ condition, or a gendered tool to pathologise and control non-conformity?

Hippocrates

Broad range of symptoms, thought to reflect a wandering womb (so only females could be affected) — anxiety, faintness, paralysis, choking or others such as emotional ‘volatility.

Treatment was ‘scent therapy’, sexual activity or pregnancy

16th/17th century

Sexual deprivation or excess fluid in uterus — treatment being sexual activity, pregnancy

19th Century (eg Freud)

A catch-all psychological diagnosis for women who defied social norms or male authority. Symptoms ranged from emotional outbursts to physical issues (conversion) to non-conforming behaviour

Drapetomania

Non-discredited “diagnosis” invented in 1851 by American physician, Samuel A Cartwright

Pathologise the desire of enslaved Africans to escape captivity — claimed it was a “mental illness” unique to enslaved Black people, causing them to run away.

Used to justify slavery by framing escape attempts as irrational, diseased behaviour rather than logical response to oppression

Homosexuality as pathological

Indicative sign of a biological defect, developmental failure, morally bad, sinful, social evil

Previously categorised as a mental disorder in DSM

Influenced by:

• Powerful institutions - religion (‘sin’) and legal/justice (‘crime’)

• Darwinism (eg Richard von Kraft-Ebing’s 1886 Psychopathia Sexualis)

Cultural shift, Stonewall, 1972 APA conference

Homosexuality removed from DSM

Organised LGBT activism emerges

Stonewall Riots June 28 1969

Broader cultural context of challenge to power: Civil Rights Movement, Anti-War Movement

Culturally-bound syndromes

A cluster or group of co-occurring, relatively invariant symptoms found in a specific cultural group, community, or context

Conceptualised as an illness within the culture, but not always

Has cultural explanation, name, method of treatment, and more

Longing for country

Problems associated with spiritual disconnection Aboriginal people experienced when separated or removed from traditional lands

1. Physical ill health, including weakness, nausea, general “sickness” and somatic complaints

2. Spiritual ill health

3. Cognitive disorientation, dissociative fugue

4. Cultural “ill health” including identity confusion, disorientation, acculturative stress

Alternative model to DSM, ICF, HiTOP, Power, Threat, Meaning Framework

Does not treat psychopathology as a medical condition — thought to be a patterned response to social, cultural, and psychological factors

PTMF emphasises the role of power, threat, and the meaning people make of their psychological distress

• What has happened to you (power)

• How did it affect you (threats)

• What sense did you make of it (meaning)

• What did you have to do to survive (threat response)

Anti-Psychiatry Perspectives

Psychiatrists including:

Thomas Szasz: mental illness is a myth (eg. No disease identified)

J.D. Laing: psychiatry inappropriately pathologists human distress (eg. Schizophrenia symptoms are a normal response to adversity)

Social theorists like Michael Foucault and Erving Goffman argued:

• Psychiatry enforces societal norms

• Serves to marginalise and stigmatise those with psychological problems

• Coercive, pseudoscientific, and socially constructed

• Causes harm

Psychoeducation

Portraying a realistic experience of being stigmatised because of psychosis — increasing understanding and empathy (by showing what it’s like to live with the condition and be stigmatised by others)

Raising awareness and encouraging help-seeking — demonstrating the challenges and recovery process to motivate seeking support

Countering stereotypes — humanising person with mental illness and showing they are more than their diagnosis

Among people who did not find psycho education videos helpful:

Empathy-building mixed with stereotype reinforcement — some parts humanised people with psychosis, other parts risked reinforcing negative perceptions

Impact varied by viewer’s prior knowledge — effective for some audiences but confusing or incomplete for others

Emotional but lacking practical guidance — no clear steps for reducing stigma