Ch 12: Culture and Mental Health

• one goal of psychology is to help those suffering from

  • psychopathology - psychological disorders that encompass behavioral, cognitive, and emotional aspects of functioning

12.1: Overview of Culture and Mental Health

What’s Normal?

• defined by:

  • using a statistical approach

    • problem: not all rare behavior is disordered, and not all disordered behavior is rare

  • applying criteria of impairment or inefficiency, deviance, or subjective distress

    • problem: also, not always the case as those with bipolar report higher productivity during mania

      • don’t like this problem/example given by book

    • problem: social deviance changes

• alternative approach - applying cultural relativism to abnormality

Views about the Association among Cultures, Mental Health, and Psychopathology

• cultural relativism: view that culture and psychopathology are intertwined

  • disorders can be understood only in the cultural framework within which they occur

• absolutist orientation: perspective of psychopathology based on biological models that purports invariant symptoms across cultures

• cross-cultural similarities exist in the psychological mechanisms and subjective experiences of psychological disorders

Culture and the Classification of Psychopathologies

• cross-cultural issues arise concerning:

  • the reliability and validity of diagnoses

  • the diagnostic categories used

• classification systems used for diagnosis

  • Diagnostic and Statistical Manual of Mental Disorders (DSM)

    • DSM 5 has been revised to include cultural concepts of distress (CCD) and the Cultural Formulation Interview (CFI)

  • International Classification of Disease (ICD)

  • Chinese Classification of Mental Disorders (CCMD)

• CCD has three concepts

  • cultural syndromes of distress: which and how symptoms are expressed in specific cultural context

  • culture idioms of distress: ways that cultural groups communicate and express their distressing thoughts, behaviors, and emotions

  • cultural explanations of distress: what groups believe is the cause

  • figure 12.1

12.2: Cross-Cultural Assessment of Psychological Disorders

Bias and Equivalence

• assessment of psychological disorders involves identifying symptoms in the broader context

  • tools and methods used should be sensitive to cultural and environmental influences on behavior and functioning

• bias or insensitivity exists when psychological tests developed in one cultural context are used to assess behavior in a different context

Assessing Mental Health in Children

• Child Behavior Checklist (CBCL)

  • used in diverse cultures to assess behavioral, emotional, and social problems of children and adolescents

  • may not capture culture-specific dimensions of problematic behaviors

Potential Biases in Test Interpretation

• cultural backgrounds of both the therapist and client build the perception and assessment of psychological disorders

• culturally responsive assessment

• requires an understanding of the cultural background of the client and one’s own potential cultural biases

Measurement of Personality to Assess Psychopathology

• personality tests used cross-culturally assess clinical states and psychopathology

  • Minnesota Multiphasic Personality Inventory (MMPI)

    • tests for abnormal behaviors in paranoia (level of trust), hypochondriasis (concern for own health), and social introversion

    • reliable and valid form of assessment in multiple cultures

    • other research cautions against the use for MMPI-2 for specific populations

  • Chinese Personality Assessment Inventory (CPAI)

    • includes indigenous concepts from Chinese culture

Results of Failure in Addressing Issues of Assessment

• overpathologizing: considering behavior as pathological, when behavior is a normal variation for that individual’s culture

• underpathologizing: indiscriminately seeing behavior as cultural, when behavior actually reflects abnormal psychological response

12.3: Cross-Cultural Research on Psychological Disorders

Schizophrenia

• International Pilot Study of Schizophrenia

  • universal symptoms - lack of insight, hallucinations, and ideas of reference

  • course of illness was more positive for patients in developing countries than developed countries

  • symptom manifestation varies between countries

• expressed-emotion construct

  • family and social interactions influence the course of schizophrenia

• diathesis-stress model: schizophrenia may develop in individuals with a genetic and biological predisposition to the disorder (diathesis) following exposure to environmental stressors (Walder et al., 2014)

• Characteristics of Schizophrenia

  • delusions and hallucinations, lack of motivation, social withdrawal, impaired memory, dysregulated emotions

Depression

• characterized by physical, motivational, emotional, and behavioral changes

• universally, women are more likely to experience depression than men

• cross-cultural symptoms

  • sadness and joylessness

  • anxiety, tension, and lack of energy

  • symptoms differ across cultures due to variations in stress sources and coping mechanisms

• somatization: bodily symptoms as expressions of psychological distress

  • Lee et al. (2007) argued that the bodily symptoms described by Chinese patients (heart panic, heart dread, and heart pain) aren’t simply somatization because the Chinese view does not separate bodily and psychological symptoms but rather experience them as closely connected

Anxiety Disorders

• cultural differences in what elicits anxiety, how and how much to express, and what to do about it when expressed

• generalized anxiety disorder, panic disorder, and various phobias

• prevalence rates of anxiety disorders vary depending on the type of disorder and culture

Attention-Deficit/Hyperactivity Disorder

• features - inattentiveness, impulsivity, and hyperactivity

• boys are more likely to be diagnosed with ADHD than girls

  • causes and treatment of ADHD differ across cultures

• neurological disorder that is found in all cultures

  • unrecognized, underdiagnosed, and subsequently, left untreated in many countries

12.4: Cultural Syndromes of Distress

• patterns of symptoms that cluster together for individuals in specific cultural groups, communities, or contexts

• findings concerning differential rates and courses of disorders across cultures

  • highlight the role of culture in shaping the expression of psychological disorders

• examples of culture-bound syndromes

  • amok, zar,

  • baksbat - Cambodia - similar but distinct to PTSD

  • susto - Latin America - freighting event that results in soul lost

    • sadness, sleep and eating disturbances, impaired social relations with others, fear

  • latah - Malaysia - echolalia, trance-like behavior, and other uncontrollable and repeated behavior

  • koro - Malaysia - fear one’s genitals is shrinking

12.5: Mental Health of Ethnic Minorities, Migrants, and Refugees

African Americans

• historical context of slavery and exclusion from social, economic, and educational fronts have influenced their mental health

• report lower lifetime and 12-month prevalence rates of major depression and panic disorder

  • protective factors against mental illness

    • strong family, community, and religious networks

• groups differ based on whether they are born to African American parents or Caribbean Blacks

  • AA women more likely substance abuse disorder

  • foreign-born CB less likely substance abuse disorder

  • US-born more likely substance abuse disorder

Latino Americans

• national Latino and Asian American Study

  • shows variations in rates of mental illness among different Latino groups

• factors that influence mental health

  • reception and history of immigration

  • varying SES and experiences with discrimination

  • strength of ethnic community

• variations exist in prevalence rates of psychological disorders with the broad category of Latino

Asian Americans

• model minority stereotype masks the fact that Asian Americans could be at risk for poor mental health

• AA population is heterogenous in terms of culture, language, and history of immigration

  • report lowest 12-month prevalences of disorders

  • gender and immigration-related factors help in understanding mental health disorders

Native Americans

• higher prevalence of depression, other mood and anxiety disorders, and rates of alcohol use and suicide

• psychological disorders could be due to:

  • historical trauma

  • community-wide poverty

  • segregation and marginalization

• preserving and promoting traditional culture helps in reducing severe psychological distress

Immigrants

• immigrants adapting to a new cultural environment are faced with acculturation issues

  • may cause depression, anxiety, and psychosomatic problems

• immigrant paradox challenges the notion that immigration is stressful, leading to poor adaptation

• an individual’s level of acculturation contributes to the content and expression of their distress

Refugees

• show higher rates of PTSD, depression, and anxiety

  • caused by the traumatic experiences marked by profound losses and upheavals

  • Dose effect - greater severity of trauma is associated with a higher likelihood of experiencing psychological disorder

• postmigration factors are equally important in predicting a refugee’s emotional distress as premigration experiences