Study Notes on PSYC 441 Schizophrenia and Neurocognitive Disorders - Cultural Case Study

PSYC 441: SCHIZOPHRENIA AND NEUROCOGNITIVE DISORDERS

  • Instructor: Joseph (Jake) Shenker, PhD

CULTURAL CASE STUDY

WHAT IS CULTURE?

  • Culture as a variable in psychotherapy can complicate the therapeutic process.

  • The “Us vs. Them” mindset:

    • Culture is often viewed in a dichotomous manner where “they” are different from the therapist, necessitating different treatment approaches.

  • The focus on understanding the cultural norms of patients is essential for understanding their symptom expression.

  • Misunderstanding cultural dynamics can alienate patients, potentially hindering successful treatment outcomes.

BRONFENBRENNER'S ECOLOGICAL SYSTEMS

  • Chronosystem: Effects of time and historical context on an individual's development.

  • Macrosystem: Includes overarching cultural elements such as economics, social norms, governments, and mass media.

  • Exosystem: Factors impacting the individual that they do not directly interact with, such as friends and parents.

  • Mesosystem: Interaction between microsystems including school and family.

  • Microsystem: Direct environment in which individuals interact, such as family, school, friends, and neighbors.

EDWARD HALL'S CULTURAL ICEBERG

  • Surface Culture:

    • Observable aspects of culture, such as:

    • Food

    • Flags

    • Festivals

    • Fashion

    • Holidays

    • Music

    • Performances

    • Dances

    • Games

    • Arts & Crafts

    • Literature

    • Language

  • Deep Culture:

    • Underlying beliefs and values that shape behavior and communication:

    • Communication styles and rules

    • Facial expressions, gestures, eye contact

    • Personal space and touching

    • Body language and conversational patterns in social situations

    • Handling emotions

    • Notions of courtesy, manners, friendship, leadership, cleanliness, and beauty

    • Concepts of self, time (past/future), fairness and justice

    • Roles related to age, sex, class, family, etc.

    • Attitudes towards elders, adolescents, dependents

    • Rule expectations, work ethics, authority, cooperation vs. competition

    • Relationships with animals, age, sin, death

    • Approaches to religion, courtship, marriage, child-rearing, decision-making, and problem-solving

WHAT IS CULTURE? (CONT.)

  • Quote by Miller: “The experience of illness is entirely shaped by the culture in which we live.”

  • Psychotherapy is practiced within specific social contexts, yet much of its theory is often developed without cultural considerations (as noted by Wachtel).

  • Minority groups are often underrepresented in studies of empirically supported treatments.

    • Recognition of how poverty, racism, and other hardships impact individuals' lives is essential, yet these issues are frequently viewed as complexities rather than intrinsic parts of patient identity and social economic status affecting therapy.

CASE STUDY

  • Introduces a case examining the profound influence of culture on an individual’s life and mental illness.

CONTENT WARNING & STATING THE OBVIOUS

  • Emphasizes discussion of sensitive topics such as systemic racism, generational suffering, poverty, and the traumatic death of a child.

  • The case study involves a black American woman discussed by a white Canadian man, acknowledging the speaker's lack of lived experience in these contexts.

NAOMI GAINES

  • Description: A black American woman raised in Robert Taylor Homes, a public-housing complex in Chicago.

  • Mental Health History: Developed prodromal symptoms during adolescence and was diagnosed with schizophrenia in her early 20s.

  • Suicide Attempt: In a state of delusion, she tried to commit suicide by jumping off a bridge with her baby twins; tragically, one child died, leading to her conviction for murder and subsequent imprisonment.

EARLY LIFE IN THE PROJECTS

  • Details Naomi's impoverished upbringing:

    • Lacked basic necessities, like food.

    • Environment characterized by intense violence, with gunfire being commonplace.

    • Internalized social marginalization and carried shame about her background, leading to hyper-vigilance and self-reliance.

    • Adulthood manifestations of these adaptations were anxiety, panic, and emotional collapse.

EARLY LIFE IN THE PROJECTS (CONT.)

  • Further details on Naomi’s family dynamics:

    • One sister was removed from the home by youth protection services.

    • Experiences with her mother, Florida, included moving away from an abusive relationship only to return to it quickly.

    • Florida struggled with addiction, leading Naomi to perceive psychological treatment as a “fanciful luxury.”

LATE ADOLESCENCE

  • Transition to motherhood led to a depressive episode for Naomi, marked by isolation, excessive crying, and difficulty coping.

  • Began exploring the history of Black women as a means of seeking meaning and connection during her struggles.

LATE ADOLESCENCE (CONT.)

  • Scholar Joseph Winters articulated the profound psychological effects of Black individuals realizing systemic discrimination:

    • Melancholy is borne from feelings of invisibility and exclusion, which undermines a coherent sense of self.

  • Reflective statement from Naomi: “I fought with everything in me to keep from becoming another casualty of circumstances.”

FEARS

  • As a new mother, she developed an intense fear of repeating the neglect she experienced and aimed to be consistently attentive and self-sacrificing.

  • Felt that expressing struggles could threaten her connection with her children, given past experiences where vulnerability led to loss or dismissal.

DETERIORATION

  • Naomi's mental health declined, characterized by:

    • Self-harm, depression, suicide attempts, and a growing sense of helplessness.

    • Perceived her depression as stemming from societal hatred and discrimination.

    • Experienced panic attacks, emotional overload, and signs of hallucinations.

    • Example: Told family “the demons are in here” and engaged in compulsive listening to music in search of symbolic meaning, believing she could cure societal racism.

DIAGNOSIS

  • Brief hospitalization followed by quick release with only a prescription for antipsychotics; viewed through a biological lens.

  • Diagnosed with “psychosis not otherwise specified” after a second hospitalization, reflecting inadequate length of stay due to insurance constraints.

    • Doctors attributed her mental symptoms to chemical imbalances rather than contextual factors.

DIAGNOSIS (CONT.)

  • Naomi felt misunderstood by the medical community, stating:

    • “The lack of knowledge about who I am and where I come from pushed me farther away.”

    • Expressed anger about being prescription only and her complaints about perceived discrimination labeled as bizarre delusions.

FINAL INCIDENT

  • Documented incident on bridge with suicidal impulses and delusions of persecution:

    • Misinterpreted a stranger's words as aggression.

    • Believed that only she and her children were at risk of extermination based on racial identity.

FINAL INCIDENT (CONT.)

  • Detailed actions taken during the incident:

    • Fearful of returning to her car, Naomi believed that death in private was imminent.

    • Convinced her only options were merciful or torturous death, leading to her tragic decision to drop her children and herself into the river.

OUTCOME

  • Rescue by a bystander saved Naomi and one child; the second child remains missing.

  • Legal repercussions included arrest and murder charge, leading to a diagnosis of untreated schizophrenia and postpartum psychosis.

CONCEPTUALIZATION

  • Naomi's perspective from the bridge:

    • Driven by fear for her children’s prospects in a prejudicial society.

    • Interpretations of her delusion were parallel to societal truths regarding her racial experience.

CONSEQUENCES

  • Questions of moral responsibility:

    • Discussed whether her actions could be deemed as “not guilty by reason of insanity.”

  • Naomi regarded her mental symptoms as significant reactions shaped by chronic stress and societal expectations, leading to significant legal outcomes.

  • Court findings indicated that her delusions stemmed from astute social observations rather than random pathology.

“CULTURAL CONSIDERATIONS”

  • Naomi framed her actions within a larger context of:

    • Extreme psychological collapse following prolonged trauma and poor support systems.

    • Mental illness informed by societal pressures of motherhood and lack of mental health infrastructure.

“CULTURAL CONSIDERATIONS” (CONT.)

  • Emphasis on understanding mental illness as not just an individual ailment but as a result of intersecting contexts:

    • Historical, racial, gender, and socioeconomic factors.

NAOMI’S STORY IS NOT OVER

  • Naomi Gaines-Young advocates for mental health awareness post-release.

  • Resources:

    • Articles and videos highlighting her journey and advocacy for mental health issues in the black community.

COMING UP NEXT

  • Optional Reading Resources:

    • First chapters of A Road Back From Schizophrenia.

  • Upcoming Lectures:

    • Scheduled discussions and quizzes related to cognitive deficits and assigned readings.