Cultural psychology
Chapter 14
Mental health

What is a psychological disorder?

Disorders are usually defined as behaviours that are rare and cause some kind of impairment to the individual, although there are many exceptions to this general pattern. Some behaviours are considered problematic in one culture but not in another.

Because the field of psychiatry is largely developed in the West, the disorders that re observed in the West are often viewed as the basic categories of diagnosis. When psychiatry is exported to other cultures, there is a tendency to evaluate the psychopathologies that are found in other cultures in terms of how well they fit into those basic categories that were developed in the West.

The distinction between universal categories of mental illness and culture-bound syndromes is not always straightforward. The symptoms of some disorders might vary across cultures, even though the underlying causes of the problems are the same.

Culture-bound syndromes

Culture-bound syndromes are those that appear to be greatly influenced by cultural factors and hence occur far less frequently, or are manifested in highly divergent ways in other cultures.

Eating disorders

Eating disorders are some of the more common psychological disorders in North America. These are Bulimia nervosa and Anorexia nervosa. One commonly held view is that both disorders are culture-bound syndromes. The rates for both disorder have increased over the past 50 years, and it seems likely that changing cultural norms are at least partly responsible. They are also more prevalent in some societies than in others.

A kind of inherited predisposition toward self-starvation might manifest itself through motivations for religious asceticism in some contexts and motivations to avoid weight gain in others. There are cultural differences in anorexia nervosa, but there are also many historical examples of people starving themselves. Some symptoms of anorexia are universal, although they are still influenced a great deal by culture.

Koro

One clinical syndrome that has been identified in a variety of countries in South and East Asia is koro. This is a morbid fear that one’s penis is shrinking into one’s body. In women, it manifests itself as a fear that one’s nipples are shrinking into one’s body.

Koro’s symptomology is nearly absent in most cultures, although it is not clear what cultural factors affect its prevalence. One interpretation is that it’s grounded in a classical Chinese medicine account of how an imbalance of yin and yang can cause the genitals to retract.

Some components of koro may be universally accessible, but they only seem to manifest as a clinical syndrome within certain cultures where people have an awareness of the existence of the disorder.

Amok

Amok has been identified in a number of Southeast Asian cultures as ‘an acute outburst of unrestrained violence, associated with (indiscriminate) homicidal attacks, preceded by a period of brooding and ending with exhaustion and amnesia. Running amok primarily occurs among males and is thought to be instigated by stress, a lack of sleep, and alcohol consumption.

Much of the symptomology and cultural meaning associated with amok appears to be specific to certain Southeast Asian cultures, however, there are similar phenomena in Western cultures. The differences is that the Western mass killings tend to be more premeditated and it is unclear whether these similar behaviours are indicative of a common underlying disorder.

Hysteria

Given that cultures change over time, it’s possible that culture-bound disorders might differentiate historical periods. One of the most common psychological disorders throughout Europe in the mid-19^th century was hysteria. In hysteria, women exhibited symptoms such as fainting, insomnia, sudden paralysis, temporary blindness, loss of appetite for food or sex, and a general ‘tendency to cause trouble’.

The diagnosis of hysteria decreased dramatically in the early 20^th century, and today it is no longer a diagnostic category in the DSM.

Other culture-bound disorders

Frigophobia is a morbid fear of catching a cold.

Susto is a condition in which people feel that a frightening experience has caused their soul to get dislodged from their bodies, leading to a wide range of physical and psychological symptoms.

Voodoo death, is a condition in which people are convinced that a curse has been put on them or that they have broken a taboo, which results in a severe fear reaction that sometimes leads to their own deaths.

Latha is a condition in which people fall into a transient dissociated state after some kind of startling event. The person usually exhibits some kind of unusual behaviour, after which the person retains no memory of the outburst.

Malgri is a syndrome of territorial anxiety. When afflicted individuals enter a new territory without engaging in the appropriate ceremonial procedures, they believe that they are invaded by a totemic spirit that makes them physically sick.

Agonias is an anxiety disorder with an array of different symptoms, including a burning sensation, a loss of breath, hysterical blindness, sleeping, and eating disorders.

Kufungisisa is a condition with anxiety and somatic problems that are thought to stem from mental exhaustion.

Ataques the nervios is a condition in which emotionally charged settings lead to such symptoms as palpitations, numbess, and a sense of heat rising to the head.

Universal syndromes

Although the following syndromes are universally observed, the manifestation can vary across cultures.

Depression

The prevalence of major depressive disorder varies depending on the specific criteria that are applied in making the diagnosis, but it appears to be a very common psychopathology in the West.

Depression is less commonly diagnosed in some other cultures.

International studies of depression have found cases that fit the DSM-based definition of major depressive disorder in very culture that has been explored.

Not all depressed individuals show the same set of symptoms. Cultural differences for symptoms can be highly pronounced. There appear to be reliable cultural differences in the extent to which people emphasize psychological versus physiological symptoms of depression. Somatization is more common among Chinese presentations of depression.

One possibility is that these differences are due to the social stigma associated with having a mental illness in the east. A second possibility is that the symptoms experienced by people across different cultures may be the same but that people from some cultures tend to focus on, and hence notice, different symptoms more than those from other cultures.

Social anxiety disorder

Social anxiety disorder is the fear that one is in danger of acting in an inept and unacceptable manner, and that such poor performance will result in disastrous social consequences.

Social anxiety is well documented around the world. It would seem that social anxiety concerns should be especially prevalent in cultural contexts where there is more emphasis placed on the value of fitting in with others.

Asians report more evidence of social anxiety symptoms than people in the West, but are less likely to be diagnosed with full-blown social-anxiety disorder. This might be due to the fact that the norms for social behaviour differ.

When people’s social anxiety become problematic, the symptoms are presented differently across cultures.

Suicide

Although suicide is recognized quite similarly across cultures, its frequency varies enormously. People in different cultures tend to commit suicide at different points in their lives. In all of the cultures, an increase is seen in suicide rates among the elderly. The rates for adolescents are also quite similar across cultures.

In some nations, the absence of a compelling cultural identity can be behind a heightened rate of suicide among Fist nation people.

People’s motivation for suicide can vary considerably across cultures.

Schizophrenia

Genetic factors affect one’s likelihood of developing schizophrenia. Certain experiences in the womb can affect the likelihood that those with genetic predispositions will develop schizophrenia, and there are clear neuroanatomical differences.

But, much is still not known about the causes of schizophrenia.

Schizophrenia emerges quite regularly across cultures. But, there is some evidence for cultural variability. Considerable variation occurred in the subtypes of schizophrenia that were identified across cultures. And the symptoms vary across population.

Mental health treatment

Cultural expectations and norms can shape the ways that people understand and react to most aspects of mental health treatment.

Because much of the success of mental health treatment revolves around the relationship and information exchange between the client and therapist, and because the nature of that relationship and the kinds of information that are exchanged are likely shaped by cultural expectations, culture affects the success of treatment.

Seeking social support differs, and so does the kind of social support offered.

The commonality across diverse Western perspectives on mental illness is that the underlying evaluation of people and their conditions hinges on the client’s ability to engage in a psychological discourse that is grounded in shared cultural meanings.

Various approaches to mental illness have emerged in other cultures.

Providing people with different conceptions of mental illness may lead them to express their own psychological difficulties in symptoms that are consistent with those conceptions.

Therapists who work with clients from different cultural backgrounds should strive to achieve cultural competence. 1) It is necessary to recognize their own cultural influences, wo that they can consciously deal with their own defences, interpretations, and projections that will be relevant when they are interacting with clients from cultural backgrounds 2) Therapists should develop knowledge about the cultural background of their client, and the kinds of expectations that the client likely has for the counselling relationship, so that they can interact with their client in the most effective way 3) The therapist should develop the appropriate skills to be able to intervene in the therapy sessions in a way that is culturally sensitive and relevant 4) The therapist must be flexible about when it appears appropriate to generalize from the client’s culture to the mainstream culture, and when it appears more appropriate to individualize the client.