PSY1PAC: Week 11

Defining Mental Health Conditions

• Psychological disorders are typically defined as behaviors that are rare and impair the individual.
• Definitions of “rare” and “problematic” vary across cultures.

Social Anxiety Disorder

• Criteria:
  • Fear of social situations with unfamiliar people
  • Exposure to the feared social situation leads to anxiety
  • Recognition that fear is excessive
  • Avoidance of the situation interferes with normal routine
• Two major methods of study:
  • Reporting symptoms on surveys
  • Clinical diagnoses through interviews
• Interdependence strongly correlates with self-reports
• East Asians report more symptoms than Westerners.
• East Asians: about 0.5% lifetime prevalence
• North Americans: about 7%
• Social approval is valued more in interdependent cultures
• Social anxiety is seen as more natural.

Taijin Kyofushou (TKS)

• Fear of confronting others
• Also triggered by social situations
• Primary concern with (imaginary) physical symptoms:
  • Body odor
  • Blushing
  • Sweating
  • Penetrating gaze
• Chief concern: others’ discomfort
• The “altruistic phobia”
• Worst around acquaintances, not strangers.

Schizophrenia

• Highly challenging; appears universal
• Criteria: 2+ symptoms over a significant time period:
  • Delusions
  • Hallucinations
  • Disorganized speech
  • Grossly disorganized or catatonic behavior
  • Negative symptoms (e.g., loss of speech, flat affect)
• A combination of genetics, prenatal experiences, and neuroanatomy.
• Less cultural variation than most mental disorders.

Schizophrenia Subtypes

• Significant variation in schizophrenia subtypes:
  • Paranoid Schizophrenia
    • Characterised by delusional visions
    • ~75% of cases in the UK
    • ~ 15% in India
  • Catatonic Schizophrenia
    • Lack of motor activity/response to stimuli
    • ~1-3% of cases in the UK
    • ~20% in India

Recovery Rates for Schizophrenia

• Much higher recovery rates in less industrialized societies
• Opposite pattern as most physical and mental illnesses
• Cause unknown
• Possible explanations:
  • Hallucinations and belief in spirit possession more common in less industrialized societies, and thus not considered abnormal
  • Often stronger sense of community in less-developed societies that provides support.

Importance of Cultural Connection

• Losing connection between one’s cultural narrative and modern society (i.e., lack of cultural continuity) is associated with the risk of suicide.
• Example: First Nations youth in Canada:
  • Low identification with traditional culture due to Western colonization, but often unable to relate to mainstream/settler Canadian culture
  • More connections with traditional culture predict lower suicide rates.

Indicators of Cultural Connection

• Connection to cultural history indicated by:
  • Political self-government
  • Control over educational services
  • Cultural facilities promoting community’s history
  • Control over policing/law enforcement
  • Negotiating a land claim with the government
• The more these indicators are present, the lower the suicide rate.

Cultural Connection and Wellbeing

• Cultural connection is important to promoting well-being, not only to reducing the risk of harm.
• Similar patterns emerge with different Indigenous cultures, highlighting the importance of (among others):
  • Traditional language
  • Traditional foods
  • Connection to Country/land
  • Cultural stories/teachings
  • Spiritual practices.

Treating Mental Illness

• Treatment of psychological disorders varies across cultures.
• Many forms of treatment are universal.

Universal Conditions

• Culture-bound concepts of distress: large example of difference
• Several psychopathologies appear universal
• Key Differences:
  • Relative Prevalence
  • Symptom Presentation

Depression

• Major depressive disorder (MDD): diagnosis requires people to exhibit at least five of nine symptoms:
  • Depressed mood
  • Inability to feel pleasure
  • Change in weight or appetite
  • Sleep problems
  • Psychomotor change
  • Fatigue or loss of energy
  • Feeling worthless or guilty
  • Poor concentration
  • Suicidality.

Depression Prevalence

• Appears universal
• Large differences in prevalence
• Rates vary based on diagnostic criteria
• Rates in China ~20% of those in USA
• Rates in Nigeria 4x those in USA

Depression Symptoms

• People with depression exhibit different symptoms.
• Cultural variability in types or manifestation of symptoms:
  • Somatization: physical symptoms (e.g., sleep disturbances, headaches)
  • Psychologization: psychological symptoms (e.g., depressed mood, crying).

Neurasthenia

• In China, more than 50 symptoms, including fatigue, poor appetite, headaches, insomnia, back weakness.
• Dropped from the DSM because symptoms were considered less important than the underlying illness.
• Some argue that most with this syndrome could be described as suffering from depression, even though only 9% reported depressed mood as a key symptom.

Depression and Cultural Norms

• In many Western cultural contexts, depression leads to:
  • Less reaction to positive and negative stimuli
  • Emotional numbness
• Study of (non) depressed Euro-Americans and East Asians:
  • Watched neutral, sad, amusing film
  • Emotions assessed
  • No difference for neutral and amusing.