PSY1PAC 2024 Semester 2 Lecture 11 Introduction to Psych PDF

latrobe.edu.au PSY1PAC Introductory Psychology: People and Culture Lecture 11: Mental Health Reading: Butler et al. (2019) Dr Matthew Ruby Department of Psychology, Counselling and Therapy...

latrobe.edu.au PSY1PAC Introductory Psychology: People and Culture Lecture 11: Mental Health Reading: Butler et al. (2019) Dr Matthew Ruby Department of Psychology, Counselling and Therapy [email protected] La Trobe University CRICOS Provider Code Number 00115M  Content Advisory This lecture explores mental health and illness in different cultural contexts, including research on eating disorders, depression, anxiety, and suicide. Our intention is to approach these topics in a sensitive fashion, but some of this content may elicit discomfort. Please be mindful of this during class today (especially in the chat).  Lecture Outline What is a Psychological Disorder? Culture-Bound Concepts of Distress Universal Conditions Treatment Approaches Cultural Responsiveness  Learning Outcomes Students should be able to: Understand what makes a condition a psychological disorder Define and provide examples of culture-bound concepts of distress Explain cultural variation in the presentation & experience of depression, social anxiety, and schizophrenia Differentiate between different therapeutic approaches Discuss the importance of cultural responsiveness among mental health practitioners Imagine for a moment... What would you do? Image is public domain / CC0 license  Defining Mental Health Conditions Psychological disorders are typically defined as behaviors that are rare and that impair the individual. Problem: The definitions of “rare” and “problematic” vary across cultures.  Experience Psychopathology Culture Interpretation  Culture-Bound Concepts of Distress In DSM-V (p. 758), “ways that cultural groups experience, understand, and communicate suffering, behavioral problems, or troubling thoughts and emotions” Three different types of cultural concepts Cultural syndromes (clusters of symptoms that occur in specific cultural groups) Cultural idioms of distress (shared ways of experiencing & talking about personal & social concerns) Cultural explanations (culturally recognized ways of explaining symptoms, illness, and distress) (APA, 2013; Ventriglio et al., 2016)  Culture-Bound Concepts of Distress Formerly known as “culture-bound syndromes” Newer wording “acknowledges that all forms of distress are locally shaped, including the DSM disorders” (APA, 2013; p. 758) Sometimes difficult to map a culture-bound concept of distress into a clear DSM diagnosis, so local cultural knowledge is essential (APA, 2013)  Hikikomori Primary locations: Japan (Korea, Taiwan) Symptoms: Withdrawal from world; barricading in room Group: any gender, but more common among young men Often begins in middle / high school Disconnect with DSM: Depression? Social Anxiety? Almost non-existent in pre-war Japan Fears about failing in social world with little tolerance for falling short / non-conformity; declining career options (Furlong, 2008; Ogino, 2004; Saito, 1998; Sakai et al., 2004) https://www.bbc.com/news/magazine-23182523  Hikikomori (Assessable) To learn more about Hikikomori, from people living with it: https://www.youtube.com/watch?v=KMkZjsDVKks (Non-assessable): If you’re curious how Hikikomori used to be depicted/understood… https://www.youtube.com/watch?v=dr5y1iP9TfU  Dhat Primary location(s): South Asia Symptoms: Morbid fear that one’s body is leaking semen Group: Young men Associated with guilt about forbidden activities (masturbation) Semen a source of vitality, defense against disease Cultures w/out belief  No dhat Image is public domain / CC0 license (Akhtar, 1988; Kleinman, 1988; Obeyesekere, 1985)  Bulimia Nervosa Primary locations: North America, Europe Symptoms: uncontrollable binge eating, along with inappropriate behaviors to prevent weight gain Group: Any gender, but more common in women Absent in much of the world, especially in cultures where food is not abundant Prevalence increasing with time, often attributed to changing cultural norms/pressures Appears confined to cultures with Western influences (Gordon, 1990; Keel & Klump, 2003; Willis, & Knobloch-Westerwick, 2014)  Anorexia Nervosa Primary locations: North America, Europe Symptoms: refusal to maintain normal body weight, intense fear of gaining weight, and denial of the seriousness of abnormally low body weight Group: Any gender, but more common in women Dramatic increase in rates of anorexia this century; but largely absent in many cultures Often manifested differently in different cultures (e.g., no fear of fatness in HK) Self-starvation has historically happened in many cultures, but often for religious reasons (Lee et al., 1993; Zhang et al., 1992; Bemporad, 1996; Keel & Klump, 2003)  Koro Primary locations: Southern China and Malaysia “Head of a turtle” Symptoms: Fear that penis is shrinking into body Groups: Men (also in women, fear of losing nipples) 1967, Singapore: Swine flu Koro epidemic 1997, Nigeria, Cameroon: penis theft riots 2001 study of American: 3 of 70 marijuana users experienced koro-like symptoms (Dzokoto & Adams, 2005; Earlywine, 2001; Ngui, 1969; Tseng, 2001) Image is public domain / CC0 license  Ataques de Nervios Primary location: Puerto Rico Group: More common in women Symptoms: Convulsions, partial loss of consciousness, heart palpitations, numbness, sudden outbursts, sense of heat rising to the head. Sense of “being out of control.” Often occurs within a couple days of a stressful event Usually brief, can happen across the lifespan Culturally recognised means of communicating strong emotion and protesting unfair treatment Higher education level associated with lower odds of having as ataque (Lopez et al., 2009; Guarniccia et al., 1993; Roche-Miranda et al., 2023)  Frigophobia Primary location: China, Singapore Group: Mostly women Symptoms: Avoidance of cold air, cold food, wearing multiple layers year round Often treated via diet (pepper, ginger, vinegar) Image is public domain / CC0 license (Chang et al., 1975)  Culture-Bound “Disorders”? Recent work on culture-bound disorders in Aboriginal Australian cultural contexts Facilitated by Dr Tracy Westerman (2021) Community consultation / meetings with Elders in the Pilbara and Perth regions Focus groups with 65 people “Culture bound syndromes are things that are often considered ‘normal’ in Aboriginal communities but when viewed from whitefella world might be considered to be mental illness, and so mob can be misdiagnosed.” (p. 4) (Westerman, 2021)  Culture-Bound “Disorders”? Longing for Country People away from Country for extended periods of time may experience different types of ‘unwellness’: Physical ill health (e.g., weakness, fatigue, nausea) Spiritual ill health Cognitive disorientation Cultural ill health (e.g., identity confusion, acculturative stress) “Appropriate intervention included returning to country to reconnect with land, culture, and spirit… Participants described going home as feeling like “a rejuvenation”. (p. 4) (Westerman, 2021)  Culture-Bound “Disorders”? Spiritual Visits “Participants spoke of examples of Aboriginal people experiencing ‘visits’ from loved ones following their passing as a normal aspect of grieving.” (p. 9) Often misdiagnosed as psychosis  Hesitancy to speak with therapists about visits Concern that these experiences could be misclassified as “delusions” Cultural and community context critical (Westerman, 2021)  Other Culture-Bound Concepts of Distress Susto: feeling the soul has been dislodged from the body, which can lead to a range of symptoms (parts of Latin America) Hörsturz: sudden and temporary impairment/loss of hearing, with no obvious cause. Often attributed to stress (Germany) Fernweh: “distance sickness.” Longing for far-away lands and travel. “Nostalgia in reverse” (Germany) Perhaps not so culture-bound in the age of Covid? (Rubel et al., 1985; HNO-Ärzte im Netz, nd)  Culture-Bound Concepts of Distress Although some of culture-specific experiences of distress may seem puzzling, it’s important to note that the distress of the people who experience them is very real. Ideas about what is “normal” can vary a LOT from culture to culture, and it’s easy to misunderstand things if one isn’t familiar with a given culture. In a different (but somewhat related) vein: Beliefs about health can lead to physical symptoms. Consider the following reactions to being injected with a particular substance.  Do you think this is safe enough to prescribe? (CDC, 2021) These are all reactions to a placebo (saline solution).  Language & Emotion Looking back to Week 8, there’s huge cultural variation in descriptions of emotions based on language An ancient Indian treatise, the Natyashastra, identifies eight basic emotions, compared to Ekman’s six. English has over 2,000 emotion words; the Chewong of Malaysia have only 8. Cultural variation in categorisation of emotion English emotion words absent in some languages (e.g., sorrow and anger not distinguished in the Ugandan language of Luganda) Emotion words existing in other languages absent in English (e.g., Schadenfreude in German) Possible implications for culture-bound concepts of distress? (Shweder & Haidt, 2000; Russell, 1991; Lutz, 1988)  Practice Question Which of the following is an example of a culture- bound concept of distress? a) Arachnophobia b) Alzheimer’s Disease c) Dementia d) Frigophobia* BREAK TIME   Universal Conditions Culture-bound concepts of distress: large example of difference Several psychopathologies appear universal Key Differences: Relative Prevalence Symptom Presentation Image is public domain / CC0 license  Depression Major depressive disorder (MDD): diagnosis requires for 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 Apparent universal Large differences in prevalence Rates vary based on diagnostic criteria Rates in China ~20% of those in USA Rates in Nigera 4x those in USA (Kessler et al., 1994; Ingram et al., 1999)  Depression People with depression can exhibit different symptoms. Cultural variability in types or manifestation of symptoms: Somatisation: physical symptoms Sleep disturbances, headaches Psychologisation: psychological symptoms Depressed mood, crying Image is public domain / CC0 license (Haroz et al., 2017)  Depression Example: 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 have argued that most with this syndrome could be described as suffering from depression, even though a study found that only 9% reported depressed mood as a key symptom (Zhang, 1989; Kleinman, 1982)  Depression In many Western cultural contexts, depression  Less reaction to positive & negative stimuli Emotional numbness Study of (non) depressed Euro-Americans and East Asians Watched neutral, sad, amusing film Emotions assessed No diff for neutral and amusing (Chentsova-Dutton et al., 2007) Image is public domain / CC0 license Depression  Departure from cultural emotion norms?  Social Anxiety Disorder Another apparent universal Criteria: Fear of social situations with unfamiliar people Exposure to the feared social situation  anxiety Recognition that fear is excessive Avoidance of situation interferes with normal routine Image is public domain / CC0 license (Clark & Wells, 1995)  Social Anxiety Disorder 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 valued more in interdependent cultures Social anxiety seen as more natural? (Hsu & Alden, 2007; Hwu et al., 1989; Hsu, 2010)  Social Anxiety Disorder 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 (Cousins, 1990; Miyamoto & Onizawa, 1985; Morita, 1917; Stein, 2009) Image is public domain / CC0 license  Schizophrenia Highly challenging; apparent universal Criteria: 2+ symptoms over significant time period Delusions Hallucinations Disorganised speech Grossly disorganised or catatonic behavior Negative symptoms (e.g., loss of speech, flat affect) Combo of genetics, prenatal experiences, neuroanatomy Less cultural variation than most mental disorders Schizophrenia / Marco Castellani / CC BY-SA 2.0 (Cannon et al., 1998; Lin et al., 1969)  Schizophrenia Significant variation in subtypes of schizophrenia 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 (WHO, 1973)  Schizophrenia Much higher recovery rates in less industrialised societies Opposite pattern as most physical and mental illnesses Cause unknown Possible explanations Hallucinations and belief in spirit possession more common in less industrialised societies, and thus not considered abnormal Often stronger sense of community in less-developed societies that provides support (Hollingshead & Redlich, 1958; Leff et al. 1992; Watters, 2010) Image is public domain / CC0 license  Importance of Cultural Connection Losing connection between one’s cultural narrative and modern society (i.e., lack of cultural continuity) associated with risk of suicide Example: First Nations youth in Canada Low identification with traditional culture due to Western colonisation, but often unable to relate to mainstream/settler Canadian culture More connections with traditional culture predict lower suicide rate (Chandler et al., 2003)  Importance 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 were present, the lower the suicide rate http://www.panoramio.com/photo/59631454 (Chandler et al., 2003)  Importance of Cultural Connection Cultural connection not only important to reducing risk of harm, but to promoting wellbeing Similar patterns emerge with different Indigenous cultures, highlighting importance of (among others): Traditional language Traditional foods Connection to Country / land Cultural stories / teachings Spiritual practices This is explored in greater depth in this week’s reading and tutorial (Butler et al., 2019)  Treating Mental Illness Treatment of psychological disorders varies across cultures. Example: Western psychotherapy Psychotherapy origins: Freudian psychoanalysis, 19th century Austria Discuss problems with therapist  help interpreting Many therapies based on idea of gaining insight via talking through problems Odd in cultures where people don’t typically seek explicit social support Talk therapy sometimes stigmatised in these contexts (Kirmayer, 2007; Sue at al., 1991)  Social Support Social support helps people cope with distress and has health benefits cross-culturally, but the ways in which people seek and provide social support may differ. West: Social support seeking common coping mechanism Not actively sought in all cultures East Asia: Avoid overt social support seeking Concern with potentially disrupting relationship Implicit social support: reflecting on close relationships (Cohen & Wills, 1985; Kim et al., 2006; Morling et al., 2003) Image is public domain / CC0 license  Treating Mental Illness Japan has some unique approaches to psychotherapy Morita therapy encourages clients to accept their circumstances. Intended for coping with anxiety and depression Involves isolated bed rest, manual activities, reading, and life training, combined with meditation and therapy Naikan therapy helps people gain insight into their past. Used to treat depression, addiction, and sociopathic behavior Involves reflecting on kindness received from close others and how little they have given in return (Weisz et al., 1984; Reynolds, 1980; Tanaka-Matsumi, 2012)  Treating Mental Illness Lee et al. (1992) examined Indigenous healing practices across 16 cultures in Africa, Asia, South America, the Middle East, and the Caribbean Two major models of healing emerged Family Most important in resolving mental health problems Shared problems and stigma among family members, who were key source of guidance Spirituality and religion Mental illness perceived as rooted in an underlying spiritual problem(s) (Lee et al., 1992; Adeofe, 2004)  Sweatlodge First Nations ceremony throughout what is now called the USA and Canada Many different variations, but common elements Grandmothers/Grandfathers (often lava rocks) Ceremonial fire Lodge structure Water Songs/prayers Range of use: treating substance dependence, distress, general illness, expressing gratitude, marking important milestones Persistence throughout ban (1885-1951) Significant cultural variation in some details (Schiff et al., 2006; Garrett et al., 2011) http://www.dancingtoeaglespiritsociety.org/swlodge.php  Treating Mental Illness Important to consider meaning of health and wellbeing in different cultural groups “Aboriginal health means not just the physical well-being of an individual but refers to the social, emotional and cultural well-being of the whole Community in which each individual is able to achieve their full potential as a human being thereby bringing about the total well-being of their Community. It is a whole of life view and includes the cyclical concept of life-death-life.” (National Aboriginal Community Controlled Health Organisation, 2010, p. 5) (Butler et al., 2019)  Treating Mental Illness Many Western psychotherapeutic approaches focus heavily on the individual, with somewhat limited attention to relationships and context Butler et al.’s (2019) review identifies many important aspects of wellbeing for Aboriginal and Torres Strait Islander peoples, but that’s not to say they aren’t important for other cultural groups Autonomy/empowerment/recognition Family and community; Culture Spirituality and identity; Country Basic needs Work, roles, and responsibilities Education Physical health; Mental health Image is public domain / CC0 license (Butler et al., 2019) Cultural Competence & Responsiveness Therapists in multicultural settings often have clients with different understandings of mental health (treatment). Cultural competence involves (1) recognising one’s own cultural influences, (2) developing knowledge of client’s cultural backgrounds and expectations, (3) developing skills for culturally sensitive and relevant ways of acting in sessions. Therapists should be flexible and adapt to each client’s individual needs. Shift in recent years toward concept of cultural responsiveness  Cultural Responsiveness Cultural competence is relatively static. Cultural responsiveness is complex, dynamic, reflexive, and ongoing. Gamilaroi First Nations researcher Pete Smith, assisted with cultural advice from an Aboriginal advisory group including Gamilaroi Elders, recently reviewed the literature on cultural responsiveness, and developed the Cultural Responsiveness Assessment Measure (CRAM). The CRAM contains 9 factors. (Smith et al., 2021; 2022; 2023)  Cultural Responsiveness Awareness I understand the types of strength and resilience that have enabled Indigenous people to resist colonisation. Knowledge I have actively sought information and knowledge about Indigenous people. Inclusive Relationships I would seek to work with family and/or community members of Indigenous clients including having them present during sessions. (Smith et al., 2023, p. 11)  Cultural Responsiveness Cultural Respect My own culture influences the way that I think and behave. Cultural Safety I take time with clients to explain therapeutic practice or to answer questions. Social Justice and Human Rights I understand how power and privilege and their psychological impacts have disadvantaged Indigenous people. (Smith et al., 2023, p. 11)  Cultural Responsiveness Self-Reflection I frequently take the time to reflect on my thoughts, emotions, and behaviours in relation to therapeutic practice. Cultural Humility Listening is an important first step in understanding a client’s culture. Cultural Competencies Working holistically with Indigenous clients is important. (Smith et al., 2023, p. 11)  Cultural Responsiveness Cultural Responsiveness is considered a core competency for practicing psychologists in Australia (also the USA and Canada). You’ll be returning to this concept throughout the Bachelor of Psychological Science. If you want to learn more in the meantime, check out this article from Edwige et al. (2022): https://www.theguardian.com/commentisfree/2022/jun/02/aust ralia-needs-to-decolonise-its-mental-health-system-and- empower-more-indigenous-psychologists  Practice Question Ray has been diagnosed with depression by a psychiatrist, but they don’t report feeling very sad. They primarily experience stomach and sleep problems. Which of the following most accurately labels Ray’s pattern of symptoms? a) collectivisation b) derealisation c) psychologisation d) somatisation*