Matsumoto Juang_7e_Chapter 12_PPT PDF

Chapter 11 & 12 Wellbeing and Mental Health Across Cultures  Chapter Objectives 1. Describe how culture is associated with health on the ecological level. 2. Identify factors that represent how culture is associated with health on the individual level....

Chapter 11 & 12 Wellbeing and Mental Health Across Cultures  Chapter Objectives 1. Describe how culture is associated with health on the ecological level. 2. Identify factors that represent how culture is associated with health on the individual level. 3. Describe issues concerning defining normality across cultures. 4. Define how culture can influence the classification of psychopathologies. 5. Recite issues concerning assessing psychopathologies across cultures. 6. Describe universal and culture-specific features of schizophrenia, depression, anxiety disorders, and ADHD. 7. Identify Culture-bound syndromes 8. Define cultural syndromes of distress and give examples. 9. Describe how cultural syndromes of distress differ from psychopathologies with universal symptom patterns. 10. Define differences in prevalence rates in psychopathologies among and within broad categories of ethnic and migrant groups.  Introduction The World Health Organization (WHO) defines health as “a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity.” From anthropological and sociological perspectives, disease refers to a “malfunctioning or maladaptation of biologic and psychophysiologic processes in the individual,” Illness refers to “personal, interpersonal, and cultural reactions to disease or dis-comfort”,  Culture and Health The important role of culture in contributing to the maintenance of health and etiology and treatment of disease has become increasingly clear. Culture affects our lifestyles and behavior, which, in turn, affect our health. Probably the two biggest arenas in which this can be seen are in diet and daily activity. Cultural differences in attitudes and beliefs about health influence how people think about causes of their health and disease states (attributions); when, where, why, and how to seek treatment, and with whom; comply with treatment regimens and suggestions; and many other factors associated with health 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  Cross-National Differences in Health Indicators Worldwide A large part of explaining such drastic differences concerns the general resources of a country (Barkan, 2010). Wealthier countries with greater resources have better access to better diet, nutrition, health care, Poorer nations with fewer resources are more likely to suffer from hunger, malnutrition, various diseases, and lack of access to basics for survival such as clean water, sanitary waste removal, vaccinations, and other medications. Also, nations experiencing war and other disasters experience disruptions that challenge survival. Infant mortality is defined as the number of infant deaths (one-year-old or younger) per 1,000 live births. Figure 11.2 shows worldwide infant mortality rates from the WHO in 2021. Countries with the highest infant mortality rates (per 1,000 births) were Lesotho (42.8), Pakistan (41.2), Central African Republic (39.7), South Sudan (38.6), and Somalia (36.9). Countries with the lowest were San Marino (0.8), Japan (0.8), Singapore (0.9), Iceland (1.0), and Estonia (1.1). Life expectancy refers to the average number of years a person is expected to live from birth. Five countries with the highest life expectancies were Japan (84.3), Switzerland (83.5), South Korea (83.3), Spain (83.2), and Singapore (83.2). The five with the lowest were Lesotho (50.8), Central African Republic (53.1), Somalia (56.5), Eswatini (57.7), and Mozambique (58.1)  Subjective Well-Being (SWB) and Cultures Subjective well-being (SWB) focuses on one’s perceptions and self-judgments of health and well-being. Subjective well-being encompasses a person’s feelings of happiness and life satisfaction There are major worldwide differences in SWB, as reported by the World Happiness Report and as measured by people’s assessments of their lives by imagining their current position on a ladder with steps numbered 0–10, with 10 representing the best possible life for themselves and 0 representing the worse (Helliwell et al., 2020). Using this index, across 153 countries the five happiest countries were Finland (7.81), Denmark (7.65), Switzerland (7.56), Iceland (7.50), and Norway (7.49). The five least happy countries were Central African Republic (3.48), Rwanda (3.31), Zimbabwe (3.30), South Sudan (2.82), and Afghanistan (2.57).  Social Support and Health Social support, healthy life expectancies at birth, freedom to make life choices, and generosity were all positively correlated with overall happiness In addition to having enough material resources, our sense of autonomy and connection to others are essential to our happiness, which is then related to physical health. Triandis and colleagues (1988) suggested that social support or isolation was the most important factor that explained the association between individualism and heart attacks. They suggested that people who live in more collectivistic cultures may have access to stronger and deeper social ties with others than do people in individualistic cultures. These social relationships, in turn, may “buffer” against the stress and strain of living, reducing the risk of cardiovascular disease. People who live in individualistic cultures may not have access to the same types or degrees of social relationships; therefore, they may have less of a buffer against stress and are more susceptible to heart disease. Table 11.1 - Summary of Findings on the Relationship between Four Cultural Dimensions and Incidence of Diseases Cultural Dimension Rates of Disease Higher Power Distance  Higher rates of infections and parasitic diseases  Lower rates of malignant neoplasm, circulatory disease, and heart disease Higher Individualism  Higher rates of malignant neoplasms and heart disease  Lower rates of infections and parasitic diseases, cerebrovascular disease Higher Uncertainty  Higher rates of heart disease Avoidance  Lower rates of cerebrovascular disease and respiratory disease Higher Masculinity  Higher rates of cerebrovascular disease  Culture and the Classification of Psychopathologies One important goal of psychology is to use the knowledge gained through research to help people suffering from psychopathology (psychological disorders that encompass behavioral, cognitive, and emotional aspects of functioning) to rid themselves of symptoms and lead more effective, productive, and happy lives. What is considered abnormal? When are a person’s behaviors, thinking, and emotions abnormal? Do cultures vary in rates of psychological disorders? Are psychological disorders expressed in the same way across cultures, or can we identify culturally distinct patterns? Having a reliable and valid classification system of diagnoses is essential for all health professionals and the people they seek to help. But because culture influences the creation, maintenance, and definition of normality, cross-cultural issues arise concerning the reliability and validity of any diagnostic categories. In the United States, the primary diagnostic classification system is the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) ICD: Another classification system in use today is the International Classification of Diseases, 11th edition (ICD-11; https://icd.who.int/en/), which is the most widely used classification system around the world for global health reporting Chinese Classification of Mental Disorders (CCMD) Figure 12.1 - Cultural Concepts of Distress Results of Failure in Addressing Issues of Assessment Describe someone with a mental and psychological disorder…  Cross-Cultural Research on Psychological Disorders SCHIZOPHRENIA Schizophrenia is characterized by delusions and hallucinations, lack of motivation, social withdrawal, impaired memory, and dysregulated emotions It is commonly misperceived as refer-ring to having multiple or split personalities, Some theories concerning the causes of schizophrenia give primacy to biological factors (e.g., excess dopamine or other biochemical imbalances). Other theories emphasize family dynamics such as parental separation and child trauma (e.g., neglect and abuse) and the broader environment such as living in a dense, urban city, socially fragmented neighborhood, or living in poverty. The diathesis-stress model of schizophrenia suggests that it may develop in individuals with a genetic and bio-logical predisposition to the disorder (diathesis) following exposure to environmental stressors The course of the illness was shown to be more positive for patients in developing countries compared with those in highly industrialized countries. Patients in Colombia, India, and Nigeria recovered at faster rates than did those in England, the Soviet Union, and the United States. Summary Characteristics of Schizophrenia Where you ever depressed?  Cross-Cultural Research on Psychological Disorders Depression Depression is one of the most widely studied disorders as it is one of the most prevalent worldwide. The Global Burden of Disease study (WHO, 2015) predicted that major depression was projected to be the second leading cause of illness-related disability. Depressive disorder is characterized by physical changes (e.g., sleep and appetite disturbances), motivational changes (e.g., apathy and anhedonia), and emotional and behavioral changes (feelings of sadness, hopelessness, loss of energy). The presence of a depressive disorder is experiencing these symptoms for at least two weeks, according to the DSM and ICD. Across race, ethnicity, socioeconomic groups, and cultures, women are more likely to experience depression than men Cross-culturally constant symptoms, including “sadness, joylessness, anxiety, tension, lack of energy, loss of interest, loss of ability to concentrate, and ideas of insufficiency” In Chinese studies, patients’ experiences include symptoms such "heart panic, heart dread, and heart pain" Another symptom was “distress of social harmony,” referring to disrupted social relations within the family or work contexts Depression  Anxiety Disorders Fear is a universal human emotion Anxiety disorders may inherently involve cultural beliefs, norms, or patterns and contexts 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 Some cultural syndromes of distress overlap with disorders that are considered universal. As such, anxiety and panic disorders are universal but there is great cultural variation in the presentation, meaning, and alleviation of symptoms (Lewis- In your community what do people mostly fear?  Attention-Deficit/Hyperactivity Disorder Culture influences understanding of disorders affecting children ADHD has three main features: inattentiveness (difficulty paying attention, easily distracted), impulsivity (having trouble waiting turns, interrupting others), and hyperactivity (fidgeting, cannot sit still) There are contrasting views of ADHD. One view focuses on a neurobiological component of the disorder, citing evidence of chemical imbalances in the brain as a primary cause of symptoms (Tripp & Wickens, 2009). Another view argues that ADHD is a social/cultural construct. Timimi (2004), for instance, contends that the stresses of modern Western culture (loss of extended family support, a busy and hyperactive family life, greater emphasis on schooling and achievement) have set the stage for the emergence of the disorder and higher rates of ADHD. Boys more likely to be diagnosed with ADHD than girls There is evidence for culture-specific attitudes and beliefs about ADHD Activity: Discussion of Psychological Disorders Consider your culture. Are there parts of it that you think influence the development of psychological disorders more so than other cultures?  Cultural Syndromes of Distress - 1 AMOK Amok has been identified in several countries in Asia (Malaysia, Philippines, and Thailand). The disorder is characterized by sudden rage and homicidal aggression. It is thought to be brought on by stress, sleep deprivation, personal loss, or alcohol consumption (Carson, Butcher, & Coleman, 1988; Haque, 2008) and has been observed primarily in men. Several stages of the disorder have been identified, ranging from extreme withdrawal prior to assaultive behavior to exhaustion and amnesia for the rage. The phrase running amok derives from observations of this disorder. ZAR Zar is an altered state of consciousness observed among Ethiopian immigrants to Israel (Grisaru, Budowski, & Witztum, 1997). The belief in possession by Zar spirits, common in Africa, is expressed by involuntary movements, mutism, and incompre-hensible language. BRAIN FAG, KORO, ODE, OGUN OUR, IN WEST AFRICA: Brain fag syndrome: unpleasant head and neck pain, burning or crawling sensations, visual disturbances, and cognitive impairments; Koro and koro-like (magical penis loss) syndrome; Ode on, including sensations of something crawling through the head and other body parts; and Ogun oru, where a person experiences being attacked at night while asleep, is unable to fall back to sleep, and exhibits abnormal behavior like making goat sounds  Cultural Syndromes of Distress - 2 LUTU JINGSHEN BING From Chinese culture, lutu jingshen bing (traveling disorder), is a psychotic condition that occurs when people travel over long distances in overly crowded, poorly ventilated trains; symptoms include illusions, delusions, hallucinations, panic, suicidal acts, and harming others (Lee, 2001). BAKSBAT Baksbat is seen in Cambodia, recognized as symptoms based on cultural trauma that is distinct from PTSD (Chhim, 2013). The term baksbat means “broken courage.” Symptoms include extreme fear, being overly submissive, being mute, and mistrusting other people as well as those in the spirit domain. SUSTO Susto is caused by a frightening event that may result in “soul loss” (Rubel, O’Nell, & Collado-Ardon, 1984; Weller et al., 2008). It is characterized by sadness, sleep and eating disturbances, fear of unfamiliar places, impaired social relations with important others, and has been observed in Mexico, Central and South America, and Latino individuals in the United States. LATAH Latah is characterized by an extreme startle response, echolalia (involuntarily and immediate repeating of words another person says), trancelike behavior, or other inappropriate, uncontrollable behavior (Haque, 2008). It is observed primarily in women in Malaysia. KORO Koro, mentioned previously, is the extreme fear that one’s genitals are shrinking or retracting into the body, causing death. It is found in China, Japan, and India ATAQUE DE NERVIOS Ataque de nervios is observed among Puerto Rican and other Caribbean individuals (Febo San Miguel et al., 2006; Guarnaccia & Pincay, 2008; Guarnaccia et al., 2010; Lewis-Fernández et al., 2010). Symptoms include feeling out of control, trembling, uncontrollable shouting, intense crying, heat in the chest rising to the head, and dizziness. Figure 12.5 - Psychological Disorders Showing Similarities and Culture-Specific Characteristics What is ‘amafufunyana’ What is “diphaiphai”  Spiritual Possession and Schizophrenia ‘amafufunyana’ is recognised as an indigenous name and concept given to a patient presenting symptoms that resemble psychosis or schizophrenia. It is often thought to result from witchcraft and is frequently reported by South African ama/isi/ Xhosa patients, who also describe it as a form of spirit possession that results from sorcery. The spirit possession is caused by a mixture of soil and ants that are taken from a graveyard, supposedly having fed from a dead body; the mixture is then placed in the path of the targeted victim (Ngubane, 1977). After stepping on the mixture, the victim will present with symptoms like those of hysteria; they throw themselves on the floor, tear off their clothes and may even harm themselves through violent acts and try to commit suicide (Niehaus, et al., 2004). Are people concerned about “body image” in your culture or community? Does that have an impact in their lives?  Body and Image Disorders Some disorders that were once considered to be culture specific have become less so over time, such as anorexia nervosa. Before 1980, anorexia nervosa was limited to Western countries and primarily to White, middle-to upper-class women The disorder is characterized by distorted body image, fear of becoming fat, and serious loss of weight associated with restraining from eating or purging after eating. Anorexia nervosa is now found in many parts of the world such as Hong Kong, Japan, and China (Gordon, 2001; Lau et al., 2006; Tachi et al., 2005; Tong et al., 2011). In countries where attention is not drawn to a woman’s figure and the body is usually entirely covered, such as in Arabic cultures, eating disorders such as anorexia nervosa have not been mentioned in psychiatric literature as much  The three dimensions of Culture Syndromes Three dimensions can aid in understanding how cultural syndromes of distress emerge (Pfeiffer, 1982). One involves culture-specific areas of stress, including family and societal structure and ecological conditions. For example, koro might be under-stood as resulting from a unique emphasis on potency in certain cultures that emphasize paternal authority. Second, culture-specific shaping of conduct and interpretations of conduct may mean that certain cultures implicitly approve patterns of exceptional behavior. An example is amok, in which aggression against others “broadly follows the patterns of societal expectations” (p. 206). Third, how a culture interprets exceptional behavior will be linked to culture-specific interventions There are misfortunes that may not be true “syndromes” is important. For example, in the Philippines there is a concept known as lanti, which refers to fever, stomachaches, shouting during sleep and incessant crying Going into trance? What actually happens? Is that a mental disorder?  Natives and Indigenous Struggles 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 Will historical background of individuals shape their mental state?  Immigrants and Xenophobia 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 his/her distress  Refugees Show higher rates of posttraumatic stress disorder (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  Conclusion Psychiatric diagnoses, classification schemes, and measurement of abnormality are complex and difficult issues Classification systems and assessment methods need to contain both etic and emic elements Where to draw lines, and how to measure psychological traits within a fluid, dynamic, and ever-changing system, is a challenge  Activity: Discussion of Mental Health of Historical Struggles, Ethnic Minorities, Immigrants, and Refugees Can you think of a situation that would either cause or buffer the development of mental health disorders among ethnic minorities, immigrants, and/or refugees?  References Judd, F., Jackson, H., Komiti, A., Murray, G., Fraser, C., Grieve, A. & Gomez, R. (2006). Help-seeking by rural residents for mental health problems: the importance of agrarian values, 40(9), 769-776. Ally, Y. & Laher, S. (2008). South African Muslim faith healer’s perception of mental illness: Understanding, aetiological and treatment, 47, 45-56. Akyeampong, E., Hill, A. G. & Kleinman, A. (2015). The culture of mental illness and psychiatric practice in Africa. United States of America: Indiana University Press. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th Ed.). Washington DC: American Psychiatric Association. Bhana, K. & Bhana, A. (2001). Conceptualization of mental illness by South African Indian adolescents and their mothers, 125(3), 313-319. Monteiro, N. M. (2015). Addressing mental illness in Africa: Global health challenges and local opportunities, 1(2), 78-95 Sehoana, M. J. (2015). Exploring the perceptions of mental illness among Pedi Psychologists in the Limpopo Province. Unpublished thesis. University of Witwatersrand. Monteiro, N. M. (2015). Addressing mental illness in Africa: Global health challenges and local opportunities, 1(2), 78-95 Sehoana, M. J. (2015). Exploring the perceptions of mental illness among Pedi Psychologists in the Limpopo Province. Unpublished thesis. University of Witwatersrand.  Activity: Self-Assessment (1 of 2) Discuss issues concerning defining normality across cultures. Describe how issues concerning defining normality across cultures affect classification of psychopathologies. Define the terms over- and under-pathologizing in relation to cultural knowledge. Identify cultural differences in attitudes, beliefs, and perceptions concerning the causes and treatments of disorders.  Activity: Self-Assessment (2 of 2) Consider how the symptom pattern of each of the cultural syndromes of distress is associated with the unique aspects of the culture in which it occurs. Note differences in prevalence rates for mental health issues between broad categories of ethnic groups and mainstream groups. Note differences in prevalence rates for mental health issues within broad ethnic categories among specific ethnic and cultural subgroups.  Summary (1 of 2) Now that the lesson has ended, you should have learned how to: 12.1 Describe issues concerning defining normality across cultures. 12.2 Define how culture can influence the classification of psychopathologies. 12.3 Recite issues concerning assessing psychopathologies across cultures. 12.4 Describe universal and culture-specific features of schizophrenia, depression, anxiety disorders, and ADHD.  Summary (2 of 2) Now that the lesson has ended, you should have learned how to: 12.5 Define cultural syndromes of distress and give examples. 12.6 Describe how cultural syndromes of distress differ from psychopathologies with universal symptom patterns. 12.7 Define differences in prevalence rates in psychopathologies among and within broad categories of ethnic and migrant groups.