Bolton

Question 1

Aim of Bolton

Answer 1

To investigate whether a Western diagnosis of depression was accepted by the local community as a valid description of their response to trauma

Question 2

Methods of Bolton

Answer 2

Case study on two rural areas in Rwanda, using different types of interviews. Gathered lists of problems as a result of genocide, identified by the local community.

Question 3

Findings of Bolton

Answer 3

• Following list of symptoms were obtained:
• Failure to sleep, hopelessness, anger, attempting suicide, isolation
• Found that interviewees described the diagnostic symptoms of depression as result of genocide and also described associated ‘local’ symptoms not included in the established diagnostic criteria.

Question 4

Conclusion of Bolton

Answer 4

the Western diagnostic criteria (from the DSM) did not fully reflect the experiences of the local community in response to the genocide.

Not very surprising as the DSM was based on cultural norms that did not include exposure to genocide, but the study demonstrates the importance of cultural relativity in diagnosis and the problems with the use of ‘universal’ diagnostic tools (classification systems such as the DSM and ICD).

Question 5

Strength of Bolton

Answer 5

• emic approach (describes the study of cultural norms that are specific to one group of people or within culture) -> can consider how culture shaped individuals health and determine appropriate treatment
• data triangulation -> strengthen the credibility of findings
• back translation - translating interviews back into the original language - is used to establish credibility.

Question 6

Limitation of Bolton

Answer 6

• limited generalizability (2 areas only + emic approach limit to community)
• reliant on determining which western disorder most resembles the locally defined problems
• The main limitation of cross-cultural psychiatry, of course, is that it fails to recognize that cultures are dynamic, complex social constructs which defy easy definition or measurement. As this study only took into account two rural communities in Rwanda, it is possible that their symptoms are a direct result of their experience in the genocide, which may be different from other parts of Rwanda.