Chapter 12 (Lecture - Ch 11 in Textbook) Flashcards
key debate related to mental health (core issue for the chapter)
Are mental disorders universal conditions, or are they culture and context specific?
- if disorders are universal, this suggests biological causes (common to human biology)
- if disorders are culturally unique or specific: may be viewed as ways of describing or understanding “abnormal” or undesirable behaviours in specific cultural contexts (remember: “normal” and “unusual” are culturally defined terms)
what is culture?
- culture is social and “shared” - it involves group membership
- cultural beliefs, values, and practices are transmitted from one member to another (and from one group to another)
- plurality of cultures: cultural components related to race/ethnicity, but also class, profession, age, etc.
- all individuals participate in and have culture, but often obscured in relation to dominant social groups
Simple definition: shared and learned beliefs and understanding
How we participate in culture
We all participate in “culture” - we are both products and producers of cultural knowledge and practices
- culture is fluid and ever-changing
Consider how we all shifted to online learning (and then transitioned back to in person learning): people had to learn new practices, and collectively figured out new modes of communicating and interacting
- disparities in power are important considerations in relation to culture (some groups and viewpoints have more dominance) and have larger impacts on how we understand mental illness (e.g., psychiatrists, the DSM)
People’s experience of mental illness is influenced by culture
- culture itself is a social determinant of health
- our ways of communicating and expressing emotion are culturally mediated - but these also relate to components of diagnostic criteria for mental disorders, can influence the likelihood of receiving a diagnosis mental illness
- mental distress and psychological problems are expressed or “performed
in cultural ways (culturally appropriate and drawing on culture)
Culture and Mental Illness
- when behaviour and personality do not fit well with cultural norms, a person is more likely to display “psychiatric symptoms” or be deemed to have a disorder (e.g., hyperactive kids and ADHD, or solitary behaviour)
- experiencing racism and discrimination due to cultural background may negatively impact mental health - may be risk factors for mental illness (they cause distress, may lead to marginalisation and barriers to care)
- as a risk factor: members of ethnic minority groups may be more likely to be diagnosed with a disorder (like schizophrenia) but may also experience more mental health problems than members of majority groups (likely partially due to racism and discrimination)
- culture can be a protective factor too: among some black women the tendency to avoid self-blame (which an individualise social problems, rather than consider structural drivers) may shield people from distress
Our response to mental distress is influenced by our cultural perspectives
- we may or may not perceive that a feeling or thought is unusual or problematic depending on our cultural background (communicating with deceased ancestors, belief in possession)
- we may or may not believe that consulting a medical professional is the best option (we may seek help from a spiritual leader or advisor, a community leader or elder, or not seek help at all)
- our beliefs about the mental distress we experience (and how we understand it) are products of our cultural context (learned ideas and understandings)
Emic vs Etic
Two terms used to describe two different perspectives for studying a culture or behaviour
Emic: insider perspective, or the perspective of the culture being studied
- emic research focuses on understanding a culture from the perspective of its members (subjective, grounded)
Etic: outsiders perspective, or the perspective of someone looking in at a culture
- Etic research studies cross-cultural differences and relies on pre-existing theories (objective, or applying external ideas or frameworks)
Terms originated in linguistics (in the 1950s) and were later adopted in anthropology in the 1960s: derived the terms from the suffixes of the words “phonemic” (sounds that are meaningful within a language) and “Phonetic” (all the sounds that can appear across all languages)
- Is the DSM emic or etc in its orientation?
Culture and Mental Illness - category fallacy
Coined by Arthur Kleinman (a anthropologist and psychiatrist)
Category fallacy: reification of one’s culture diagnostic categories and their application to people in another culture, where these categories lack coherence and their validity has not being established
- conceptualisation/expression of mental distress is dependent on cultural context, so trying to use singular/”universal” systems to understand and treat psychological distress is ineffective (discourages a singular or universal system for understanding mental distress, rather consider “in-context” or in an emic view
culture and mental illness - transcultural psychiatry
Combines anthropology and psychiatry to examine how culture interacts with mental illness
- mental disorders take different forms or look differently depending on socio-cultural context
- culture shapes individual vulnerability to mental health problems, and diagnosis as well
- culture also defines how one experiences, expresses, manifests, and is treated for mental health problems - highly influential in numerous different ways
Our expression of mental distress is influenced by our culture
- illustrating how mental disorders may look very different (or be expressed differently) in different cultural contexts
- for example, somatisation (experiencing symptoms through/in the body) may be more common in cultures where the outward expression of emotionality and pain is discouraged
- it could be argued that mental illness is a way of “performing” mental distress in a way that is understandable to other members of our cultural group (culturally appropriate)
For example, North Americans and Europeans are thought to experience depression in largely psychological ways (less often through somatisation)
More on culture and mental illness
- experiencing depression psychologically is perhaps culturally specific to European ancestry (consider implications of this view for the DSM, where description of “depression” is largely based on North American medical understanding of the condition)
- examination of cross-cultural and inter-ethnic manifestations of disorders (like OCD, ED, anxiety, and PTSD) leads to the conclusion that culture plays a key role in experience and expression of mental distress
Culture and Mental Illness - are we looking at or experiencing the same illnesses or conditions?
- if the expression of mental distress is very different, how do we know if we see is the same disorder (depression, for example?)
- are there illnesses which are culturally specific, rather than universal
- has Western ethnocentrism fundamentally biased dominant diagnostic systems towards seeing European and North American norms as “universal”?
Culture and Mental Illness - are disorders universal?
- assumption in psychiatry is that people around the world are experiencing the “same” disorder, but content of delusions (for instance) is culturally shaped
- argument is that disorders are universal diseases which have been discovered and documented as psychiatry and abnormal psychology have progressed (perhaps a positivist view)
Other view (non-universal): argues there is little evidence for viewing them as “universal”
- diagnosis is a work in progress: not certain, or objective (no biomarkers, definitive lab tests)
- subjectively assessed through an interpersonal and cultural encounter (by definition, subjective)
Suman Fernando: clinical assessment/diagnosis is a meeting between two people, in which both human actors (not robots) bring their own language, feelings, tensions, and underlying beliefs (cultural influences) to the clinical encounter
- somatized depression (stomach and chest pain) vs psychological (low mood, hopelessness) depression: 2 expressions of same condition or different/separate conditions?
Critiques of Psychiatry and its view of culture
- psychiatry has tended towards broad (and perhaps overly simplified or stereotyped) generalisations of non-Euro/American cultural groups
- (until recently) has not meaningfully considered culture in relation to conceptualisations of mental health and illness, and views itself as neutral and objective - treats culture as an “afterthought” rather than recognising the influential and deterministic role it has
- “culture” is something patents (rather than practitioners) possess
- people outside of majority cultural groups are more likely to be mistreated and misdiagnosed in healthcare settings
- culturally appropriate behaviours (belief in possession, communication with ancestors) may be deemed a behaviour indicating a psychiatric condition (disorder)
- real psychological stress may be discounted as just “cultural difference”, as it may not be recognised as a symptom in the DSM
