Culture and measurement Flashcards
What does the evidence suggest on the dichotomy of body and mind across cultures?
Most cultures differentiate illnesses of the spirits and illnesses of the body
- mental distress vs. somatic
How are illnesses of the spirit / mental distress categorised in most cultures?
- Causation: external/internal
- ancestors, witchcraft, god-given, hereditary, alcohol - Phenomenology: external/internal
- type and severity of behavioural disturbance
What does the phenomenology of mental illnesses (illnesses of the spirit) refer to?
The type and severity of behavioural disturbance
What do causation and phenomenology of illnesses of the spirit / mental distress determine in all traditions?
- Illness beliefs/prognosis
- Help-seeking
- Treatment
What does Kleinmann’s explanatory models (1980) propose?
Service users, clinicians and policymakers operate in cultural settings AND hold their explanatory models of illness
What is the purpose of Kleinmann’s explanatory models (1980)?
Useful to explain influence of culture on mental illness experience
What did Kleinmann’s explanatory models (1980) mark in history?
- A great leap forward for cross-cultural psychiatry
- Beginning of documenting and accounting for cultural differences in experiences of illness
What was the purpose of the questionnaire in Kleinmann’s explanatory models (1980)?
Reveal labels and cultural idioms in experiences of illness
- related beliefs about aetiology
- causation and relevant health-seeking behaviours
What was particular to panic disorder and PTSD in Khmer refugees?
Autonomic symptoms (e.g. dizziness and palpitations) interpreted as blocked wind - "Kyol Goeu" = 'wind overload'
- wind is essential to Khmer psychophysiology
- they believe small vessels carry blood and wind through the body
- symptoms of blockage associated to death if no intervention
What did the study on panic disorder and PTSD in Khmer refugees illustrate?
Challenges associated with understanding mental health and diagnoses across cultures
- Khmer refugees interpreted autonomic symptoms as blocked wind (“Kyol Goeu” - ‘wind overload’)
What are the implications of the challenges associated with understanding mental health and diagnoses across cultures?
> Need to develop cultural phenomenology of illness experience
> Clinicians and researchers should understand cultural syndromes
- how they relate to cognitions, experiences and MH outcomes
> It’s important in order to quantify burden of disease
> Also important when developing health services, systems and models of care
What did Francis Galton put forward about measurement?
It’s an essential component of scientific research (natural, social, health)
What was the purpose of objective (or close to objective) measurement according to Francis Galton?
- Lab/tissue -> basis for diagnosis
- Determine if patient has / does not have the disease
- Appropriate amount of time after disaster: count survivors
In which cases does measurement create challenges in mental health?
- Subjective states (e.g. quality of life)
- Conditions without biomarkers (e.g. mental disorders)
What is the place of diagnostic criteria (e.g. DSM, ICD)?
> Diagnosis relies on report or observations of behaviour and internal mental states
- important for quantification of burden and impact of disease
> We use diagnostic criteria which we believe represent the latent structures of disorders
What is the aim of diagnostic criteria?
To obtain optimum validity and reliability
What is validity in diagnosis?
A diagnosis reflects the disorder it is designed to identity
What is reliability in diagnosis?
Diagnosis works in the same way
- among different people
- in different settings
- over time in same patient
What does the DSM and ICD represent in mental illnesses?
They represent categories based on phenomenology, NOT aetiology
What are the criticisms of the DSM and ICD?
> Pharma companies have too much influence over categorisations
> Labels are unhelpful for clinicians
> Labels stigmatise patients
> Categorisation pathologist problems of everyday life
> DSM and ICD are based upon research and clinical experience from Western countries (not rest of the world)
What would be the consequences if the Western basis of the DSM and ICD results in bias?
> Symptoms that are important in particular parts of the world would be missed from DSM or ICD
> Some symptoms included in criteria might not be reported in particular populations / cultural groups
What did Haroz and colleagues (2016) identify in the experience of depression around the world?
Important signs of bias:
- features such as social isolation, crying, anger and pain are not part of DSM criteria
- problems like concentration, agitation and slowing which are part of DSM criteria were not commonly mentioned in studies
What do the signs of bias in the DSM diagnostic criteria regarding mental illness experience around the world reveal?
Need for a review of content of standard instruments
- beyond the focus on DSM diagnostic criteria
- AND beyond regional variation and instruments
- to reflect local variation in presentation of symptoms
What constitutes the universalist approach to mental illness?
= Etic approach:
- mental illness is similar around the world
- psychiatric taxonomies, measuring instruments and models of healthcare designed in the West are globally applicable