Culture and mental health Flashcards
Universalist perspective of mental health
Many disorders have identical symptoms
cultural relativism of mental health
View that culture and psychopathy are intertwined
Abnormality in mental health
Disorders can be understood only in the cultural framework within they occur
- cautions against ethnocentrism
Classification systems for mental disorders
- DSM
- ICD
- CCMD
DSM
Diagnostic and statistical manual of mental disorders
–> DSM V revised to include cultural concepts of distress (CCD) and cutural fromulation
ICD
International classification of diseases
CCMD
Chinese classification of mental disorders
Three aspects of cultural understanding of mental health
- cultural syndromes of distress
- cultural idioms of distress
- cultural explanation of distress
Cultural syndromes of distress
Patterns of symptoms that tend to cluster together for individuals in specific cultural grooups, communities, or contexts
Cultural idioms of distress
Ways that communities and cultural groups communicate and express their distressing thoughts, behaviors and emotions
Cultural explanations of distress
What communities and cultural groups believe is the cause of the distress, symptoms, or illness
Cross-cultural assessment tools for mental health
- questionnaires, interview protocols, or standardized tasks requiring behavioral response
- play limited role in other cultures with varying definitions of abnormality
- large scale comparatie studies often need local (emic) supplements
- cultural backgrounds of both therapist and client
–> perception + assessment
Somatization
- mental health
- more prototypically collectivist cultures more somatization (physical symptoms/complaints)
- more prototypically individualist cultures more psychologization (emotional symptoms/complants)
Karabasan
The way that people describe having a sleeping disorder in Turkey, sounds a lot like hallucinations. It is not, they describe like some ghost is sitting on top of them, but apparently, this is normalin Turkey when you talk about having a sleeping disorder
Overpathologizing
Considering behavior as pathological, when behavior is a normal variation for that individual’s culture
Underpathologizing
Indiscriminately seeing behavior as cultural, when behavior actually reflects abnormal psychological response
Cross-cultural research of schizophrenia
- universal symptoms - lack of insight, auditory and verbal hallucinations, and ideas of reference
- course of illness was more positive for patients in developing countries than developed countries
- symptoms manifestation varies between countries
–> Family and social interactions influence the course of schizophrenia
Trends in mental health
Relabeling and inclusiom of these manifestations in the mainstream diagnostic categories in the upcoming revisions of the diagnostic manual would pave way for a better understanding and management of these conditions
–> moving away from ‘culture-bound syndromes’ leads to cultural syndromes of distress
African American minorities in mental health
- historical context
- lower rates of depression
Latino American minorities in mental health
- variety of Latino groups
- Ethnic community vitality/strength
Asian American minorities in mental health
- Heterogenous, low prevalence
- model minority
–> masking mental health issues
Native American minorities in mental health
- Higher prevalence
- Culture-loss
Common mental health problems in immigrants and refugees
- intitial mental health issues lower than general population
- prevalence of trauma
- assessment and treatment benefit from interpreters and cultural brokers
- mental health assessment should include trajectory
Migration and mental health
Prevalence rates of minorities =/= prevalence rates countries of origin»_space; relevance of migration trajectories
- major shift: personal ties, socio-economic system, cultural system
- immigrants and refugees less likely than locals to access mental health services
- refugees particularly vulnerable
Migration and mental health services
- communication
- cultural narratives of symptoms and illness behaviors
- family structure, acculturation, intergenerational conflict
- receiving society’s facilitation/hindrance of adaption
Conclusion of minorities in mental health
- psychiatric diagnoses, classifcation schemes, and measurement of abnormality are complex and difficult issues
- psychopathologies are influenced by culture in terms of: specific behavioral and contextual manifestations and the meaning of disorder to individuals
- classification systems and assessment methods need to contain both etic and emic elements
Psychotherapie for mental health
- western origin, focused on the individual
- cognitive behavioral therapy: one of the most common therapies
- what the person can do himself, very individuallistic approach
- talking about the issues and processing your thoughts, how you make sense of things and self-awareness
Cultural limitations in mental health treatment
therapy is bound to cultural framework
- definition of abnormality
- relevance of the self
- knowledge/skills of therapist
- what is success/functionality
Role of the person in mental health treatment
- western psychotherapy applies everywhere
- self-reflection/-awareness and introspection are universal
- modification
Exporting and modifying psychotherapy
- incorporating religion
- engaging in family versus individual psychotherapie
- meta-analysis: culturally modified psychotherapies more effictive than non-modified psychotherapy to treat depressive disorders
- similar effects of (modified) CBT in ethnocultural groups in USA
- cultural relativist position - psychotherapy was developed in a specific culture and cannot be exported to other cultures
- universailst position - there are aspects of psychotherpay that are relevant for all people
–> culturally sensitive (modified) psychotherapies are usefull
Treatment of mental disorders
- Disparities between and within countries
–> those in lower income countries are less likely to receive treatment than those in countries with mre economic resources
–> same difference within one country, and mental health utilization and length of treatment differ by racial or ethnic group
Treatment barries
- mental disorders
- Language barriers: language proficiency affects the use of mental services
- Stigma and mistrust: Emotions such as shame and loss of face is associated with mental health services
- beliefs on health and illness: people are encouraged to rely on willpower to confront problems rather than relying on formal treatment
- social structures and policies: lack of availability of mental health services, health insurance, and culturally competent services
Removing barriers in mental health treatment
- barriers interact with racial or ethnic backgrounds, immigration status, and socioeconomic status
- hire bilingual and bicultural staff
- increasing outreach and practitioners in the communality
- having flexible hours (multiple jobs)
- reducing stigma (different per group)
Treatment challanges
Particularly when therapist and client do not share linguistic/cultural background:
–> cultural idioms of distress
–> communication patterns
- treatment expectations
Matching therapist and client
- what is a match?
- ehtnic matching critical for counselling, small effects for therapy
- cognitive and cultural matching, communication skills more relevant
- for culturally competent services
Indigenous/tradition healing
- reliance on family and community
- incorporation of traditional, spiritual, and religious beliefs
- use of shamans in treatment
James Gone’s work with native Americans
–> indigenous healing
- traditonal healing in the Native American community places emphasis on: Rank and status, role and protocol and relationship
- indigenous healing serves as the foundation for incorporating other treatments
The way forward in mental health
- internal validity, comparisons, RCT
- Go beyond the clinical field - include basic cultural psychology - some groups don’t like positive feedback!
- cultural competence of therapists
- cultural competence = good outcomes?
- cultural adaptions are not always good
