Lecture two

Question 1

What is the idea of ‘concept creep’ in Jackson and Hasslam (2022).

Answer 1

The idea that conepts that originally had a specific definition begin into be used in relation to other concepts that may have some similarities. This results in the understanding of one concept becoming conflated to some degree with other concepts or phenomenon.
They speak about this idea in response to concepts or depression and clinical anxiety being used “recklessly” within the larger community in place of erveryday experiences of sadness or worry, for example.

Question 2

According to the DSM-5-TR. what are CULTURAL IDOMS OF DISTRESS?

Answer 2

“Burn out”, “At capacity”. “Knackered”. These are some Australian/US cultural idioms of distress that refer to feeling exhausted and in need of deep rest.

Question 3

How is CULTURE defined in the DSM-5-TR?

Answer 3

Culture refers to systems of knowledge, concepts, values, norms, and practices that are learned and transmitted across generations.
Culture includes language, religion and spirituality, family structures, life-cycle stages, ceremonial rituals, customs, and ways of understanding health and illness, as well as moral, political, economic, and legal systems.

Question 4

According to the DSM-5-TR, what are cultural idioms?

Answer 4

Cultural idioms are are ways of expressing distress that may not involve specific symptoms or syndromes, but that provide collective, shared ways of experiencing and talking about personal or social concerns.

Question 5

In what way does the DSM limit or over-prescribe treatment to individuals from different cultures outside that of the DSM’s conception?

Answer 5

Just something to think about.

Question 6

The section on culture and diagnosis in the DSM advocates for taking into account cultural differences that may influence diagnosis of clincal psychiatric conditions. However. how does the DSM propose we address these differences in diagnosis, when the DSM itself functions based on meeting certain criteria?

Answer 6

Something to think about.

Question 7

How does Laroi et al. define culture?

Answer 7

Shared patterns of meaning that are learned within a particular social world.

Question 8

Cultural explanations of social problems are important to take into account when helping an individual. Including cultural understanding of aetiology of symptoms and culturally endorsed responses to certain symptoms, experiences, ‘disorders’. An example may be prayer in response to psychological distress.
Why?

Answer 8

If we do not take culture into consideration we may cause further distress for client.

We may perpetuate stereotypes.

It may lead to us misdiagnosing.

We won’t be able to help client as much as we could should we take culture into consideration.

Question 9

What happens if we do not take culture into account when helping someone in distress?

Answer 9

We may misdiagnose.
We risk reinforcing stereotypes of members of a culture. e.g. black males in US overdiagnosed with psychosis, when they were behaving very normally given their culture. This is a form of weaponisation of western medicine.

Question 10

What are some of the umbrella terms that are used frequently and non-specifically that Jackson and Haslam contend are losing their use?

Answer 10

Mental health.
Wellbeing.
Mental illness.
Trauma.
Overwhelm.
Burnout.

Question 11

What is the risk of ‘concept creep’ according to Jackson and Haslam around mental health terms?

Answer 11

When these umbrella terms are used in relation to more benign experiences that are within the “normal” spectrum of human emotional responses, then we marginalise those who experience more severe symptoms.

I don’t really agree with this, but this is what they contend.

However, this idea resonates with the experiences of some and I guess I can relate when people talk about OCD in a loose and incorrect way.

Question 12

What are ‘clinically significant’ experiences that engender a clinical diagnosis?

Answer 12

Distress.
Impaired function.

Question 13

An ancient mesapotamian text used the following descritption: “his mouth is always confused”.

I relate to this.

Answer 13

haha.

Question 14

What is one of the most common verbal hallucinations people can experience?

Answer 14

Commands.

This is seen across cultures and throughout history, as seen in historical texts, such as the bible.

Question 15

What did Hippocrates think of the supernatural explanations of psychopathology?

Answer 15

He rejected this supernatural approach and put forward the idea that there were biological and psychological reasons behind these experiences in the terms of ‘humors’ and whether they were in balance or not.

Question 16

Culturally-bound was a term that DSM used to describe experiences, explanations, understanding, responses and treatments that are culturally specific.
What is the updated term used by the DMS-5-TR?

Answer 16

Cultural concepts of distress.

Question 17

What are some of the culturally-bound psychopathology for Aborginal people as described by Tracy Westerman?

What are some of the interventions for these experiences?

Answer 17

Longing for Country.

Sorry cutting.

Question 18

What is ataque de nervois?

Answer 18

A syndrome in Latino cultures. Severe anxiety is one of the symptoms.

Question 19

What culture does the the term “thinking too much” (Kufungisisa)?

Answer 19

This term comes from the Shona culture in Zimbabwe.

Question 20

What does the Haitian term maladi moun mean?

Answer 20

This is a cultural explanation for where psychopathologies can come from. It means that one’s enemies have sent the sickness. “Sent sickness”. “Human-sent illness” is one of the translations.

Question 21

What are some differences in how say the US interprets auditory verbal hallucinations and how African cultures may interpret them?

How do these different interpretations influence how people experience and cope with these experiences?

Answer 21

Pathology.

Spiritual connection. Connection to ancestors and a realm outside this physical world.

When cultures do not see these experiences as pathology, then there is not only less stigma around the experience, but also these experiences may differ in such a way that may result in less distress. An example being that in cultures that see auditory verbal hallucinations as connection with ancestors, commands from these voices may be less harmful and more helpful. e.g. instead of “cut yourself”, it may be “rest. Feed yourself.”

Question 22

Are visual hallucinations more common in high-income countries than lower-income countries?

Answer 22

Yes.

Question 23

How does stigma influence the way the stigmatiser behaves and how the stigmatised behaves?

See the Mental-Illness Stigma Framework by Fox et al. (2017).

Answer 23

The stigmatiser:
The stigmatiser’s actions are filtered through cultural stereoptypes, prejudice and discrimination, which leads to the exclusion and “othering” of the individual/community on the receiving end.

The stigmatised:
The stigmatised’s actions and wellbeing are filtered through internalised stigma, anticipation of stigma, and the actual experience of stigma, which lead to reduced help-seeking, further distress, and impairment to self esteem.

Question 24

How does Public stigma manifest? (there are three main ways we discussed).

Answer 24

1. Stereotyped attitudes and beliefs.
2. Prejudicial affective responses.
3. Discriminatory behaviour.

Question 25

What are the steps of how stigma plays out for the stigmatiser?

Use schizophrenia as an example.

Answer 25

Signal -> Stereotype -> Prejudicial Emotion/Affect -> Descriminatory Behaviour

Stigma toward those who experience schozophrenia:

Question 26

What is Structural Stigma?

Answer 26

An example would be that it is much more difficult for individuals with mental illnesses to get health insurance.

An example of this would be HIV-AIDS and the male gay community. We see this continue to play out today. Gay men are required to test negative for HIV before giving blood, for example.

Question 27

What is Public Stigma?

Answer 27

Public stigma is the stigma exhibited by public toward those with a mental-illness, disability etc.

Question 28

How does perceiving stigma influence the experiences, affect, attitudes, beliefs and behaviours of the stigmatised?

Question 29

How does ANTICIPATED stigma influence the lives of the stigmatised?

Question 30

What are two of the most stigmatised mental health conditions in our society?

Answer 30

Schizophrenia and BPD.

Question 31

What is Corrigan’s model of Self-Stigma?

Answer 31

Awareness.
Agreement.
Application to the self.
->
Damage to self.

Question 32

How is the social distancing scale used to measure stigma around mental health struggles?

Question 33

What is The National Stigma Report Card?

Answer 33

A government-funded program to determine public stigma toward certain mental health disorders.

Participants are asked to read a vignette describing a person with a certain mental-illness. Then they are asked questions questions that attempt to determine levels of stigma toward that mental-illness, e.g social distancing scale.

Question 34

What is Our Turn to Speak?

Answer 34

This was a study to determine how people living with mental-illness experienced stigma.

Question 35

What is the number one issue for individuals experiencing mental health distress and stigma they experience because of it?

Answer 35

The domain where they experience the most stigma and where the negative effects of this stigma is most felt is with family and friends.

Question 36

What is The National Stigma and Discrimination Reduction Strategy?

Question 37

What is the “culturally compatibility hypothesis”?

Answer 37

This hypothesis contends that better clinical outcomes are observed when the client and practitioner have the same cultural, racial, ethnic background.

There are varying research papers to back this up, but logically it makes sense.

Question 38

Do Aboriginal people in Australia have the highest rate of psychosis in Australia?

How does culture play a role in this prevalence and how does the DSM and other western constructs influence this prevalence?

Answer 38

Yes.

Question 39

What is Loroi’s definition of culture?

Answer 39

“Shared patterns of meaning that are learned within a particular social world.”

Question 40

What are some of the risks we take when we do not take a client’s (and our own) culture into consideration?

Answer 40

We risk misdiagnosis.

We risk the perpetuation of clinical stereotypes, such as ethnicity, and gender.
An example being back males in the US being over diagnosed with schizophrenia.

Question 41

Mental-health is spoken about more than mental-illness.
Why?

Answer 41

The reason behind this is that mental-health feels less stigmatising.
However, euphamisms to avoid stigma is actually stigmatising.

Question 42

According to Tracy Westerman, an Australian Aboriginal psychologist, what are some of the culturally-bound syndromes experienced by Indigenous Australians?

Answer 42

Longing for Country.

Wrong way relationships.

Spiritual visits.

Self-harmful behaviour, known as Sorry Cutting.

Question 43

The DSM-5-TR does not refer to cultural understandings of certain psychologial/medical distress as ‘culturally-bound syndromes’. How do they refer to these concepts now?

Answer 43

‘Cultural concepts of distress.’

Question 44

When hallucinations are considered to be a psychopathology, is the experience associated with more distress?

Answer 44

Yes.
Those who experience hallucinations in cultures that do not pathologise hallucinations do not experience as much distress. Furthermore, in these cultures halluncinations in the form of commands tend to be less harmful, and even helpful, compared to cultures that pathologise hallucinations. Hallucinations in the form of commands in these cultures can take the form of more harmful content for self and other.

Question 45

In practice, how does taking culture into consideration play out?

Answer 45

It may be that clients are better off seeing a therapist who comes from a similar culture and religion, for example.

We can easily see this when we consider women tending to want a woman therapist.

Question 46

Where does the term STIGMA originate from?

Answer 46

Ancient Greece when slaves and prisoners were physically branded.