Social and cultural aspects

Question 1

How does culture affect what is considered to be abnormal?

Answer 1

Culture plays a role in determining what is and is not abnormal.

Decisions about abnormal behaviour always involve social judgments and are based on the values and expectations of one’s culture or subculture

Question 2

what is the DSM definition of delusion?

Answer 2

A false belief based on incorrect inference about external reality that is firmly held despite what almost everyone else believes and despite what constitutes incontrovertible and obvious proof or evidence to the contrary. The belief is not ordinarily accepted by other members of the person’s culture or subculture (i.e., it is not an article of religious faith). (APA, 2013, p. 819)

Question 3

how does culture impact the dictator game?

Answer 3

Nevertheless, there is considerable cultural variation.
Henrich et al. (2005) had participants from three different cultures play the DG:
The Orma, a semi-nomadic community in Eastern Kenya. The Hadza, hunter-gatherers in north-central Tanzania. The Tsimane’, a hunter-gatherer culture in lowland Bolivia.
Few if any of the participants in these societies offered zero.

Question 4

outline homosexuality and the DSM

Answer 4

There are many instances in which groups representing particular social values have brought pressure to bear on decisions shaping the DSM.

Homosexuality and the DSM

DSM-I and DSM-II: Homosexuality a form of mental disorder.

Late 60s: gay/lesbian rights leaders challenged assumption that homosexuality was pathological.

1973: the APA board of trustees agreed to remove homosexuality as a form of mental illness.
2016: President Obama declares the Stonewall Inn a National Monument.

Question 5

what were Freuds argument with homosexuality?

Answer 5

‘Freudian’ theories of homosexuality:

Homosexuality develops in people whose heterosexual desires are too psychologically threatening (Rado, 1962).

Another argument was that domineering, emotionally smothering mothers and detached, hostile fathers played a causal role

Question 6

gender identity and the DSM

Answer 6

DSM-IV: Gender identity disorder Intense discomfort with one’s biological gender; strong identification with, and desire to be, the opposite gender.
DSM-5: Gender dysphoria Emphasises importance of distress about the incongruity b/n biology and identity.

Question 7

What is the role of sociocultural factors in the aetiology of mental disorders?

Answer 7

Evidence: many psychological disturbances – symptoms and patterns of symptoms – are cross-cultural universals.

But sociocultural factors often predict prevalence.

E.g., Andrade et al. (2003). Assessed prevalence of major depressive disorder in various countries; prevalence ranged from 3% in Japan to 17% in the USA.

Andrade, L., et al. (2003). The epidemiology of major depressive episodes: results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. International Journal of Methods in Psychiatric Research, Volume 12(1), 3-21.

Question 8

outline pathonogenic factors in the aetiology of mental disorders?

Answer 8

Low SES and unemployment:

Western society: Inverse correlation b/n SES and incidence of mental disorders

Relationship stronger for certain types of disorders (e.g., stronger for APD than depression).
Unemployment associated with emotional distress and vulnerability to psychopathology. Underemployment (e.g., demotions, downsizing) has comparable effects.

Causality?

Low SES  Mental disorder?

Stressors, resources, help. Familial: low birth weight, modelling.

Mental disorder Low SES?

Primary and secondary difficulties may decrease SES.

Question 9

give other factors that could cause mental health disorders culturally

Answer 9

Prejudice and discrimination (race, gender etc.)
By the mid- to late-1960s, schizophrenia was a diagnosis disproportionately applied to the hospital’s growing population of African American men from urban Detroit. Perhaps the most shocking evidence I uncovered was that hospital charts “diagnosed” these men in part because of their symptoms, but also because of their connections to the civil rights movement.
Social changes.
Social media users are more aware of stressful events experienced by online friends (the “cost of caring”).
Violence and homelessness.

E.g., domestic violence against women and children leads to anxiety, PTSD, depression, suicidality.

Major stressors associated with being homeless. Estimated 1/3 of homeless people affected by severe mental illness. Bicausality here.

How does culture shape the clinical presentation of mental disorders?

Question 10

Outline culture adn the DSM

Answer 10

One important goal of the DSM is to identify and diagnose mental health problems in a similar way across cultures. This approach assumes that medical illnesses will present in a universal way across cultures.

A questionable assumption?

Does emotional distress manifest in the same way in different cultures?

Question 11

Outline Culture and personal distress

Answer 11

Somatization – a tendency to experience and communicate emotional distress in the form of physical symptoms.
Relatively rare in Western cultures.
Common in Asian cultures, perhaps because such cultures disapprove of the strong expression of (particularly negative) emotions.

The more Westernised the individual the less likely they are to report predominantly somatic symptoms when reporting psychological distress
No word for “depressed” in certain Native American languages.

Prevalence investigations need to adapt tests and measures across linguistic and cultural barriers.

Care must be taken not to miss culture specific elements and manifestations.

Question 12

what is the Culutral Symptom Reprotoire?

Answer 12

Some cultures (e.g., Thailand) highly intolerant of undercontrolled behaviour (e.g., aggression, disobedience, disrespect).

Children taught to inhibit expression of anger.

Western cultures more tolerant.

Culture and Behavioural Control

Expression of anger is associated with biological health risk (BHR) – but moderated by culture.

Kitayama et al. (2015). Greater expression of anger predicted increased BHR for Americans, but reduced BHR for Japanese.

Question 13

Outline culture and drunkeness

Answer 13

“Persons learn about drunkenness what their societies import to them, and comporting themselves in consonance with these understandings, they become living confirmations of their society’s teachings”
Drunken comportment: A social explanation. Oxford, England: Aldine.

Cultural factors such as extant technology can shape the content of reality-distortion symptoms such as delusions and hallucinations.

E.g., Tan et al. (1997) reported a case of systematized delusions involving the Internet

Question 14

capragas delusion and culture

Answer 14

What is presumably the same neurocognitive impairment may manifest in different contents, influenced by extant culture.

In the folklore of different countries (e.g., Germany), a doppelganger was a ‘double’ of a living person sometimes portrayed as a portent of bad luck.

Capgras Delusion and Culture

More recent presentations of Capgras are likely to involve cyborgs or robots.

In a recent case (Gibson et al., 2013) an adolescent girl with Capgras believed “people were not who they said they were, and they were using voice editing techniques to disguise their voices.”

Question 15

what is a delusion of referecne?

Answer 15

The most common delusional themes include paranoia, grandiosity and ideas of reference.
Examples:
Believing that people on TV or radio are talking about you or to you.
Believing that you are an especially famous or important person, that the whole world revolves around you.

Question 16

give an example of delusion of referecne

Answer 16

The Truman Show Delusion

Gold & Gold (2012).

Described five patients who believed they were the subjects of something akin to a reality television show, broadcasting their daily life for the entertainment of others.

Gold, J. & Gold, I. (2012). The “Truman Show” delusion: Psychosis in the global village. Cognitive Neuropsychiatry, 17(6), 455-472.

Patient 1: Mr A. said that his life was like The Truman Show… He believed that the attacks of 9/11 were fabricated as part of his narrative. He had travelled from out-of-state in order to see if the World Trade Centre had in fact been destroyed; if the towers were standing, he would have proof that he was on the show. On first presentation, he demanded to speak to ‘‘the director’’.

Patient 2: Mr B. was admitted after he told psychiatric outreach that he believed he was being taped continuously for national broadcast… He said: ‘‘I realized that I was and am the centre, the focus of attention by millions and millions of people . . . my [family] and everyone I knew were and are actors in a script, a charade whose entire purpose is to make me the focus of the world’s attention’’.

Question 17

give some culture specific disorders

Answer 17

Culture can shape the expression of psychopathology. At the extreme, entire patterns of symptoms may be more or less unique to a particular culture.

A patient with delusional ‘‘turabosis’’, who believed she was being covered by sand from sandstorms, was reported in Saudi Arabia but such a case would perhaps be less likely in the UK.

Puppy pregnancy

Puppy pregnancy in humans:
Windigo / Wendigo

Algonquin Indian hunters

Victims become anxious and agitated, convinced they are bewitched

Fears centre on being turned into cannibal by the power of a monster with an insatiable craving for human flesh.

Taijin Kyofusho Fear of offending others by social clumsiness or b/c of imagined physical defect. Excessive concern over how a person presents him or herself in social situations

Kitsunetsuki A belief that one is possessed by a fox and that one’s facial expressions change to resemble those of a fox.

Hikikomori A disorder of acute social withdrawal in which young people remain in their bedroom and refuse social interaction for at least six months.

Question 18

How to explain the social acquisition of maladaptive beliefs and behaviours?

Answer 18

Content biases: The content of some beliefs is compelling as it “fits” underlying cognitive structures and preferences.

E.g., Practices such as bloodletting.

Beliefs such as “most Muslims are extremists” or “vaccines cause autism”.
Context biases:

Conformity bias: favours adopting beliefs that are commonly held.

Prestige bias: favours adopting beliefs espoused by high status individuals

Question 19

Culture specific disorder?

Answer 19

Sleepy Hollow’: Kalachi, Kazakhstan.

Every 10th villager has unexpectedly fallen asleep in broad daylight – some unable to wake up for several days.

Despite numerous attempts to find the cause of the inexplicable disorder, the Sleepy Hollow riddle remained unsolved – until recently…

In a recent case, children started falling down on the first day of school in September, with eight kids falling asleep within one hour. Before that, 20 people fainted and slept for several days, and “at least 60 at once in the winter…we laid them in rows”, according to an ambulance worker.

Culture-Specific Document?