Chapter 9: Psychological Disorders

Costanza Maio

Definition Mental disorder:

Clinically significant behavioral and psychological syndrome or pattern that occurs in an individual and that is associated with present distress (a painful syndrome) or disability (impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom

BASICALLY, a mental disorder is: A pattern of behavior or psychology that happens in a

person Associated with present distress, a disability, or significant

risk of suffering

To examine disorders…

Use the multiaxial diagnostic system Axis I – observing clinical syndromes/conditions that need

attention Axis II – observing clinical syndromes/conditions that need

attention Axis III – reporting individual’s current medical conditions Axis IV – reporting psychosocial/environmental problems that

may affect diagnosis/treatment Axis V – reporting doctor’s judgment of individual’s level of

functioning

Culture and Psychopathology

Culture can affect psychological disorders Individual’s subjective experience

Including knowledge about psychological problems Idioms of distress

The ways individuals explain/express their symptoms according to culture-based rules

Diagnoses for disorders Including professional and nonprofessional judgments

Treatment for disorders Outcome

Principles according to which results of treatment are evaluated

Culture and Psychopathology

Two hypotheses #1: Relativist perspective

Humans develop ideas/behavioral norms/emotional responses according to their culture There should be significant differences in people’s understanding

of disorders if they are from different cultures Criticize ethnocentrism

#2: Universalist approach People share similar features, despite different cultures

The understanding of disorders is univers There are universal symptoms for disorders

Inclusive approach Disorders have:

Central symptoms – observed throughout the world Peripheral symptoms – culture-specific

Culture-Bound Syndromes

Definition: Recurrent patterns of abnormal behavior that may/may not be linked to a

“mainstream” disorder

Different categories: Symptoms that are recognized as an illness in a cultural group but not in the West Symptoms that do not have an identifiable organic cause but is identified locally

as an illness and seems like Western illness But major features are different from Western illness But lacks symptoms recognizable in West

An illness not yet recognized by Western professionals An illness whose symptoms occur in many cultures but are only recognized as

official illnesses in a few cultures Culturally accepted idioms of illness that do not match those of West A set of behaviors connected to hearing/seeing/communicating with spirits A syndrome that is said to exist in a culture but does not in fact exist

Anxiety Disorders Definitions vary across cultures

Central symptoms: Psychologically: persistent worry, fear, apprehension, causes

stress Physically: fatigue, lack of concentration, muscle tension

Peripheral symptoms: Sometimes based on how individual views success Sometimes accepted in culture, not defined as an illness

Ex: China

Mood Disorders Factors that influence clinical understanding

Diagnostic practices Some doctors avoid diagnosing illness because mentally ill

people in some cultures carry a stigma Some doctors provide situational explanations, not clinical

diagnostic of actual illness Some doctors diagnose individuals with an illness for political

reasons, not actually justified Individual’s understanding of symptoms

Individual could not realize that they have some symptoms Disclosure of symptoms

Some cultures more readily reveal bodily problems, some more readily reveal psychological problems

Depressive Disorders Defined often by melancholy

Main assumptions Physical/somatic causes Emotional problems that upset balance of bodily functions Sometimes caused by life events and experiences

Central symptoms Dysphoria – dissatisfaction with life Anxiety Lack of energy Ideas of sufficiency

Peripheral symptoms Western patients show feelings of guilt more than non-Western patients Low prevalence of depression in Asian cultures because symptoms are not

defined as depression

Schizophrenia Definition:

A disorder characterized by the presence of delusions, hallucinations, disorganized speech, disorganized behavior

Mostly central symptoms

Peripheral symptoms Some cultures have more schizophrenic cases than others

Especially third-world countries In US, blacks more than whites Mostly more common in men than women

Not true in China

Culture and Suicide Suicide trends

Much higher in high-pressure cultures than in less achievement-oriented cultures High in Germany, Taiwan, US, Japan

Some Asian countries have high trends Countries in Central/South America have low trends Lower in cultures in which religion is strongly against “self-

murder” Ex: Catholic & Muslim (low) vs. Western & Protestant

(high) Some suicides originate from religious or ideological beliefs

Ex: terrorism Mostly higher with men

Culture and Suicide Specific trends

High in Japan People interpret suicide as an honorable death – seppuku

Highest: Sri Lanka – probably because of ethnic violence Hungary – not sure what the cause is

Personality Disorders Definition:

Persistent patterns of behavior and inner experience that do not conform to the expectations of the individual’s culture

Main assumptions Hypothesis about specific culture-bound personality traits

Coping strategies development of similar traits in individuals belonging to same cultural group

Existence of specific social & cultural circumstances that determine our views on personality traits and personality disorders affect our evaluations of them Some traits – seen as common from one culture and abnormal from another

Differences in personality traits across nations or ethnicities Ex: Westerners are extraverts, non-Westerns are introverts Rarely backed by actual empirical evidence – not valid

Too much diversity in personality traits within nation/ethnicity Yet certain traits are suppressed in some cultures and encouraged in others

Personality Disorders Tolerance threshold

A measure of tolerance or intolerance toward specific personality traits in a cultural environment Low = societal intolerance High = relative tolerance

Mostly central symptoms

Substance Abuse & Culture

Cultural variations in: Attitudes toward substance consumption Patterns of substance use Accessibility of substances Prevalence of disorders related to substance Biological factors (sometimes)

Alcohol-related disorders Associated with:

Lower educational levels Lower socio-economic status Higher rates of unemployment

Difficult to find cause and effect

Psychodiagnostic Biases

Psychologists have own perception of link between mental illness and culture/ethnicity

Important: Keeping social distance between patients and psychologists

Ex: high and low statuses, not letting it interfere Considering how psychologist’s beliefs/expectations could make them see

psychopathology wherever they look Always sees mental illness, even if it isn’t Ex: “If the patient arrives early for his appointment, then he’s anxious. If he

arrives late, then he’s hostile. And if he’s on time, then he’s compulsive.” Some do not think it can work to apply Western diagnostic criteria to other

cultures and vice versa Some think culture-specific disorders are difficult to interpret in terms of other

national classifications

Psychologists have to identify illness correctly in relation to cultural context

Psychotherapy Definition:

The treatment of psychological disorders through psychological means, generally involving verbal interaction with a professional therapist

In some cases, it is global: Drug rehabilitation and prevention programs are applicable to many ethnic

and social categories

In some cases, it is not global: Tolerance/intolerance

Tolerant/supportive cultures – patients function better Intolerant cultures – patients have difficulty

Collectivist/individualist Collectivist cultures – patients show improvement quickly Individualist cultures – patients show few signs of improvement

Attitudes Some cultures do not seek this service or drop out easily

Culture Match? Factors that affect therapists’ diagnostic judgments

May not understand cultural background of patients misinterpret patients’ responses

Knowledge of cultural trends lacks critical thinking distorted diagnosis Ex: stereotypes & schemas

Language barriers or accents Political barriers

Culture Match? Ethnic matching – pairing therapists and patients of same

culture May help problems More studies are necessary

Desirable types of therapy between therapist and patient of different cultures Intercultural therapy

Therapist who knows language and culture of patient Bicultural therapy

Therapist and native of patient’s culture work together on patient

Polycultural therapy Patient meeting with different therapists who represent

different cultures

Experiment Cultural Influences on Clinical Perception

By Diana Li-Repac

http://jcc.sagepub.com/cgi/content/abstract/11/3/327

Experiment Variables

Independent: five white therapists, five Chinese-American therapists

Dependent: conceptions on normality, emphatic ability, and perception on Chinese/white patients

Original aim Comparing dependent variables Differences in conceptions, emphatic ability, and perception

in therapists of different cultures

Experiment Results

Both therapist groups agreed on conceptions of normality White therapists =more accurate in predicting self-descriptive

responses of white clients than of Chinese patients Significant differences between diagnosis of patients given

Chinese-American therapists said white patients were more disturbed than the white therapists did

White therapists thought the Chinese patients were more depressed than Chinese-American therapists did

Implications Therapists have biases when diagnosing patients Ties in with therapists’ world view and culture What can be done to prevent biases?