Mental and Physical HealthMental and Physical Health

Summary of Points:Summary of Points: Review of last Wednesday’s in-class assignment:Review of last Wednesday’s in-class assignment:

– Situational versus dispositional attribution of Situational versus dispositional attribution of suicides/murdersuicides/murder

– Historical trauma among NA/AI as situational attributionHistorical trauma among NA/AI as situational attribution Universally identifiable mental health disorders:Universally identifiable mental health disorders:

– Depression: somatic versus psychological symptomsDepression: somatic versus psychological symptoms– Social anxiety: different symptoms in JapanSocial anxiety: different symptoms in Japan– Suicide: frequency differs across culturesSuicide: frequency differs across cultures– Schizophrenia: least culturally variable, but some Schizophrenia: least culturally variable, but some

subtypes do differ in frequencysubtypes do differ in frequency

Summary of Points:Summary of Points:

Physical health and biology are also Physical health and biology are also influenced by culture:influenced by culture:– Moken eyesight underwaterMoken eyesight underwater– Height and weightHeight and weight

Genetic variation:Genetic variation:– Skin tone and UVR Skin tone and UVR – Lactose intoleranceLactose intolerance

Socioeconomic status and healthSocioeconomic status and health Doctors’ understanding of medicineDoctors’ understanding of medicine

VA Tech ShootingVA Tech Shooting ““The The Virginia Tech massacreVirginia Tech massacre was a was a school shootingschool shooting

consisting of two separate attacks approximately two hours consisting of two separate attacks approximately two hours apart on April 16, 2007, that took place on the campus of apart on April 16, 2007, that took place on the campus of Virginia Polytechnic Institute and State University. The Virginia Polytechnic Institute and State University. The perpetrator, Seung-Hui Cho, killed 32 people and wounded perpetrator, Seung-Hui Cho, killed 32 people and wounded many others before committing suicide. many others before committing suicide.

““Cho, a senior English major at Virginia Tech, had been Cho, a senior English major at Virginia Tech, had been diagnosed with and was treated for a severe anxiety diagnosed with and was treated for a severe anxiety disorder in middle school and continued receiving therapy disorder in middle school and continued receiving therapy and special education support until his junior year of high and special education support until his junior year of high school. While in college in 2005, Cho had been accused of school. While in college in 2005, Cho had been accused of stalking two female students and was declared mentally ill stalking two female students and was declared mentally ill by a Virginia special justice. At least one professor had by a Virginia special justice. At least one professor had asked him to seek counseling.”asked him to seek counseling.”

Your Responses:Your Responses:

Stress from social isolation as an Stress from social isolation as an immigrant American immigrant American

Stress from racial discriminationStress from racial discrimination Argument with girlfriend that dayArgument with girlfriend that day Sexual humiliation from being Sexual humiliation from being

rejected by womenrejected by women

Greater dispositional accounts of VA Greater dispositional accounts of VA Tech in mainstream American media:Tech in mainstream American media:The The Associated PressAssociated Press notes that he was notes that he was referred to school counselors after his referred to school counselors after his instructors found his creative writing instructors found his creative writing rather disturbing. rather disturbing.

The The Chicago TribuneChicago Tribune also reports that he also reports that he apparently left a rambling suicide note apparently left a rambling suicide note that railed against “‘rich kids,’ that railed against “‘rich kids,’ ‘debauchery’ and ‘deceitful charlatans’ on ‘debauchery’ and ‘deceitful charlatans’ on campus” and that he had committed campus” and that he had committed several strange and violent acts in recent several strange and violent acts in recent weeks.weeks.

Greater situational accounts of VA Greater situational accounts of VA Tech in Asian Am media:Tech in Asian Am media:

Racial discrimination and social isolation:Racial discrimination and social isolation:– ““[Korean Americans] can still say that [Korean Americans] can still say that

ultimately Cho’s actions should be understood ultimately Cho’s actions should be understood as the as the aberrant behavior of an extremely aberrant behavior of an extremely troubled individualtroubled individual, while at the same time , while at the same time saying that his mental illness could have been saying that his mental illness could have been made worse by made worse by feeling like an outsider and ridiculed for being feeling like an outsider and ridiculed for being differentdifferent — sentiments that inevitably do exist among — sentiments that inevitably do exist among many Asian Americans.”many Asian Americans.”

“…“…[American] culture of violent [American] culture of violent masculinity”masculinity”

Asian NationAsian Nation

Greater situational accounts of VA Greater situational accounts of VA Tech in Korean media?Tech in Korean media?

Korean government apologized for Korean government apologized for the acts of Cho.the acts of Cho.

Greater reporting of social isolation Greater reporting of social isolation of Cho.of Cho.

Mental HealthMental Health

There is cultural variation in a number of psychopathologies around the world.

There may be biological factors underlying most or all of various psychopathologies, but how those symptoms are interpreted and experienced varies significantly across cultures.

The challenge for studying mental disorders across cultures is that the symptoms that are identified for the disorders typically were done in Western samples, and it’s not always clear whether Western cultural beliefs are bound to the disorders.

Culture and mental health:Culture and mental health:

Koro as a culture-bound syndromeKoro as a culture-bound syndrome

Men develop morbid anxiety that their penis is shrinking into their body

Far less commonly, women fear their nipples are shrinking.

This occurs primarily in South and East Asia, especially Southern China and Malaysia.

There can be epidemics of koro, where hundreds of people develop symptoms.

Suicide rates vary quite dramatically around the Suicide rates vary quite dramatically around the world.world.

In North America, some of the highest suicide rates In North America, some of the highest suicide rates that are found are among Aboriginal youth, where that are found are among Aboriginal youth, where the rates are several times higher than the national the rates are several times higher than the national rates (see Chandler & Lalonde, 1998).rates (see Chandler & Lalonde, 1998).

There is tremendous variability in suicide rates There is tremendous variability in suicide rates among Native bands from different tribal councils in among Native bands from different tribal councils in Canada. The suicide rates for one five year period Canada. The suicide rates for one five year period ranged from a low of 0/100,000 people to a high of ranged from a low of 0/100,000 people to a high of 633/100,000 people.633/100,000 people.

What factors predict the likelihood of a high suicide What factors predict the likelihood of a high suicide rate among First Nations peoples?rate among First Nations peoples?

SuicideSuicide

Suicide among First Nation peoplesSuicide among First Nation peoples

In general, people who feel a lack of In general, people who feel a lack of continuity within their selves are more continuity within their selves are more vulnerable to suicide. People at risk for vulnerable to suicide. People at risk for suicide often don’t have a clear narrative suicide often don’t have a clear narrative about how their life fits together.about how their life fits together.

A sense of cultural continuity, that is, a clear A sense of cultural continuity, that is, a clear narrative about what your culture is and how narrative about what your culture is and how it fits together, can be related to a sense of it fits together, can be related to a sense of self-continuity.self-continuity.

Many First Nations bands do not have a Many First Nations bands do not have a strong sense of cultural continuity as a result strong sense of cultural continuity as a result of Western colonization. Their present of Western colonization. Their present culture can be in many ways quite divorced culture can be in many ways quite divorced from what the past culture was like.from what the past culture was like.

Suicide among First Nation peoplesSuicide among First Nation peoples

Chandler and Lalonde (1998) assessed Chandler and Lalonde (1998) assessed various markers of cultural continuity various markers of cultural continuity among 196 Native bands/tribes in BC, among 196 Native bands/tribes in BC, and compared these with the suicide and compared these with the suicide rates for those bands/tribes. rates for those bands/tribes. Markers of Markers of cultural continuity:cultural continuity:

self-governmentself-government control over their control over their educational serviceseducational services Self-management of Self-management of police and fire police and fire

services,services, Self-management of Self-management of health serviceshealth services cultural facilitiescultural facilities..

Suicide and Cultural Continuity Suicide and Cultural Continuity among First Nationsamong First Nations

Suicide Rates among First NationsSuicide Rates among First Nations

In-class assignment:In-class assignment:

Use “cultural continuity” and Use “cultural continuity” and “historical trauma” as situational “historical trauma” as situational attributions for poor mental health attributions for poor mental health among NA/IAs.among NA/IAs.

Give one concrete example of each Give one concrete example of each situational explanation.situational explanation.

Physical HealthPhysical Health

Some biological variation is due to Some biological variation is due to differences in inherited genes (e.g., differences in inherited genes (e.g., skin color).skin color).

Some biological variation is due to Some biological variation is due to interactions between environment interactions between environment and genes.and genes.

• Skin color is strongly correlated with the amount of ultraviolet radiation (UVR) that reaches the surface in different parts of the globe. People need light enough skin to allow sufficient UVR be able to synthesize Vitamin D, but dark enough skin to prevent the breakdown of folic acid.

Physical HealthPhysical Health

Skin color is an example of how geographic factors have influenced Skin color is an example of how geographic factors have influenced population variation in the human genome.population variation in the human genome.

There are also some cases where cultural factors have influenced There are also some cases where cultural factors have influenced the genome.the genome.

For example, people from cultures in which cows have been For example, people from cultures in which cows have been domesticated for a longer period of time are more likely to have a domesticated for a longer period of time are more likely to have a mutation that allows them to digest lactose into adulthood.mutation that allows them to digest lactose into adulthood.

Thus far, the majority of adaptive gene Thus far, the majority of adaptive gene variations have been associated with thermal variations have been associated with thermal regulation, resistance to pathogens, and regulation, resistance to pathogens, and enduring dietary practices. There is much enduring dietary practices. There is much variation associated with non-adaptive genetic variation associated with non-adaptive genetic drift.drift.

There is scant known variation in genes There is scant known variation in genes associated with clear psychological outcomes, associated with clear psychological outcomes, but surely this will increase as research in but surely this will increase as research in genetic population variation progresses. genetic population variation progresses.

In addition to genetic variation across In addition to genetic variation across populations, there is also some populations, there is also some acquiredacquired physical variation. That is, various aspects of physical variation. That is, various aspects of people’s bodies may change because of people’s bodies may change because of cultural experiences.cultural experiences.

One example of acquired physical variation is that One example of acquired physical variation is that the Moken, sea gypsies from Southeast Asia, have the Moken, sea gypsies from Southeast Asia, have twice the underwater visual acuity as Europeans.twice the underwater visual acuity as Europeans.

• From a young age Moken children swim underwater to retrieve seafood.

• Their enhanced underwater visual acuity appears to be the result of experience rather than a genetic adaptation.

Obesity rates vary dramatically across countries, from a low of 1.5% of Obesity rates vary dramatically across countries, from a low of 1.5% of Chinese women to a high of 55% for Samoan women.Chinese women to a high of 55% for Samoan women.

These differences across countries are most likely cultural as opposed These differences across countries are most likely cultural as opposed to genetic.to genetic.

One source of evidence for the role of culture is that obesity rates have One source of evidence for the role of culture is that obesity rates have been growing remarkably across many countries - there have not been been growing remarkably across many countries - there have not been parallel changes in gene prevalence. Americans have gained about parallel changes in gene prevalence. Americans have gained about 1.5 lbs. a year over past 20 years.1.5 lbs. a year over past 20 years.

Obesity and DietObesity and Diet

Within the West itself, there is considerable variation Within the West itself, there is considerable variation in obesity rates.in obesity rates.

France, for example, has about one fifth the obesity France, for example, has about one fifth the obesity rate of the US.rate of the US.

This is despite the fact that French food is rich in fat. This is despite the fact that French food is rich in fat. Some evidence of this is that the French have higher Some evidence of this is that the French have higher blood cholesterol levels than Americans, yet they blood cholesterol levels than Americans, yet they have lower heart disease rates than Americans. This have lower heart disease rates than Americans. This is known as the “French Paradox.”is known as the “French Paradox.”

One account for this is that the French live in a One account for this is that the French live in a culture where food comes in smaller portions than it culture where food comes in smaller portions than it does in North America.does in North America.

Paul Rozin and colleagues set about measuring food Paul Rozin and colleagues set about measuring food serving sizes in the US and France. There were some serving sizes in the US and France. There were some striking differences.striking differences.

Yogurt containers are about 80% bigger in Yogurt containers are about 80% bigger in the US than they are in France.the US than they are in France.

McDonald’s french fries are about 70% bigger McDonald’s french fries are about 70% bigger in the US than in France.in the US than in France.

A meal at a Chinese restaurant in France is A meal at a Chinese restaurant in France is less than 60% the size of a meal at a Chinese less than 60% the size of a meal at a Chinese restaurant in the US.restaurant in the US.

Recipes in the US call for larger portions of Recipes in the US call for larger portions of ingredients than they do in France.ingredients than they do in France.

Even fruit is bigger in the US! About 28% Even fruit is bigger in the US! About 28% larger for the same fruit. larger for the same fruit.

Curiously, cat food cans are slightly larger in Curiously, cat food cans are slightly larger in France than in the US.France than in the US.

Large American portion sizes are the result of fairly Large American portion sizes are the result of fairly recent cultural change. Here are some examples of recent cultural change. Here are some examples of changes since the 1950s.changes since the 1950s.

Food or Beverage

1950s 2003

French Fries 2.4 ounces up to 7.1 ounces

Fountain Pop 7 ounces 12 to 64 ounces

Hamburger 3.9 ounces4.4 to 12.6

ounces

Muffin 3 ounces 6.5 ounces

Pasta Serving 1.5 cups 3.0 cups

Aside from portion sizes, French have different attitudes Aside from portion sizes, French have different attitudes towards food compared with Americans.towards food compared with Americans.

French savor their food more, and take more time eating it. French savor their food more, and take more time eating it. It takes them 50% longer to finish a McDonald’s meal, despite It takes them 50% longer to finish a McDonald’s meal, despite the fact that it is a smaller meal.the fact that it is a smaller meal.

A far smaller proportion of French food products have been A far smaller proportion of French food products have been altered to make them healthier, such as being low salt, low altered to make them healthier, such as being low salt, low fat, or sugar-free.fat, or sugar-free.

Americans are more likely to associate food with fat.Americans are more likely to associate food with fat. People were asked to choose which of the following options is People were asked to choose which of the following options is

the best metaphor for the human body in relation to its diet: the best metaphor for the human body in relation to its diet: a tree, a car, or a temple.a tree, a car, or a temple.

The most common answer, by far, for French was a tree - this The most common answer, by far, for French was a tree - this was the least common for Americans, who preferred a car was the least common for Americans, who preferred a car metaphor.metaphor.

One of the strongest predictors of health within a given One of the strongest predictors of health within a given country is one’s SES.country is one’s SES.

The higher one’s SES, the longer one lives, on average. The higher one’s SES, the longer one lives, on average. Even relatively small increments are associated with Even relatively small increments are associated with longer life outcomes.longer life outcomes.

Socioeconomic Status (SES) and HealthSocioeconomic Status (SES) and Health

Evidence or an SES gradient in health has been found in Evidence or an SES gradient in health has been found in every industrialized country investigated.every industrialized country investigated.

There is also evidence from non-industrialized countries. For There is also evidence from non-industrialized countries. For example, in north east Burkina Faso there are three ethnic example, in north east Burkina Faso there are three ethnic groups that coreside - the Fulani, Mossi, and Rimaibe.groups that coreside - the Fulani, Mossi, and Rimaibe.

A major cause of death in the region is malaria, and the A major cause of death in the region is malaria, and the Mossi and Rimaibe have evolved much genetic resistance to Mossi and Rimaibe have evolved much genetic resistance to malaria over thousands of years.malaria over thousands of years.

The Fulani moved to the region less than 200 years ago, and The Fulani moved to the region less than 200 years ago, and lack most of the genetic resistance to malaria.lack most of the genetic resistance to malaria.

However, the Fulani have higher SES, and when they first However, the Fulani have higher SES, and when they first arrived they conquered, enslaved, and decultured the Mossi arrived they conquered, enslaved, and decultured the Mossi and Rimaibe.and Rimaibe.

Despite that they have less genetic resistance to malaria, the Despite that they have less genetic resistance to malaria, the Fulani contract malaria less often than do either the Mossi or Fulani contract malaria less often than do either the Mossi or the Rimaibe.the Rimaibe.

No simple single answer.No simple single answer. Access to health care cannot explain all of this Access to health care cannot explain all of this

relation. The relation is similar for people with the relation. The relation is similar for people with the same health care access, and the relation is at least same health care access, and the relation is at least as pronounced for conditions that are the least as pronounced for conditions that are the least amenable to treatment.amenable to treatment.

Lower SES people are more likely to engage in Lower SES people are more likely to engage in unhealthy habits, such as smoking, eating fast food, unhealthy habits, such as smoking, eating fast food, and are less likely to exercise. However, the SES and are less likely to exercise. However, the SES differences still remain if you control for health habits.differences still remain if you control for health habits.

One mediating role between status and health One mediating role between status and health outcomes is stress.outcomes is stress.

What Causes the Lower Health Risks for What Causes the Lower Health Risks for Higher SES People?Higher SES People?

Stress affects health in at least two ways.Stress affects health in at least two ways.– First, when people are stressed they’re more likely to First, when people are stressed they’re more likely to

engage in health-compromising behaviors like smoking engage in health-compromising behaviors like smoking and drinking.and drinking.

– Second, stress directly weakens the immune system’s Second, stress directly weakens the immune system’s ability to fight off infections.ability to fight off infections.

People also feel stress when they feel a lack of People also feel stress when they feel a lack of control over their lives. One situation that creates control over their lives. One situation that creates this is being lower in a hierarchy.this is being lower in a hierarchy.

Lower-SES people feel less in control of their lives Lower-SES people feel less in control of their lives than higher-SES people, and lower-SES people than higher-SES people, and lower-SES people show less vulnerability to illness when they are show less vulnerability to illness when they are provided with control (Chen, 2007).provided with control (Chen, 2007).

Stress and HealthStress and Health

Primates lower in the hierarchy show greater Primates lower in the hierarchy show greater stress hormone levels when they belong to a stress hormone levels when they belong to a social system where:social system where:

– the hierarchy is stable, the hierarchy is stable,

– is maintained through intimidation rather is maintained through intimidation rather than direct physical attacks, than direct physical attacks,

– the subordinates cannot avoid dominant the subordinates cannot avoid dominant individuals, and individuals, and

– they have low availability for social support.they have low availability for social support.

There are many similarities to these societal There are many similarities to these societal features and those experienced by low-SES features and those experienced by low-SES people in modernized industrialized societies people in modernized industrialized societies (see Sapolsky, 2005).(see Sapolsky, 2005).

Objective levels of wealth in many ways are less Objective levels of wealth in many ways are less relevant than subjective experiences of SES in relevant than subjective experiences of SES in terms of people’s health outcomes. Feeling poor terms of people’s health outcomes. Feeling poor can matter as much as being poor.can matter as much as being poor.

For example, at the national level, there is only a For example, at the national level, there is only a relation between GDP and longevity up until a GDP relation between GDP and longevity up until a GDP of about $10,000.of about $10,000.

African-Americans who are poor have African-Americans who are poor have more health problems than do Indians more health problems than do Indians living in the poor province of Kerala, living in the poor province of Kerala, despite the fact that in absolute dollar despite the fact that in absolute dollar terms, the African-Americans as a group terms, the African-Americans as a group are better off.are better off.

The more income inequality in a country, The more income inequality in a country, on average, the lower is that country’s on average, the lower is that country’s longevity.longevity.

The more income inequality in a country The more income inequality in a country also the stronger the relation between also the stronger the relation between SES and health outcomes. Greater SES and health outcomes. Greater income inequality is associated with income inequality is associated with stronger feelings of relative deprivation stronger feelings of relative deprivation for those lower in the hierarchy (e.g., for those lower in the hierarchy (e.g., Oscar winners live longer than nominees)Oscar winners live longer than nominees)