PL3236: Abnormal Psychology - Term Paper

Describe the influence of culture on the experience of psychopathology.

Why is it important for the clinician to acknowledge and appreciate the patient’s culture before determining a diagnosis?

In the study of psychological disorders, the “biopsychosocial” approach is often adopted, offering an integrative and multidimensional perspective. Since culture can be seen as “the belief systems and value orientations that influence customs, norms, practices, and social institutions” (APA, 2002b, p. 8), it could then be expended as the “social” aspect of the “biopsychosocial” approach, whose influence is deemed crucial. Belief and value systems tend to pervade the experience of psychopathology and may differ broadly on many areas, “including the models for the etiology of mental disorders, their symptomatic expressions, and their management” (Hughes, 1992). In other words, culture influences the etiology, diagnosis as well as treatment of psychological disorders.

Culture can affect the etiology of psychological disorders. For instance, in mood disorders, 70% of the population diagnosed with major depressive disorder and dysthymia are women (Durand & Barlow, 2006) and despite differences in the prevalence among countries, such occurrence of gender imbalance still persists around the world. What accounts for this occurrence is largely the gender roles assigned to men and women in society. Males are often expected to be emotionally strong and independent while women are often deemed as sensitive, emotionally dependent and weak. Women also tend to “ruminate more than men about their situation and blame themselves for being depressed” (Durand & Barlow, 2006). In addition, women are more likely to be subjects of sexual harassment, abuse and discrimination in many societies today. As such, women experience greater feelings of uncontrollability and helplessness and hence, become more vulnerable to mood disorders.

Cultural factors can also influence the diagnosis of an individual’s disorder. An example would be conversion disorder, a type of somatoform disorder which an individual experiences physical malfunctioning, such as blindness, paralysis or even seizures and trance states that are unaccountable by medical conditions. However, in some cultures such as the rural fundamentalist religious groups in the United States, these symptoms are often observed in their religious or healing rituals and “seen as evidence of contact with God” (Durand & Barlow). Similarly, in dissociative trance disorder, a type of dissociative disorder where an individual falls into an altered state of unconsciousness or trance, this symptom is sometimes identified as possession, a common aspect of some religious and cultural practices in many Asian and African countries. Therefore, in these cases, the diagnosis of each disorder may or may not be awarded to the individuals by clinicians, depending on whether their experiences are culturally sanctioned in their society.

When individuals are studied in their cultural context, effective treatment can also be formulated to “address multicultural and community factors, both in the manner in which mental health is conceptualized and in delivery of interventions that prevent or treat mental health problems” (Nagayama, 2005). In the treatment of schizophrenia, Hispanics would usually rely on family support since they are less likely to seek help from institutional settings. In China, antipsychotic drug treatment is frequently administered though a small percentage of them undergo traditional herbal medicine and acupuncture (Durand & Barlow, 2006). In most Asian settings, family psychotherapy is recommended since they are a collectivist society and thus “assumed that the family knows best and will participate in the therapeutic process” (Yamamoto, Silva, Justice, Chang & Leong, 1992).

As mentioned earlier, culture can exert influence on the diagnosis of an individual’s disorder. Hence, acknowledging and appreciating the patient’s culture before determining a diagnosis becomes important. This is evident from the previous discussion of conversion disorder and dissociative trance disorder, where some cultures “may not endorse seeking help for mental or emotional problems but may judge somatic problems as socially acceptable” (Westermeyer, 1992). Additionally, culture-bound symptoms such as 1Amok, 2Koro, and 3Latah can present confusing diagnostic problems to the clinician when not understood. With the knowledge and awareness of such culture sanctions and atypicality, clinicians can then be more cautious in delivering a more accurate and valid diagnosis and propose appropriate measures to deal with the symptoms.

Another reason for the importance in understanding a patient’s culture prior to diagnosis would be that while much of the patients’ behaviors are structured by their cultural background, so is that of the clinician (Hughes, 1992). Thus, a situation of culture countertransference, where the feelings and attitudes of the psychiatrist towards a patient’s culture which may influence the clinician’s interaction with the patient (Spiegel 1976; Westermeyer, 1989b), could occur. Such bias could then negatively impact the clinician-patient relationship, hence treatment outcome, as well as inhibit a valid clinical assessment of the patient.

To recapitulate, cultural dimensions are of great significance in the experience of all aspects of psychopathology. Therefore, it is essential for clinicians to fully appreciate the range of cultural differences among patients as well as to “identify and control their own biases to respectfully collaborate with their clients” (Stuart, 2005) in pursuit of multicultural sensitivity and diagnostic validity in psychopathology.

Notes:
1Amok - Dissociative episode(s); outburst(s) of violent and aggressive or homicidal behavior directed at people and objects; persecutory ideas, automatism; amnesia; exhaustion and return of consciousness following the episode (for amok runners who are not killed during the episode). Observable in Malaysia and Indonesia.

2Koro – Intense and sudden anxiety that the penis (or, for females, the vulva and breasts) will recede into the body; the penis is held by the victim for someone else, or devices are attached to prevent its receding. Observable in South China; Chinese and Malaysian populations in Southeast Asia; Assam (Hindus).

3Latah – Hypersensitivity to sudden fright or startle; hypersuggestibility; echopraxia; echolalia; dissociative or trancelike behavior. Observable in Malaysia and Indonesia.

(Hughes & Simons, 1992)

Citations:

1) Durand, V. Mark, & Barlow, David H. (2006) Essentials of Abnormal Psychology. United States of America: Thomson Wadsworth.

2) Hughes, Charles C. (1992). Culture, Ethnicity & Mental Illness. Gaw, Albert C (Ed.), Culture in Clinical Psychiatry (pp. 3-42). Washington, D.C: American Psychiatric Press.

3) Hughes, Charles C, & Simons, Ronald C. (1992). Culture, Ethnicity & Mental Illness. Gaw, Albert C (Ed.), Culture-Bound Syndromes (pp. 75-99). Washington, D.C: American Psychiatric Press.

4) Yamamoto, Joe, Silva, J. Arturo, Justice, Ledro R., Chang, Christine, Y & Leong, Gregory B. (1992). Culture, Ethnicity & Mental Illness. Gaw, Albert C (Ed.), Cross-Cultural Psychotherapy (pp. 101-124). Washington, D.C: American Psychiatric Press.

5) Westermeyer, Joseph J. (1992). Culture, Ethnicity & Mental Illness. Gaw, Albert C (Ed.), Cross-Cultural Psychiatric Assessment (pp. 125-144). Washington, D.C: American Psychiatric Press.

6) Nagayama, Gordon C. (2005). Introduction to the Special Section on Multicultural and Community Psychology: Clinical Psychology in Context. Journal of Consulting and Clinical Psychology, 73, 787-789.

7) Stuart, Richard B. (2004). Multiculturalism: Questions, Not Answers. Professional Psychology: Research and Practice, 35, 576-578.

8) American Psychological Association. (2002b).Guidelines on multicultural education, training, research, practice, and organizational change for psychologists. Retrieved April 2006 from http://www.apa.org/pi/multiculturalguidelines.pdf