Culture and Health

1. Culture and Health

2. Hikikimori • You live in Japan and are the parent of 14 year old Keisuki (boy). One day he went into the family kitchen, closed the door and refused to leave. • As a parent what would you do?

3. Con’t • Three years later he has not left the kitchen, nor has he allowed anyone else in. His mother made meals for him and left them at the door three times a day and he used the adjacent toilet. • Parents ordered take out for about 6 months then built another kitchen onto their house. • As a therapist, what would you do?

4. Hikikomori • Social withdrawal • Japanese high school junior high (refusal to go to school) • Recent phenomenom (1.2 million kids) • Three times more likely in boys, typically older sons or only children. • Parents pressure, homogeneity of Japanese culture, lack of sibling socialization, parenting style (strick father, overindulging mother)

5. Emic and Etic • Cultural bound syndromes • Ex. Eating disorders • Emic logic of western women: appearance • Emic logic of African women: food scarcity

6. Diagnosis • Tools of the trade • 1. clinical manuals • 2. Disease vs. illness behavior • disease: biological process • Illness behavior: psychological experience and the social expression of the disease.

7. In groups Discuss the culturally bound syndrome: • What is it in ‘etic language?’ What might it look like? • What is it closest to in our culture (if anything)? • Does the US have any culture bound syndromes not included in the DSM?

8. 3 Different configurations of Depression • Psychiatrists in training • Middle Class White Americans • American Indian Psychiatric Patients

9. Explanatory models of illness • Individual and cultural • Organize signs symptoms, labels, idioms • Organize beliefs about causation, psychology,

10. Residents • DSM basis for category decisions • American Indian • Eight categories, one cluster unconnected (mind body dualism) • White middle class • 15 categories, more finely discriminated somatic and body sensation

11. Cuban study • Boxer and Garvey (1985) • 109 refugees • Reviewed medical decision in Cuba, in US. • Upheld schizophrenic decisions, (72%) • Overturned 43% of antisocial personality disorder

12. What is antisocial personality disorder • Antisocial personality disorder (APD) is a psychiatric condition characterized by an individual's common disregard for social rules, norms, and cultural codes, as well as impulsive behavior, and indifference to the rights and feelings of others

13. Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest • Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure • Impulsivity or failure to plan ahead • Irritability and aggressiveness, as indicated by repeated physical fights or assaults • Reckless disregard for safety of self or others • Consistent irresponsibility, as indicated by repeated failure to sustain steady work or honor financial obligations • Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another • The manual lists the following additional necessary criteria: • There is evidence of conduct disorder with onset before age 15 years.

14. Why might antisocial personality disorder be more accepted in the US than in Cuba? • Collectivism and duty to others: loners are weird.

15. Universal syndromes • Depression • Social Anxiety • Suicide • Schizophrenia

16. Fig. 10.1

18. Culture bound syndromes • Lots of them • Anorexia/bulimia • Koro • Amok • Brain fag • Latah • Voodoo death

19. Physical health • Do we vary in physical health cross culturally? • Why do we vary in physical health cross culturally?

20. Reciprical The relationship between culture and health

21. Six degrees of separation • Psychological variables are linked to our physical health. (health psych) • Culture influences a wide range of psychological variables • Thus,….

22. Innate biological differences: pressure from environments • (Chickchi and short appendages) • Acquired biological differences: experiences in our own lifetimes • (supersize me)

25. Genetic variation across population • Skin color (occurred in the last 60,000 years) • Vitamin D absorption needs UVR. Too much causes break down of folic acid and birth defects. • As people left Africa to higher latitudes and needed to absorb relatively more UVR those with less melanin had better survival.

26. Why does alcohol flush cheeks differently? • Asian populations have a lower rate of enzyme that detoxifies alcohol • Why? Why do Yam farmers get less sick with malaria? Malaria resistance genetic variant for hemoglobin associated with sickle cell

27. Physical variation across culture • Moken visual acuity underwater through pupil constriction (2x European children)

28. Diet and Obesity • 170 million (30%) children under 5 are malnourished (UNICEF, 2008)

29. Reasons • Vitamin A • Iron deficiency • Iodine • Zinc

30. Fig. 10.2

31. Fig. 10.3

32. Height • Genetic or acquired? • (Malcom, 1974)

33. Health and SES

34. Who is living a shorter life?

35. Fig. 10.5

36. Burkina Faso • Fulani, Mossi, Rimaibe • Fulani migrated in 19th century and are pastoralist. Do not have malaria resistance. • Mossi and Rimaibe have been living in the region for thousands of years, have resistance. • More Mossi and Rimaibe die of malaria…. • Why?

37. Why? • Money for health care • Jobs that place them in danger • Engage in more unhealthy behaviors • (drinking , smoking, fast food)

38. Mediating factor • Personality characteristics of pesimism and cynicism • Stress • Objective SES and subjective SES

39. Feeling poor may matter more than being poor. • Relative deprivation

40. Fig. 10.6

41. Groups in the US • African Americans (more than SES) Because health disparities remain across matched SES and education groups. West African’s have hypertension rates similar to EA. Something about being African American in the US……. Stress

42. Table 10.1

43. Immigrant health • Healthy migrant hypothesis: only healthier ones endured the move here. • Salmon hypothesis: the ill and old return home to die. • Decreases to US norms the longer a person stays.

44. The Invisible Cure • History of HIV/AIDS in Africa • Activity: • You have been hired by WHO to reduce rates of HIV In sub-Saharan Africa. Please break up into groups and develop an outline for a program to reduce HIV rates. • Use the diagram on slide 20 and answer the following questions • Why did you choses this strategy • What is the advantage of the strategy • What is the disadvantage of the strategy • What cultural obstacles do you forsee?