Chapter 9: Psychological Disorders

1. Chapter 9: Psychological Disorders CostanzaMaio

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. Experiment • Cultural Influences on Clinical Perception • By Diana Li-Repac • http://jcc.sagepub.com/cgi/content/abstract/11/3/327

21. 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

22. 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?