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CULTURE AND MENTAL ILLNESS

CULTURE AND MENTAL ILLNESS. CULTURE. SYSTEMS OF MEANING, GOALS, AND VALUES THAT ARE COMMON WITHIN A GROUP AND DIFFERENT FROM OTHER GROUPS RELIGION, POLITICS, SOCIAL CLASS, ETHNICITY. ETHNICITY .

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CULTURE AND MENTAL ILLNESS

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  1. CULTURE AND MENTAL ILLNESS

  2. CULTURE • SYSTEMS OF MEANING, GOALS, AND VALUES THAT ARE COMMON WITHIN A GROUP AND DIFFERENT FROM OTHER GROUPS • RELIGION, POLITICS, SOCIAL CLASS, ETHNICITY

  3. ETHNICITY • ETHNICITY = SOCIAL GROUPS THAT DISTINGUISH THEMSELVES FROM OTHER GROUPS BASED ON SHARED DESCENT, CULTURE, AND IDENTITY • VARIES IN IMPORTANCE BY INDIVIDUALS AND GROUPS

  4. RECENT INTEREST IN ETHNICITY • IMMIGRATION - 31 MILLION OF 292 MILLION FOREIGN BORN – MOST EVER • E.G. NYC – 40 % IN 2000 VS. 28% IN 1990; WHITES NOW MINORITY • DIVERSITY OF CULTURES • MULTICULTURALISM

  5. PROBLEMS IN STUDYING ETHNICITY • COMPLEXITY OF ETHNIC GROUPS • HOW TO SEPARATE ETHNIC CULTURE FROM OTHER FACTORS • INCOME, FAMILY STRUCTURE, ACCULTURATION, ETC. • CULTURALLY INSENSITIVE INSTRUMENTS

  6. 3 WAYS ETHNICITY AFFECTS MENTAL ILLNESS • RATES OF MENTAL ILLNESS • EXPRESSION OF MENTAL ILLNESS • RESPONSE TO MENTAL ILLNESS

  7. RATES OF MENTAL ILLNESS

  8. AFRICAN AMERICANS • EXPECT HIGHER • DISCRIMINATION, LOWER INCOME • FIND RATES NOT HIGHER THAN WHITES • ANXIETY DISORDERS (PHOBIAS) ARE EXCEPTION • PERHAPS BETTER COPING ABILITIES, SOCIAL SUPPORT, RELIGION

  9. HISPANICS • HISPANICS TOTALLY INCONSISTENT - SOMETIMES HIGHER, SOMETIMES LOWER • PERHAPS DIVERSITY OF GROUPS, POOR INSTRUMENTS

  10. HISPANICS • THOSE BORN IN US HAVE HIGHER RATES THAN THOSE BORN IN NATIVE COUNTRIES • MORE ACCULTURATED HAVE HIGHER RATES THAN LESS ACCULTURATED • ASSIMILATION BAD FOR MENTAL HEALTH?

  11. OTHER ETHNIC GROUPS • ASIANS - LOW RATES • MORE PHYSIOLOGICAL EXPRESSIONS, HIGHER INCOME? • NATIVE AMERICANS VERY HIGH RATES, ESPECIALLY ALCOHOLISM AND SUICIDE

  12. CONCLUSION • DIFFERENT ETHNIC GROUPS HAVE DIFFERENT RATES OF M.I. • BUT, LITTLE CONSISTENCY

  13. EXPRESSION OF SYMPTOMS

  14. GROUPS HAVE DIFFERENT ILLNESS VOCABULARIES • “STRUCTURING” - GENERAL SENSATIONS BECOME PARTICULAR ENTITIES • E.G. DEPRESSION - • SOME: PSYCHOLOGICAL - SADNESS, HOPELESSNESS, LOW SELF ESTEEM • OTHERS: PHYSICAL - FATIGUE, ACHES, LOSE APPETITE, NOT PSYCH

  15. EXPRESSIONS • WESTERN CULTURES = PSYCHOLOGICAL EXPRESSIONS • NON-WESTERN CULTURES = PHYSIOLOGICAL EXPRESSIONS

  16. IMMIGRANTS • COMPARE SYMPTOMS OF NEW AND LONG-TERM IMMIGRANTS • STUDY OF CHINESE-AMERICANS • NEW IMMIGRANTS SHOW MORE PHYSICAL SYMPTOMS • LONG-TERM IMMIGRANTS SHOW MORE PSYCHOLOGICAL SYMPTOMS • ASSIMILATION CHANGES SYMPTOMS

  17. IMPLICATIONS • CLINICIANS SHOULD BE SENSITIVE TO CULTURAL NATURE OF SYMPTOMS • CLINICIANS CAN UNDERSTATE OR OVERSTATE MENTAL ILLNESS • OUR MENTAL ILLNESSES - EATING DISORDERS, A.D.D. ETC. CAN BE “CULTURE BOUND” TOO

  18. SOCIAL RESPONSES

  19. PSYCHOTHERAPY • WHITES FAR MORE LIKELY TO BE IN P.T. • EVEN MORE LIKELY TO STAY IN P.T. • BLACKS ESPECIALLY UNLIKELY

  20. REASONS FOR ETHNIC DIFFERENCES • DEFINITIONS OF M.I. • USE OF INFORMAL OR FORMAL RESOURCES • TRUST IN MENTAL HEALTH PROFS • RESPONSE OF MENTAL HEALTH SYSTEM

  21. MEXICANS DEFINE AS “NERVIOS” KEEP IN FAMILY GAP IN COMMUNICATION WITH M.H.P. ANGLOS DEFINE AS PSYCHOSES BRING TO M.H.P. SHARED DEFINITIONS OF PROBLEM RESPONSE TO SCHIZOPHRENIA IN L.A.

  22. MEXICANS DELAYED TREATMENT MORE SEVERITY LESS COMMUNICATION MORE FAMILY SUPPORT WHITES QUICKER TREATMENT LESS SEVERITY MORE COMMUNICATION LESS FAMILY SUPPORT COSTS AND BENEFITS

  23. HORWITZ STUDY IN NJ • COMPARE WHITE AND BLACK PARENTS AND SIBLINGS OF SERIOUSLY MENTALLY ILL • HOW MUCH HELP PROVIDE • HOW MUCH BURDEN THEY HAVE

  24. RESULTS • WHITE AND BLACK PARENTS PROVIDE SAME AMOUNT OF HELP • WHITE PARENTS REPORT MORE BURDEN THAN BLACK PARENTS • BLACK SIBLINGS PROVIDE MORE HELP THAN WHITE SIBLINGS • BLACK SIBLINGS FEEL LESS BURDENED THAN WHITE SIBLINGS

  25. REASONS • DIFFERENT CULTURAL EXPECTATIONS? • SENSE OF FAMILY OBLIGATION EXTENDS FURTHER AMONG BLACKS THAN WHITES, LESS INDIVIDUALISM

  26. FAMILY SUPPORT • MANY ETHNIC GROUPS – ESPECIALLY NEW IMMIGRANTS • GREATER SENSE OF FAMILY OBLIGATION AND LESS INDIVIDUALISM • LESS ADEQUATE PROFESSIONAL TREATMENT

  27. SUMMARY • FEW OVERALL CONCLUSIONS FOR RATES IN US • ETHNICITY AFFECTS WAY PEOPLE EXPRESS DISORDERS • ETHNICITY AFFECTS DEFINITIONS, SOCIAL SUPPORT AND HELP-SEEKING

  28. IMPLICATIONS • PROFESSIONALS SHOULD BE CULTURALLY SENSITIVE • ETHNIC-SENSITIVE PROGRAMS TEND TO WORK BETTER • PARTICULARLY IMPORTANT NOW WITH HIGH RATES OF IMMIGRATION

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