PSYSCHOLOGY PSY101
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PSY101Lecture102020.pptxPSY101 Introduction to Cultural Psychology
Lecture 10
All tables and figures Copyright ©2017 Cengage Learning.
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Psychological Disorders
Outline
Defining Abnormality
Culture and the Categorization and Assessment of Psychological Disorders
Culture and Categorization of Psychological Disorders
Cross-Cultural Assessment of Psychological Disorders
Measurement of Personality to Assess Psychopathology
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Outline
Cross-Cultural Research on Psychological Disorders
Schizophrenia
Depression
Cultural Syndromes of Distress
Summary
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Outline
Mental Health of Ethnic Minorities, Migrants, and Refugees
African Americans/Latino Americans/Asian Americans/Native Americans
Immigrants
Refugees
Summary
Conclusion
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Defining Abnormality
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Defining Abnormality: Some Core Issues
Cultural relativism: View that culture and psychopathology are intertwined
Disorders can be understood only in the cultural framework within which they occur
Psychopathology: Psychological disorders that encompass behavioral, cognitive, and emotional aspects of functioning
Cross-cultural similarities exist in the psychological mechanisms and subjective experiences of psychological disorders
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Defining Abnormal
Defined by:
Using a statistical approach
Applying criteria of impairment or inefficiency, deviance, or subjective distress
Alternative approach - Applying cultural relativism to abnormality
Culture and the Categorization and Assessment of Psychological Disorders
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Culture and the Categorization and Assessment of Psychological Disorders
Assessment of psychological disorders involves identifying symptoms in the broader context
Tools and methods used should be sensitive to cultural and environmental influences on behavior and functioning
Bias or insensitivity exists when psychological tests developed in one cultural context are used to assess behavior in a different context
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Culture and Categorization of Psychological Disorders
Cross-cultural issues arise concerning:
The reliability and validity of diagnoses
The diagnostic categories used
Classification systems used for diagnosis
Diagnostic and Statistical Manual of Mental Disorders (DSM)
DSM V has been revised to include cultural concepts of distress (CCD) and Cultural Formulation Interview (CFI)
International Classification of Diseases (ICD)
Chinese Classification of Mental Disorders (CCMD)
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Figure 12.1 - Cultural Concepts of Distress
Cross-Cultural Assessment of Psychological Disorders
Tools used for assessment
Questionnaires, interview protocols, or standardized tasks requiring behavioral response
Should reliably and validly assess psychological parameters
Play limited role in other cultures with varying definitions of abnormality
Child Behavior Checklist
Used in diverse cultures to assess behavioral, emotional, and social problems of children and adolescents
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Cross-Cultural Assessment of Psychological Disorders
Cultural backgrounds of both the therapist and client build the perception and assessment of psychological disorders
Culturally responsive assessment
Requires an understanding of the cultural background of the client and one’s own potential cultural biases
Results of Failure in Addressing Issues of Assessment
Considering behavior as pathological, when behavior is a normal variation for that individual's culture
Overpathologizing
Indiscriminately seeing behavior as cultural, when behavior actually reflects abnormal psychological response
Underpathologizing
Measurement of Personality to Assess Psychopathology
Personality tests used cross-culturally assess clinical states and psychopathology
Minnesota Multiphasic Personality Inventory (MMPI)
Tests for abnormal behaviors in paranoia (level of trust), hypochondriasis (concern for own health), and social introversion
Reliable and valid form of assessment in multiple cultures
Other research cautions against the use of MMPI-2 for specific populations
Chinese Personality Assessment Inventory (CPAI)
Includes indigenous concepts from Chinese culture
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Cross-Cultural Research on Psychological Disorders
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Characteristics of Schizophrenia
Delusions and hallucinations
Lack of motivation
Social withdrawal
Impaired memory
Dysregulated emotions
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Schizophrenia
International Pilot Study of Schizophrenia
Universal symptoms - Lack of insight, auditory and verbal hallucinations, and ideas of reference
Course of illness was more positive for patients in developing countries than developed countries
Symptom manifestation varies between countries
Expressed-emotion construct
Family and social interactions influence the course of schizophrenia
Depression
Characterized by physical, motivational, emotional and behavioral changes
Universally, women are likely to experience depression than men
Cross-cultural symptoms
Sadness and joylessness
Anxiety, tension, and lack of energy
Symptoms differ across cultures due to variations in stress sources and coping mechanisms
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Cultural Syndromes of Distress
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Cultural Syndromes of Distress
Patterns of symptoms that cluster together for individuals in specific cultural groups, communities, or contexts
Findings concerning differential rates and courses of disorders across cultures
Highlight the role of culture in shaping the expression of psychological disorders
Examples of culture-bound syndromes
Amok, zar, baksbat, susto, latah, and koro
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Summary
Universal aspects of symptoms and disease expression exist for depression, schizophrenia, and ADHD
Culturally specific disorders manifest symptoms that are localized to a particular culture/community/context
Psychopathologies are influenced by culture in terms of:
Specific behavioral and contextual manifestations
The meaning of disorder to individuals
Contains both universal and culturally specific components
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Mental Health of Ethnic Minorities, Migrants, and Refugees
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African Americans
Historical context of slavery and exclusion from the social, economic, and educational fronts have influenced their mental health
Report lower lifetime and 12-month prevalence rates of major depression and panic disorder
Protective factors against mental illness
Strong family, community, and religious networks
Groups differ based on whether they are born to African American parents or Caribbean Blacks
Latino Americans
National Latino and Asian American Study
Shows variations in rates of mental illness among different Latino groups
Factors that influence mental health
Reception and history of immigration
Varying SES and experiences with discrimination
Strength of ethnic community
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Asian Americans
Model minority stereotype masks the fact that Asian Americans could be at risk for poor mental health
Asian American population is heterogeneous in terms of culture, language, and history of immigration
Report lowest 12-month prevalences of disorders
Gender and immigration-related factors help in understanding mental health disorders
Native Americans
Higher prevalence of depression, other mood and anxiety disorders, and rates of alcohol and suicide
Psychological disorders could be due to:
Historical trauma
Community-wide poverty
Segregation and marginalization
Preserving and promoting traditional culture helps in reducing severe psychological distress
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Immigrants
Immigrants adapting to a new cultural environment are faced with acculturation issues
May cause depression, anxiety, and psychosomatic problems
Immigrant paradox challenges the notion that immigration is stressful, leading to poor adaptation
An individual’s level of acculturation contributes to the content and expression of his/her distress
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Refugees
Show higher rates of posttraumatic stress disorder (PTSD), depression, and anxiety
Caused by the traumatic experiences marked by profound losses and upheavals
Dose effect - Greater severity of trauma is associated with a higher likelihood of experiencing psychological disorder
Postmigration factors are equally important in predicting a refugee's emotional distress as pre-migration experiences
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Summary
To understand ethnic differences in rates of mental disorders:
Contextual factors such as poverty, discrimination, and stresses associated with immigrating to new country need to be considered
Assets that can counteract stresses and contribute to positive mental health:
Strong ties to family and ethnic networks that characterize African American, Latino American, Asian American, and Native American communities
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Conclusion
Psychiatric diagnoses, classification schemes, and measurement of abnormality are complex and difficult issues
Classification systems and assessment methods need to contain both etic and emic elements
Where to draw lines, and how to measure psychological traits within a fluid, dynamic, and ever-changing system, is a challenge
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PSY101
Tutorial 10
What is “Normal?”
Rate the extent to which you find the behaviour or custom “quite ordinary” or “quite strange” by using the scale below. Indicate your gut-level reaction.
Quite Ordinary Ordinary Neutral Strange Quite Strange
1 2 3 4 5
Quite Ordinary Ordinary Neutral Strange Quite Strange
1 2 3 4 5
Slurping your soup loudly in a restaurant
Sticking out your tongue to say “hello”
Two male adults holding hands in public
Adults living with parents until marriage
Haggling over the price of clothes in a
department store
Quite Ordinary Ordinary Neutral Strange Quite Strange
1 2 3 4 5
Knocking on people’s doors and asking for food
Taking food from your friend’s refrigerator without asking your friend for permission
Calling a stranger aunty or uncle
Patting the table with a finger repeatedly
Shaking one’s head, saying “yes”
Chapter 13 - Culture and Treatment for Psychological Disorders
Copyright ©2017 Cengage Learning. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Treatment for Psychological Disorders
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Outline
Culture and Psychotherapy
Traditional Psychotherapy
Contemporary Psychotherapy
Cultural Limitations of Psychotherapy
Psychotherapy in Diverse Cultures
Summary
Receiving Treatment and Barriers to Treatment
Disparities in Receiving Treatment
Barriers to Seeking Treatment
Removing Barriers to Treatment
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Outline
Treatment Issues
Culturally Competent Services
Indigenous and Traditional Healing
An Example of Blending Indigenous Healing Practices with Traditional Western-Based Treatment Approaches
A Community Approach to Treatment
Culture and Clinical Training
Conclusion
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Culture and Psychotherapy
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Culture and Psychotherapy
Psychotherapy: Method of healing that emphasizes an explicit focus on the self
Traditional psychotherapy
Sigmund Freud - Father of psychoanalysis
Developed the psychoanalytic model
Carl Rogers - Developed the client-centered approach
Emphasized the client's self-propelled growth
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Contemporary Psychotherapy
Differs in theoretical perspective, activity or passivity of the therapist, guidance, and focus of treatment
Cognitive behavioral therapy: Emphasizes development of strategies for teaching cognitive skills
Contemporary psychotherapeutic techniques are infused with cultural assumptions
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Cultural Limitations of Psychotherapy
Psychotherapy is less effective for people of non-European descent
Expressions of abnormality varies based on cultures
Cultures differ on notions of self
Ability of the therapist to assess is related to his/her knowledge, understanding, and appreciation of cultural context
Goal of psychotherapy - To help people become more functional within their society
Functionality is culturally determined
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Table 13.1 - Cultural Configurations of the Self and Healing Systems
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Psychotherapy in Diverse Cultures
Psychologists incorporate essential elements of their culture to make psychotherapy useful
Incorporating religion into psychotherapy helps solve psychological distress
Culturally modified psychotherapy is more effective than non-modified psychotherapy to treat depressive disorders
Modifications include colloquial language, integrating local remedies and health practices, and using culturally meaningful stories, idioms and symbols
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Summary
Psychotherapy is widely used North America and Europe
Used in other parts of the world to a lesser extent
Cultural relativism and universalism helps one understand whether psychotherapy is exportable
Cultural relativist position - Psychotherapy was developed in a specific culture and cannot be exported to other cultures
Universalist position - There are aspects of psychotherapy that are relevant for all people
Culturally sensitive psychotherapies are useful
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Receiving Treatment and Barriers to Treatment
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Disparities in Receiving Treatment
Not all people receive treatment
Those in lower income countries are less likely to receive treatment than those in countries with more economic resources
Disparities for receiving treatment exist within one country
Mental health utilization and length of treatment differ by racial or ethnic group
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Source: Wang et al # (2007). Worldwide use of mental health services for anxiety, mood, and substance disorders: Results from 17 countries in the WHO World Mental Health (WMH) surveys. Lancet, 370, 841-850.
Figure 13.1 - Percent of Those Classified with a “Serious” Diagnosis Reporting Using Mental Health Services in the Last 12 Months
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Source: Garland, et al., 2005. Page 1338.
Figure 13.2 - Mental Health Service Use among Youths Aged 6–18 in a Large, Publicly Funded System of Care by Racial/Ethnic Group (N = 1,256)
Barriers to Seeking Treatment
Language proficiency affects the use of mental services
Language barriers
Emotions such as shame and loss of face is associated with mental health services
Stigma and mistrust
People are encouraged to rely on willpower to confront problems rather than relying on formal treatment
Beliefs on health and illness
Lack of availability of mental health services, health insurance, and culturally competent services
Social structures and policies
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Removing Barriers to Treatment
Focus - To examine how barriers interact with racial or ethnic backgrounds, immigration status, and socioeconomic status
Hiring bilingual and bicultural staff
Increasing outreach and the number of practitioners in the community
Having flexible hours
Reducing stigma associated with mental illness
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Treatment Issues
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Treatment Issues
Challenges faced when the clinician and patient differ with respect to cultural backgrounds
Different ways of thinking and expressing thoughts about illness
Language difficulties
Variations in communication patterns of ethnic groups
Cultural variations in the importance of hierarchy in interpersonal relationships
Differences in treatment expectations
Recognition and involvement of members of the extended family
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Culturally Competent Services
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Culturally Competent Services
Involves understanding and respecting the histories, traditions, and value systems of the various cultural groups
Acculturation status and ethnic identity are determinants of client responses to treatment
Cultural matching is an inessential factor in effective counselling
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Table 13.2 - Characteristics of Culturally Competent Counselors
Indigenous and Traditional Healing
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Indigenous and Traditional Healing
Indigenous healing: Therapeutic beliefs and practices rooted within a given culture
Indigenous, traditional healers, and doctors are primary systems of care for a majority of the world
Commonalities
Reliance on family and community
Incorporation of traditional, spiritual, and religious beliefs
Use of shamans in treatment
Complementary medicine: Treatments that do not originate within that culture
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An Example of Blending Indigenous Healing Practices with Traditional Western-Based Treatment Approaches
James Gone’s work with Native Americans
Traditional healing in the Native American community places emphasis on:
Rank and status
Role and protocol
Relationship
Indigenous healing serves as the foundation for incorporating other treatments
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A Community Approach to Treatment
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Community Approach to Treatment
Analysis of mental health at a community level
Combines traditional principles of clinical psychology with an emphasis on multiple or diverse ecologies of individuals
Community-based treatments help immigrants and refugees
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Culture and Clinical Training
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Culture and Clinical Training
Psychologists need to have a base for understanding the role of culture
Contemporary clinicians and therapists receive training in the broad base of culture’s influence on all aspects of psychology
Factors to be considered in the development of a treatment plan
Language proficiency, level of acculturation, and cultural influence on symptoms
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Culture and Clinical Training (continued)
Clinical training program at McGill University emphasizes on:
Focusing on one’s own cultures rather than that of others
Multicultural backgrounds
Respect, empathy, and humility in recognizing that individuals have unique histories, experiences, and situations that are unfamiliar to the clinician
Conclusion
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Conclusion
Study of culture, psychopathology, assessment, and psychotherapy expands one’s theoretical and conceptual horizons regarding abnormality and treatment
Continued cross-cultural research on clinical issues is a must
Future research needs to explore the efficacy of approaches that address both etic and emic concerns
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