What is the term that refers to the tendency to imagine one’s own culture as being “correct”?
- ethnocentrism
What is culture?
- culture is social and “shared” - it involves group membership
- cultural beliefs, values and practices are transmitted form one member to another (and from one group to another)
Review more about what culture is
We all participate in “culture” – we are both products and producers of cultural knowledge and practices
* Culture is fluid and ever-changing
Consider how we all shifted to online learning, and now have transitioned back to in- person instruction: people had to learn new practices, and collectively figured out new modes of communicating and interacting
- Disparities in power are important considerations in relation to culture (some groups and viewpoints have more dominance) and have an impact on how we understand mental illness (e.g., psychiatrists, and the APA through the DSM)
What is culture itself?
- a social determinant of health
- people’s experience of mental illness is influenced by culture
*Our ways of communicating and expressing emotion are culturally mediated – but they are also components of mental disorder diagnoses, so they influence the likelihood of receiving a diagnosis of mental illness
*Mental distress and psychological problems are expressed or “performed” in cultural ways
What are the cultural risk factors for mental health problems
- experiencing racism and discrimination because of cultural background
- cause distress, may lead to marginalization and barriers to care
What are culturally mediated?
- experience, emotion, and relationship formation
- these parts of experience are central to diagnostic criteria (think of words like excessive, distress, abnormal)
- culture shapes who is deemed to be mentally ill or have a mental disorder
When behaviour and personality do not fit well with culture, a person is more likely to what?
- to display psychiatric symptoms or be deemed to have a disorder (ex. hyperactive kids and ADHD)
*as a risk factor: members of ethnic minority groups may be more likely to be diagnosed with a disorder (like schizophrenia) but may also experience more mental health problems than members of majority groups (likely partially due to racism and discrimination
Culture can be a protective factor too like…?
- among some black women the tendency to avoid self-blame (which can individualize social problems) may shield people from distress
our response to mental distress is influenced by what?
- our cultural perspectives
- we may or may not perceive that a feeling or thought is unusual or problematic depending on our cultural background (communicating with deceased ancestors, belief in possession)
- we may or may not believe that consulting a medical professional is the best option (we may seek help from a spiritual leader or advisor, or not seek help at all)
- our beliefs about the mental distress we experience are products of our cultural context
How is our expression of mental distress influenced by our culture?
- Mental disorders may look very different (or be expressed differently) in different cultural contexts)
- ex. somatization (experiencing psychological symptoms through bodily pain/discomfort) may be more common in cultures where the outward expression of emotionality and pain is discourages
It could be argued that mental illness is a way of “performing” mental distress in a way that is understandable to other members of our cultural group. Give an example
- North Americans and Europeans are thought to experience depression in largely psychological ways (less often through somatization)
What is Category fallacy? and who coined it?
- coined by Arthur Kleinman, an anthropologist and psychiatrist
- reification of one culture’s diagnostic categories and their application to people in another culture, where these categories lack coherence and their validity has not been established
*conceptualization/expression of mental distress is dependent on cultural context, so trying to use singular/universal systems to understand & treat psychological distress is ineffective
What is transcultural psychiatry?
- combines anthropology and psychiatry to incorporate cultural understandings of illness into clinical practice
*mental disorders take different forms/presentations or look differently depending on sociocultural context
*culture also defines how one experiences, expresses, manifests, and is treated for mental health problems
What is culturally specific to European ancestry
- experiencing depression psychologically (as opposed to primarily through somatization)
*research into cross-cultural and inter-ethnic manifestations of disorders (like OCD, ED< anxiety, and PTSD) has lead to the conclusion that culture plays a key role in experience and expression of mental distress
Review: Are we experiencing the same illness or conditions?
- if the expression of mental distress is very different across cultures and even individuals, how do we know if we are all experiencing depression (for example)?
- are there illnesses which are culturally specific, rather than universal?
- has Western ethnocentrism fundamentally biased dominant diagnostic systems towards seeing European and North American norms as “universal”?
What are the assumptions? are disorders universal?
- assumption in psychiatry and psychology is that people around the world are experiencing the “same” disorder but that content may be culturally shaped
— ex. content of delusion - Assumption that disorders in DSM are universal diseases and are discovered and documented as psychiatry and abnormal psychology progress
What is another view on culture and mental illness
- little evidence for this
- diagnosis is a work in progress, not certain, no biomarkers
- subjectively assessed through an interpersonal and cultural encounter
Suman Fernando: clinical assessment/diagnosis. is a meeting between 2 people, in which both actors bring their own language, feelings, tensions and underlying beliefs to the clinical encounter
Somatisized (stomach and chest pain) vs. psychological (low mood, hopelessness) depression : 2 expressions of same condition or different conditions?
What are the critiques of psychiatry and its view of culture?
- Psychiatry has tended towards broad (and perhaps overly simplified) generalizations of non-White cultural groups
- (Until recently) Has not meaningfully considered culture in relation to conceptualizations of mental health and illness, and views itself as neutral and objective- treats culture as an “afterthought” rather than recognizing the influential and deterministic role it has
- Frequent assumption: “Culture” is something patients, rather than practitioners, possess
- People in non-majority cultural groups are more likely to be misdiagnosed in healthcare settings
- Culturally appropriate behaviour (belief in possession) may be deemed a psychiatric condition
- On the other hand, real psychological stress may be discounted as just “cultural difference”
- It may be helpful to consider that psychiatry itself is a set of cultural beliefs (a shared system of knowledge, evolving, and transmitted among individuals and between groups)
What can be done? How to translate theory into practice?
- culture is not contained within individuals, it is shaped by social context and social interactions
- psychiatry as system of knowledge represents “cultural beliefs” not universally applicable objective “science”
- avoid racial and ethnic stereotypes, and take a nuanced view (like transcultural psychiatry)
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