Transcultural psychiatry is a field of study that ____
Combines anthropology and psychiatry to examine how culture interacts with mental illness
Does western psychiatry make sense in non-western cultural contexts? Why is it imperialistic
- it is argued that imposing Western psychiatry upon non-Western populations is a form of imperialism
- imperialistic bc a “narrowly defined view of mental distress - one that is situated in the dominant American psychiatric perspective - displaces local understandings of suffering”
What are people with non-Western identities at risk for?
- involuntary and harmful treatment
Why have indigenous communities in particular criticize the colonial approach to mental health care?
it dismisses other perspectives regarding health and wellness through emphasis on pathology and biology (ignoring spiritual)
Argue that assumption of contemporary mental health care is that Western Science is superior to other knowledge forms
◦ However, “normal” and “healthy” behaviour is based on cultural norms
◦ Superiority is a fallacy but leads to transforming difference into illness
◦ This then leads to assumptions about links between Indigeneity and inherent mental pathology
What does the movement to decolonize mental health call for?
- Challenging the dominance of Western assumptions in mental health
- Validating diverse/personal experience and alternate explanations for suffering and mental distress
- Rejecting imposition of psychiatric care and allowing for more culturally meaningful approaches
- Challenges hegemonic conceptualizations of “mental illness”, like those contained in the DSM
Why has the DSM been previously critiqued?
- ignoring culture or treating it too simply
does the DSM-5 acknowledge culture?
- DSM-5 acknowledges (or tries to acknowledge) the importance of cultural context in understanding and responding to mental distress in an attempt to better conceptualize and respond to cultural influences
- It now describes concepts such as “cultural syndromes”, “cultural idioms of distress”, and “cultural explanations or perceived causes”, as well as “culture- related diagnostic issues”
review what the DSm states
The DSM states:
* “Mental disorders are defined in relation to cultural, social, and familial norms and
values”
* “The boundaries between normality and pathology vary across cultures for specific types of behaviours”
* “Diagnostic assessment must therefore consider whether an individual’s experiences, symptoms, and behaviours differ from sociocultural norms” before diagnosing a person’s behaviour as pathological
The above appears to acknowledge that mental illness is a culturally specific phenomenon (e.g., not universal, but relative)
◦ Was previously more limited: culture-bound syndromes - described abnormal, patterns of behaviour recognized only within specific cultural contexts
including “culture-bound syndromes” can be seen as acknowledgement of the importance of cultural context upon understanding mental illness, but may be viewed as…?
- pathologizing/exoticizing non-Western forms/expressions of mental distress, while cementing the DSM as independent of culture (and thus unbiased/correct)
How does the DSM treat culture “paradoxically”?
◦ Acknowledges culture as central to defining & responding to mental disorders, encouraging practitioners to consider whether behaviours/symptoms/experiences differ from sociocultural norms before diagnosing
◦ Despite acknowledging that mental disorders are cultural formations, it still conceptualizes Eurocentric formulations of “core” disorders as universal
explain cultural syndroms
- Describe presentations of abnormal behaviour found only within a specific (non-Western)
culture – similar to “culture-bound syndrome”
◦ May not be considered an illness within the culture - In DSM-5, these are then linked to related (Western-defined) conditions, i.e.,: taijin kyufusho (Japanese) is defined as “interpersonal fear disorder”- linked to social anxiety & OCD
Explain cultural idioms of distress
- Ways of talking about suffering within a given cultural group without involving specific symptoms or syndromes; describe general patterns of describing an individual’s personal or social problems “kufungisisa” (Shona people of Zimbabwe) = “thinking too much” (included in DSM-5)
- Non-specific, and may be applied in varied ways (i.e, the way we colloquially use “depression” or “my nerves are acting up”
explain cultural explanations or perceived causes
- Describe causal reasons for a person’s psychological distress and abnormal
behaviour that are culturally bound or specific - In DSM-5, Haitian term “maladi moun” is included, which posits that a mental disorder may be caused by the bad intentions of other people
◦ E.g., people can send psychosis and social and academic failure to others
explain the short section in each diagnostic category of DSM-5 called culture-related diagnostic issues
- Lists cultural factors that might affect how clinicians form a diagnosis
- Includes flexibility for regional variation in both symptom expression and attitudes/interpretations of varying behaviour
◦ E.g.: form that OCD takes may differ based on sociocultural location; differences in ADHD rates may be due to whether or not hyperactivity is thought of as problematic
What are the 3 key approaches that have characterized the debate about whether mental illness are universal or culturally specific?
- The absolutist school: mental disorders are globally shared (form & content of mental disorders are “universal” phenomena)
- The universalist school: illnesses are globally consistent, but content is shaped by culture (e.g., content of delusions, obsessions, etc.)
- The relativist school: perceptions of distress are unique to each culture and diagnosis is culturally-bound (mental disorders cannot be universal, they inherently involve violations of “normality” which are by definition culturally dependent)
Global mental health is a movement which aims to what?
improve equity in mental health treatment globally
- Mental health treatment is positioned as a fundamental human right
- Mental illnesses are highlighted as a major contributor to the global burden of diseases and disability
What is the major focus of the global mental health movement
- provide access to treatment to people in low-income countries
What are some critiques of the global mental health movement
- May result in ignoring structural, economic, and political issues (like SDoH) and focuses attention on symptoms (distress) rather than potential causes (SDoH, war, famine)
- “Neocolonial” trying to exert Western psychiatric norms on the rest of the world (where they may not be appropriate) - can be viewed as “psychiatric imperialism”
- Displaces local ideas about suffering, abnormal behaviour, and how to respond by promoting a Western system of classification and treatment
- Individualizes & depoliticizes problems like war & poverty by reframing distress as a psychological issue rather than a logical response to suffering
- May focus on mental disorders as the problem without framing global economic and political (and environmental) problems as the cause (disorders are symptoms of the wider situation)
- The production of knowledge in mental health is increasingly limited to large and resource-rich Western institutions: represents a research bias that is Anglo- American
Since the 1990’s a number of international organizations have mobilized to provide emergency mental health interventions in response to emergencies such as famine, war, and natural disasters
* These groups include…?
the Red Cross, Médecins sans Frontières, and the World Health Organization
* Services include counselling, and training and support of local workers
these groups and services attract support because?
they are considered to be effective long- term investments
- Another rationale is the usefulness of early intervention in order to prevent PTSD and reduce subsequent burden
- A third is that responding to trauma in a population can help prevent future violence and conflict (as potential sequelae of war or armed conflict)
- Finally, these initiatives are a way of maintaining connections between the global community and the traumatized population (not ignoring these problems and communities)
What are some critiques of these international trauma interventions?
- Are these programs culturally relevant/appropriate? (may sideline or displace indigenous/local responses and forms of care/healing)
- Is there actually a universal response to trauma, and does it always look like PTSD, or is this a Western construct?
- Is it possible that Western-style interventions, like individual counselling, could actually be harmful in other cultural contexts? (perhaps collective, group, or communal approaches would be more appropriate and effective)
Who is a co-founder of the movement for Global Mental Health?
Vikram Patel
What did the N in SUNDAR stand for?
Unpack the treatment into smaller components for less-trained individuals
What did Dr. Vikram Patel note was the biggest barrier to implementing key mental health interventions in India?
- Lack of workforce and expertise, particularly psychologists and psychiatrists - different models are needed
- Translated the proportion of psychiatrists in the population that one might see in Britain to India: anticipate roughly 150,000 psychiatrists in India.
- Actual number is approx. 3,000, about two percent of what would be expected if we use the ratio from the UK
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