Background of you as psychologist
- We live in heterogeneous, diverse and multicultural society.
- Mental health disparities.
- Psychotherapy is found be less effective for those marginalized
- Drop-out rates are higher among ethnic minorities
two ways how psychiarty and culture could interact
- culture in psychiatry: how is psychiatry shaped by culture
- culture and psychiatry: How does culture present itself within psychiatry
Culture IN Psychiatry
Clinical sciences are largely based on western (EuroAmerican) norms, views, values and concepts.
* Concepts of the self/individual/being human
* Psycho-medical etiology of illness
* How to distinguish between normal and abnormal
* How to define and classify pathological behavior
Examples of cultural defenition of pathology
- Homosexuality
- Frigidity (Freud, 1905) – Women who are not able orgasm during vaginal penetration (vaginal orgasm myth).
- Drapetomania – Obsessive need among slaves to flee.
Conceptualizing the social determinants of mental health.
People develop psychiatric problems from a bad childhood or bad genes. Nowadays show that social determinants are controbuting largely at developing psychiatric problems. (Contextualising)
=> Public policies and social norms
=> Distribution of opportunity (no equality among humanity)
Culture and psychiatry
Negative effects of culture could lead to mental health issues and illnesses
=> vb. forced marriage
Effects of culture on psychiatry
- Cultural norms and values affect pathogenesis
- Cultural beliefs on health illness emphasize certain symptoms (over the others).
- Cultural norms determine the type of symptoms expressed:
– Anorexia nervosa – Taijin kyofusho - Cultural beliefs determine the boundaries between normal and abnormal phenomena.
Expression of symptoms
Language and communication norms affect the expression of symptoms
Cultural beliefs
Cultural beliefs determine the experience and explanation of symptoms
Symptoms
Physically, but also what we communicate
Cultural concepts of distress
- Idioms of distress
- Cultural syndromes (like anorexia)
- Explanatory models of illness (EMs)
Idioms of distress (IoD)
Culturally constituted experiences and expressions of distress, which are associated
with culturally pervasive values, norms and health concerns, and initiate particular types of interaction
* burn-out, spirits (but also heartbreak of brainfart)
Research refugees traumatic experiences
Anxiety, depression was expressed. PTSD was made out of idioms of distress.
Explanatory models of illness (EMs)
- Causes
- Timing
- Pathophysiology
- Course (nature, severity) * Preference for
treatment
Treatment outcome and attenance
Correlate with Therapist vs patients psychological explanations
Psychotic disorders
- Culture affects the content and frequency of
hallucinations - Minorities have a greater risk of receiving the schizophrenia diagnosis
- Evidence for overdiagnosis of schizophrenia in some immigrant groups
- Overdiagnosis of + symptoms goes together with underdiagnosis of affective symptoms
Mood disorders
- Prevalence varies across groups
*Even the recognition and impact of the core symptoms is dependent on cultural notions (Chentsova-Dutton, 2015) * Somatic symptom presentation
