PSY3056
Culture, Diversity,
& Mental Health
- Day 1
There remains one other kind of practitioner, known as a "listener." This witchdoctor has the power
to exorcise the devils that lodge in the heads of people who have been bewitched. The Nacirema
believe that parents bewitch their own children. Mothers are particularly suspected of putting a curse
on children while teaching them the secret body rituals. The counter-magic of the witchdoctor is
unusual in its lack of ritual. The patient simply tells the "listener" all his troubles and fears, beginning
with the earliest difficulties he can remember. The memory displayed by the Nacirema in these
exorcism sessions is truly remarkable. It is not uncommon for the patient to bemoan the rejection he
felt upon being weaned as a babe, and a few individuals even see their troubles going back to the
traumatic effects of their own birth.
From: “Body Ritual Among the Nacirema,” Horace Miner, American Anthropologist 58 (3), 1956:
503-507.
Read and reflect
Kirmayer, 2007
Cultural Psychology
“the study of the way cultural traditions and social practices regulate, express, and
transform the human psyche, resulting less in psychic unity for humankind than in
ethnic divergences in mind, self, and emotion”
Schweder: “culture and mind make each other up”
Objectives:
o Pluralism: document the diversity of “normal” functioning between cultural communities
o Decentring: develop a language that allows the understanding and appreciation of the mental
lives of others
Note: Relativism and Meta-relativism and the example of OCD
Western Mental Health
(DSM)
oDSM-III, a revolutionary psychiatric nosology
o Psychopathology belongs to the field of medicine.
o Mental illnesses can be discovered in the field of disordered biology.
o Psychiatric research should rely primarily on statistical inference.
o The science of psychopathology requires a standardization of
concepts
o Discrete disorders should be presented in patients with explicit
diagnostic criteria.
o Limitations:
o Standardisation: infinite range of principles to define abnormality
o Biological: (neuro)scientists have not yet identified the biological
pathways—known today to be complicated
This Photo by Unknown Author is licensed under CC BY-NC-ND
Idiom of Distress
oNatural models of disease: Universal causes, their diagnoses can be specified by
operational criteria
o Note about meta-relativism
oExplanatory models of disease: Cultural explanations of illness, the implicit and explicit
beliefs and values that a person shares with members of his or her cultural group about the
causes, manifestations, consequences and treatments of an illness.
o Idioms of distress:
o Idiom: cultural/linguistic-bound meaning (“It’s raining cats and dogs.”)
o These are the modes of expression of distress, suffering or illness.
o They determine not only the manner in which symptoms are expressed, but also the meaning and
perceived severity of the symptoms.
All cultural groups share:
Healing implies a basic logic which
dictates path from illness to wellbeing:
Certain forms of afflictions
Logic is dictated by important cultural metaphors
Defined roles (patient et healer)
Example: Burn-out and the machine
Places and times for healing rituals/interventions
Symbolic acts specific for healing
Expectations for recovery
Healing
The effectiveness of healing is judged by
objectives/expectations that vary widely across cultures
The
Effectiveness
of Healing
Epistemological: how do we know if something works?
Ethics and aesthetics: how do we define health, wellness, or positive
change?
Ethical/aesthetic and epistemological issues go together
Different ways to define a successful intervention
1. the sick person recovers
2.the person with the disease does not recover, but the family, the family or the
community is healed
3. the healing system is affirmed (e.g. biomedicine)
Kirmayer, 2007
Psychotherapy
Definition: the use of speech (or non-verbal interaction)
regarding thoughts, feelings, emotions and relationships
to bring about change
Requires self-awareness (“psychological mindedness”)
But: the self takes different forms according to cultures
Western: the real/authentic self
Self-representation: there is a true representation (image,
understanding, etc.) of oneself
Self-Concept
Essence of self: the true self as an inviolable nucleus that
can be researched (extroverted/introverted, etc.)
But…
Psychotherapy is a cultural process of dynamic coconstruction (Kirmayer)
North America: individualism
Def: autonomous, worthy of the free pursuit of his private goals
Two forms of individualism:
expressive individualism: defines the person in terms of his or her
ability to articulate and adopt his or her unique experience
Self-Concept
utilitarian individualism: defines the person as an agent who continues
to maximize his well-being
Ex: CBT
China: collectivism
Def: relationships with others
Ren: "a social being," the Chinese word for personality
The individual expresses his unique qualities through his mature
commitment with his family or a social group
Diversity of Meaning in Practice
Example: a young Egyptian woman born in Canada (immigrant parents), postpartum depression
Admits struggling between being a devoted step-daughter vs. her own role as a mother
What is the problem with a therapy that aims to support her individualised selfactualisation?
Different Psychotherapies
UK:
Objective: improving self-control, adjustments to immutable circumstances are
secondary
How to construct meaning of distress: look within the individual and personal history,
client’s distress (often) unfortunate victim of circumstance [bio-psycho-social]
Japan:
Objective: "aru ga mama" acceptance of things as they are (Morita
psychotherapy)
How to construct meaning of distress : reflection on one's debt to others; generates
both guilt and gratitude which frees the client (Naikan psychotherapy)
Intercultural intervention
Cultural competence: an ability to both analyse and understand
situations that involve contact with another person or group of people
with different values
Cultural awareness: being sensitive to a person's values, beliefs, etc.
Cultural knowledge: understanding the worldview of other cultures
Cultural encounter: the process that encourages the stakeholder to
engage directly in cross-cultural interactions with clients
Cultural skills: collecting relevant cultural information on the patient’s
health history
Cultural desire: the motivation to want to engage in the process of
cultural competence