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