Chapter 9:
Psychological Disorders
Costanza Maio
Definition
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Mental disorder:
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Clinically significant behavioral and psychological syndrome or
pattern that occurs in an individual and that is associated with present
distress (a painful syndrome) or disability (impairment in one or more
important areas of functioning) or with a significantly increased risk
of suffering death, pain, disability, or an important loss of freedom
BASICALLY, a mental disorder is:
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A pattern of behavior or psychology that happens in a person
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Associated with present distress, a disability, or significant risk of
suffering
To examine disorders…
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Use the multiaxial diagnostic system
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Axis I – observing clinical syndromes/conditions that need attention
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Axis II – observing clinical syndromes/conditions that need attention
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Axis III – reporting individual’s current medical conditions
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Axis IV – reporting psychosocial/environmental problems that may
affect diagnosis/treatment
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Axis V – reporting doctor’s judgment of individual’s level of functioning
Culture and
Psychopathology
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Culture can affect psychological disorders
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Individual’s subjective experience
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Idioms of distress
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Including knowledge about psychological problems
The ways individuals explain/express their symptoms according to
culture-based rules
Diagnoses for disorders
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Including professional and nonprofessional judgments
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Treatment for disorders
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Outcome
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Principles according to which results of treatment are evaluated
Culture and
Psychopathology
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Two hypotheses
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#1: Relativist perspective
 Humans develop ideas/behavioral norms/emotional responses according
to their culture
  There should be significant differences in people’s understanding of
disorders if they are from different cultures
 Criticize ethnocentrism
#2: Universalist approach
 People share similar features, despite different cultures
  The understanding of disorders is univers
 There are universal symptoms for disorders
 Inclusive approach
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Disorders have:
 Central symptoms – observed throughout the world
 Peripheral symptoms – culture-specific
Culture-Bound Syndromes
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Definition:
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Recurrent patterns of abnormal behavior that may/may not be linked to a
“mainstream” disorder
Different categories:
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Symptoms that are recognized as an illness in a cultural group but not in the West
Symptoms that do not have an identifiable organic cause but is identified locally
as an illness and seems like Western illness
 But major features are different from Western illness
 But lacks symptoms recognizable in West
An illness not yet recognized by Western professionals
An illness whose symptoms occur in many cultures but are only recognized as
official illnesses in a few cultures
Culturally accepted idioms of illness that do not match those of West
A set of behaviors connected to hearing/seeing/communicating with spirits
A syndrome that is said to exist in a culture but does not in fact exist
Anxiety Disorders
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Definitions vary across cultures
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Central symptoms:
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Psychologically: persistent worry, fear, apprehension, causes stress
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Physically: fatigue, lack of concentration, muscle tension
Peripheral symptoms:
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Sometimes based on how individual views success
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Sometimes accepted in culture, not defined as an illness
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Ex: China
Mood Disorders
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Factors that influence clinical understanding
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Diagnostic practices
 Some doctors avoid diagnosing illness because mentally ill people in
some cultures carry a stigma
 Some doctors provide situational explanations, not clinical diagnostic
of actual illness
 Some doctors diagnose individuals with an illness for political reasons,
not actually justified
Individual’s understanding of symptoms
 Individual could not realize that they have some symptoms
Disclosure of symptoms
 Some cultures more readily reveal bodily problems, some more readily
reveal psychological problems
Depressive Disorders
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Defined often by melancholy
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Main assumptions
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Central symptoms
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Physical/somatic causes
Emotional problems that upset balance of bodily functions
Sometimes caused by life events and experiences
Dysphoria – dissatisfaction with life
Anxiety
Lack of energy
Ideas of sufficiency
Peripheral symptoms
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Western patients show feelings of guilt more than non-Western patients
Low prevalence of depression in Asian cultures because symptoms are not
defined as depression
Schizophrenia
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Definition:
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A disorder characterized by the presence of delusions, hallucinations,
disorganized speech, disorganized behavior
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Mostly central symptoms
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Peripheral symptoms
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Some cultures have more schizophrenic cases than others
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Especially third-world countries
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In US, blacks more than whites
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Mostly more common in men than women
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Not true in China
Culture and Suicide
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Suicide trends
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Much higher in high-pressure cultures than in less achievement-oriented
cultures
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High in Germany, Taiwan, US, Japan
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Some Asian countries have high trends
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Countries in Central/South America have low trends
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Lower in cultures in which religion is strongly against “self-murder”
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Some suicides originate from religious or ideological beliefs
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Ex: Catholic & Muslim (low) vs. Western & Protestant (high)
Ex: terrorism
Mostly higher with men
Culture and Suicide
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Specific trends
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High in Japan
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People interpret suicide as an honorable death – seppuku
Highest:
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Sri Lanka – probably because of ethnic violence
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Hungary – not sure what the cause is
Personality Disorders
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Definition:
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Persistent patterns of behavior and inner experience that do not conform to the
expectations of the individual’s culture
Main assumptions
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Hypothesis about specific culture-bound personality traits
 Coping strategies  development of similar traits in individuals belonging to same
cultural group
Existence of specific social & cultural circumstances that determine our views on
personality traits and personality disorders  affect our evaluations of them
 Some traits – seen as common from one culture and abnormal from another
Differences in personality traits across nations or ethnicities
 Ex: Westerners are extraverts, non-Westerns are introverts
 Rarely backed by actual empirical evidence – not valid
 Too much diversity in personality traits within nation/ethnicity
 Yet certain traits are suppressed in some cultures and encouraged in others
Personality Disorders
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Tolerance threshold
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A measure of tolerance or intolerance toward specific personality traits
in a cultural environment
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Low = societal intolerance
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High = relative tolerance
Mostly central symptoms
Substance Abuse
& Culture
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Cultural variations in:
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Attitudes toward substance consumption
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Patterns of substance use
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Accessibility of substances
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Prevalence of disorders related to substance
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Biological factors (sometimes)
Alcohol-related disorders
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Associated with:
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Lower educational levels
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Lower socio-economic status
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Higher rates of unemployment
Difficult to find cause and effect
Psychodiagnostic Biases
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Psychologists have own perception of link between mental illness and
culture/ethnicity
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Important:
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Keeping social distance between patients and psychologists
 Ex: high and low statuses, not letting it interfere
Considering how psychologist’s beliefs/expectations could make them see psychopathology
wherever they look
 Always sees mental illness, even if it isn’t
 Ex: “If the patient arrives early for his appointment, then he’s anxious. If he arrives late,
then he’s hostile. And if he’s on time, then he’s compulsive.”
Some do not think it can work to apply Western diagnostic criteria to other cultures and vice
versa
Some think culture-specific disorders are difficult to interpret in terms of other national
classifications
Psychologists have to identify illness correctly in relation to cultural context
Psychotherapy
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Definition:
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In some cases, it is global:
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The treatment of psychological disorders through psychological means, generally
involving verbal interaction with a professional therapist
Drug rehabilitation and prevention programs are applicable to many ethnic and social
categories
In some cases, it is not global:
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Tolerance/intolerance
 Tolerant/supportive cultures – patients function better
 Intolerant cultures – patients have difficulty
Collectivist/individualist
 Collectivist cultures – patients show improvement quickly
 Individualist cultures – patients show few signs of improvement
Attitudes
 Some cultures do not seek this service or drop out easily
Culture Match?
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Factors that affect therapists’ diagnostic judgments
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May not understand cultural background of patients  misinterpret
patients’ responses
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Knowledge of cultural trends lacks critical thinking  distorted
diagnosis
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Ex: stereotypes & schemas
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Language barriers or accents
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Political barriers
Culture Match?
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Ethnic matching – pairing therapists and patients of same culture
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May help problems
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More studies are necessary
Desirable types of therapy between therapist and patient of different
cultures
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Intercultural therapy
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Bicultural therapy
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Therapist who knows language and culture of patient
Therapist and native of patient’s culture work together on patient
Polycultural therapy
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Patient meeting with different therapists who represent different
cultures
Experiment
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Cultural Influences on Clinical Perception
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By Diana Li-Repac
http://jcc.sagepub.com/cgi/content/abstract/11/3/327
Experiment
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Variables
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Independent: five white therapists, five Chinese-American therapists
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Dependent: conceptions on normality, emphatic ability, and perception
on Chinese/white patients
Original aim
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Comparing dependent variables
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Differences in conceptions, emphatic ability, and perception in therapists
of different cultures
Experiment
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Results
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Both therapist groups agreed on conceptions of normality
White therapists =more accurate in predicting self-descriptive responses of
white clients than of Chinese patients
Significant differences between diagnosis of patients given
 Chinese-American therapists said white patients were more disturbed
than the white therapists did
 White therapists thought the Chinese patients were more depressed than
Chinese-American therapists did
Implications
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Therapists have biases when diagnosing patients
Ties in with therapists’ world view and culture
What can be done to prevent biases?