Culture and Mental Illness
What is Mental Illness?
 Actually, the preferred term is Psychological
Disorder. The problem with using Mental illness
is that it implies a medical disorder which is not
the case.
 A Psychological Disorder is defined as any
psychological dysfunction associated with
distress or impairment in functioning that is not
typical or culturally expected.
What Constitutes Abnormality?
 Defining Abnormality
 Statistical approach-define behavior as abnormal
because its occurrence is rare or infrequent.
 Problem: Not all rare behavior is abnormal.
 Whether an individual’s behavior is associated
with impairment or inefficiency, deviance, or
subjective distress.
 Problem: Using Social Norms.
Most Common Types of Psychological
Disorders
Depression
 Depression is a mood disorder characterized by feelings
of extreme sadness and dejection – more than just the
feeling of sadness; we all experience at times!
 Depression is one of the most common mental
disorders. Roughly from 15% to 25% will experience
depression at some time in their life.
Psychological Disorders (cont.)
Bipolar Disorder
 Bipolar disorder, like depression, is a mood disorder. It is
a new name for what used to be called manic
depression. Bipolar disorder affects the functioning of the
brain, causing exaggerated swings of mood from being
high, over-excited and self-important to feeling extremely
low and helpless, and having difficulty in making
decisions.
Psychological Disorders (cont.)
Anxiety
 Anxiety disorders, of which there are several
types, have in common an intense and
paralyzing sense of fear or a sustained pattern
of worrying when there is no real danger or
threat.
Psychological Disorders (cont.)
 Anxiety disorders include:
1) panic disorders
2) phobias
3) obsessive-compulsive
disorder (OCD)
4) post traumatic stress
disorder PTSD)
Psychological Disorders (cont.)
Schizophrenia
 Schizophrenia interferes with the mental functioning of a
person and limits our ability to think, feel and act.
 Symptoms include:
- delusions,
- phobias,
- hallucinations and
- confused thinking.
Psychological Disorders (cont.)
An alarming fact:
Approximately one in a hundred
people (1%) will develop
schizophrenia. Some may
experience only one or more brief
episodes, while for others, it
remains a life-long condition.
Psychological Disorders (cont.)
Eating Disorder
 Anorexia and bulimia are the two most
recognized and serious eating disorders. Each
involves having a preoccupation with control
over eating, body weight and food. People with
anorexia are determined to control the amount
of food they eat, while people with bulimia tend
to feel out of control where food is concerned.
What’s the Role of Culture?
 Two points of view:
1. Culture and psycho-pathology are inseparable—
abnormal behaviors can only be understood
within the cultural context in which they occur.
 This perspective is called CULTURAL
RELATIVISM
Culture’s Role?
2. Basic psychological disorders are present in
all cultures. (universality argument)
Culture, however, plays a role in determining
the exact behavioral and contextual
manifestation
Cross-Cultural Research
 International Pilot Study of Schizophrenia
 Discovered set of symptoms across cultures: lack of
insight, auditory and verbal hallucinations, ideas of
reference (assuming one is center of attention).
 Also discovered course of illness easier for patients in
developing countries (i.e. Colombia, India, and Nigeria
vs. England, Soviet Union, and U.S.).
 Differences in symptom expression: Patients in U.S.,
less likely to demonstrate lack of insight and auditory
hallucinations than Danish or Nigerian patients.
Cross-Cultural Research (cont.)
 Cross-cultural studies of depression
 World Health Organization Study
 Investigated Depression in Canada,
Switzerland, Iran, and Japan
 76% reported cross-culturally constant
symptoms-sadness, joylessness, anxiety,
tension, lack of energy, loss of interest, loss of
ability to concentrate, and ideas of
insufficiency.
 More than half reported suicide ideation.
Cross-Cultural Research (cont.)
 Other studies report differences in expression of
symptoms
 Some cultural groups less likely to report
extreme feelings of worthlessness and guiltrelated symptoms.
 Others are more likely to report somatic
complaints.
 Cultures vary in communication of emotional terminology
and hence, how they experience and express
depression (Leff, 1977).
Cross Cultural Research (cont.)
 Somatization
 Bodily symptoms/complaints as expression of
psychological distress.
 Some studies indicate, certain cultural groups
(Hispanics, Japanese, Arabs) somaticize more
than Europeans or Americans.
 However recent studies, indicate that there is not
much support that somatization varies across
cultures (Kirmayer, 2001).
 Although previously considered culture specific, it
is a universal phenomenon with culture specific
meanings and expressions.
Culturally Bound Syndromes
Culturally Specific Syndromes
 Forms of abnormal behavior found only in certain
cultures
 AMOK – sudden rage and homicidal aggression
- Found: Parts of Asia (Malaysia, Philippines, Thailand)
 WITIKO (OR WINDIGO) – possession by an evil spirit
(witiko, a man-eating monster)
- Can produce cannibalistic behavior
- Found: Algonquin Indians in Canada
Culturally Bound Syndromes (cont.)
 ANOREXIA NERVOSA – distorted body image,
fear of getting fat, a serious loss of weight from
food restraining or purging
- Found: Although at first limited to Western
Europe and North America, the disorder is
spreading to other cultures.
 ZAR – involuntary movements, mutism,
incomprehensible language
- Found: Africa (possession by Zar)
Culture and Psychiatric Diagnoses
Culture and Psychiatric Assessment
 The DSN (Diagnostic and Statistical Manual of
Mental Disorders)
 First published in 1952, it is currently in its fifth
edition, DSN-V
 This latest version, DSM-V-TR, claims to
acknowledge the influence of culture.
Developing Diagnostic Systems Across
Cultures
 Diagnostic and Statistical Manual of Mental
Disorders
 Adjustments were made to most recent version to
include:
 Incorporating information on how
manifestations of symptoms can vary across
cultures
 Including 24 culture bound syndromes in the
appendix
 Adding in depth guidelines for including
cultural backgrounds
 However, Even the most recent DSM Edition does not
require an assessment of cultural elements.
Developing Diagnostic Systems Across
Cultures (cont.)
 International Classification of Diseases
 100 major diagnostic categories encompassing
329 individual clinical classifications.
 Fails to incorporate culture.
 Chinese Classification of Mental Disorders
 Has culture specific features that do not exist in
international systems
Cross Cultural Assessment
 Traditional tools are based on a standard definition of
abnormality and standard set of classification.
 Therefore having little meaning in cultures with varying
definitions.
 The American Indian Depression Schedule
 Developed to assess depressive illness.
 Includes items not found in the Diagnostic Interview
Schedule and the Schedule for Affective Disorders and
Schizophrenia.
 Researchers have offered guidelines for developing
measures.
 Examine socio-cultural norms of healthy adjustment and
culturally based definitions of abnormality.
Cross Cultural Assessment (cont.)
 Cultural backgrounds of therapist and client contribute to perception
and assessment of mental health.
 2 types of errors in making assessments (Lopez, 1989)
 Overpathologizing-clinician incorrectly judges the
client’s behavior as pathological when in fact they are
normal in that individual’s culture.
 Underpathologizing-a clinician explains the client’s
behavior as cultural when in fact it is an abnormal
symptom.
Mental Health of Ethnic Minorities
 African Americans
 Reiger et al (1993)
 Studied over 18,000 adults from five US cities on the
prevalence of a variety of disorders.
 Found that prevalence of mental illness was higher among
African American than European American
 Lindsey and Paul (1989)
 African American more often diagnosed with schizophrenia
than European Americans.
 Differences may be due to SES disparities
 When Regier controlled for SES, the prevalence difference
disappeared.
 Differences in misdiagnosis may be due to biases
Mental Health of Ethnic Minorities
 Asian Americans
 Some studies indicate a higher prevalence of
mental disorders among Asian than European
Americans
 However, other studies indicate a variation within
Asian Americans depending on Ethnic
Background, Generational Status, and Immigrant
or Refugee Status
 I.e. Kuo’s study (1984) found that Korean
Americans had higher rates of depression followed
by Fillipino Americans, Japanese Americans, and
Chinese Americans.
Mental Health of Ethnic Minorities
 Latino Americans
 Fewer differences have been found between
Latino Americans and European Americans in
rates of psychiatric disorders.
 Canino et al. (1987) study of Puerto Ricans
 Reported similar lifetime and 6-month prevalence
rates of disorders compared with there US
communities.
Mental Health of Ethnic Minorities (cont.)
 Also significant within group differences
depending on specific Latino group.
 I.e. one study found Puerto Ricans have
higher rates of major depression than
Cubans and Mexican Americans. (Cho,
1993)
 US born Mexican Americans in
California showed rates of mental
disorders similar to US nationals,
whereas Mexican-born showed lower
rates. (Alderete et al. 2000)
Mental Health of Ethnic Minorities
 Native Americans
 Few studies have included this group, but those that have
suggest that Depression is a significant problem.
 Alcohol abuse, and rates of suicide significantly higher
than US nationals.
 Migrants
 Experiencing stresses associated with acculturation may
lead to poorer mental health (Berry and Sam, 1997)
 Findings are inconsistent
 Refugees
 Migrants forced to flee from their countries because of
political violence, social unrest, war, etc.
 They report higher rates of PTSD, depression and anxiety.