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Culture andAbnormal Psychology
Chapter 11
Outline
Defining Abnormality: Some Core Issues
Cross-Cultural Research on AbnormalBehaviors
Culture-Bound Syndromes
Culture and the Assessment of AbnormalBehavior
Mental Health of Ethnic Minorities andMigrants
Conclusion
DEFINING ABNORMALITY:SOME CORE ISSUES
Two views on influence of culture onpsychopathology
• Cultural relativism: abnormal behaviors canonly be understood in the cultural frameworkwithin which they occur
• There are universalities in the underlyingpsychological mechanisms and subjectiveexperiences of many psychological disorders;culture plays a role in behavioralmanifestations of abnormal behavior
CROSS-CULTURAL RESEARCHON ABNORMAL BEHAVIOR
Schizophrenia
World Health Organization Study
• Universal symptoms of schizophrenia: lack ofinsight, auditory and verbal hallucinations, andideas of reference
• Cross-cultural differences in• Rate of recovery• Symptom expression
Schizophrenia
Criticism of World Health Organization Study
Other studies found cross-cultural differencesin symptoms
Cross-cultural differences in diagnosis• Raises question about validity of assessment
techniques used in cross-cultural comparisonsof schizophrenia
Depression
World Health Organization Study• Universal symptoms of depression: loss of
enjoyment, appetite, or sleep
Other studies document cross-culturaldifferences in expression of symptoms
Kleinman and Marsella argue that expressionand course of illness are culturallydetermined
Somatization
Somatization may be a universalphenomenon with culture-specific meaningsand expression modes
Attention-Deficit/HyperactivityDisorder
No large-scale comparative cross-culturalstudies have been conducted so currentlycannot establish whether ADHD is universallyexperienced disorder
Some argue that ADHD is a cultural construct
ADHD Working group argued that ADHD is avalid disorder found in both developed anddeveloping cultures with neurobiological basisand untreated in many countries
CULTURE-BOUNDSYNDROMES
Using emic (culture-specific) approaches,several culture-specific disorders have beenidentified
• Sinbyong in Korea
• Amok in Malaysia, Philippines, and Thailand
• Anorexia nervosa in the West (now spreadingto other countries)
• Ataque de nervios in Latin American groups
• Zar among Ethiopian immigrants to Israel
• Whakama among New Zealand Maori
These culturally unique disorders from:
• Culture-specific areas of stress, includingfamily and societal structures and ecologicalconditions
• Culture-specific shaping of conduct andinterpretations of conduct may mean thatcertain cultures implicitly approve patterns ofexceptional behavior
• How culture interprets exceptional behaviorwill be linked to culture-specific interventions
Paniagua's assessment guidelines forpractitioners
1) Become familiar with cultural background ofclient
2) Check own cultural biases and prejudice3) Do not automatically jump to conclusion that
client's symptoms are culture-boundsyndrome
4) Ask culturally appropriate questions thatallow elaboration by client on possiblecultural factors
Summary
Research provides evidence thatpsychopathology across cultures containsboth universal and culturally specificcomponents
CULTURE AND ASSESSMENTOF ABNORMAL BEHAVIOR
Culture and Psychiatric Diagnoses
Modifications made to the DSM-IV to increasecultural sensitivity; difficulty in classifyingculture-bound syndromes remain
Local diagnostic system (e.g. ChineseClassification of Mental Disorders) created
Development of more culturally validclassification manual of disorders needed
Cross-Cultural Assessment ofAbnormal Behavior
Valid and reliable measurement of pathologyacross cultures difficult and complex
Traditional tools of clinical assessment mayhave little meaning in cultures with varyingdefinitions of abnormality
Culturally sensitive assessment methodsexamine sociocultural norms of healthyadjustment and culturally based definitions ofabnormality
Cross-Cultural Assessment ofAbnormal Behavior
Importance of examining indigenous healingsystems
Cultural backgrounds of therapists and clientmay contribute to perception and assessmentof mental health
Overpathologizing and underpathologizing
Language issues in psychological testing
Measurement of Personality to AssessPsychopathology
• Clinical studies across cultures involvingpersonality scales are reliable and valid inassessing psychopathology and abnormalbehavior in other cultures
• Others argue that items of personalitymeasure do not mean the same thing in othercultures
MENTAL HEALTH OF ETHNICMINORITIES AND MIGRANTS
African Americans
African Americans report higher rates ofmental disorders than European Americans
This may be due to socioeconomic disparities
Asian Americans
Very limited information available on AsianAmericans' mental health
Recent survey found that Asian Americansreport lowest prevalence of disorderscompared to other ethnic groups• This study is limited because it did not
distinguish between different Asian ethnicgroups
Latino Americans
The National Latino and Asian Americanstudy report variations in rates of mentalillness among different Latino groups• This may be due to reception of immigration,
history of immigration, varying SES,experiences with discrimination, and strengthof ethnic community
Native Americans
Native Americans report highest prevalenceof mood and anxiety disorders compared withother ethnic groups
Variations within the Native Americancommunity exists
Migrants
"Immigrant paradox": immigrants report betterhealth and mental health compared to theirUS-born peers; this may be due to strong tiesto family and access to a supportive ethniccommunity
Findings are inconsistent whether immigrantsare at higher risk for mental health problemsdue to acculturation
Migrants
Ecological perspective on acculturation mayclarify how acculturation relates to mentalhealth of immigrants
Individual's level of acculturation may alsocontribute to content and expression of his orher distress
Refugees
Due to their traumatic experiences, refugeesshow higher rates of PTSD, depression, andanxiety than immigrants
Summary
Contextual factors like poverty, discriminationand immigration stress, should be taken intoaccount to understand ethnic differences inrates of mental disorders
There is great diversity among and withinethnic groups in the prevalence of mentaldisorders
CONCLUSION