Case Study Mr. and Mrs. Gomes, a first-generation Portuguese
American couple brought their 20-month-old son John to the
developmental-behavioural clinic because of his refusal of food,
inadequate weight gain and poor sleeping patterns. Mrs. Gomes and
her mother had taken to feeding John all day long, following him
around with food and a spoon as he played. John looked thin, pale
and weak to his mother and grandmother and that image was
reinforced by neighbors and relatives. Sleep subsequently emerged
as a problem within a week of the Gomess moving form the maternal
grandparents home to their own place where they had lived the first
9 months. What do you need to consider when helping the
family?
Slide 3
Culture permeates all aspects of Psychopathology Experience
Expression Explanation Assessment Treatment
Slide 4
Culture and Psychopathology Whats normal and abnormal ?
Expression of Abnormal Behavior Assessment and Diagnosis of
Abnormal Behavior Explanations of Psychopathology Treatment
Slide 5
Whats normal? Mental illness in a Laotian village Dangerous
behavior Disruptive and dysfunctional activities Communication
problems Delusions Inappropriate affect Somatic symptoms
Slide 6
Case Studies A Pakistani patient complains of pain and weakness
I have pains in my head, I have a body ache I have lost all of my
strength Whats your diagnosis?
Slide 7
Expression of Abnormal Behavior Symptoms of depression as an
affective disorder Affect- depressed mood Behavior- withdrawn
Cognitive- guilt, worthlessness Somatic complaints Is depression
manifest the same way across cultures ?
Slide 8
Studies of Depression Kleinmanns study in Taiwan: 88%
complained of somatic symptoms 40% never admitted to depressed
affect 28% rejected the notion they were depressed Cross-cultural
study (Ulusahin et al., 1994): Turkish patients had higher scores
for somatic complaints British patients had higher scores for core
psychological complaints Matsumotos cross-cultural study: Americans
experiences more intense emotions for a longer duration than
Japanese
Slide 9
Feelings of Guilt Guilt-based societies: I have done something
wrong, and even if it is never discovered and nobody else but me
knows about it, I am distressed and disgusted with myself.
Shame-based societies: I have done something wrong in the eyes of
other people. People who matter to me are disgusted with my
behaviour, and therefore I am distressed because I cannot face
them.
Slide 10
Assessment and Psychological Testing Chinese Personality
Assessment Inventory Mental disorders are caused by malfunction of
the vital organs (SOM) I have to hide my homosexual orientation
(SM) I feel indebted to people around me. (DEP)
Slide 11
Assessment and Psychological Testing American Indian Depression
Scale Worry sickness Unhappiness Heart-broken Drunken-like
craziness Disappointment
Slide 12
Explanations of Psychopathology Biological Psychological Social
Spiritual Ecological
Slide 13
Treatment of Psychopathology Importance of matching treatment
with explanation Similarity of process across therapeutic
approaches
Slide 14
MODELS OF PSYCHOPATHOLOGY UNIVERSAL MODELS AND CULTURE- BOUND
SYNDROMES
Slide 15
Models of culture and pathology Psychopathology as universal
Psychopathology as culturally constructed Hybrid orientation to
psychopathology
Slide 16
Assumptions of the Universal Perspective Abnormal behaviors
occur across cultures Principal categories of psychopathology occur
world-wide Incidence and prevalence of disorders in diagnostic
categories vary little across cultures Manifestation of various
disorders are similar
Slide 17
Standardized Diagnostic Systems International Classification of
Disorders (ICD-10) Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV)
WHO study of affective disorders Schedule for Standardized
Assessment of Depressive Disorders Switzerland, Canada, Japan, Iran
Core symptoms present in 76% of cases Cultural variations in some
symptoms and in the expression of depression
Slide 20
Schizophrenia WHO pilot study Two year follow-up WHO
prospective study
Slide 21
Pilot Study 1200 patients in 9 countries Nigeria, India,
Taiwan, Czech Republic, Denmark, Russia, U.K., Columbia, U.S. Core
symptoms
Slide 22
Two year follow-up 75% of original patients Most positive
symptoms absent Cultural variation in negative symptoms Cultural
variation in prognosis Cultural variation in predictors
Slide 23
Prospective Study 1300 patients in 10 countries Incidence of
functional psychosis comparable across cultures More acute onset in
developing countries
Slide 24
Childhood Disorders Reactions to temperament differ Diagnosis
of hyperactive and disruptive behaviours of children appears to be
culturally variable: function of the nationality of both the child
and the diagnostician Childhood Behaviour Checklist
Slide 25
Culture Specific Idioms of Disease Ataque de nervios Nervios
Rootwork Susto