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Cultural Considerations
Conceptions of abnormality differ between cultures which can affect the validity of the of
diagnosis of mental disorders ∴ psychiatrists should be careful of cultural biases
Some abnormalities can be considered to be universal (emics); however, they are
culture-bound syndromes meaning they are culturally specific (etics)
o Example: Shenjing Shuairuo (neurasthenia) is a disorder specific to Chinese
people; therefore, this disorder is included in the CCMD-2 but not in the DSM-IV
o Fernando (1988): Although the APA included culture bound syndromes in the
appendix of the DSM-IV, as long as these syndromes are limited to other cultures,
they will not be admitted into western classification that could lead to
misdiagnosis and improper treatment.
Example: Depression is found in western culture, but absent in Asian
cultures.
o Asians have ready access to social support due to it being a collectivist culture.
o Rack (1982): Asians only report physical problems related to depression not
emotional distress as they intend to sort it out within the family.
Reporting bias causes cross cultural comparison to be difficult
Reporting bias: low admission rates found in many ethnic groups may reflect
cultural beliefs about mental health
o Cohen (1988): mentally ill people in India are looked down upon
Some could argue that it is not just the misinterpretation of diagnosis data, but the real
differences exist between the actual symptoms of different cultures.
o Marsella (2003): depression is more affective (emotional) in individualistic cultures,
while it is more somatic (physiological) in collectivist cultures such as headaches
o Depressive symptom patterns differ across culture because of the cultural variation in
sources of stress, as well as resources for coping with stress.
Cultural blindness may lead to problems with identifying symptoms of a psychological
disorder if they are not the norm in the clinician’s own culture.
o Rack (1982): if someone from a minority exhibits same symptoms of a western
person, they are diagnosed with the same disorder but that might not be the case
To avoid cultural biases:
o Learn about different cultures
o Bilingual patients should be evaluated in both languages
o Psychiatrists should work with local practitioners
7. Analyse etiologies (in terms of biological, cognitive, and/or sociocultural factors) of one disorder
from 2 of the following groups (anxiety disorders, affective disorders, eating disorders)
DEPRESSION
Biological
Genetic predisposition can partly explain depression
- The way to see this is by twin studies = Nurnberger and Gershon (1982) found
the concordance rate for major depressive disorder was consistently higher for
MZ twins (65%) than for DZ twins (14%)
- Duenwald (2003) suggested that a short variant of the 5-HTT gene may be
associated with higher risk of depression. (This gene plays a role in serotonin
pathways and scientists think that this controls mood, emotions, aggression,
sleep, and anxiety.
-
Depression ay be caused by a deficiency in neurobiological systems (neurotransmitters and
hormones)
-Catecholamine hypothesis (Joseph Schildkraut 1965) = depression is associated with low
levels of noradrenaline also called the serotonin hypothesis (serotonin is the neurotransmitter
responsible for depression)
- Janowsky et al (1972) conducted a study tat showed that drugs which decrease the
level of noradrenaline end to produce depression-like symptoms. [Participants given
drug called physostigmine depression] *The fact that depression can be artificially
induced by a certain drug means that some cases of depression can stem from a
disturbance in neurotransmission.
-Cortisol hypothesis = (cortisol is a major hormone of the stress system)
- Stress can predispose a person to psychological and physical disorders (depressed
people have high levels of cortisol)
- High levels of cortisol may lower the density of serotonin receptors and impair the
function of receptors of noradrenaline
- High amount of depression among people who have Cushing’s syndrome (disease
that results in a lot of production of cortisol)
STUDY: The theory of social factors in depression (Brown and Harris, 1978)
Aim: Examine relationship between social factors and depression in a group of women in
London
Studied women who received hospital treatment for depression, women who visited their
doctor seeking help for depression, and the general population sample of 458 women (ages =
18 – 65 years)
Findings = 82% of depressed had experienced a severe life event compared to 33% of the
non-depressed group
-General population Working class = 23% depressed compared to middle class (3%)
- More children = more depressed compared to childless
- Women who were widowed, divorced, or separated = depressed
- Only a minority of 20 % of the women who experienced severe difficulties became
depressed
BULIMIA
Biological, cognitive and sociocultural levels of analysis apply to the etiology of bulimia
nervosa.
In my opinion the biological and cognitive factors of bulimia set the ground for the disorder,
and the sociocultural factors trigger the disorder.
Biological:
Twin research show that genes play a role in bulimia nervosa
o Strober (2000) found that women with first-degree relatives were 10 times more likely
to inherit the disorder.
Increased serotonin medial hypothalamus is stimulated decreased food intake
o Carraso (2000) found bulimic had lower levels of serotonin
Cognitive:
Body-image distortion hypothesis
o Delusion of being fat
o Patients use their emotional appraisal rather than perceptual appraisal when evaluating
their body size
o Uncertain about their size and shape of their own body overestimate body size
Gender differences
o Men and women were surveyed about their own shape, ideal figure and figure they
thought would be most attractive to opposite sex
o Women tended to choose thinner body shapes for all three choices
Cognitive disinhibition: “all or nothing approach” to judging oneself strict dieting
breaking diet will lead to binge eating
However, the cognitive explanation is limited as it only is descriptive not explanatory.
Sociocultural:
Perfect body image changes over time and is becoming more and more thin
Film starts represent ideal body size
People constantly compare themselves to other people self esteem is affected
Media images and message influence their desire to be thin
Sanders and Bazalgette (1993): dolls sizes are emphasized to be skinny
Distorted ideas about what is normal and acceptable dissatisfaction with own shape
By the age of 12, girls begin self evaluate their shape
Social pressure and cultural pressure leads to bulimia
Biomedical, individual and group treatment is over simplistic if a patient uses only one treatment.
No one treatment works for everyone. Some people do not respond to the treatment. Some people get
better without any formal treatment.
professionals use more than one treatment at the same time = eclectic approach