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

There are both etic and emic aspects ofpsychopathology

Therefore classification systems andassessment methods need to contain bothetic and emic elements