Culture and Mental Health

(Abnormality)
 Defining abnormality
• Psychopatalogy is believed to be related to
culture and can be understood within the
culture framework  this is called CULTURE
RELATIVISM
 Introduction
• This lecture highlights on a few things:
 what constitutes of being normal vs abnormal
in traditional (mainstream) belief of
psychology.
 Differences in abnormal behaviour across
cultures.
 Treatment in abnormal behaviours across
cultures.
 Limitations in defining abnormality in
traditional approach
a. Statistical approach to due to rare occurances/infrequent
b. Impairment/ inefficiency when carrying out customary roles
- hallucinations might prevent people from performing
normal roles  e.g. thought that being followed by somebody, always being
scared of something, thus prevent from perform activities/duties.
c. Deviance – behaviours that are against social norms  e.g.
homosexuality is deviant in Malaysia, but not in most states in the USA.
d. Subjective distress – depends on a person’s
perception on how distress is viewed.
 Cross-cultural research on abnormal
behaviours
• Schizophrenia
• Depression
• Somatisation
• Cultural-bound syndrome
 Culture and schizophrenia
• SCHIZOPHRENIA = a group of psychotic disorders
featured by:

 gross distortions of reality,

 withdrawal from social interaction, and
 disorganisation of thought, perception, and emotion

(Carlson , Butcher, & Coleman, 1988).

 Culture and schizophrenia
• The etiology (penyebab) of schizo is due to
biological (excess of dopamine or biochemical
imbalances) and environmental factors (e.g.
hostility in family).

• Diathesis-stress model  those who are

biologically predisposed to schizo, and living in
hostile environment, have more chances to
become one (schizoic).
 Culture and schizophrenia
• The WHO research (1973, 1979, 1981) was conducted
in comparing the prevalence and course of
schizophrenia in several continents.
- found that research assessment in diagnosing
schizophrenia was reliable.
- also, similar (universal) symptoms found for
schizophrenia, i.e. lack of insight, auditory and verbal
hallucinations, and ideas of reference ( that becoming
the centre of attention).
HOWEVER……
 Culture and schizophrenia
• People of developing countries (i.e. Colombia,
India and Nigeria) recovered at faster rates
than those of highly industrialised countries
(e.g. USA, UK)
• These differences were attributed to cultural
factors, such as the presence of kin networks
(a lot of relatives to turn to for support) and the
tendency to hurry back to work (no work, no
money, no food on the table)
 Culture and schizophrenia
• Murphy (1982) – Irish admitted for
schizophrenia 4 times higher than the English
and Welsh
• Sue & Morishima (1982) – Schizoic Japanese
were more withdrawn and passive than their
European counterparts  reflecting the
Japanese culture.
 Culture and schizophrenia
• Expressed emotion as a mechanism in
identifying relapse cases in schizophrenia
patients may raise a question as whether or
not it is appropriate to be used amongst
cultures that do not encourage verbal
communication (Kleinman, 1988).
• Racial bias in diagnosis of schizophrenia may
account for some cultural differences in the
expression of symptomatology.
 Depression
• Depression = “intense sadness, feelings of futility and
worthlessness, and withdrawal from others” (Sue, Sue
& Sue, 1990).
• Depression = characterised by physical changes,
emotional and behavioral changes.
• Some cultures (e.g. Nigerians) are less likely to report
extreme feelings of worthlessness.
• Others (e.g. Chinese) are more likely to rpeort somatic
complaints.
• Rates of depression also vary from culture to culture.
 Somatization
• Somatization – bodily complaints due to
psychological distress.
• Japanese, and Chinese > somaticize more than
Europeans/ Americans
 Culture-bound syndrome
• Culture-bound syndrome – forms of abnormal
behaviour observed only in certain
sociocultural milieus.
 Types of culture-bound syndrome

1. Amok – sudden rage and homicidal aggression;

probably due to stress, less sleep, & alcohol
consumption.
2. Witiko – (windigo) –amongst Alongquin Indians in
Canada – man-eating monster suicide to avoid
cannibalistic urges.
3. Anorexia Nervosa – distorted body image, fear of
becoming fat, serious loss of weight by food
restraining or purging. Found in urbanised part of
the world.
 Types of culture-bound syndrome

4. Zar – an altered state of consciousness amongst

Ethiopian immigrants to Israel. Believe to be
possessed bu Zar spirit, expressed by involuntary
movement, mutism, and incomprehensible
language.
5. Sinking heart – condition of distress in the Punjabi
culture, affecting heart or chest; probably due to
excessive heat, exhaustion, worry, or social failure
 Types of culture-bound syndrome
• Others:
 whakama (in New Zealand)
 Avanga – In Tonga
 Latah – amongst Malay women in
 South EastAsia, esp. in Malaysia.
 Koro – retracting of penis, in Southeast Asian man.
 Susto
 Culture, assessment and treatment of
abnormal behaviour
• In assessing abnormal behaviour, psychologist seek to
classify abnormal behaviours into categories.
• There is limitation on DSM and ICD-10 (International
Classification of Diseases 1oth ed.) in assessing
abnormal behaviour.
• Cultural sensitive therapist should be knowledgeable
in diverse cultures and lifestyles, skillful and
comfortable in using innovative treatment method,
and experienced in working with culturally diversified
clients.