SELF-STUDY ASSSIGNMENT

Culture and Psychopathology

Culture and psychopathology
The word culture comes from the Latin word colo –ere, which means to cultivate or inhabit.
Edward Burnett Tylor(1871) defined culture as, “That complex whole which includes
knowledge, belief, art, morals, law, custom, and any other capabilities and habits acquired by
man as a member of society.”
According to UNESCO(2002) culture should be regarded as the set of distinctive, spiritual,
material, intellectual, and emotional features of society, and that it encompasses, in addition
to art and literature, lifestyles, ways of living together, value systems, traditions, and beliefs.
Culture has many dimensions and it includes ethnicity, race, religion of the country, and
many other features( Eshun and Gurung, 2009).

Mental illness refers to a wide range of mental health conditions — disorders that affect your
mood, thinking and behavior. Examples of mental illness include depression, anxiety
disorders, schizophrenia, eating disorders and addictive behaviors. According to WHO
around 20% of the world's children and adolescents have mental disorders or problems,
mental and substance use disorders are the leading cause of disability worldwide, and Over
800 000 people die due to suicide every year and suicide is the second leading cause of death
in 15-29-year-olds.

It has been well established now that Cultural dynamics play and important role in shaping
the perceptions, beliefs and practises of people towards mental illness and its Treatment
(Satcher,2001). Every society has its own culture and social norms which is distinct from
others and these cultural and social norms define the person as normal or deviant ( Siewert,
1999). It has been seen that the Culture influences the Epidemiology, Phenomenology,
outcome, and treatment of mental illness (Viswanath and Chaturvedi, 2012).

Theoretical Perspective
To better understand how culture influences mental illness there are three theoretical
perspectives explained by Berry in 1995, which are:

1. The absolutist view assumes that culture has no role in the expression of behaviour.
This view implies that the presentation, expression, and meaning of mental illness are
the same, regardless of culture.

2. Relativist view with the view that all human behaviour (including the expression of
mental illness) ought to be interpreted within a cultural context.

3. The universalist view takes more of a middle position, with the assumption that
specific behaviours or mental illnesses are common to all people, but the
development, expression, and response to the condition is influenced by culture. A
 study was done by Draguns in 1990 where it was confirmed that though sad mood,
anxiety, lack of energy and tension was reported as the common symptoms of
depression across cultures, the westerns reported guilt whereas non westerns somatic
symptoms in addition to the common symptoms.

Different ways culture contribute to Psychopathology

There are six different ways that culture can contribute to psychopathology (Tseng, 2001).

1. Pathogenic effects- refer to situations in which culture is a direct causative factor in

forming or ‘generating’ psychopathology. Cultural ideas and beliefs contribute to
stress, which, in turn, produces psychopathology. Stress can be created by culturally
formed anxiety, culturally demanded performance, culturally prescribed restricted
roles with special duties. The psychopathology that occurs tends to be a culturally
related, specific syndrome; for instance,
 The folk belief that death will result if the penis shrinks into the abdomen,
inducing the Koro panic; or the popular anxiety over the ‘harmful’ leaking of
semen, leading to the development of the semen-loss anxiety disorder, or Dhat
syndrome.

2. Pathoselective effects- refer to the tendency of some people in a society, when

encountering stress, to select certain culturally influenced reaction patterns that result
in the manifestation of certain psychopathologies.
 For example, in Japan, cultural influences lead a family encountering serious
stress or a hopeless situation to choose, from among many alternative
solutions, to commit suicide together, forming the unique psychopathology of
‘family suicide’ observed in Japanese society (Ohara, 1963).

3. Pathoplastic effects- refer to the ways in which culture contributes to the modeling or
‘plastering’ of the manifestations of psychopathology. Culture shapes symptom
manifestations at the level of the content presented. The content of delusions, auditory
hallucinations, obsessions, or phobias is subject to the environmental context in which
the pathology is manifested.
 For instance, an individual’s grandiose delusions may be characterized by the
belief that he is a Russian emperor, Jesus Christ, Buddha, the president of the
United States, or the prime minister of the United Kingdom, depending on
which figure is more popular or important in his society.

4. Patho-elaborating effect-While certain behaviour reactions (either normal or

pathological) may be universal, they may become exaggerated to the extreme in some
cultures through cultural reinforcement (Simon, 1996).
  This is well illustrated by the unique mental phenomenon of latah, which is
mainly observed in Malaysia. The phenomenon is characterized by the sudden
onset of a transient dissociative attack induced by startling. The person is often
provoked on social occasions and acts like a clown, providing social
entertainment. Thus, culture supports the latah attack, and elaborates the
function of this unique mental condition.

5. Pathofacilitative effects- imply that, although cultural factors do not change the
manifestation of the psychopathology too much – that is, the clinical picture can still
be recognized and categorized without difficulty in the existing classification system
– cultural factors do contribute significantly to the frequent occurrence of certain
mental disorders in a society. In other words, the disorder potentially exists and is
recognized globally, yet, due to cultural factors, it becomes prevalent in certain
cultures at particular times. Thus, ‘facilitating’ effects make it easier for certain
psychopathologies to develop
 A liberal attitude towards weapons control may result in more weapon-related
violence or homicidal behaviour (Westermeyer, 1973); cultural permission to
consume alcohol freely may increase the prevalence of drinking problems.

6. Pathoreactive effects- indicate that, although cultural factors do not directly affect
the manifestation people’s beliefs and understanding of the disorders and mould their
‘reactions’ towards them.
 An example of pathoreactive effects is susto. Susto is a Spanish word that
literally means ‘fright’. The term is widely used by people in Latin America to
refer to the condition of loss of soul (Rubel, 1964; Rubel et al., 1985). Susto is
based on the folk belief that every individual possesses a soul, but, through
certain experiences, such as being frightened or startled, a person’s soul may
depart from the body. As a result, the soul-lost person will manifest certain
morbid mental conditions and illness behaviour.

Culture Bound Syndromes-

The term and the concept of "Culture-bound Reactive Syndromes" was introduced in the
1960s by Pow Meng Yap. Several hundred such conditions have since been cited in the
literature under their indigenous names . Some were listed in a DSM-IV Glossary and in the
ICD-10 Diagnostic Criteria for Research. Some culture bound syndromes are:
1. Amok- Malaysia
A sudden, wild outburst of violent aggression or homicidal behaviour in which
an afflicted person may kill or injure others, usually found in males.
2. Latah- Malaysia and Indonesia, Japan, Siberia
 Hypersensitivity to sudden fright often occurring in middle aged women of
low intelligence who are subservient and self-effacing. This disorder is
precipitated by the word snake or by tickling. Characterized by echolalia and
echopraxia.
3. Koro- Southeast Asia and China
A fear or anxiety state in which a man fears that his penis will withdraw into
his abdomen and he may die. This reaction may appear after sexual over
indulegence or excessive masturbation.
4. Windigo- Algonquin, Indian hunters
A fear in which a hunter becomes anxious and agitated, convinced that he is
bewitched. Fear centres on his being turned into a cannibal by the power of the
monster with an insatiable craving for human flesh.
5. Kitsunetsuki- Japan
Victims believe that they are possessed by foxes and are said to change their
facial expressions to resemble foxes. Entire families are often possessed and
shunned by the community.

Indian Perspective

India is culturally diverse country where it is believed that, in every twenty five miles we
come in contact of people from a diverse culture( Srivastava, 2002).

Srivastava(2002) has mentioned three different theories of causation of mental illness;

1. Supernatural theory- Possession of a evil/soul that causes a change in the
psychology of person. These Psychological changes in the mind mark that person as
mentally ill.

2. Shock theory- Sudden changes of the individual’s environment in which the

individual is unable to cope with the situation, can lead to mental illness.

3. Biochemical theory- Shows that chemical imbalances occur in the brain and are
causes of mental illness.

So the treatment sought by the people depends on their beliefs about the cause of mental
illness, people who believe in supernatural causes for mental illness prefer traditional healing
practises to address mental illness. Upto about 70% to 80% of the population of mentally ill
belong to rural areas and first visit religious places for their treatment( Trivedi and Sethi,
1979; Thara et al., 1998). People who have the knowledge of modern medicines prefer to
consult with the Psychiatrist for their treatment.
Disorders- Prevalence, phenomenology and outcome

1.Schizophrenia

.The prevalence of schizophrenia in “least developed” countries was significantly lower than
in the “emerging” and “developed” countries. Indian studies have suggested that the
prevalence of schizophrenia is lower in India than in the West. One reason for this difference
could be underreporting. Indian studies have found FRS to be generally culture free.
However, there is a lower occurrence of FRS in non-Western countries. FRS were present in
35% in India ( Avasthi, 2012).The Madras longitudinal study and the study of factors
associated with course and outcome of schizophrenia demonstrated that two-thirds of
schizophrenia patients in India have partial to full remission of symptoms (Thara, 2004). Kala
and Wig, 1978 studied the content of delusions in paranoid schizophrenia in Indian patients
and found that the common themes were of murder, assault, magic and religion.

2. Affective disorders

The prevalence of affective disorders has been found to be lower in most Indian studies than
the West ( Chandrashekhar, 2007). A comparison of depression in Western and non-Western
societies noted that disorders of conduct and somatic complaints were more common in non-
Western cultures (Venkoba Rao, 1966).The outcome of affective disorders has been found to
be favourable in India than in developed countries. In a 4-year follow-up of first-episode
manic patients from Ranchi, 40% of the patients did not have any recurrences and 25% had
one recurrence( Khess et al., 1997).

3.Obsessesive compulsive disorder

Religious and contamination concerns and repeating compulsions may be more common in
Muslims than Christians due the emphasis on religious cleansing rituals and the practices of
repeating religious phrases (to ward off sin and blasphemous thought) that forms an integral
component of Islamic religion and culture(Okasha et al, 1996).

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References:

 Srivastava, V.K. (2002). Some thoughts on the anthropology of mental health

and mental illness with special reference to India. Anthropos, 97(2), 529-541.
 Eshun & Gurung (2009).Culture and Mental health: Socio cultural influence,
theory and practise, United Kingdom: Blackwell Publishing limited.
 Satcher, D. (2001). Mental health: Culture, race and ethnicity. A supplement
to mental health: A report of the surgeon general. U.S: Public Health service.
 Viswanath, B. and Chaturvedi, S.K. (2012). Cultural aspects of major mental
disorder: A critical review from an Indian perspective. Indian Journal of
Psychological Medicine, 34(4), 306-312
 Tseng, W. (2001). Culture and psychopathology. In S. Diego (Ed.), Handbook
of cultural psychiatry. CA, USA: Academic Press.
 Trivedi, J. and Sethi, B. (1979). A psychiatric study of traditional healers in
Lucknow city. Indian Journal of Psychiatry, 21(2), 133.
 Thara, R., Islam, A. and Padmavati, R. (1998). Beliefs about mental illness: A
study of a rural south Indian community. International Journal of Mental
Health, 17(3), 70-85.
 Avasthi A. Indianizing psychiatry – Is there a case enough? Indian J
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 Math SB, Chandrashekar CR, Bhugra D. Psychiatric epidemiology in India.
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 Venkoba Rao A. Depression – A psychiatric analysis of 30 cases. Indian J
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 Khess CR, Das J, Akhtar S. Four year follow-up of first episode manic
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 Thara R. Twenty-year course of schizophrenia: The Madras longitudinal
study. Can J Psychiatry. 2004;49:564–9.
 Viswanath, B. and Chaturvedi, S.K. (2012). Cultural aspects of major mental
disorder: A critical review from an Indian perspective. Indian Journal of Psychological
Medicine, 34(4), 306-312.