PSYC30014 Lecture Notes - Lecture 12: Posttraumatic Stress Disorder, State Protection Authority, Khyl
18 Jun 2018
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Lecture 12
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- When assessment fails to take into account sociocultural factors it risks misdiagnosis
and the perpetuation of clinical stereotypes based on race, ethnicity, gender, religion
or sexual orientation (among other factors) [context is key - consider culture]
- → i.e. numerous studies documenting elevated rate of misdiagnosis of schizophrenia
among African Americans
- Cultural considerations:
-⬥ Cultural identity of individual
-⬥ Cultural explanations of the individual’s illness
-⬥ Cultural factors related to psychosocial environment and levels of functioning
-⬥ Cultural elements of the relationship between the individual and the clinician
- Cultural syndrome:
- ⇒A cluster or group of co-occurring, relatively invariant symptoms found in a specific
cultural group, community, or context.
- ⇒The syndrome may or may not be recognized as an illness within the culture (e.g.,
it might be labelled in various ways), but such cultural patterns of distress and
features of illness may nevertheless be recognizable by an outside observer.
- Ataque de nervios:
- A syndrome among individuals of Latino descent [typically older females]✧
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- Characterised by symptoms of intense emotional upset, ✧including acute anxiety,
anger, or grief; screaming and shouting uncontrollably; attacks of crying; trembling;
heat in the chest rising into the head; and becoming verbally and physically
aggressive.
- ✧Sometimes, but not always, dissociative experiences (e.g., depersonalization,
derealization, amnesia), seizure-like or fainting episodes, and suicidal gestures are
prominent.
- Khyâl cap:
- A syndrome found among Cambodian people both in Cambodia and ❀
internationally;
- ❀Common symptoms include those of panic attacks, such as dizziness, palpitations,
shortness of breath, and cold extremities, as well as other symptoms of anxiety and
autonomic arousal (e.g., tinnitus and neck soreness).
- ❀Khy'l attacks include catastrophic cognitions centered on the concern that khy'l (a
windlike substance) may rise in the body—along with blood—and cause a range of
serious effects (e.g., compressing the lungs to cause shortness of breath and
asphyxia; entering the cranium to cause tinnitus, dizziness, blurry vision, and a fatal
syncope)
- Can be many culturally bound ways psychopathology can manifest
- Disorders can manifest - don’t see direct correspondence of cross-cultural disorders
with DSM framework
- Cultural idiom of distress: a linguistic term, phrase, or way of talking about suffering
[psychopathology] among individuals of a cultural group (e.g. similar ethnicity and
religion) referring to shared concepts of pathology and ways of expressing,
communicating, or naming essential features of distress
- Kufungisisa:
- ‘❄thinking too much’ in Shona (Zimbabwe)
- As an explanation, it is considered to be causative of anxiety, depression, and ❄
somatic problems (e.g. “my heart is painful because I think too much”)
- As an idiom of psychosocial distress, it is indicative of interpersonal and social ❄
difficulties (e.g. marital problems, having no money to take care of children)
- Cultural explanation or perceived cause:
- → A label, attribution, or feature of an explanatory model that provides a culturally
conceived etiology or cause for symptoms, illness, or distress (e.g. ‘maladi moun’ -
Haiti)
- → Causal explanations may be salient features of folk classifications of disease used
by laypersons or healers
- Cultural explanation: Maladi moun
- Literally “humanly-caused illness”, also referred to as “⇒sent sickness”;
- An explanatory model, interpersonal envy and malice cause people to harm their ⇒
enemies by sending illnesses such as psychosis, depression, social or academic
failure, and so on
- Psychosis:
- – Visual hallucinations more common in developed than developing cultures;
- – Paranoid delusions more common now whilst delusions of wealth and grandeur
more documented during 1930’s in US;
- Auditory verbal hallucinations
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- – phenomenology and cultural responses vary considerably.
- USA vs Africa/Asia:
- – Explanations of voices. [US - medical interpretation; Africa/Asia - more spiritual
explanation (less distress whens spiritual explanation was acceptable)]
- USA vs India/Ghana:
- – Distress
- – Command-Order AVH phenomenology [Western - mostly more malevolent/harmful;
non-Western - voice more functional, commands about navigating through day]
- Kenya – Masai
- – Culturally sanctioned AVH [death of loved one] vs not.
- Culture, access to and engagement with services
-• Cultural barriers to accessing mental health service include:
- ↪Cultural perceptions of disorder (e.g. Anorexia Nervosa in Hong Kong pre/post
1994).
- Language differences (idioms and so forth).↪
- Challenges with transportation.↪
- Navigation of referral processes and processes around payment.↪
- Mental health and Indigenous Australians
- There are ⇢higher rates of: depression, substance abuse and comorbidity, post-
traumatic stress disorder.
- ⇢Rates of schizophrenia and bipolar disorder are roughly equal (however rates are
rising in Indigenous population).
- There is a high rate of ⇢domestic violence in Aboriginal communities, most of it
directed toward women. The majority of sexual or physical assaults against
Aboriginal women go unreported.
- ⇢Trauma and grief in particular are significant concerns in Aboriginal mental
wellbeing, both with relation to current conditions (e.g. discrimination, higher mortality
rates, abuse) and historical conditions (e.g. stolen generation, destruction of culture).
- ⇢Depression is present in 50% of Aboriginal people, based on random samples,
and two-thirds of those presenting to a GP.
- ⇢The suicide rate is higher than the Australian standard. This is particularly high for
young men in custody. [7x Caucasian counterparts]
- ⇢Mental disorders are frequently co-morbid with general health conditions.
Depression associated with diabetes is a particular concern, as the rate of diabetes is
very high.
- ⇢Psychiatry of Old Age is not well understood in the Aboriginal population, due to
the low life expectancy.
- Children's mental health receives inadequate attention, as there is a ⇢high tolerance
of behavioural problems in children.
- Providing mental health services for Indigenous Australians
- ⇉Aboriginal and Torres Strait Islander mental health workers: trained in various
western medical skills, with some having degrees or diplomas in health, community
development or social science. For many Aboriginal communities a person's point of
entry into the western health system will be through the Aboriginal health or mental
health worker.
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Document Summary
When assessment fails to take into account sociocultural factors it risks misdiagnosis and the perpetuation of clinical stereotypes based on race, ethnicity, gender, religion or sexual orientation (among other factors) [context is key - consider culture] I. e. numerous studies documenting elevated rate of misdiagnosis of schizophrenia among african americans. Cultural factors related to psychosocial environment and levels of functioning. Cultural elements of the relationship between the individual and the clinician. A cluster or group of co-occurring, relatively invariant symptoms found in a specific cultural group, community, or context. A syndrome among individuals of latino descent [typically older females] Characterised by symptoms of intense emotional upset, including acute anxiety, anger, or grief; screaming and shouting uncontrollably; attacks of crying; trembling; heat in the chest rising into the head; and becoming verbally and physically aggressive. Sometimes, but not always, dissociative experiences (e. g. , depersonalization, derealization, amnesia), seizure-like or fainting episodes, and suicidal gestures are prominent.
