HLTHAGE 2G03 Lecture Notes - Lecture 8: Falun Gong, Serbsky Center, Arthur Kleinman

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7/23/2014
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Lecture 8: Culture-Bound
Syndromes and Socio-Political
Construction of Mental Health
Mat Savelli
Office hrs: M,W 5-6 at KTH 241
savellm@mcmaster.ca
Debate
Are mental illnesses strictly biomedical conditions of
socio-cultural constructions?
Debate highly charged if socio-cultural, does this mean
thatmentalillnessisn’t“real?”
If strictly biomedical, does this mean that trained medical
staff should have a monopoly on treatment?
Is this a zero sum game? Could both explanations work
concurrently?
• Canamentalillnessbe“exported?”
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Quiz 3: MC and Lectures 4-8 (5 classes)
are mental illnesses these biomedical brain based universal conditions that affect all people everywhere? or are they socio-cultural constructions
- this tension is at the heart of this class, and psychiatry, and abnormal psychology!
why highly charged? when you talk about social aspect to mental health, some people imply that they mean that mental illness is not real
- what can we do to make it real? a brain scan and hope for a lesion to come up?
if you think mental illness is stricktly biomedical and it is in the brain, and there is a neuromedical cause for every medical illness, it may imply that
medical staff should have a monopoly on treatment… we would want trained MDs doing this!
is this a zero sum game? where it is one of the other?
- a lot of people avoid for simplicity, but there is a high likelihood
of both being present!!
**can a mental illness be
exported?
- specific disorder be exported
from one place to another? can
people get ill from changes one
society brings to another society?
- if our knowledge is exported
does that mean mental illness
changes?
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Intro Notes on Culture
Many people criticize models of mental illness
(especially the medical model) because they fail to
include culture within their list of variables.
A person’ssymptomsarepartiallyshapedbytheir
behaviour and experience those things are themselves
shaped by culture. Thus many argue we need to pay
more attention to culture.
Problematically, the DSM criteria is primarily designed by
English-speaking, middle class, white North Americans.
How can Canadian diagnosticians approach the 250 000
immigrants who have moved here in the last ten years?
Culture and Experience
Defines if behaviour is considered deviant.
Hallucinations among aboriginal communities vs. non-
aboriginal.
Possession versus psychosis in Latin America.
Content (i.e. FBI v KGB).
Expression of illnesses done in a culturally-accepted way.
Depression in West v East Asia
Panic attacks.
– “Weknowhow toactcrazy.”
Development of mental disorders
– Effectofdiet,conflict,supports,etc…
More mental illness found in N. Ireland than England or
Scotland.
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this class goes beyond medical understanding… language, politics, culture, religion, play a role
not many people are pleased with medical model because it doesn't include other aspects in it
- culture is not in the list of variables in the DSM… the DSM is trying to improve but isn't there yet
a persons life and what they have experienced will somehow shape their symptoms and the behaviour that experience!
- this means culture plays a big role!
- medical anthropology as a field can and maybe should add to mental illness research
DSM criteria are by in large white men
that live in NA, speak english, upper
middle class
- not much culture involved
in these peoples'
knowledge
Our population is largely turning
into an immigrant population
and most people carry with them
a different history…
- how are these NA people
supposed to diagnose
the disorders? it is not
an easy thing when you have
people coming from
across the globe
culture helps define whether or not a behaviour is seen as abnormal
Hallucinations, primarily for schizophrenia
- however, in certain cultures, such as aboriginals, hallucinations are good, and not considered as a sign of mental illness!
Possession…
- someone saying they are possessed by a demon in NA = think of as a delusion
- someone in latin america would not think of it as a delusion/symptom for illness
content
- our minds, even when their exhibiting
mental illness, stil reflect the culture from
where we are from (is police FBI or KGB?)
expression of illness
- example: in NA, when we talk
about depression we look for low
mood, sleep distrubances, people
who do not enjoy doing things
… in East Asia, depression
is diagnosed by the person
having somatic problems, such
as pains in the stomach
- NA = mood
- EA = somatic
Panic attack in NA: hyperventalating
.. but in North Africa, PA's are
diagnosed through complains of
headache… still physical, but different
expression of illness!
diets may affect whether person will develop a disorder
i.e. person tying increases in suicide to increases in potato consumption
N. ireland has more religius aspects… perhaps why more mental illness?
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Culture and Care
Differential rates of particular illnesses .
Depression more common in West,
mania in developing world. Are
these natural differences, e.g. effect
of Judeo-Christian guilt?
Etiological & treatment models (e.g
medical v supernatural).
Diagnostic bias
African Americans and schizophrenia
/ mood disorders.
Gender expectations and PDs.
Outcomes issues of stigma,
conceptualization of experience.
Arthur Kleinman
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Culture Bound Syndromes
An illness or disorder that is recognized only within a
specific culture or society.
• “Localized, folk, diagnostic categories that frame
coherent meanings for certain repetitive, patterned, and
troubling sets of experiences and observations.”
Should be commonly known within a culture and
unknown in outside cultures.
Not the same as a disease with a clear somatic (i.e.
genetic) basis that only occurs in particular populations.
Not simply the expression of a DSM disorder by another
name something separate. Some theorize that culture-
bounddisordersmayrepresent“collections”ofsymptoms
from various DSM diagnoses.
americans tend to diagnose schizo differently than UK and so rates of diagnosis are different!
in the west, depression is more common than BPD, but in many parts of developing world, BPD/mania is more common
why? western has more judaism/christians, and concept of this religion is the feeling of guilt, so some medical anthros/psychiatrists talk about this
concept… the fact that we lived with christianity for 2000 years make us more prone to depression, but cultures not lived with christianty may be
more prone to other disorder for other reasons!
care may not simply require a psychiatrists, but also a religios figure
diagnostic bias;
African Americans are disproportionally diagnosed
with schizo, and underdiagnosed with mood disorders
- did a test when they
changed the names of the
person tested between white
names and African names
- when they associated
a black person with a white
name, they were less likely
to be diagnosed with schizo!
- same type of test for
genders
- women names were more
likely to be diagnosed with a
certain disorder
culture bound disorders are illnesses that occur/are recognized only within very specific cultures/societies!
- it has to be known among most members of society and be understood
- it it not something that happens once, but over and over again
- limited to culture
For something to be culture bound, it has to be known widely, but limited to a specific culture
it is not like a DSM disorder with a different name, it has to have something inherently different about it
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Document Summary

Office hrs: m,w 5-6 at kth 241 savellm@mcmaster. ca. Debate: are mental illnesses strictly biomedical conditions of socio-cultural constructions, debate highly charged if socio-cultural, does this mean that mental illness isn"t real? . Could both explanations work concurrently: can a mental illness be exported? . Thus many argue we need to pay more attention to culture: problematically, the dsm criteria is primarily designed by. Culture and experience: defines if behaviour is considered deviant. Hallucinations among aboriginal communities vs. non- aboriginal. Possession versus psychosis in latin america: content (i. e. fbi v kgb), expression of illnesses done in a culturally-accepted way. We know how to act crazy. : development of mental disorders. More mental illness found in n. ireland than england or. Culture and care: differential rates of particular illnesses . Depression more common in west, mania in developing world. Are these natural differences, e. g. effect of judeo-christian guilt: etiological & treatment models (e. g medical v supernatural), diagnostic bias.

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