Culture and Cognition Chapter 11: Mental Health
• Some psychopathologies are far more prevalent, or manifest in highly different forms across cultures
• dhat syndrome men from some parts of South Asia become morbidly anxious that they are losing semen.
• The symptoms that are identified for the disorders typically were done in Western samples, and it’s not
always clear whether Western cultural beliefs are bound to the disorders. (DSM 4 now is beginning to
incorporate some cultural bound syndromes but still a lot are missing)
Hikikomori (social withdrawal)
• Commonly afflicts male (3x more than females) adolescents.
• Doesn’t map on to any diagnoses in the DSMIV ( nonexistence in prewar and other countries)
• Typical response is to drop out from the social world, often barricading oneself up in a room for years, and
not interacting with anyone, except perhaps to make requests/demands to one’s parents.
• Reason: Perhaps extreme pressure from school. If they drop out it is hard to catch up and thus a lot of
disappointment. Other believes that interdependent society; if you are NOT part of the community you
might feel really bad. Even the exams and the ability to get into school is even more stress.
• Anorexia involves symptoms where a person refuses to maintain a normal body weight because of a
preoccupation with their body.
• Bulimia involves symptoms where one uncontrollably binge eats, and then subsequently takes
inappropriate measures to prevent weight gain (i.e. vomit everything after eating)
• Both: somewhat present in other cultures BUT predominantly found in the west.
• Saints were highly motivated to engage in such voluntary starving because of their ascetic lifestyles. So,
such a behavior is called “Holy Anorexia.”
• In contrast, the main cause of anorexia common in contemporary Western societies relates to body image
(specially started to increase in 1970’s and 1980’s in Western societies)
• Thus meaning system associated with both are different.
• Men develop morbid anxiety that their penis is shrinking into their body (or, far less commonly, women
fear their nipples are shrinking).
• This occurs primarily in South and East Asia, especially Southern China and Malaysia.
• Most common in Southeast Asia.
• A condition where there is an acute outburst of unrestrained violent and homicidal attacks, preceded by
brooding, and followed by exhaustion and amnesia
• May be the result of not having culturally acceptable means to express frustrations.
• Could have parallels with Western mass homicidal attacks.
• It is found largely in China. A morbid fear of catching cold.
• People will avoid cold air, eating cold food, and dress with several layers, even in summer.
• A unique hysterical attack observed among Arctic Inuit communities, particularly among women.
• People suddenly tear off their clothes, roll in the snow, and convulse, with no clear precipitating factors.
Other Culturalbound Syndromes:Culturebound syndromes dramatically reveal the cultural basis of some
• HwaByung (Korea):
Ghost Sickness (Native Americans): psychotic disorder. General weakness, loss of appetite, and feeling of
terror. Illusion that they can’t breath and are breath alive.
• Windigo (Native Americans): fear of being eaten by this monster.
• QiGong Psychotic Reaction (China): special bleeding techniques that are often dillusion
• Zar (Ethiopia): loss of function of the autonomic nervous system ( cry laught without any reason)
• SustoSoul Loss (South America): people feel that their soul is dislodged from their body • Mal De OjoEvil Eye (Mediterranean Culture): insomnia. Vomiting, diarhehia without any causes.
• Channeling (All Over the World)
Universal Syndromes: But we still have some variation in them though
• Depression is probably the most familiar psychopathology, and it is found all over the world.
• General Symptoms: You have to have 5/9 and at least for MORE THEN 2 weeks
– a) depressed mood
– b) an inability to feel pleasure
– c) change in weight or appetite
– d) sleep problems
– e) psychomotor change
– f) fatigue or loss of energy
– g) feelings of worthlessness or guilt
– h) poor concentration or indecisiveness
– i) suicidality (suicide)
Depression and Culture
• Depression is found everywhere, however rates of depression vary across cultures.
• In particular, much research has identified how depression rates in China are only about 1/5 that observed
in the West.
• However, a challenge in comparing rates of depression across cultures arises because the presentation of
depression also appears to vary.
• SomatizationPhysiological Symptoms ( no energy, fatiques, sleep problem etc)
• PsychologizationPsychological Symptoms (guilt, worthless, etc)
Somitization vs. Psychologization
• Arthur Kleinman, an anthropologist and psychiatrist, conducted extensive interviews with Chinese
neurasthenia patients and concluded that a majority (87%) could be diagnosed as having depression, even
though only 9% of them reported depressed mood as a chief complaint.
• That is, he argued that depression manifests itself among Chinese chiefly through somatization rather than
psychologization (say they ok but when you observe them they have headache, pain etc)
• Thus manifestation of depression are different.
Causes of Cultural Variation in Depressive Symptoms
• Why do these different presentations of depression exist?
• (1) Chinese people with depression are worried about the public stigma of having a mental disorder, and
thus conceal it with somatic symptom reporting. (do not report it openly)
• (2) Westerners are more attentive than the Chinese to their emotional states. Western psychological
symptoms might thus be more accessible to them than they are for Chinese.
• One recent study investigated this question by comparing psychiatric outpatients in China and Canada
(Ryder et al., 2008).
• All patients had to report at least one of the nine diagnostic markers of depression. Patients reporting any
kind of psychotic symptoms were excluded.
• Patients’ symptoms were assessed with three different methods.
• A spontaneous problem report , where they described their concerns with little prompting from the
• A standard clinical interview , in which the patients responded to specific questions about symptoms
from an interviewer.
• A standard questionaire , which was completed in private, in which patients gave answers to specific
• Patients also completed measures of stigma and attention to emotional states ( how much pay attn?)
• Results: Chinese expressed greater somatic except the private questionnaire. Canadians e