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Culture and Mental Health17.1 Universality and Cultural Particularity
o Kraepelin’s voyage to the island of Java. He was a well-respected German Psychiatrist
who coined the term dementia praecox- Schizophrenia.
o After visited Java, Kraeplin concluded that dementia praecox was ‘very common’, with
differences in presentation limited to severity, and not the type of symptoms.
o Concluded that overall similarities between Javanese and German patients far
outweighed the deviant features.
o Dementia praecox is a genetic illness that develops in slightly different ways in Germany
and Java.
o Seligman reported that Psychosis was not observed among the natives of New Guinea.
He did not consider that the behaviours and experiences included in such rituals and
activity were comparable to psychosis, despite any similarities he may have noted.
o Universalist and a culturally particularist position with regard to culture and mental
disorder.
o Research indicates that there is no evidence to support a real difference in major
psychiatric disorders across cultures and societies, cultural variation in mental health is
mainly in presenting features rather than in the nature and frequency of the underlying
neuropsychiatric impairments and disorders.
o Culture gives colouring and shape to disorder, but the underlying form of symptoms
remains unchanged.
o However, there is now work that questions cross-cultural validity of psychiatric
diagnostic categories and has deepend our understanding of the range of cultural
influences on mental health.
17.1.1 The WHO studies
o WHO studies concluded that schizophrenia is a condition found across the globe.
o International pilot study of Schizophrenia. Researchers were able to establish that
symptoms of Schizophrenia cluster in the same way in both non-Western and Western
societies, thus supporting that it is universal disease.
o Studies reported that treatment outcomes were better in developing than in developed
countries.
o Incidents of Schizophrenia was largely similar across all test centres.
o Depression: Singer concluded that there is insufficient evidence to support the prevalent
view that depressive illness in primitive and certain other non-Western cultures has
outstanding deviant features.
o Trans-cultural research-criticised foe down playing and trivialising cultural differences in
its search for universal symptoms. By employing standardised questionairs to identify a
core schizophrenic syndrome, cross-cultural researchers were excluding other
presentations in favor of reliable syndrome. The cross-cultural existence of this
syndrome would then support the idea that schizophrenia and depression are universal
disorders, occurring with similar structure in diverse culture.
, o 2 important issues arose as a reaction to the WHO studies and similar research:
1. Do psychiatric categories have cross-cultural validity?
2. What is the extent of cultural influences on mental disorder?
17.1.2 Do psychiatric categories have cross-cultural validity?
o Relatability- potential for making consistent observations. In cross cultural research, this
would be accurate identification of a particular category of mental disorder by various
researchers and across different research centres.
o Validity- concerns whether such categories actually do pick up what they presume to: a
pathological condition.
o Critics of WHO research questioned the cross-cultural validity of psychiatric categories.
Argument: psychiatric categories are not culture-free entities that we can go and find
elsewhere, but they have histories and are culturally embedded. To apply them across
the globe is t disregard subjective experience, by trying to fit [people] into alien patterns
that make them qualify as patients or cases and to brush aside whatever doesn’t fit.
o The way schizophrenia is embedded in culture can be appreciated when we see how key
schizophrenic phenomena violate normal experience and belief as seen through
Western concept of self.
o Hooper asked if it made sense for Western clinicians to look elsewhere for entities so
obviously of their own making. Answer is that it could make sense, but that it cannot be
the starting assumption.
o Part of problem with WHO studies is the assumption that schizophrenia has cross
cultural validity. This made its application in diverse settings ‘ a classic instance of
Kleinman’s category fallacy’: mistaking reliability for validity.
o Kleinman wasn’t necessarily ruling out possibility that schizophrenia might have validity
for other cultures, but that this is an empirical question and we can’t assume this
validity as WHO did.
o Some cultures have particular ways of understanding psychological changes. These
‘changes’ fit with spiritual/religious explanations. The changes are non-Western cultural
opinions and therefore not published while western views on the changes were
published since not regarded as medical symptoms.
o Validity of category of schizophrenia is further complicated by the fact that together
with other elements of modernisation, psychiatry has become a reality in many
communities around the world.
o While clinical psychiatry and diagnostic categories may become available in different
cultural contexts, existing explanations and understandings of behavioural and
psychological changes won’t necessarily be replaced. Hybrid models are embraced, as
when traditional healing and supernatural explanatory models operate alongside
biomedical approaches. Doesn’t mean that some mental health diagnosis are invalid in
cultures, rather that competing and contradictory views on the understanding of mental
illness are expected in a multicultural world.
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