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Summary Culture and Psychology & African Psychology

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All content on the lectures and readings from the Psychology Themes and Variations (3rd ed) textbook by W. Weiten. Only the chapter on Culture and Psychology is from the textbook. All content on African Psychology is from articles by Nwoye and Ratele. I include tables for easy memorisation!

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  • September 4, 2022
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  • 2021/2022
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CULTURE & MENTAL HEALTH:
WHAT IS CULTURE?
 shared norms, values, beliefs, meanings, behavioural patterns of group of people
 language, nonverbal expression of thoughts/ emotions (i.e. gestures/ facial expressions), religious + moral
beliefs, spirituality, family structures, life-cycle stages, customs, legal systems rituals + traditions, technologies,
etc.

 CULTURAL REFERENCE GROUPS: transmitted over generations + change as individuals/ groups are exposed to
multiple other cultures
 not just distinct, homogenous groups of people = ecosystems w. evolve + influence each other

 Individuals don’t necessarily have all same values/ beliefs as others in their cultural group = often members of
multiple cultural groups w. different sets of values/ beliefs
 Individuals choose to accept/ reject elements of their cultures throughout their lives

 affects way we feel, think, behave in the world
 affects expression, experience, interpretation, course, outcome of mental illness



HOW IS CULTURE RELEVANT IN MENTAL HEALTH PRACTICE?
 Clinician/ patient relationships
 Experiences of mental illness
 Understanding of mental illness
 Assessment
 Diagnosis
 Treatment

EARLY HISTORY OF TRANSCULTURAL PSYCHIATRY:

Are mental illnesses universal across cultures?
 academic debate whether all cultures experience same symptoms has been in literature domain for a century

 UNIVERSALIST: Kraepelin’s 1903 voyage to the island of Java
 Kraepelin concluded t. dementia praecox (precursor to schizophrenia) was ‘very common’ w. differences in
presentation limited severity (NOT type) of symptoms

 CULTURALLY PARTICULARIST: Cecil Seligman’s expedition to New Guinea in 1904
 Seligman didn’t consider t. behaviours/ experiences included in rituals = activity comparable to psychosis despite
any similarities he may have noted


1970s: World Health Organisation (WHO) cultural psychiatry studies
 International Pilot Study of Schizophrenia (1966–1975) = Schizophrenia is found worldwide + among various cultures
 incidence of schizophrenia similar across world BUT treatment outcomes better in developing countries

 CRITICISED: WHO research methods downplayed cultural differences + influences in search for universal symptoms
 employed standardised questionnaires to identify core schizophrenic syndrome = cross-cultural researchers
excluded other presentations in favour of reliable (familiar) syndrome

ACADEMIC VIEWS ON WHO STUDIES RAISED 2 NB QUESTIONS:

, (Initiated by Kleinman in 1977)



1. DO PSYCHIATRIC CATEGORIES HAVE CROSS-CULTURAL VALIDITY?
 CROSS-CULTURAL VALIDITY: whether measure/ category developed in one culture accurately picks up w. is
presumed to be identified in another culture

 CATEGORY FALLACY: diagnostic interview schedules were consistent in picking up symptoms in other
countries (i.e. reliable) BUT weren’t valid (i.e. actually measured incidence of schizophrenia) in another
culture

 Kleinman wasn’t ruling out possibility t. schizophrenia might have validity for other cultures = BUT is it an
empirical question + can’t assume this validity as WHO researchers had done
 NB to know some cultures have particular ways of understanding psychological changes + fit w.
spiritual/religious explanations
 ‘changes’ are non-Western cultural opinions (NOT cultural signs of illness) = not published while
Western views on ‘changes’ were published + regarded as medical symptoms

 Despite poor cross-cultural validity of psychiatric categories = recurring patterns of affect/ thought/
behaviour t. are similar + can be identified across cultures
 some cultures, pattern called ‘depression’ or ‘schizophrenia’ + in another culture equivalent patterns
called ‘soul loss’ or ‘spirit possession’


2. HOW DOES ‘CULTURE’ INFLUENCE ‘MENTAL DISORDER’?
 cultural role in constitution of symptoms = content of symptoms aren’t solely swayed by biological factors
 i.e. cultural beliefs shape presentation of psychosis (e.g. hallucinated voice belongs to Satan)

 cultural conceptions of t. self may impact interpretation of symptoms
 i.e. some cultures are connected to ancestors/ afterlife = hallucinatory voices in head not so distressing
bc. sense of self is connected to spiritual world + other people
 HOWEVER in cultures where separateness/ individuality of self is valued = hallucinatory voices very
distressing bc. it feels intrusive/ abnormal

 Judgements of ‘normal’ / ‘abnormal’ differ between cultures

 Cultures have different explanatory models for illnesses/ psych changes = impact person + treatments




EXAMPLE:
EXPLANATORY MODELS FOR PSYCHOLOGICAL & BEHAVIOURAL CHANGES

, SPIRIT POSSESSION BIOMEDICAL
 Recognises problem  Recognises problem

 Allows kind of action to be taken = spirit removed  Locates problem in person = something wrong w.
genetics/ brain + hereditary

 Temporary affliction = possessed self/ body not  self/body potentially permanently altered
permanently altered/ harmed

 “Problem” located outside of the person  lots of stigma since it’s incurably in brain
 May reduce stigma + promote social inclusion

 factors may improve subjective experience of illness/  Stigma + social exclusion + belief of incurable nature
course/ outcome of condition of disease + internalisation of problem = may worsen
course/ outcome for patient

 Exorcism ceremony  Psychiatric hospitalisation



CONCLUSION: UNIVERSALITY AND CULTURAL PARTICULARITY OF MENTAL DISORDERS
 Despite poor cross-cultural validity of some psychiatric categories = researchers identified particular patterns of
affect/ thought/ behaviour that are cross-cultural
 major mental disorders (e.g. depression and schizophrenia) are universal = can identify ‘equivalents’

 various aspects of these mental disorders (i.e. expression/ experience/ interpretation/ symptom clusters/ course/
outcome) all culturally particular = influenced by + particular to culture



CULTURAL CONCEPTS OF DISTRESS:

CULTURAL CONCEPTS OF DISTRESS: ways t. cultural groups experiences, understand, and communicate suffering,
behavioural problems, or troubling thoughts / emotions



1. CULTURAL SYNDROMES: clusters of symptoms/ attributions t. tend to co-occur among individuals in specific cultural
groups, communities, or contexts + recognized locally as coherent patterns of experience
 e.g. Major Depressive Disorder, Psychosis, Amafufunyane

2. CULTURAL IDIOMS OF DISTRESS: ways of expressing distress t. may not involve specific symptoms/ syndromes, BUT
provide collective, shared ways of experiencing + talking about personal or social concerns
 “nerves” or “depression” can refer to widely varying forms of suffering without mapping onto discrete sets of
symptoms

3. CULTURAL EXPLANATIONS: perceived causes, labels, attributions, or features of explanatory model t. indicate
culturally recognised meaning/ aetiology for symptoms, illness or distress
 vary in intensity of distress they express + in their meanings
 mental disorders + criteria in DSM-5 are cultural concepts of distress

IDIOMS OF DISTRESS:

 enables people to communicate their distress in way t. is recognisable in their culture

,  can enable patient to communicate their distress to doctor BUT can be used by anyone
 can communicate distress t. ranges in intensity = i.e. mildly stressful to trauma + incapacitating suffering
 TYPES OF DISTRESS COMMUNICATED may include anger, anxiety, loss, social marginalisation, insecurity,
powerlessness
 can refer to past, present, or anticipated future distress
 sometimes effective ways of expressing distress to those around you + coping w. distress
 can signify psychopathology in individual + cause ↑ distress in individuals/ those around them
 may indicate a physical or psychological disorder BUT by not necessarily
 can change over time = globalisation = different cultures mix + form new hybrid idioms of distress



EXAMPLES OF IDIOMS OF DISTRESS:
EXPANDED ON IN THE TEXTBOOK SOME OTHER EXAMPLES
 can be expressed using language and/or behaviour,  Visiting places and/or people valued for their healing
and can reflect values of society. powers in culture
 Experiencing lower back pain associated with (i.e. doctors, sangomas, counsellors, rehab centres,
“back-breaking work” = overwork/ stress places of worship, special places in nature, religious
leaders, psychologists, chiropractors, acupuncturists,
 Biomedical disease terminology (clinician/ self- homeopaths, etc.)
diagnosis) = use of psychiatric terms ‘confirm’  “I feel out of balance”
distress  “The voices in my head are controlling me”
 “My stomach is upset” (somatisation = physical
 Taking medication = symbolises help-seeking complaints to express distress)
 “God is punishing me”
 Diagnostic testing = test results used to validate  “I feel anxious and worried.” (psychologization=
person’s distress using psychological concepts to express distress)
 “My life is going to hell”
 Changing consumption patterns (e.g. smoking,  “My neighbours have bewitched me”
drinking coffee/energy drinks/alcohol, eating junk  Think about what idioms of distress you use!
food) = ↑ substance use suggests stress



MEANING AND VALUE OF IDIOMS OF DISTRESS:
 should interpret idioms in terms of means of self-expression t. are normal/ valued by particular group
 need to understand sociocultural context to understand meaning of specific idiom of distress

 Understanding idioms of distress is helpful in mental health practice:
 Indicators of psychopathology
 Indicators of life distress (interpersonal, health, safety, finance, politics, etc)
 Facilitators of rapport/ empathy




SOMATISATION AS IDIOM OF DISTRESS:

 SOMATISATION: expressing psychological distress as somatic illness / physical complaint

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