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Essays on cross cultural mental health
The effects of culture on mental health patients essay
Essays on cross cultural mental health
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One of the major global concerns of International Psychology is that relating to physical and mental health (Stevens & Gielen, 2007). One of the biggest challenges Western Psychologists face today is that “imported psychotherapeutic models and methods are not equally applicable within different cultural, economic, historical, political, religious, and social context, and must, therefore, be substantially modified” (Stevens & Gielen, 2007), this means that the diagnoses and disorders listed by the DSM-V may not be entirely applicable to cultures across the globe, as seen in each case study of Crazy Like Us, an investigation and analysis of psychological cases and disorders around the world. As Dr. Lee discovered with his patients in Hong Kong, …show more content…
was that a global definition of a disorder was not necessary, rather, a “local understanding” of the culture at hand was more vital and provided a greater resource to diagnosing a patient (Watters, 2010).
That being said, are global definitions necessary or useful with regard to International Psychology and the concern for mental health? Do global definitions of disorders prove to be useful or serve a place in International Psychology in the long run if each culture finds that it must adapt the definition to fit within their society and embodiment of the disorder? This question relates to Stevens and Gielen’s (2007) concern of intergroup conflict because groups from differing cultures and backgrounds may not agree on the definition or classification of symptoms, or the best treatment plan. International Psychology seeks to standardize and provide a cultural competence for psychologists across the globe in order to accurately study human behavior and treat it in the manner most fit for that society and individual; each case study examined in Crazy Like Us indicates the need for a greater global push in International Psychology. The first case study in Crazy Like Us focuses on the rising percentage of Anorexia cases in Hong Kong, as …show more content…
researched by Dr. Sing Lee and presented by the author of Crazy Like Us, Ethan Watters. The majority of people living in the Western world would conceptualize the onset of Anorexia Nervosa as a result of body dysmorphia and pressures placed typically on young women by society and culture to behave and look a certain way. Due to feelings of inadequacy based upon body image, these sufferers, typically young females, will resort to extreme dieting and starvation to attain their goal weight, placing themselves in a highly dangerous lifestyle that in extreme cases, can lead to death if not treated. However, Dr. Lee found that young women he treated in Hong Kong did not complain or discuss any feelings or symptoms of Body Dysmorphic Disorder, inadequacy, or unhappiness surrounding their body image (Watters, 2010). Nor did the women identify cultural pressures to maintain a certain image. Yet, these women were frighteningly skinny due to self-starvation. Dr. Lee found himself in a quandary as he struggled to diagnose these young women, who appeared to have anorexia, but whose symptoms did not align with the typical symptoms named in the DSM by Western Psychologists. Instead, these girls identified symptoms of physical pain such as a lack of appetite, abdominal pains, or a problem with their throats (Watters, 2010). More confusing still, many of the young women that came to Dr. Lee for treatment came from outlying villages with limited access or exposure to culture of the Western world and ideals, therefore, their symptoms did not come from a penetration of Western cultural norms and standards, thus this poses the issue of Western ideals relating to intergroup conflict and risks to both physical and mental health(Watters, 2010). The shift in the cultural understanding and diagnosis of anorexia in China expressed the influence of two types of concern regarding physical health. Issues regarding the approach to mental health in International Psychology and intergroup conflict may also be seen in the Western Approach to PTSD as compared to Eastern cultures, namely Sri Lanka, as examined in Crazy Like Us. In 2004, a devastating tsunami hit Sri Lanka, plunging the country into a state of panic and emergency to recover the dead, find the missing, and to rebuild their towns. As a result, many Western Psychologists, concerned about the mental health and impact of the trauma on the Sri Lankan population, began to enter the country offering counseling services, aid, and medication to ease the pain of PTSD and trauma. With an in depth understanding of the lasting effects trauma can have on a person, psychologists and psychiatrists expressed deep concern over the mental health of the population, all while failing to assess the importance of basic needs such as food, water, and shelter, as well as cultural norms in Sri Lankan society. Similar to cases of anorexia in Hong Kong, Sri Lankans adopt and process trauma in a manner different than that of Westerners, and it is assuming and egotistical of Westerners, even those with the best of intentions, to rush into a country offering services the people may not want or understand. Beyond cultural understanding, trauma is processed as a function of what the traumatic event means to each individual, and thus, it is a unique experience with which a formula for cure and treatment cannot be implemented, similar to Anorexia (Watters, 2010). The traumatic experience and treatment plan results from cultural understanding and communication while the manifestation of the traumatic symptoms also differ country to country, such that Sri Lankans typically exhibited physical symptoms rather than mental ones commonly found in Western cases (Watters, 2010). The inability of Western Psychologists to express cultural competency in times of need presents a need for greater cultural understanding and education in order to avoid a “one size fits all” model for mental illness across the globe. With regard to Western intervention in Sri Lanka, Western psychologists in a sense dehumanized the people and symptoms the Sri Lankans faced post-tsunami, indicating that they [the Sri Lankans] were incapable of processing and living with the trauma, imposing the Western standards, symptoms, and treatments, even though these standards did not apply (Watters, 2010). Risks to an individual’s mental health, in addition to intergroup conflict, clearly play a role in the diagnosis, or lack thereof, of schizophrenia in Zanzibar. Watters (2010) witnessed a case of schizophrenia that differed greatly than the cases in developed, Western nations. In Zanzibar, a case of mental illness, particularly schizophrenia, is commonly attributed to the possession of a spirit or other supernatural cause, and Juli McGruder specifically analyzes the emotional roller coaster and experience of a Zanzibari individual with schizophrenia. Ultimately, McGruder claims that a patient struggling with schizophrenia will lead a happy, healthier and overall better life in Zanzibar than he would in the United States due to the manner in which schizophrenia is conceptualized and treated in Zanzibar (Watters, 2010). Due to a schizophrenic’s home and familial environment, in junction with his religion, both of these environmental factors dictate the path of the illness. Zanzibar, as a collectivistic culture, relies heavily on family while familial emotional and intellectual support is critical and expected (Watters, 2010). This was true for the case McGruder studied, the family of the individual with schizophrenia displayed support, while relieving any pressure to act normally amongst them or society—a striking comparison to the Western world and expectations (Watters, 2010). Research has shown that stress and overly emotional family and environments only create difficulties and relapses in schizophrenic individuals (Watters, 2010). Finally, the deeply religious faith of the Zanzibari people deeply impacts the conceptualization of schizophrenia, while the Western world fails to acknowledge any such impact. The Zanzibaris believe that the spirit has possessed the schizophrenic individual as a punishment for sin, but Allah would not give a person this hardship if the individual were incapable of handling it (Watters, 2010). Overall, the Western conceptualization of schizophrenia defining it as a genetic or biomedical disorder or abnormality, increases the stigmatization of the disease and treatment given, in contrast to the loving and open relationship the Zanzibari people maintain with an individual with schizophrenia due to a possession of spirit (Watters, 2010). The final case study in Crazy Like Us investigates and analyzes the manifestation of depression in Japan, with particular emphasis on the recent pharmaceutical intervention and marketing in the mental health field.
The major pharmaceutical company GlaxoSmithKline desired to supply anti-depressant medication to the Japanese population suffering from depression in order to relieve their symptoms and provide treatment (Watters, 2010). However, the Japanese population was very aversive to the idea of depression as a legitimate psychological disorder, and particularly more averse to treating symptoms with a psycho-pharmaceutical approach. After GlaxoSmithKline successfully entered the market in Japan, research and data indicating the ineffectiveness of these drugs was released to the public (Watters, 2010). In fact, the side effect insinuated by these drugs may be equally detrimental as the original symptoms the drugs attempt to treat, such as suicidal ideation (Watters, 2010). Therefore, the risk of the population’s mental health is at great risk, as are children and adolescents as depression becomes increasingly prominent in both of those populations. The psycho-pharmaceutical approach to treating depression, as GlaxoSmithKline propagates, may at best lead to minimal improvement in success, and perhaps this approach to treatment and mental health must be reconsidered. Furthermore, after the implementation of depression as an acknowledged disorder in Japan, the language used to
advertise depression marketed it as a “‘cold of the soul’”, indicating depression was a common phenomena, while instead Dr. Ono, a Japanese psychiatrist, claimed it should be characterized as “‘cancer of the soul’” (Watters, 2010). Overall, the majority of Japanese psychiatrists agree that selective serotonin re-uptake inhibitors (SSRI’s) sold by companies like GlaxoSmithKline are grotesquely overprescribed (Watters, 2010). Each of these examples indicates that the state of mental health is at a terrible risk due to the advertisement and marketing campaigns of both depression, and SSRI prescriptions, ultimately leading to a risk of a person’s physical health if suicidal ideation begins to take place, or when the depression manifests as physiological symptoms.
As an expat child having gown up and lived across three continents-politely labelled as a third culture kid, but in reality not belonging to any one culture-I doubt if my own parents would understand me let alone a doctor in another country. My mother suffers from trichotillomania and on visiting a psychiatrist in a foreign country, he mentioned not seeing this disease often in his country: he had made her feel at once both alienated and awkward, and not likely to trust his diagnosis or his treatment. I have seen her throwing her medication away- Pharmacotherapy cannot work without psychotherapy-and the demands of psychotherapy seem to be only increasing when you add a complex cultural element to it. Gold and his brother argue that both biological and social factors contribute to psychosis. In the field of psychiatric and behavioural sciences this would call for physicians skilled in appreciating all sorts of cultures and environments and while this may seem a tall order, a first step towards a solution would lie in acknowledging the role and importance of such external stimuli. Doctors cannot know it all but at least when they give a label it will be real. In a field where labels tend to stick and where the social stigma attached to mental illness is still considerable, it is worth while for doctors to make more informed diagnoses. Diagnoses that we can
Kleinman, A. 1980. Patients and Healers in the Context of Culture: An Exploration of the Borderland between Anthropology, Medicine, and Psychiatry. University of California Press.
Culture is a collection of religion, traditions, and beliefs that are passed down from generation to generation. Culture is created and maintained through the repetition of stories and behavior. It is never definite because it is continuously being modified to match current trends, however, historical principles are still relevant. With respect to mental illness, culture is crucial to how people choose to deal with society and the methods used to diagnose and cope with mental illnesses. In Watters’ The Mega-Marketing Depression of Japan, he focuses on how Japan and other cultures define depression, but also displays how the influence of American treatments in eastern countries eventually becomes the international standards. Even though the
Across the world, there are thousands upon millions of people who suffer from depression. Upon the numerous sufferers,
Measuring depression in different culture is a complicated task, “there is a need for tools for multicultural mental health primary in order to promote communication and improve clinical diagnosis” (Lehti et al, 2009). This results indicated that there is still a need for a tool to accurately measure depression in patients from different countries/cultures. Each culture is unique in its very own, and certain abnormal behavior can only be found in certain culture. For instance, in western society we have the histrionic personality disorder, in which an individual desperately seek out attention, while in Japan, there is a phenomenon called “hikikomori” is an abnormal behavior where a person would go great length to avoid any social contract at any means. This abnormal behavior is similar to the avoidant personality disorder, however hikikomori is more severe. “Hikikomori is used to refer to group of young people who have withdrawn from social life and have had no relationships outside of family for a period in excess of six months.” (Furlong, 2008). The long period of time to be withdrawn from society is quite serious and will have many psychological damage. Another factor that is important when looking at abnormal behavior is the gender. The gender of an individual have play an important role in shaping the diagnosis and the diagnostic feature of these symptoms.
Crazy Like Us is a book written by Ethan Watters. Through this book, Ethan explores the spread of anorexia, post-traumatic stress disorder, depression, and schizophrenia. Through case studies, the author explains the causes, and symptoms of Anorexia in Hong Kong, depression in Japan, post-traumatic stress disorder in Sri Lanka, and how Schizophrenia came to Zanzibar. Moreover, he explains how these disorders are prevalent in the Eastern nations due to the American influence. In addition, Ethan Watters outlines the implications of the American influence, and the urgent need to treat these illnesses in a culturally suitable framework. Ethan states that American influence changes a lot the way many nations view these disorders, and the American mental health treatments do not work well live the cultural treatment of many nations.
Hikikomori can be perceived as a manifestation of Japanese democracy, in which the good society is imagined as cohesive, protective and secure, rather than one in which the individual can freely exercise the right to be different. But that is not always so. Schools, families and the sphere of mental health care have focused on producing social inclusion, but have discouraged citizens from being labeled as ‘‘different’’, even when such a distinction could aid them.[5] For example, Japan’s postwar education and health care encouraged relative equality and common social values, as a key to a healthy and productive society. However, society offers limited and constrained substitutes to mainstream social practise. Mental health is often described as a matter of an individual’s attitude (ki no mochiyo ¯), so it is important to keep in good spirits. The over-arching cultural value is attached to being active and participative, and if one fails to do so they are considered “different”. As a result a more diffuse assumption is that mental degeneration, whether in the form of mental illness, senility or even suicide, is, at least in some part, voluntary. [3] This approach to depression does not recognize nor does it emphasize psychological, developmental or even familial issues that were potentially at play in the youth. Instead, the stress is almost exclusively placed on healing through
The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures shares the journey of cultural illiteracy from the Hmong and American side. Fadiman states, “In 1995, for the first time, the national guidelines for training psychiatry residents stipulated that they learn to assess cultural influences on their patients’ problems,” (Fadiman 270). Though the unfortunate events that occurred were definitely able to avoid now, at the time, there was no standard set of actions and procedures to take in order to provide the best health care to different cultures. Fadiman truly succeeded in showing the reader that good intentions and compassion must be weighed more heavily when analyzing events and the consequences must be met with an objective eye.
Each year millions of people in the United States develop serious and often fatal eating disorders. More than ninety percent of those are adolescent and young women. The consequences of eating disorders are often severe--one in ten end in death from either starvation, cardiac arrest, or suicide. Due to the recent awareness of this topic, much time and money has been attributed to eating disorders. Many measures have been taken to discover leading causes and eventual treatment for those suffering from anorexia. (http://www.kidsource.com/kidsource ...er.html#Causes of Eating Disorders) )
...y of international trends. Social psychiatry and psychiatric epidemiology , 45 (9), 889 - 897.
Culture has a huge influence on how people view and deal with psychological disorders. Being able to successfully treat someone for a mental illness has largely to do with what they view as normal in their own culture. In Western cultures we think that going to a counselor to talk about our emotions or our individual problems and/or getting some type of drug to help with our mental illness is the best way to overcome and treat it, but in other cultures that may not be the case. In particular Western and Asian cultures vary in the way they deal with psychological disorders. In this paper I am going to discuss how Asian cultures and Western cultures are similar and different in the way they view psychological disorders, the treatments and likelihood of getting treatment, culture bound disorders, and how to overcome the differences in the cultures for optimal treatments.
Antidepressant usage has increased all around the world and is used by all ages. Doctors are prescribing more prescriptions, even if the patient does not need the medication. “Antidepressants prescriptions in the UK have increased by 9.6% in 2011, to 46 million prescriptions” (Are Antidepressants overused?). This study took place in the United Kingdom; however, a lot more prescriptions are being prescribed all around the world. The use of antidepressants is increasing to an all time high because doctors do not want to waste time talking about feelings. The psychologist’s just want the patients to feel better quickly so they prescribe antidepressants. Human beings as well as doctors think that prescribing medicat...
Neither article, Cookie Monster and Fighting Anorexia – New Research Into Its Origins- and Its Youngest Victims, provide adequate research and details about the study. The articles needed additional information to understand and evaluate the research that was done. To better understand the results of the studies the following information is needed: age, gender, ethnicity, the duration of the study and the setting where the study took...
In the later part of the 1900s psychologists started to explore more deeply the entire aspect of human behavior. In the 1980s Albert Bandura started this study of the whole spectrum of human behavior and how it would influence the mental problems found in patients (Devonis & Kaufman, 2014, p. 169), this study conducted by Bandura looked at aspects such as observational learning, cognitive regulators and self- regulatory behavior to name a few (Devonis & Kaufman, 2014, p. 169). The modern world has seen talking therapies becoming the main premise of psychologists by following the model of cognitive behavioral therapy to address and interpret mental health issues (Chung & Hyland, 2012, p. 288). An issue with modern psychology is the use of anti-depressants and anti-psychotic drugs with the intent to cure mental health issues but many of these drugs simply suppress these issues, in which the main goal is to cure mental health issues not suppress them (Chung & Hyland, 2012, p.
This concept is typically viewed as one of the positive aspects of cognitive behavioral therapy because this approach to therapy focuses on the client’s immediate problems and by staying in the present moment rather than having the client recollect past experiences. However, to some cultures, it can feel that by staying in the present there is an abandonment of cultural influences significant to the client if the therapist does not take the time to explore and reflect the client’s past (Nelson, et al., 2014). By spending large amounts of time in the present the therapist can neglect to learn about the history of their clients by not examining where the client came from and other important cultural factors that would be found by looking at the clients past and obtaining a full history of the