|Year : 2017 | Volume
| Issue : 5 | Page : 3-4
|Date of Web Publication||8-Nov-2017|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Theme Symposium. Indian J Soc Psychiatry 2017;33, Suppl S1:3-4
Cultural Diversity and Mental Health
Cultural Diversity and Psychiatry
P. K. Singh
Department of Psychiatry, Patna Medical College, Patna, Bihar, India. E-mail: [email protected]
Cultural diversity has always been a reality. Cultural diversity is gradually giving way at least partly to multiculturality in the modern times, which essentially means that individuals are becoming adept at adopting, adapting and acting in different cultures in accordance to the norms and demands of more than one cultures. Culture is a component of the social dimension of man. The degree of inter-individual and inter-group differences are maximally manifest at the sociocultural level. Human beings who are made of exactly similar constituent units at the biological level become nearly absolutely dissimilar at the sociocultural level in terms of language, norms, value systems, roles and rituals.
Psychiatry at the present state of its development is it still groping for the validity of its diagnostic categories. All its diagnostic categories essentially are of purely descriptive nature, heavily dependent on subjective professional judgments for their identification. Such judgments are influenced by diktats of cultural imperatives. Culture also provides norms for acceptable level and language for distress, dysfunction and disability; it also provides norms for what is good and what is right; what is permissible and what is proscribed. In the absence of any objectively verifiable and measurable parameters for psychopathology, these cultural parameters of norms provide the yardsticks for drawing a line between order and disorder.
Apart from culture having a role in definition of mental disorders, it also has a role in causing and colouring the form and content of mental disorders, i.e. it has pathogenic and pathoplastic effects. In addition, cultural factors also have powerful therapeutic and healing effects on disorders of mind because culture is a very powerful regulator of human behaviour and also subjective experiences. Social support and social-networking are very important considerations. Therefore culture and psychiatry can never be divorced. The dynamic and pervasive relationship between cultural influences and science of mental healing will have to be recognized by all mental health professionals. We have to devise ways and means of giving this process a place and structure. Culture is of relevance at every step in Psychiatry.
Keywords: Cultural diversity, psychiatry, multiculturality
Cultural Diversity and Psychopathology
N. Gupta, J. Garg
Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India. E-mail: [email protected]
Culture is broadly a way of life of a group of people. Development of personality, coping behaviours and several other aspects of life are dependent on culture. Cultures differ with each other in their level of dependence, psychological sophistication, linguistic competence, social support, expressed emotions and materialism which in turn influence the psychopathology of mental illnesses. For understanding psychopathology of psychiatric disorders, cultural factors carry equal importance as biological and psychological factors. Psychiatrists must focus on exploration of cultural factors in the history taking phase because culture has a prominent effect on psychiatric diagnosis; this being a consistently proven etiopathogenic and pathoplastic factor.
In addition culture exerts psychoselective, psychoplastic, pathoelaborating, psychofacilitating, and psychoreactive influences on psychopathology. There are some recurring frameworks which address the way in which psychopathology is influenced by culture. These include the sociobiological approach, the ecocultural approach, the biopsychosocial approach and multiculturalism.
There is documented evidence of influence of culture on phenomenology of mental disorders. To exemplify-in schizophrenia, wide variations are seen in the prevalence of subtypes, frequency of occurrence of first rank and negative symptoms in different cultures. The themes of delusions and types of hallucinations have also been noted to be different. In depression, patients from developed countries report guilt more often when compared with patients from developing countries where somatic symptoms are reported more frequently. There are more manic episodes in Indian patients compared to patients of Western countries and the themes of their delusions are different. Culture bound syndromes provide additional evidence on influence of culture in manifestation of psychopathology.
The presentation will try to provide an overview, with a critique of the topical issues related to cultural aspects surrounding psychopathology.
Keywords: Cultural diversity, psychopathology, phenomenology
Cultural Diversity and Classification in Psychiatry
Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India. E-mail: [email protected]
The universalist perspective on psychiatric classification posits that psychiatric disorders and syndromes are universal and have core symptoms that cluster into universal syndromal patterns. The relativistic perspective contends that culture shapes the individual's biological and psychological unfolding to a substantial degree, hence there is a need to integrate culture within the classificatory system.
Most studies on cultural issues related to psychiatric classification focus on comparison of prevalence rates of diagnoses across groups and have suggested that common diagnostic categories may be found universally. However, these studies emphasize reliability rather than validity, which is linked to the meaning of symptom patterns in a given social system.
The recognition of symptoms and the labeling of distress as being deviant or pathological depend on the norms of behavior accepted in a particular culture. Societies may differ with respect to the explanatory models put forward to explain illnesses. In addition, literature suggests cultural variation in clinicians' definition of and attitudes towards behaviours, e.g. hyperactivity. Consequently, the categorization as 'pathological' may depend on the perception of the clinician even if uniform criteria are used across cultures. Some researchers have also described syndromes that exist in one culture that are not found in other cultures. For example, substantial proportions of individuals from the community and those receiving psychiatric services in clinics in Peurto Rico were reported to have 'ataque de nervios.' These findings suggest the need to address cultural validity issues regarding psychiatric disorders in specific socio-cultural contexts in order to avoid the category fallacy; which is the projection of a diagnostic category in another culture where this category lacks coherence.
While some disorders that are mostly based on neural pathology are likely to be universal; other more common disorders may be substantially shaped by social context, cultural norms and developmental stage. Much empirical work is needed to establish the validity of diagnostic categories across cultures.
Keywords: Cultural diversity, classification, psychiatry
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