Lecture 1 Culture and psychopathology
In the past, psychiatry was used to oppressed people that were against the status quo.
NOW: Interdisciplinary = we aren't only taking the perspective from the purely mental
health biomedical model, we are looking at what the person’s cultural environment (+
other types of disciplines) have contributed to the conceptualisation of cross-cultural
psychiatry, including sociology.
If the occurrence of a condition is the same everywhere, that condition is primarily caused by
genetic make-up.
Incidence of psychosis is independent of the environment and a characteristic of human
populations
Prevalence of psychosis is similar across the world.
Eu-GEi study:
- Incidence study
- Identified new cases of psychosis in 19 different sites in Europe, 1 in Brazil
- Mix of urban and rural centers
- All incident cases with psychotic disorder
- Denominator data from statistical offices
They found that:
- In inner city Chicago
- The rates of incidence per 100,000 of population decrease steadily from 362 in
the disorganized areas hear the center of the city to 55.4 in the residential
sections near the outskirts
- Dose response
- Conclusion
- Trend of lower rates in Southern Europe compared to Northern European sites
- Strong urban-rural effect in north Europe; No effect in South Europe
- However
- In the largest study to date o the association between urbanicity and psychosis
in LMICs, we found that urban living was not associated with psychotic
experiences or psychotic disorder
- Why?
- Urbanicity as protective fact: moderation by resources/social cohesion
- Multiple levels
- Culture
, - Social capital
- Cultural norms (i.e. What is considered “normal”)
- Social and economic mechanisms
- Economic deprivation
- Social isolation
- Environmental exposures
- Nature/ Green space
- Air pollution
Reasons to study mental health globally and cross-culturally
May reveal sociocultural influences on:
- Etiology
- Manifestations/ clinical presentation
- Course
- Help-seeking and effective treatment
Most mental health research done in white population in HIC/Global north
Majority of world population lives in LMIC/Global south
Case Mohamed:
- 48 year old man of Moroccan origin
- Moved from a small village in Morocco to the Netherlands at age 22 to study
Mathematics at university
- Age 28; mentally unwell; thinks he is followed by AIVD, on television people seem to
be applauding for him
- Recently referred for CBT because of fear of Jinns. Afraid he will be processed.
Is psychopathology culturally universal?
There are universal psychopathologies, for example depression, but the way it is
expressed is highly affected by culture.
Is psychopathology culturally specific?
The sociocultural context: a brief history showing us that:
- Evolution of psychology and psychiatry as a field goes hand in hand with the events in
the world. It's not only the science of the discipline itself, but also the cultural context in
which this science is evolving.
- Biological psychiatry: we have come to this consensus that we are not going to find this
one “gene” or one underlying neurobiological mechanism that will explain
psychopathologies.
, Taking stock
- No scientific discoveries that led to major improvements in clinical practice in the past
30 years (e.g., no new psychotropics that are more effective)
- Many advances in fundamental research, yet few breakthroughs in better treatments
- Neurobiological perspective since decades the dominant paradigm
- Is it time for a paradigm shift?
Cultural formulation interview
- Needed to conceptualize a cultural formulation
- A systematic review of a person;s cultural background and the role of culture in the
manifestation of symptoms and level of functioning
- Social context, narratives of illness experience and help-seeking (e.g., alternative
pathways to care)
- DSM-IV: outline for cultural formulation (OCF)
- DSM-5: cultural formulation interview (CFI)
- Person-centered care
- Any clinical setting
- Any type of mental health professional
- Transfiagnostic
- Improve intercultural clinical communication and connection
Domains of CFI
- Cultural perceptions of cause, context and support
- Cultural factors affecting self-coping and past help seeking
- Cultural factors affecting current help seeking
Examples of questions of CFI
- What do others in your family, your friends, or others in your community think is causing
your [problem]?
- Often people look for help from many different sources, including different kinds of
doctors, helpers, or healers. In the past, what kinds of treatment, help, advice, or
healing have you sought for your [problem]?
In the past, psychiatry was used to oppressed people that were against the status quo.
NOW: Interdisciplinary = we aren't only taking the perspective from the purely mental
health biomedical model, we are looking at what the person’s cultural environment (+
other types of disciplines) have contributed to the conceptualisation of cross-cultural
psychiatry, including sociology.
If the occurrence of a condition is the same everywhere, that condition is primarily caused by
genetic make-up.
Incidence of psychosis is independent of the environment and a characteristic of human
populations
Prevalence of psychosis is similar across the world.
Eu-GEi study:
- Incidence study
- Identified new cases of psychosis in 19 different sites in Europe, 1 in Brazil
- Mix of urban and rural centers
- All incident cases with psychotic disorder
- Denominator data from statistical offices
They found that:
- In inner city Chicago
- The rates of incidence per 100,000 of population decrease steadily from 362 in
the disorganized areas hear the center of the city to 55.4 in the residential
sections near the outskirts
- Dose response
- Conclusion
- Trend of lower rates in Southern Europe compared to Northern European sites
- Strong urban-rural effect in north Europe; No effect in South Europe
- However
- In the largest study to date o the association between urbanicity and psychosis
in LMICs, we found that urban living was not associated with psychotic
experiences or psychotic disorder
- Why?
- Urbanicity as protective fact: moderation by resources/social cohesion
- Multiple levels
- Culture
, - Social capital
- Cultural norms (i.e. What is considered “normal”)
- Social and economic mechanisms
- Economic deprivation
- Social isolation
- Environmental exposures
- Nature/ Green space
- Air pollution
Reasons to study mental health globally and cross-culturally
May reveal sociocultural influences on:
- Etiology
- Manifestations/ clinical presentation
- Course
- Help-seeking and effective treatment
Most mental health research done in white population in HIC/Global north
Majority of world population lives in LMIC/Global south
Case Mohamed:
- 48 year old man of Moroccan origin
- Moved from a small village in Morocco to the Netherlands at age 22 to study
Mathematics at university
- Age 28; mentally unwell; thinks he is followed by AIVD, on television people seem to
be applauding for him
- Recently referred for CBT because of fear of Jinns. Afraid he will be processed.
Is psychopathology culturally universal?
There are universal psychopathologies, for example depression, but the way it is
expressed is highly affected by culture.
Is psychopathology culturally specific?
The sociocultural context: a brief history showing us that:
- Evolution of psychology and psychiatry as a field goes hand in hand with the events in
the world. It's not only the science of the discipline itself, but also the cultural context in
which this science is evolving.
- Biological psychiatry: we have come to this consensus that we are not going to find this
one “gene” or one underlying neurobiological mechanism that will explain
psychopathologies.
, Taking stock
- No scientific discoveries that led to major improvements in clinical practice in the past
30 years (e.g., no new psychotropics that are more effective)
- Many advances in fundamental research, yet few breakthroughs in better treatments
- Neurobiological perspective since decades the dominant paradigm
- Is it time for a paradigm shift?
Cultural formulation interview
- Needed to conceptualize a cultural formulation
- A systematic review of a person;s cultural background and the role of culture in the
manifestation of symptoms and level of functioning
- Social context, narratives of illness experience and help-seeking (e.g., alternative
pathways to care)
- DSM-IV: outline for cultural formulation (OCF)
- DSM-5: cultural formulation interview (CFI)
- Person-centered care
- Any clinical setting
- Any type of mental health professional
- Transfiagnostic
- Improve intercultural clinical communication and connection
Domains of CFI
- Cultural perceptions of cause, context and support
- Cultural factors affecting self-coping and past help seeking
- Cultural factors affecting current help seeking
Examples of questions of CFI
- What do others in your family, your friends, or others in your community think is causing
your [problem]?
- Often people look for help from many different sources, including different kinds of
doctors, helpers, or healers. In the past, what kinds of treatment, help, advice, or
healing have you sought for your [problem]?
