19 Cultural psychiatry This chapter considers the presentation of psychiatric disorders in non-Western populations, including immigrants to Western countries. This is followed by a brief description of specific disorders that occur in certain non-Western countries, known as culture-bound syndromes. Culture has been defined as describing the sum of learned knowledge and skills, including religion and language, which distinguishes one community from another and passes on in a recognizable form from generation to generation. Ethnic minorities share a cultural heritage and may experience discrimination. Ethnicity should be self-assigned and not based on country of birth. Presentation of psychiatric disorders Depression A number of cultures do not have a word for our modern day term, depression. Although depression is widespread, its symptomatology varies between countries. Christian cultures show more guilt and suicidal ideas, whereas other cultures show more paranoia (e.g. some African and South American cultures). The lifetime prevalence of depression has been found to vary widely in different groups. For example, studies published during the first decade of the 21st century have reported a lifetime prevalence of 5.5% in American Indian tribes, 6.9% in Los Angeles Chinese Americans, 8.0% in Mexican-Americans (living in the USA), 10.4% in white Americans and 21% in Chinese American women. Immigrants to Western countries who are of non-Western origin may not tell their doctor that they feel depressed or low when they are suffering from depression. Afro-Caribbean men, for example, may instead complain of erectile dysfunction or reduced libido. Those from the Indian subcontinent often somatize their depressive symptoms, talking instead of stomach pains, for example. It is clearly important to have a low threshold for identifying an underlying depressive illness in such cases. Appropriate investigations of physical illnesses that can cause low mood, such as tuberculosis, should be carried out when a depressed mood has been uncovered. Suicide rates may be low among those who adhere to particular religious beliefs that condemn suicide (e.g. Judaism, Roman Catholicism and Islam), although there may be an otherwise increased acceptance of some specific forms of ceremonial or other suicide acts, for example dowry suicides among Hindus when dowries cannot be met. Historical examples include Hindu suttee, when the widow throws herself on her husband’s funeral pyre, and Japanese hara-kiri (seppuku) (disembowelment) among Japanese soldiers. Schizophrenia The prevalence of schizophrenia is similar throughout the world when standardized interviewing techniques are used (e.g. the present state examination (PSE)), despite apparent local higher rates. In the past in the USA, schizophrenia was diagnosed in cases where UK psychiatrists would have diagnosed mood (affective) disorder, and in Russia a diagnosis of slow schizophrenia was applied to cases, which in the UK would have been labelled personality disorder. However, high rates (two to three times the national rate) have been reported for isolated populations in northern Sweden and for parts of Finland. Interestingly, Norwegian immigrants in the USA have been reported as having higher rates of psychotic symptoms. Transient hallucinations, unsystematized (often paranoid) delusions, excitement and confusion have been found to be more common in Africa, and catatonic symptoms are more common in India. The outcome of schizophrenia in terms of symptoms and social functioning has been found to be better in developing countries, which may reflect the differing demands placed on patients and the way they are supported. Some people of Afro-Caribbean origin believe in voodoo and the like, so that the expression of such beliefs does not necessarily imply that they are delusional. It is very helpful in such cases to speak to an informant from the subject’s community, in order to ascertain whether the beliefs of the subject are out of keeping with those of that community. A similar consideration relates to religious beliefs in general. In the UK much controversy has arisen over the veracity of studies showing a ninefold increase in psychosis among Afro-Caribbeans in the UK, especially among those of second-generation immigrants, compared with white British people. There is no such increase in their country of origin (e.g. the West Indies), i.e. it is not genetic. (A sixfold increase in psychosis in black African immigrants in the UK has also been found reported.) Controversy also surrounds why Afro-Caribbean individuals are more likely to be detained in psychiatric hospitals, especially in secure forensic facilities. Reasons given include: stress resulting from racial discrimination, including the consequent increase in unemployment; a greater stigma attached to mental disorders, leading to later presentation; differing sources of referral for psychiatric care (whites via GPs and Afro-Caribbeans via the police and courts); and being more likely to reside in more deprived, high-crime areas of the UK, leading to more law involvement and increased identification of mental illness as a result. Others have suggested misdiagnosis or diagnostic disagreements between Jamaican and British psychiatrists.< div class='tao-gold-member'> Only gold members can continue reading. 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19 Cultural psychiatry This chapter considers the presentation of psychiatric disorders in non-Western populations, including immigrants to Western countries. This is followed by a brief description of specific disorders that occur in certain non-Western countries, known as culture-bound syndromes. Culture has been defined as describing the sum of learned knowledge and skills, including religion and language, which distinguishes one community from another and passes on in a recognizable form from generation to generation. Ethnic minorities share a cultural heritage and may experience discrimination. Ethnicity should be self-assigned and not based on country of birth. Presentation of psychiatric disorders Depression A number of cultures do not have a word for our modern day term, depression. Although depression is widespread, its symptomatology varies between countries. Christian cultures show more guilt and suicidal ideas, whereas other cultures show more paranoia (e.g. some African and South American cultures). The lifetime prevalence of depression has been found to vary widely in different groups. For example, studies published during the first decade of the 21st century have reported a lifetime prevalence of 5.5% in American Indian tribes, 6.9% in Los Angeles Chinese Americans, 8.0% in Mexican-Americans (living in the USA), 10.4% in white Americans and 21% in Chinese American women. Immigrants to Western countries who are of non-Western origin may not tell their doctor that they feel depressed or low when they are suffering from depression. Afro-Caribbean men, for example, may instead complain of erectile dysfunction or reduced libido. Those from the Indian subcontinent often somatize their depressive symptoms, talking instead of stomach pains, for example. It is clearly important to have a low threshold for identifying an underlying depressive illness in such cases. Appropriate investigations of physical illnesses that can cause low mood, such as tuberculosis, should be carried out when a depressed mood has been uncovered. Suicide rates may be low among those who adhere to particular religious beliefs that condemn suicide (e.g. Judaism, Roman Catholicism and Islam), although there may be an otherwise increased acceptance of some specific forms of ceremonial or other suicide acts, for example dowry suicides among Hindus when dowries cannot be met. Historical examples include Hindu suttee, when the widow throws herself on her husband’s funeral pyre, and Japanese hara-kiri (seppuku) (disembowelment) among Japanese soldiers. Schizophrenia The prevalence of schizophrenia is similar throughout the world when standardized interviewing techniques are used (e.g. the present state examination (PSE)), despite apparent local higher rates. In the past in the USA, schizophrenia was diagnosed in cases where UK psychiatrists would have diagnosed mood (affective) disorder, and in Russia a diagnosis of slow schizophrenia was applied to cases, which in the UK would have been labelled personality disorder. However, high rates (two to three times the national rate) have been reported for isolated populations in northern Sweden and for parts of Finland. Interestingly, Norwegian immigrants in the USA have been reported as having higher rates of psychotic symptoms. Transient hallucinations, unsystematized (often paranoid) delusions, excitement and confusion have been found to be more common in Africa, and catatonic symptoms are more common in India. The outcome of schizophrenia in terms of symptoms and social functioning has been found to be better in developing countries, which may reflect the differing demands placed on patients and the way they are supported. Some people of Afro-Caribbean origin believe in voodoo and the like, so that the expression of such beliefs does not necessarily imply that they are delusional. It is very helpful in such cases to speak to an informant from the subject’s community, in order to ascertain whether the beliefs of the subject are out of keeping with those of that community. A similar consideration relates to religious beliefs in general. In the UK much controversy has arisen over the veracity of studies showing a ninefold increase in psychosis among Afro-Caribbeans in the UK, especially among those of second-generation immigrants, compared with white British people. There is no such increase in their country of origin (e.g. the West Indies), i.e. it is not genetic. (A sixfold increase in psychosis in black African immigrants in the UK has also been found reported.) Controversy also surrounds why Afro-Caribbean individuals are more likely to be detained in psychiatric hospitals, especially in secure forensic facilities. Reasons given include: stress resulting from racial discrimination, including the consequent increase in unemployment; a greater stigma attached to mental disorders, leading to later presentation; differing sources of referral for psychiatric care (whites via GPs and Afro-Caribbeans via the police and courts); and being more likely to reside in more deprived, high-crime areas of the UK, leading to more law involvement and increased identification of mental illness as a result. Others have suggested misdiagnosis or diagnostic disagreements between Jamaican and British psychiatrists.< div class='tao-gold-member'> Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Psychiatry of the elderly Schizophrenia and delusional (paranoid) disorders Psychiatry of sexuality Sleep disorders Mood disorders, suicide and parasuicide History taking and clinical examination Stay updated, free articles. Join our Telegram channel Join
