Cultural Psychology by S.J. Heine (third edition) – Summary chapter 14

Every culture provides a symptom pool of recognized and discussed symptoms that lead people to express their inner conflicts in a familiar language. There are cultural differences in the extent to which certain mental illnesses are prevalent and in the extent to which certain symptoms are part of mental disorders. There is also a difference in the way mental illnesses are perceived and dealt with (i.e. stigma).

There is a difference in psychologization and somatization of depression across cultures. This might be due to the social stigma associated with the disorder (1) and a different focus on internal emotional states across cultures (2).

It is not a good idea to use a therapist from a different culture than the patient. Cross-cultural psychotherapy leads to higher drop-out rates (1) and less effective treatment (2). It is more effective to make use of culturally adapted psychotherapy.

However, this requires cultural competence. This can be achieved by recognizing one’s own cultural influence (1), developing knowledge about the cultural background of a patient (2) and develop appropriate skills to be able to intervene in the therapy session in a way that is culturally sensitive and relevant (3). A therapist needs to be flexible about when it is appropriate to generalize from a client’s culture to mainstream culture and when it is more appropriate to individualize the client.

There are universal syndromes (table 1), mental disorders that exist in all cultures, although cultural differences can exist in prevalence and symptom expression. Culture bound syndromes (table 2) are syndromes that appear to be greatly influenced by cultural factors.

DISORDER	PRESUMED CAUSES	CULTURAL DIFFERENCES
Depression	Neurotransmitter imbalance, stress associated with tragic life events.	Difference in prevalence across cultures. Psychologization in Western cultures. Somatization in Eastern cultures.
Schizophrenia	Genetic factors, prenatal conditions	Paranoid sub-type is more prevalent in the United Kingdom. Catatonic sub-type is more prevalent in India. Better prognosis in non-industrialized societies.
Social anxiety disorder	Not specified	Difference in prevalence across cultures. Interdependence leads to more social anxiety concerns but less diagnosis because social concerns are culturally normative.
Suicide	Not specified	Increase in suicide rates in the elderly. Increase in suicide rates among indigenous people. Increase in suicide rates as a culture becomes more westernized.

DISORDER	LOCATION	DESCRIPTION
Dhat syndrome	South Asia	Anxiety because of a belief among young men that they are leaking semen.
Bulimia nervosa	Western societies	Binge eating and induced vomiting.
Koro	South and East Asia	A fear of one’s penis/nipple shrinking into the body which is believed to have harmful consequences.
Amok	Southeast Asia (Malay culture)	An acute outburst of unrestrained violence, associated with homicidal attacks. It is preceded by periods of brooding and ends with exhaustion and amnesia. It is instigated by stress, lack of sleep and alcohol consumption.
Hysteria	Mid-19^th century Europe	Fainting, insomnia, sudden paralysis, temporary blindness, loss of appetite for food or sex, tendency to cause trouble.
Neurasthenia	19^th-century Western societies	A disorder with more than 50 symptoms.
Frigophobia	China	Morbid fear of catching a cold, leading people to always dress in warm clothes.
Susto	Latin America	The feeling that a frightening experience has caused their soul to be dislodged from the body.
Voodoo death	Africa	Excessive fear that a curse has been put on a person.
Latah	Southeast Asia	Transient, disassociated state after some kind of startling event in which the person performs behaviour that is unusual or culturally inappropriate. The person has no memory of it at the end.
Malgri	Australian aboriginals	Fear that entering a new territory without the right rituals will lead to a totemic spirit invading them, causing physical illness.
Agonias	Portuguese and Azoreans	Anxiety disorder in which people report a burning sensation, loss of breath, hysterical blindness and eat- and sleeping disorders.
Kufungisia	Zimbabwe, Caribbean, Africa, Native Americans and East Asia	Belief that the mind has been damaged by excessive thinking and can no longer properly function. It is characterised by panic attacks and irritability.
Ataques de nervios	Puerto Rico	Emotionally charged settings lead to palpitations, numbness and a sense of heat rising to the head.
Tajin kyoufushou (TKS)	Interdependent cultures	Fear of confronting others expressed in psychological and somatic symptoms. It is aimed at how uncomfortable others will be.

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