Understanding Psychopathology South African Perspectives Pdf Download
Basa Benejan
Background. Mental health research appears to be continually transforming. Recent literature reflects a greater appreciation for the ways in which pathoplastic features of culture modulate emotional regulation. This article introduces those aspects of the literature which explore the (re)consideration of culture as a dynamic and essential construct in the clinical formulation of psychopathology.
Objectives. The study aims to review literature that focuses on the dynamic influence of culture in psychopathology. Furthermore, the researchers aim to present a view on the ways in which culture appeared to shape the topography of psychopathology nosology.
Results. The review indicated that 29 literature sources were conceptual in design, suggesting a great need for more empirical research. This section also explores themes identified during the literature review. The literature is tabulated according to features and emerging themes. Three major themes were identified and included: the cultural context; the evolving definitions of culture; and culture and psychopathology.
Conclusion/discussion. An analysis of the themes is offered. The authors conclude by highlighting the significance of the literature at present. Areas of particular interest suggest that health and behaviour are dependent, at least in part, on culture; psychopathology may also be appreciated as a social construct; culture influences psychopathology regardless of the aetiology; diagnostic classes do not adequately consider operational definitions; and a greater focus on hermeneutic perceptivity in appreciating cultural dynamics in psychopathology will benefit clinical assessment.
Certainly, research into culture will help clinical formulation develop towards a more holistic approach. While there is currently an emphasis on a biopsychosocial model of psychopathology, this ought to become more holistic and therefore biopsycho-sociocultural.8 According to Miller,9 the acknowledgement of culture is important to most applicable frameworks, irrespective of the discipline or paradigm. Furthermore, the view that diagnoses and experiences are constant within cultures is reasonably imprecise, as constant taxonomies and definitions of psychopathologies suggest an ideal, not realistic, state. 10 How, then, does one operationalise culture and psychopathology as constructs?
Constructive research will weave multiple studies together, giving clinicians the chance to gain a comprehensive appreciation of culture and psychological distress.16 Draguns and Tanaka-Matsumi17 recommend that research should focus on linking discrete studies, in a way that makes greater understanding of psychological dynamics available to academia. It appears that a literature review will fulfill this requirement,18 and this was the method selected for this study, based on the observation that studies regarding psychopathology are often dispersed and divided.17 , 19 This investigation therefore endeavours to assimilate discrete studies, and to emphasise the significance of considering cultural aspects in the understanding of psychopathology. The specific method of literature review used was research synthesis,20 , 21 which entails outlining and integrating research22 , 23 in order to augment practice and policy.24
The literature search terms included the following terms, both separately and in combination: culture, psychopathology, psychiatry, psychology, worldview, and epistemology. The databases consulted included major search facilities such as GoogleScholar, JSTOR and EBSCOHOST.
Table 1 summarises the data accrued during the literature review. A total of 31 literature sources met the inclusion criteria. Of these, 3 were empirical and 29 were conceptual in design. This suggests a need for more empirical research to be conducted in this domain. Note that the resourced literature was available in the public domain and freely available to academic staff and students at the University of Pretoria. Other references could not be accessed due to the limited resources available to the authors.
Defining culture and ethnicity; culture as environmental feature; facets of culture; framework of culture; ethnicity; identity; cultural psychopathology; Africa and the West; universalism, relativism, absolutism; ethnocentricity
Socio-cultural mental illness; behaviour and culture; defining culture; culture in groups; cultural shifts; evolutionary nature of culture; ethnicity; culture-bound syndromes; cultural diversity; psychiatry and clinical psychology
Cultural similarities and differences in psychopathology; development of cultural psychology; framework of culture; identity; psychopathology in Africa; cultural psychopathology; psychiatry and clinical psychology
In the present review, 3 themes were identified in the literature. These included: the cultural context; the evolving definitions of culture; and culture and psychopathology. These are discussed in detail hereafter.
People ardently defend their cultural worldviews.26 This is understandable as worldview defines their conception of the nature of reality and all epistemological notions thereof. Indeed, culture and religion define the acceptability of affect, cognition, and connation. Suicidal behaviours are a good example:27 a common Muslim view is that suicide is forbidden in Islam, but in certain Japanese communities it may be seen as honourable.
There appears to be an increase in the body of literature regarding ethnic, racial, and cultural perceptions,29-31 which in turn seems to focus on increasing awareness of various perspectives on psychological distress.30 As a result, recent research has attempted to explore what culture means in clinical psychology.26
The question that needs be clarified when considering culture-related psychopathology is whether the phenomenon is culturally induced, culturally modified, or culturally labelled. Clearly, these dimensions suggest that some phenomena warrant little psychiatry-specific differentiation.13 Behavioural scientists without psychiatric knowledge and experience find it complex to appreciate the nature of culture-related psychopathology in a suitable and meaningful way. Culture-related disorders stem from cross-cultural psychopathology, a position which contemporary transcultural psychiatry is attuned to appreciate.13
From a sociobiological point of view, evolutionary and biological features affect culture, and culture evolves in order to sustain the survival of society. The ecocultural approach focuses on the relationship between ecology and culture, specifically the manner in which actions and opinions affect the environment and vice versa. The biopsychosocial view considers the interaction between biological, psychological, and social factors. This approach interprets the influence of culture on psychopathology through a trimodal framework (bio-psycho-social) and its dynamic interplay on social interaction. Multiculturalism is a postmodernism-endorsed approach and highlights the significance of equity between and approval of all cultural views. Proponents of this approach aim to expand awareness of the dynamics of all cultures, so as to promote positive interaction between all societies.43
While Draguns and Tanaka-Matsumi17 demonstrate that culture has a substantial influence on psychopathology, the various facets of culture in producing idiosyncratic symptoms of psychopathology have yet to be discovered. From an etic perspective, prospective researchers may explore collective views regarding antecedents in relation to the emergence of psychopathology. From an emic orientation, nuances may be explored with regard to culturally shared premises and concerns. Draguns and Tanaka-Matsumi request that prospective studies explore the generic association between culture and psychopathology, as well as identifying relationships between psychological distress and cultural features.
Every culture possesses personalised knowledge with regard to the perception and interpretation of illness.46 Although anxiety disorders are prevalent in many cultures, they are expressed differently across cultures;29 the dissimilarities in psychopathological expressions across diverse cultures are extraordinary.17 The experience, and interpretation, of hallucinations depends by and large on cultural construal. This is most notably evident in cultural interpretations of hallucinations as either pathological or supernatural. It is therefore of great consequence to appreciate that hallucinations transpire in context, are related to antecedent and consequential events, and only develop into a symptom when they are regarded as such.17
It appears that diagnostic classes fail to consider operational definitions with regard to culture. For this reason, many clinicians have to depend solely on clinical impressions.54 Often, culture-focused researchers have found that this process led to frequent misdiagnoses.7 This is particularly evident if considering the body of knowledge signifying, for example, that auditory hallucinations are dependent on the pathoplastic influences of culture.7
The manifestation of pathology across cultures is diverse.17 Symptoms, therefore, ought to be largely interpreted within the cultural context. Discounting the correlation between culture and pathology29 often leads to inaccurate clinical impressions and diagnoses.8 However, perhaps the culture-pathology association has been overstated at present, with insufficient information relating to the way in which pathology is affected by culture.
The influences of culture suggest that perceptions of normal and abnormal experiences are regulated by culture, modulating intrapsychic conflict and psychological distress.8 If it is accepted that culture exerts an influence on psychopathology, then the social function of pathology is insinuated. Further elucidation in this regard may be valuable. Summerfield55 holds that diagnosticians assume the subsistence of mental illness, irrespective of whether it is diagnosed or not. However, psychopathology may be appreciated as a social construct, buttressed by cultural conceptions of personhood.55 In this regard, cultural influences shape what people deem normal or abnormal, as well as acceptable or unacceptable.
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