Culture and Health

HikikimoriYou live in Japan and are the parent of 14

year old Keisuki (boy). One day he went into the family kitchen, closed the door and refused to leave.

As a parent what would you do?

Con’tThree years later he has not left the kitchen,

nor has he allowed anyone else in. His mother made meals for him and left them at the door three times a day and he used the adjacent toilet.

Parents ordered take out for about 6 months then built another kitchen onto their house.

As a therapist, what would you do?

HikikomoriSocial withdrawal

Japanese high school junior high (refusal to go to school)

Recent phenomenom (1.2 million kids)

Three times more likely in boys, typically older sons or only children.

Parents pressure, homogeneity of Japanese culture, lack of sibling socialization, parenting style (strick father, overindulging mother)

Emic and EticCultural bound syndromes

Ex. Eating disorders

Emic logic of western women: appearanceEmic logic of African women: food scarcity

DiagnosisTools of the trade

1. clinical manuals2. Disease vs. illness behavior

disease: biological processIllness behavior: psychological experience

and the social expression of the disease.

In groupsDiscuss the culturally bound syndrome:

1. What is it in ‘etic language?’ What might it look like?

2. What is it closest to in our culture (if anything)?

3. Does the US have any culture bound syndromes not included in the DSM?

3 Different configurations of DepressionPsychiatrists in training

Middle Class White Americans

American Indian Psychiatric Patients

Explanatory models of illnessIndividual and cultural

Organize signs symptoms, labels, idioms

Organize beliefs about causation, psychology,

ResidentsDSM basis for category decisions

American IndianEight categories, one cluster unconnected

(mind body dualism)White middle class

15 categories, more finely discriminated somatic and body sensation

Cuban studyBoxer and Garvey (1985)

109 refugees

Reviewed medical decision in Cuba, in US.

Upheld schizophrenic decisions, (72%)Overturned 43% of antisocial

personality disorder

What is antisocial personality disorderAntisocial personality disorder (APD) is

a psychiatric condition characterized by an individual's common disregard for social rules, norms, and cultural codes, as well as impulsive behavior, and indifference to the rights and feelings of others

Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest

Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure

Impulsivity or failure to plan ahead Irritability and aggressiveness, as indicated by repeated

physical fights or assaults Reckless disregard for safety of self or others Consistent irresponsibility, as indicated by repeated

failure to sustain steady work or honor financial obligations

Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

The manual lists the following additional necessary criteria:

There is evidence of conduct disorder with onset before age 15 years.

Why might antisocial personality disorder be more accepted in the US than in Cuba?

Collectivism and duty to others: loners are weird.

Universal syndromesDepression

Social Anxiety

Suicide

Schizophrenia

Fig. 10.1

Culture bound syndromesLots of them

Anorexia/bulimiaKoroAmokBrain fagLatahVoodoo death

Physical healthDo we vary in physical health cross

culturally?

Why do we vary in physical health cross culturally?

The relationship between culture and health

Knowledge about health

Methods and treatments

Cultural beliefs, traditions

Reciprical

Six degrees of separationPsychological variables are linked to our

physical health. (health psych)

Culture influences a wide range of psychological variables

Thus,….

Innate biological differences: pressure from environments(Chickchi and short appendages)

Acquired biological differences: experiences in our own lifetimes(supersize me)

Genetic variation across populationSkin color (occurred in the last 60,000 years)

Vitamin D absorption needs UVR. Too much causes break down of folic acid and birth defects.

As people left Africa to higher latitudes and needed to absorb relatively more UVR those with less melanin had better survival.

Why does alcohol flush cheeks differently?Asian populations have a lower rate of

enzyme that detoxifies alcoholWhy?

Why do Yam farmers get less sick with malaria?

Malaria resistancegenetic variant for hemoglobin associated with sickle cell

Physical variation across cultureMoken visual acuity underwater through

pupil constriction (2x European children)

Diet and Obesity170 million (30%) children under 5 are

malnourished (UNICEF, 2008)

ReasonsVitamin AIron deficiencyIodineZinc

Fig. 10.2

Fig. 10.3

HeightGenetic or

acquired? (Malcom, 1974)

TodayToday 18651865

DutchDutch 6’1”6’1” 5’5”5’5”

AmericanAmerican 5’10”5’10” 5’8”5’8”

Health and SES

Who is living a shorter life?

Fig. 10.5

Burkina FasoFulani, Mossi, Rimaibe

Fulani migrated in 19th century and are pastoralist. Do not have malaria resistance.

Mossi and Rimaibe have been living in the region for thousands of years, have resistance.

More Mossi and Rimaibe die of malaria….Why?

Why?Money for health care

Jobs that place them in danger

Engage in more unhealthy behaviors(drinking , smoking, fast food)

Mediating factorPersonality characteristics of pesimism and

cynicism

Stress

Objective SES and subjective SES

Feeling poor may matter more than being poor.

Relative deprivation

Fig. 10.6

Groups in the USAfrican Americans (more than SES)Because health disparities remain across

matched SES and education groups. West African’s have hypertension rates similar to EA.

Something about being African American in the US…….

Stress

Table 10.1

Immigrant healthHealthy migrant hypothesis: only

healthier ones endured the move here.

Salmon hypothesis: the ill and old return home to die.

Decreases to US norms the longer a person stays.

The Invisible CureHistory of HIV/AIDS in Africa

Activity:You have been hired by WHO to reduce rates of

HIV In sub-Saharan Africa. Please break up into groups and develop an outline for a program to reduce HIV rates.

Use the diagram on slide 20 and answer the following questionsWhy did you choses this strategyWhat is the advantage of the strategyWhat is the disadvantage of the strategyWhat cultural obstacles do you forsee?