Culture and the Individual

Jenkens & Barrett Chs. 1,2 & 5

Chapter 1: Hunter JenkinsSchizophrenia is relevant to understanding normal human

traits and processesOne of the biggest struggles for a person with

schizophrenia is constructing shared meaningsIf culture is shared meanings, then this ties schizophrenia

directly to cultureSubjectivity is the emic perspective of an individualIntersubjectivity is the interaction of two or more emic

perspectives Ontological vs positivist views of mental illness Ontological view = mentally ill individuals have qualitatively

different traits than normal individualsPositivist view = mentally ill individuals are functioning at a

different place on the continuum of normal emotion and cognition. THIS IS HUNTER JENKIN’S PERSPECTIVE.

Hunter Jenkins 2Sapir on culture: “the true locus of culture is in the interaction of

specific individuals, and, on the subjective side, in the world of meanings which each one of these individuals may unconsciously abstract for himself from his participation in these interactions.”

Ortner on Culture:Culture must include both 1) ways in which human

action is constrained by a given social and cultural order, and 2) ways in which human action makes, reproduces or transforms culture

Hunter Jenkins on Culture:Culture as an orienting axis for interaction with

others

Hunter Jenkins 3

Illness as a socially constructed reality based on experiences rather than on beliefs and behaviors

Three areas of focus:

1. self and self processes

2. emotions

3. social engagement and cultural orientation

Hunter JenkinsThe Self and Self Processes

Self as an interrelated set of processes that developed over the lifespan that provide the capacity for orientation and awareness.

Self is NOT a discrete, unchanging entity

Self is NOT neuroscience based test results and designated medical conditions

Hunter Jenkins: The VoicesAre the voices part of self or are they part of

other?The struggle is to experience voices as

other.Being able to use earplugs asserts

intentionality, personal efficacy and controlThe ability of some people with

schizophrenia to control the voices without medication.

Earplugs as placebo, and placebos as a metaphor for successful efficacy and intentionality.

Hunter Jenkins: Emotions

Schizophrenia characterized as flattened affect (blunted emotions, emotional dullness)

Schizophrenia characterized as opposing/competing feelings about the same thing

The unacceptability of characterizing schizophrenia as a single excessive emotion like “rage”

Hunter Jenkins: Emotions

The need for metaphor to explain what feelings are like

Emotion is felt, but not expressed in normal modes such as facial expression, body language, etc.

Among the most frequently described emotions are fear and anxiety derived from voices, visions, ideas

Joy, happiness, hope, contentment have not been studied very much, but are very prevalent as well

Hunter Jenkins - Social Engagement and Cultural Orientation

Sullivan’s definition of schizophrenia as an interactive process

Mentally ill individuals do react emotionally to their social and physical environments

They are not only fully aware of them, but also are VERY sensitive to them

Research has highlighted:1. EE (Expressed emotion) from families2. The relationship between EE and the way the mental

illness is culturally framed3. The emotional style patients use to deal with their world4. The relationship between gender and recovery5. The importance of residential setting in recovery

Hopper

How is the concept of culture being used in international studies of Schizophrenia?

30 research sites in 19 cultures

1. IPSS (International Pilot study of Schizophrenia),

2. DOSMed (Determinants of Outsome of Severe Mental Disorder),

3. ISoS (International Study of Schizophrenia

Hopper 2

Developed vs Developing Countries

The case of Hong Kong

Two questions:

1. To what extent do studies show that culture is a significant variable?

2. What do these studies use as criteria for measuring culture?

Hopper 3Culture as “there vs here”, where here is U.S. and Western

Europe, and there is everywhere else.Culture as either developed or developingCulture as nationality or geographic areaCulture broken down into smaller variables

1. The availability of low skilled or domestic work2. Living situation – residential facility vs family living3. Culture as treatment mode (modern medical vs local healer)4. Culture as the relative presence of EE (expressed

emotion = negative), with lower EE associated with better outcomes

5. Culture as a score on a “cultural inventory” survey/questionnaire6. Culture as what researchers noticed in the social environment and described (investigator bias?)

Hopper 4

Developing outcomes always superior to Developed outcomes

Factors that should reverse this finding, BUT DON”T:1. Loss of subjects over time – less loss in developed

group2. The selection of countries or cultures as developed or

developing 3. Diagnostic differences between developed and developing groups4. Outcome measures that are not comparable5. Gender and age differences – should favor developed

group

Hopper 5

The selection of one aspect of culture to compare outcomes: marriage

High marriage rates are associated with better outcomesDeveloping societies that have arranged marriages show 5

times the marriage rate for people with schizophrenia of developed societies without arranged marriages

Studies show a high rate of marriage success for people with schizophrenia in developing groups

Marriage in developing groups is combined with strong familial support and stable traditional roles that are widely shared

Lucas 1

Ethnographic research should be used to investigate what the daily lived experience of people with schizophrenia is like. This is an argument for a particular methodological approach to understanding schizophrenia.

Participants all knew the technical diagnostic criteria and attitudes toward their condition

Participants searched for the location of their condition in their bodies:alien intelligencereceptive bodyin-dwelling spiritsbodily vibrationshormonessensory or physical input into the body

Participants saw their condition as unavailable to others directly or indirectly through participant descriptions

Lucas 2

Viewing Schizophrenia as a cultural phenomenon:

1. Schizophrenia as a return to some primitive state that existed in past societies.

2. The form of society creates mental illness, and schizophrenia is an extreme manifestation of the state of modern society

3. Schizophrenia as an extension of art, fantasy and literature

Lucas 3

Participants’ culture – the culture described by participants as shaping their lives and being created by them

Participants’ culture focused on understanding their daily experiences and the labeling of those experiences as extraordinary by medical professionals

The use of cultural traditions and products to help understand themselves: eg. The Bible as an manual for managing internal voices

The interpretation of cultural traditions and products according to their own experience: the television as a “delusion of real life”