MEDICINE AS CULTURE 2

1. MEDICINE AS CULTURE 2 Culture-Bound Syndromes Lay Health Beliefs & Explanatory Models

2. Culture Bound Syndromes

3. What are Culture Bound Syndromes? They are constellations of symptoms, classified as “disease” or “dysfunction”, which are characterised by one or more of the following elements: • They cannot be understood apart from their specific cultural or sub-cultural context. • The aetiology of a traditional illness summarizes and symbolizes core meanings and behavioural norms of that culture. • Its diagnosis relies on culture-specific technology as well as ideology. • Successful treatment is accomplished only by participants in that culture. Although its symptoms may be recognised and similarly organised in other (e.g. western) cultures, they are not perceived as belonging to the same ‘disease’ or ‘dysfunction’

4. The DSM IV recognizes in its Appendix the following „culture bound syndromes“ • Amok, ataque de nervios, bilis and colera, boufée delirante, brain fag, dhat, falling out or blacking out, ghost sickness, hwa byung, koro latah, socura, mal de ojo, nervios, piblotoq, qi-gong psychotic reaction, rootwork, sangue dormido, shenjing shuairuo („neurasthenia“), shin-byung, spell, susto, taijin kyofusho, zar

5. Are there western „culture-bound syndromes? • Some Authors give us the following list: Anorexia Nervosa, Adolescence, drug abuse, chronic fatigue syndrome, petism among old people who live surrounded by cats and dogs, ADHS, bulimia nervosa, Munchhausen by proxy, obesity, premenstrual tension syndromes, multiple personality disorder, type A personality, involutional paraphrenia: (Spain, Germany) paranoid disorder occurring in midlife. • Others say: all Psychiatric categories, regardless of culture, are always culturally influenced constructs

6. ANOREXIA NERVOSA

7. ANOREXIA NERVOSA Anorexia nervosa (North America, Western Europe): severe restriction of food intake, associated with morbid fear of obesity. Other methods may also be used to lose weight, including excessive exercise. May overlap with symptoms of bulimia nervosa

8. “KORO” : The Disappearing Penis

9. “KORO” • Koro is typically defined as a culture bound syndrome involving: • delusions of genitalia shrinkage; • acute anxiety; • psychosomatic complaints; • the conviction among some individuals that death will occur once the genitalia fully retract.

10. What does the DSMIV suggest to mental health practitioners (also to social workers?) when encountering clients from a different cultural context (e.g. migrants or ethnic minorities): • Note the individual‘s ethnic or cultural reference group, his language and involvement in host culture and culture of origin (degree of integration or assimilation) • Elicit his cultural explanations of his illness (his „explanatory model“ for his compaint) • Note his interpretations of social stressors, social supports. What stresses exist in his environment? What is role of reli-gion and kin networks in coping and in providing support? • Be aware of and describe the differences in culture and social status of client and clinician and the difficulties in communicating and mutual understanding („doctor-patient relationship“)

11. Lay Health Beliefs & Explanatory Models

12. Lay Health Beliefs • Lay health beliefs refer to the set of beliefs held by individuals about their health (and how to maintain it), AND about all illness and diseases known to them. • An understanding of people’s ideas about health maintenance, disease prevention and causation is crucial to the success of health education and health promotion programmes, particularly in multicultural societies

13. Explanatory Models (EM)of particular illnesses • One way in which differences between lay and professional beliefs about health and illness have been conceptualised is the Explanatory Model Framework. • EMs are based on lay and professional health beliefs and are used in response to particular or specific illness episodes. They are developed and used to cope with a specific health problem. Kleinmann , A (1980) Patients and Healers in the Context of Culture. Berkley: UCLA Press.

14. Explanatory Models • Explanatory models (EMs) are the notions and beliefs about an episode of illness held by both lay individuals and health professionals. • EMs provide explanations ofsickness and treatment which guide choices among available therapies and therapists and which give personal and social meaning to the experience of sickness.

15. Explanatory Models • Structurally, it is possible to distinguish five major questions that EMs use to explain each illness episode: • 1. Aetiology (what caused the illness?) • 2. time and mode of onset of symptoms • 3. Pathophysiology (what happens in body?) • 4. course of sickness ( the degree of severity and whether it is chronic or acute) • 5. treatment