Academic journal article South African Journal of Psychiatry

Considering the Cultural Context in Psychopathology Formulations

Academic journal article South African Journal of Psychiatry

Considering the Cultural Context in Psychopathology Formulations

Article excerpt

It has become apparent that psychiatric patients yearn for more than a diagnosis: they have a great need to appreciate their experiences from a cultural and social perspective. [1] Culture influences views and experiences during the course of one's life, which then have an influence on behaviour. Thus, persons of different cultures may articulate similar behavioural tendencies, but express them according to culturally sanctioned norms. [2]

Of significance is a culture's capacity to modulate emotional regulation. [3] In traditional African cosmology, for example, the symbiosis between the seen and unseen is unquestionably acknowledged. [4] Numerous theories focused on the composition of emotion do not illustrate the African experience effectively. [5] To illustrate such experiences, there appears to be a need for thorough assessment of cultural views on psychopathology. However, the need to explore cultural conceptualisations of psychopathology is not new. Edgerton [6] researched psychopathology in the traditional African domain and requested that research explore the cultural domain so in order to inform academia. Edgerton's primary concern was that modern nosologies misrepresent the cultural and social veracity of authentic cultural experience. To reframe these views, it appears that, in some clinical contexts, a culture of misunderstanding psychopathology has been observed.

In many ways cultures, relative to epochs and geographical contexts, determined the development of present-day psychopathology formulation. As such, the understanding of psychopathological symptoms has varied from place to place, time to time, and community to community. None of the formulations, however, appear to have received as much academic interest as the Western view of mental illness. Bhugra and Bhui [7] hold that the misdiagnoses of what they describe as Western-specific psychopathology may occur due to limited cultural awareness. This is particularly evident if one considers the body of knowledge signifying, for example, that auditory hallucinations are dependent on the pathoplastic influences of culture--that is, the ways in which psychological distress manifests. [7]

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?

Culture is a quality which is environmentally acquired, and should be viewed as containing beliefs, principles, standards, activities, and symbols. [3] It reflects mutual societal experiences, is conveyed cross-generationally, and transforms in due course. Culture is also self-sufficient, and consists of concrete and abstract components. Furthermore, a population's survival and acclimatisation are dependent on culture. Many aspects of culture, such as cultural principles, affect the manner in which people perceive and react. [3] Further, Reber and Reber [11] define psychopathology as the investigation of mental illness or anguish, or signs of behaviours and occurrences which may denote mental illness or psychological wounding. Hence, the terms psychopathology and serious psychological distress may be used interchangeably.


According to Wohl, [12] researchers and clinicians alike contend that therapists who work with patients from various cultures must aim to attain as much knowledge about a culture as possible, so as to develop insight into a patient's cultural influences. …

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