Kleinman's cultural belief questions
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I'm reading an essay by Arthur Kleinman, "How Is Culture Important for DSM-IV," dissecting its extreme cultural biases and blind spots. Great stuff.
Brief notes follow - note that this is all simplified and primarily meant as notes to myself.
- The most clearly culturally universal mental illness are schizophrenia, bipolar disorder, major depression, and a set of anxiety disorders including panic disorder and OCD. Many others are solely western culture-bound phenomena. However, the course and symptoms of all illnesses may differ enormously across cultures. Schizophrenia is more severe and long-lasting in industrialized areas; non-western people often experience depression as a far more somatic illness, sometimes with no "depressed mood," and if they do experience that, may describe it as "emptiness/soul loss" rather than "sadness."
- Many cultures have normal experiences which may be misidentified as psychosis, from evangelical Christians who may normally be tempted by the Devil to Plains Indians who hear the voices of recently deceased relatives. Many cultures have normative experiences of being possessed, hearing voices, communicating with God, etc.
- Questions to ask clients/patients:
1. What do you call your illness? Is it an illness?
2. What do you think caused it?
3. Why did it start when it did?
4. What does your illness do to you? How does it work?
5. How severe is it? Will it have a short or long course?
6. What do you fear most about this illness?
7. What are the main problems that your illness has caused for you?
8. What is the normal treatment for this illness? What are you expected to do when you have this illness?
9. What do you hope to receive from treatment?
10. Are you following the prescribed treatment? If not, can you explain why?
I think these are great questions. Kleinman suggests making them part of a proposed cultural axis, to be asked to all clients, not just the ones who are singled out as "culturally different."
I'm reading an essay by Arthur Kleinman, "How Is Culture Important for DSM-IV," dissecting its extreme cultural biases and blind spots. Great stuff.
Brief notes follow - note that this is all simplified and primarily meant as notes to myself.
- The most clearly culturally universal mental illness are schizophrenia, bipolar disorder, major depression, and a set of anxiety disorders including panic disorder and OCD. Many others are solely western culture-bound phenomena. However, the course and symptoms of all illnesses may differ enormously across cultures. Schizophrenia is more severe and long-lasting in industrialized areas; non-western people often experience depression as a far more somatic illness, sometimes with no "depressed mood," and if they do experience that, may describe it as "emptiness/soul loss" rather than "sadness."
- Many cultures have normal experiences which may be misidentified as psychosis, from evangelical Christians who may normally be tempted by the Devil to Plains Indians who hear the voices of recently deceased relatives. Many cultures have normative experiences of being possessed, hearing voices, communicating with God, etc.
- Questions to ask clients/patients:
1. What do you call your illness? Is it an illness?
2. What do you think caused it?
3. Why did it start when it did?
4. What does your illness do to you? How does it work?
5. How severe is it? Will it have a short or long course?
6. What do you fear most about this illness?
7. What are the main problems that your illness has caused for you?
8. What is the normal treatment for this illness? What are you expected to do when you have this illness?
9. What do you hope to receive from treatment?
10. Are you following the prescribed treatment? If not, can you explain why?
I think these are great questions. Kleinman suggests making them part of a proposed cultural axis, to be asked to all clients, not just the ones who are singled out as "culturally different."