1.3. The socio-cultural approach to mental disorders

Micro social factors

• Micro-social factors are environmental influences that are limited to primary groups, whose member share direct, close and frequent relationships, such as families.

Macro social factors

• Macro-social factors are environmental influences on behavior playing out among secondary groups.
• Secondary groups are large groups of people that do not share direct and close relationships but defining characteristics (age, gender, socio-economic status, ethnicity, culture...)

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• Look up the symptoms of a mental disorder in the ICD-10 (http://alturl.com/9edtd)
• Explain how micro and macro-social factors might influence such behaviors

Micro social factors

• Micro-social factors are environmental influences that are limited to primary groups, whose member share direct, close and frequent relationships, such as families.
• Dysfunctional interpersonal interactions are a factor in the development of mental disorders.

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• Bruch (1973) : bulimia nervosa may originate in faulty learning processes that occured during childhood, when parents provided the child with food whenever they were dissatisfied.

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• O'Hara and Philips (1991) : the building relationship between mothers and newborn children can cause the romantic partner to develop depression

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• Lewis et alia (2011) studied 852 families with children born by assisted conception and found that the concordance rate for depression was the same (32%) for biologically related and unrelated mothers and children.
• This suggests a knock-on effect--that can run both ways

Macro social factors

• Macro-social factors are environmental influences on behavior playing out among secondary groups.
• Secondary groups are large groups of people that do not share direct and close relationships but defining characteristics (age, gender, socio-economic status, ethnicity, culture...)

Sociological factors

• Hudson (2005) evidenced a positive correlation between socio-economic status (SES) and mental health.
• He found a striking difference between lower and middle classes, and notably a very high correlation between unemployment and depression. There was virtually no difference between middle and upper classes.

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• The National Health Interview Survey (2012) evidence a positive correlation between education and mental health.
• 19% of those with less than a high school diploma frequently feel sad, worthless, and hopeless Only 5.2% of those with a BA or higher do

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• This might be a superficial correlation, reducible to the one evidence by Hudson (2005).
• But it might also be an added layer, less education leading to lower cognitive abilities to cope with negative circumstances

Cultural factors

• Culture can be defined as a shared mental framework made of representations, expectations, habits, values and norms.

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• Makino et alia (2004) : meta-analysis showing that eating disorders are more prevalent in the West than in the rest of the world.
• Lifetime prevalence of bulimia nervosa in females Western countries : 7.3% Non-Western countries : 3.2%

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• A possible explanation is the importance of body image, associated with a "thin ideal", in Western culture, which has been said to lead to "normative discontent"
• Becker et alia (2014)

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• In 1991, the World Health Organization compared prevalence rates of depression in 14 countries on 5 continents and found very low rates in Asian countries : USA : 6.4% China : 2.4% Japan : 1.9%

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• A possible explanation is that Asian cultures, being more collectivistic, offer greater social support and sense of belonging (compared to more individualistic Western cultures)

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• Asian countries such as China have high prevalence rates for neurasthenia
• The diagnosis resembles depression, but with a focus on physiological symptoms (generalized fatigue and pain)
• There is a tendency in Chinese culture to express emotional issues in somatic terms
• Traditional Chinese medicine focuses on energy flow (qi) imbalances

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• International comparisons are difficult because it is much harder to diagnose or simply survey populations in underdevelopped countries

Culture-bound syndromes

• Culture-bound syndromes are mental disorders specific to a given culture
• Koro (Genital retraction syndrome) is a SEA culture-bound syndrome consisting in a morbid fear to lose one's genitalia / nipples and associated wiht a culture stressing the importance of lineage

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• Culture might be a factor in the way people experience, express, and understand mental disorders
• Kleinman (1987) proposed a distinction between Disease : the biological anomaly behind the disorder Illness : the culturally shaped manifestation of the disorder