Transcultural Psychiatry

This section opens with a review of a study by M. K. OPLER who stresses the importance of knowing social, familistic and cultural processes in order to discover a relational system between culturally induced stresses and psycho pathology. H. B. M. MURPHY argues that the ways in which culture influences the development of delusion are more varied and more potent than are usually realized. N. A. CHANCE et al. compare Eskimo and Taiwan groups in relation to the hypothesis that more symptoms of personality maladjustment are to be found among people who identify with a modern society but who have little contact with that society, than among those who have a greater amount of intercultural contacts. Finally, a crosscultural analysis of types of explanations of disturbed behavior held in different societies is presented by J. D. DENKO.

Public attitudes towards mental illness have been widely studied, but the attitudes of psychiatric patients towards their hospitals have received less crosscultural attention. Using an attitude schedule, M. W. KAHN et al. com pared the attitudes of Korean psychiatric patients towards hospitalization with those of psychiatric patients in the U.S.A. Their investigations demonstrate that in hospitals in different countries patients can hold considerably different views of their situations and suggest that the differences noted have a cultural base.

Research observations by L. SECHREST in the Philippines have been reported in a previous issue of this Review (Transcultural Psychiatric Research IV (April I967), I8-25). Further studies by this investigator in the same cultural area concerned themselves with the concepts and management of mental disorder in a number of negro communities and with the relevance of sibling rank to psychopathology in Filipino patients. B. G. BURTON-BRADLEY reports from Papua and New Guinea on the practice of betel-nut chewing which is ultimately wrapped up with the social life and customs of the indigenes. A description is given of the association of betel-nut chewing with social functions and of its pathological effects. There are three fairly well defined syndromes associated with betel-nut chewing—habitation, addiction, and psychosis. R. I. LEVY discusses the reasons for the decline of alcoholism in the Society Islands of French Polynesia. In a previous issue of this Review (Transcultural Psychiatric ResearchIII (October I966), I03-I6) R. SALISBURY reviewed the literature on Possession on the New Guinea Highlands (with special reference to studies carried out by L. L. LANGNESS) and reported observations of his own among the Siane in New Guinea. The views expressed by SALISBURY gave rise to a discussion between L. L. LANGNESS and himself. This discussion is presented.

In accordance with a revival of interest in ancient etiological concepts of treatment of disease and in ancient methods of treatment of mental disorders in India, N. S. VAHIA et al. treated a number of patients—largely patients suffering from conversion hysteria, anxiety states or from psychosomatic disorders— in a traditional manner. The treatment procedures which they employed and the therapeutic results which they obtained are described. B. P. SHARMA noted differences in the frequency and nature of psychoneurotic symptoms between the rural and urban population of Nepal. Particularly common in urban psychoneurotic patients are symptoms related to sexual function. The nature of these symptoms is described and an explanation for the frequency of these disorders is offered.

J. H. ABRAMSON carried out a health questionnaire survey among 970 persons comprising a random sample of the adult population of a predominantly immigrant neighborhood of Jerusalem. He describes the implications of this survey for the epidemiology of emotional disorder in this neighborhood. Turkish folk beliefs involving the evil eye, sorcery and jinns as well as treatment of folk illnesses by religious mysticism and related procedures are described by O. M. ÖZTÜRK. A psychodynamic formulation is advanced to explain the persistence of folk therapies despite nearly twenty years of prohibitions out lawing their use.

M. and E. ORTIGUES explored the meaning of the Oedipus complex among Islamic tribal Senegalese. They suggest that for the Senegalese under study, rivalry of the son with his father is systematically displaced on to brothers, cousins and peers; that agressiveness is principally expressed in the form of persecutory ideas; and that separation anxiety appears to be the dominant equivalent of castration anxiety. R. GIEL and his associates reporting from Ethiopia stress the difficulties of establishing rapport with patients and of evaluating the clinical significance of the dramatically described and ethnically determined symptomatology. In a paper dealing with guilt emanating from transgression of culturally approved norms of sexual behavior, R. M. WINTROB suggests that in Liberia severe depressive symptomatology is warded off by displacement and projection. These ego-defence mechanisms give rise to a highly systematized complex of culturally shared beliefs in possession by malevolent supernatural powers. A. BOROFFKA describes a rapid increase in the habit of Cannabis smoking in the Lagos region of Nigeria. This increase is most notable among skilled workers, semi-Westernized and semi-alienated from traditional group membership. R. J. M. COLLIS in his study of mentally ill Yoruba patients explored the importance of physical illness, especially of lowgrade parasitic infection, for the development of psychopathology and for the treatment of psychiatric disorders. He utilized placebos, measures to counteract organic pathology, and psychopharmaceuticals as comparative treatment procedures and obtained highest levels of improvement with psychopharmaceuticals. S. K. WEINBERG noted in Ghana a recent decline in social status of native healers and an increasing tendency of the urban popu lation to consult faith healers for the treatment of mental disorders. He attri butes the decline in the social status of the native healers to detribalization, internal disorganization of the 'profession', official government discouragement and the spread of competing therapies. Based on clinical material and obser vations in the field, T. A. BAASHER describes folk treatment procedures in the Sudan; he analyzes in particular the relative therapeutic efficacy of the Zar cult, of witchcraft and of Islamic faith healing.

O. RIOS and M. DOBKIN, a Peruvian psychiatrist and an American anthro pologist (a) review the literature on ayahuasca, a South American plant con taining Harmine, (b) summarize earlier studies regarding its pharmacological and psychological effects, and (c) describe its use in folk healing in Peru.

The significance of social class is often stressed in relation to mental disease. In a study of German and Polish patients living in the United States, E. B. PIEDMONT found that ethnicity is more significant in regard to schizophrenic development than social class. Rates of mental illness are usually based on patients treated in psychiatric institutaons. J. G. BRUHN et al. show that cultural differences between communities must be taken into account when interpreting such rates. In a richly condensed publication, W. MADSEN summarizes beliefs, attitudes and practices in the field of disease, therapy and witchcraft found among the Mexican-Americans of South Texas. There follows a brief bibliographical review by T. J. BOAG of mental health problems among native and white groups in the Arctic. P. SINGER describes an attempt at group therapy with students recently arrived in the U.S. from India, and points out some specific problems which the Hindu tradition poses for such patients. In a fascinating sum mary of a case history of a patient with the 'mono-symptomatic' schizophrenic compulsion of hamburger hoarding, W. M. BOLMAN and A. S. KATZ analyze their data in comparison with descriptive accounts of the cannibalistic 'whitico' psychosis among Algonkian Indians of the Hudson Bay area of Canada.

C. SAFILIOS-ROTHSCHILD describes the problem which cultural attitudes towards mental disorders create for psychiatry in Greece.