2017 depression and culture: etic or emic ? can memetics help?
TRANSCRIPT
In many parts of Chinese society, the experience of depression is physical rather than psychological.
Culture and DepressionArthur Kleinman, M.D.N Engl J Med 2004; 351:951-953
Etic – Emic Approaches
ETIC* Phonetic
* Pronunciation rules
* external categorization* Global - Universal* More structured
EMIC* Phonemic:
* sounds produced
* Within culture interpretation* Local – specific - Relativistic
Combinations within ICD/DSM-ologyDepressive Disorder F32.0
A. Low mood
Loss of interest
Low energy
1. Appetite (decrease, increase)
2. Body weight (decrease, increase)
3. Sleep (decrease, increase)
4. Psychomotor (decrease, increase)
5. Libido loss
6. Low self esteem
7. Guilt, self blame
8. Irritability, worry
9. Thoughts of death …Suicide Ideation
B.
8 combinations
126 combinations
Study Associated features of depressed mood/sadness
Bolton et al., 2012 “thinks a lot with hand on chin,” “makes people sick” “person is unstable/unbalanced/cannot think straight” “food does not taste good/unable to eat,” “because of sadness the person stays alone”
Halbreich et al., 2007
loss of pleasure, risk-taking behaviors irritability,
Kaiser et al., 2014 “thinking too much,” “distance in one's thoughts,” “becoming quiet, cannot cry”“sadness really lies in one's thoughts”
Lim et al., 2013 “spirit fall” “the heart falls down”
Meyer et al., 2014 “thinking too much,” “afraid of the boss,” “not earning enough money,” “think about the future,” “lack of everything”
Murray et al., 2006 “worries,” “losing sleep,” “thinking too much,” “losing appetite,” “withdrawal,” “loneliness,” “suffering inside” “feeling hopeless,
How is depression experienced around the world?A systematic review of qualitative literature
https://doi.org/10.1016/J.SOCSCIMED.2016.12.030
World Mental Health Surveys: 12 month prevalence of MOOD
disordersKessler & Üstün, 2008 CUP
0% 2% 4% 6% 8% 10% 12%
United StatesUkraine
FranceNetherlands
ColombiaLebanonBelgium
SpainMexico
ItalyGermany
JapanPRC Beijing
PRC ShanghaiNigeria
Prevalence
* 1952 DSM I * 1968 DSM-II * 1980 DSM-III* 1987 DSM-III-R* 1994 DSM-IV* 2000 DSM-IV-TR* 2013 DSM 5
* ICD-6 * ICD-8* ICD-9
* ICD-10
* ICD-11
• IN YOUR LIFETIME• TWO WEEKS OR LONGER
• NEARLY EVERY DAY• SAD
• EMPTY• DEPRESSED
• FOR MOST OF THE DAY
* Criterion Equivalence
The CIDI Depression Questions relate to the same established criteria of ICD/DSM
* Content Equivalence
Depression exists and is measured
* Semantic Equivalence
Same meaning is given to Depression literally & culturally
* Technical Equivalence
CIDI questions allow the measurement of Depression in the same way
* Metric Equivalence
Same item-response characteristics exist
* Conceptual Equivalence
Underlying the Depression, the same construct is being measured
Cross- cultural Applicability of CIDI
1. Depression is expressed in both physical and psychological symptoms* What you get is what you ask – how you ask* Stem Questions vs Symptom Clusters
2. Most invariant symptoms in depression:* Loss of vitality – slowing down * Thoughts of death and suicidality varies due to culture
3. Whatever the symptomatology is FUNCTIONING decreases
“Personal” Summary
* Phenomenology
* Psychopathology
* Syndromes
* Clinical Intuition
* Expert Consensus
P h e n o t y p e s
N e u r o s c i e n c e
P h y s i o l o g y
E p i d e m i o l o g i c a l
Va l i d a t i o n
E v i d e n c e b a s e
Change of Paradigm
Depression“Dysregulation of mood homeostasis”
* Stuck in ‘blues’ ( Area 25 )
* Hypothalamus: * Appetite, energy,
* Brain Stem & RAS* Sleep
* Amygdala & insula* Anxiety, mood
* Hippocampus* Memory processing, attention
* Frontal Cortex* Self-esteem, insight
Emotion
Cognition
* Human babies are born into a culture* Culture is everything that humans have
created against nature:* Gender, sexuality, …* Religion* Education* Social structures* …..
* DNA of CULTURE = “Meme”* Monkey like human-cub grows into a child
that implicitly acquires:* incest taboo …* aspirations …* sexual orientation …
Humans Culture&