Disorders of culture: the need to understand ‘why’ before you study.
My aim here is to highlight the need to take culture and social aspects into account when talking about and diagnosing disorders. It’s important that we do not study disorders blindly, without context. It could lead to misjudgements about causes and underlying problems
The rise in knowledge of and about many disorders has also increased the rise in non professionals taking an interest. This in turn has caused more problems of individuals faking disorders or they become ‘cool’ or interesting within groups of people. This has been discussed as the development of different versions of a disease. For example one of the well known groups of disorders this has happened in is eating disorders. They are specifically shaped by social and cultural development. Different causes cause a disease to be expressed in different ways, so when researching it is vital you know the social factors surrounding the disorder you are studying. The study of anorexia for example has identified many social and cultural risk factors, for example being female, in a place of rapid social change that is industrialised and democratic are all associated with a higher chance of getting the disease. As Katzman and Lee (1997) stated, with eating disorders becoming thinner is often not the objective, but what is critical is a fear of losing control of oneself. This manifests as a social problem, and a disorder of culture. In more industrialised countries there is more free choice this is often linked with more people feeling like they have less control, we are told we can be who we want to be, and do what we enjoy, for many this is a choice they would rather not have.
Another example of culture affecting psychological disorders has become apparent as we have been able to study the increasing development of Asian countries, particularly China and Japan. (Pike & Borovy, 2004). Japanese women were thought to be more protected culturally from disorders of eating by living in a stable, and family orientated country. They typically have lower levels of weight related health problems. However, Japanese women living in England and the US are at a greater risk of developing eating disorders. This clearly shows a cultural link. Back in Japan, since the 70’s, data shows increases in documented cases. (You have to take into account that a part of this will be due to having more doctors/psychologists to do the diagnosing, and the ability to out a name to disorders that were already occurring).
Other cultural factors that have a big influence are traditions and trends of a country. For an industrialised country Japan remains an outlier of how gender is separated within work. For other countries a more equal outlook has been embraced, this has been absent in Japan. A more traditional approach for women is accepted, where maturity comes with having children yourself: this message is passed down within families and school, where a 12 year curriculum of domestic education takes place (specified by the ministry of education). This development and focus on motherhood causes there to be no clear intermediate age between child and adult (our teenage years) making few ways other than motherhood a way to become a mature adult. This is not just a social ideal but a paradigm at the core of the country: for example, a divorced woman is not automatically allowed city funded housing, whereas a divorced mother is. This focus on motherhood and therefore the lack of adolescence was seen with less of the disorders we see in teenagers.
Although I focused here on Japan as an example: what I am trying to highlight is that a disorder we think we know can be incredibly differenent depending on the social and cultural situation of the person. When researching disorders we should never study a participant without this context, particularly with disorders that seem to descend from culture.
- Pike & Borovy (2004). The rise of eating disorders in Japan. Culture, Medicine and Psychiatry 28: 493–531, 2004. DOI: 10.1007/s11013-004-1066-6
- Katzman & Lee (1997). Beyond Body Image: The Integration of Feminist and Tran cultural Theories in the Understanding of Self Starvation. International Journal of Eating Disorders 22:385–394.