Cultural conceptions of mental disorder and psychiatric symptomatology in Hawaii's Japanese-American community
Description
This work questions the appropriateness of the positivist paradigm in psychiatry and the claim of universality for Western psychiatric nosology, and examines an alternative interpretative approach, George Devereux's ethnopsychiatric model, in the context of Hawaii's Japanese American subculture. In this psychoanalytically-oriented model, Devereux proposed that cultural conceptions (or 'thought models' in his terminology) of mental disorder: (a) define the nature and intensity of traumata to which insanity is seen as a justifiable response; (b) specify appropriate symptoms; (c) reflect conflicts present in the majority of normal individuals, and; (d) incorporate signal symptoms which are affronts to major cultural values and serve to announce the transition to the status of the mentally ill. In short, symptomatology is viewed as the culturally mediated expression of underlying mental disorder, and the recognition of mental disorder depends on conformity to thought model symptomatology rather than residual deviance as Scheff proposed A description of the Japanese American thought model of mental disorder was developed through informal interviews and an open-ended questionnaire. The symptom specifications of this thought model, which resemble schizophrenia, were compared with the behavior of Japanese American and European American psychiatric patients as recorded in their case records at the Hawaii State Hospital. As predicted by Devereux's model, the majority of Japanese American mental patients conformed symptomatically to the Japanese American thought model to a significantly greater extent than did patients of European American ancestry. The difference between the two ethnic groups was driven by those patients who carried diagnoses other than schizophrenia Although the psychiatric case records lacked sufficient detail to permit an adequate evaluation of Devereux's propositions pertaining to legitimate precipitating stresses, signal symptoms, and underlying conflicts, nothing was found that would discredit his model. On the basis of indirect evidence it is argued that the conflict underlying the Japanese American ethnic psychosis is related to the frustration of narcissistic needs The results of this study suggest that psychiatric nosology and diagnosis could be improved by making explicit the thought models upon which rest both clinical judgment and the patient's presentation