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Depression and social change. From transcultural psychiatry to a constructivist model

Published online by Cambridge University Press:  11 October 2011

Mauro Giovanni Carta ,
Piero Coppo ,
Mario Antonio Reda ,
Maria Carolina Hardoy  and
Bernardo Carpiniello
Mauro Giovanni Carta*
Affiliation:
1Psychiatric Unit, Department of Public Health, University of Cagliari, Cagliari, Italy
Piero Coppo
Affiliation:
1Psychiatric Unit, Department of Public Health, University of Cagliari, Cagliari, Italy
Mario Antonio Reda
Affiliation:
2Institute of General and Clinical Psychology, University of Siena, Siena, Italy
Maria Carolina Hardoy
Affiliation:
1Psychiatric Unit, Department of Public Health, University of Cagliari, Cagliari, Italy
Bernardo Carpiniello
Affiliation:
1Psychiatric Unit, Department of Public Health, University of Cagliari, Cagliari, Italy
*
Indirizzo per la corrispondenza: Professor M.G. Carta, Unità di Psichiatria, Dipartimento di Salute Pubblica, Università di Cagliari, Via Liguria 13, 09127 Cagliari. Fax: +39-070-496.295 E-mail: [email protected]
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Summary

Based on the findings of previous studies carried out by our group, which will be briefly summarised, the present paper puts forward several hypotheses to account for the evolution of depressive symptoms and the possible increase observed in risk of depression subsequent to social changes. The particular mood disorders presented by Senegalese emigrants and several protective factors which appear to determine a low risk in these populations, such as a strong social support, will be examined. Based on a previous investigation carried out by our group, which seems to indicate the presence of depressive pictures among poorly westernised populations such as the Peul nomads or Dogon farmers from the Sub-Saharian regions, the hypothesis that “westernalisation” (considered as the loss at an individual level of traditional ways of life, working habits, cultural patterns and languages in favour of different attitudes influenced by western culture) may represent a risk factor for depressive illness, in its clinical expressions commonly observed in western contexts, has been considered. In these populations, with the exception of educated individuals, the albeit rare depressive symptoms appear to be secondary to serious somatic disorders. Research performed identified two well-defined means of clinical expression, which has been termed, respectively, “western style” or “guilty” and “traditional” or “dislocation from the group”. Further studies carried out in rapidly changing areas seem to indicate how environmental factors are able to influence the evolution of depressive symptoms from the first form to the latter and to modify the threshold of onset of emotive, behavioural and depressive patterns. It has been hypothesised that rapid changes in the social organisation tend to exacerbate attitudes of “compulsive hyper-responsibilisation”, a cognitive set of basic assumptions which may be considered at the same time both as a product of “westernalization” at an individual level and a risk factor for depression. Individuals who possess these basic characteristics, subsequent to the opportunities afforded by the social changes, tend to develop new complex systems of interpreting reality, causality, controlling of events and ways of expressing emotions. Accordingly, we herewith propose a reviewal of the entire threshold concept and provide a means of interpreting the transformation in depressive phenomena in view of the fact that, although the new levels of knowledge and learning better equip subjects to face the new situations, they also render them more vulnerable to depression.

Riassunto

Sulla base di precedenti studi del nostro gruppo i cui risultati verranno sintetizzati, il lavoro avanza alcune ipotesi sull'evoluzione della sintomatologia depressiva e sul possibile incremento del rischio depressivo legato alle modificazioni sociali. Vengono esaminati i disturbi dell'umore in emigrati senegalesi ed i fattori protettivi quali uno stretto supporto sociale che sembrano determinare un basso rischio in queste popolazioni. Verrà analizzata l'ipotesi che l'“occidentalizzazione”, intesa come la perdita a livello individuale dello stile di vita tradizionale, delle abitudini lavorative, dei valori culturalmente determinati, della lingua, a favore delle attitudini influenzate dalla cultura occidentale, possa rappresentare un fattore di rischio per i disturbi depressivi, almeno nelle espressioni cliniche comuni nei contesti occidentali. Precedenti ricerche del nostro gruppo, sembrano infatti indicare la presenza di quadri depressivi in popolazioni scarsamente occidentalizzate quali i nomadi Peul o i contadini Dogon del Sub-Sahara, ma, in questo contesto, tuttavia, i sintomi depressivi, peraltro rari, appaiono secondari a disturbi somatici gravi, tranne che in individui scolarizzati. Le ricerche rilevano due distinte e contrapposte modalità di espressione clinica che vengono definite rispettivamente “occidentale” o della “colpa” e “tradizionale” o della “dislocazione dal gruppo”. Ulteriori indagini condotte in aree in rapida trasformazione sembrano indicare che i fattori ambientali possano influenzare l'evoluzione dei sintomi depressivi dall'una all'altra forma e modificare la soglia di scatenamento di schemi emotivo comportamentali depressivi. E' supposto che le perturbazioni dell'assetto sociale rendano adattive attitudini alia “iperesponsabilizzazione compulsiva”, una serie di convinzioni profonde che possono essere considerate allo stesso tempo come un prodotto dell'“occidentalizzazione” e come fattore di rischio depressivo. Gli individui dotati di tali caratteristiche di base, attraverso opportunità di vita offerte dal cambiamento sociale maturerebbero sistemi complessi e innovativi di interpretazione della realtà, di attribuzione della causalità e del controllo degli eventi, di vivere le emozioni. A partire da tale modello viene proposta una ridiscussione del concetto di soglia e una chiave di lettura della trasformazione della fenomenologia depressiva, se si ipotizza che i nuovi sistemi organizzativi della conoscenza, pur capaci di rispondere alle esigenze emergenti, espongano ad una maggiore vulnerability depressiva.

Keywords

transcultural psychiatrydepressionsocial changeAfricacognitive approachpsichiatria transculturaledepressionecambiamento socialeAfricaapproccio cognitivista.
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 10 , Issue 1 , March 2001 , pp. 46 - 58
Copyright
Copyright © Cambridge University Press 2001

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References

Abas, M.A. & Broadhead, J.C. (1997). Depression among women in an urban setting in Zimbabwe. Psychological Medicine 27, 59–71.CrossRefGoogle Scholar
Ainsworth, M.D.S. (1978). Patterns of Attachment Assessed in the Strange Situation and at Home. Lawrance Erlbaum: Hillsdale.Google Scholar
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Diseases (DSM-1I1-R), 3rd. ed. rev. American Psychiatric Press: Washington DC.Google Scholar
Arieli, A. & Aycheh, S. (1992). Psychopathology among Jewis Ethiopian immigrants to Israel. Journal of Nervous and Mental Diseases 7, 465–466.CrossRefGoogle Scholar
Asberg, M., Montgomery, S.A., Perris, C, Schalling, D. & Sedvall, G. (1978). A comprehensive psychopathological rating scale. Ada Psychiatrica Scandinavica, Supplementum No. 271, 5–27.CrossRefGoogle Scholar
Awas, M., Kebede, D. & Alem, A. (1999). Major Mental Disorders in Butarjira, southern Ethiopia. Ada Psychiatrica Scandinavica, Supplementum No. 397, 56–64.CrossRefGoogle ScholarPubMed
Bastide, R. (1971). Le Principe d'Individualisation (Contribution a Une Philosophic Africaine). Colloques Internationaux du CNRS. La Notion de Personne en Afrique Noire. CNRS: Paris.Google Scholar
Bebbington, P. (1990). Population surveys of psychiatric disorder and the need for treatment. Social Psychiatry and Psychiatric Epidemiology 25, 33–40.CrossRefGoogle ScholarPubMed
Bertschy, G., Viel, J.F. & Ahyi, G.G. (1992). Depression in Benin: an assessment using the Comprehensive Psychopathological Rating Scale on the principal component analysis. Journal of Affective Disorders 25, 173–180.CrossRefGoogle ScholarPubMed
Bhagwanjee, A., Parekh, A., Paruk, Z., Petersen, I. & Subedar, H. (1998). Prevalence of minor psychiatric disorders in an adult African rural community in South Africa. Psychological Medicine 28, 1137–1147.CrossRefGoogle Scholar
Bitinie, A. (1981). The clinical manifestations of depression in Africa. Psychopathologie Africaine 17, 36–40.Google Scholar
Blackwell, G. (1992). L'evolution politique au Malawi. Afrique Contemporaine 162, 3, 17–25.Google Scholar
Bowlby, J. (1980). Loss, Sadness and Depression. Hogarth: London.Google Scholar
Carta, M.G., Carpiniello, B. & Rudas, N. (1991a). L'emigration senegalaise et marocaine en Sardaigne. Psychopathologie Africaine 23, 329–352.Google Scholar
Carta, M.G., Morosini, P. & Rudas, N. (1991b). Mental disorders in Sardinia. Psychological Medicine 121, 1061–1071.CrossRefGoogle Scholar
Carta, M.G., Coppo, P., Carpiniello, B. & Mounkuoro, P.P. (1997). Mental disorders and health care seeking in Bandiagara. A community survey in the Dogon plateau. Social Psychiatry and Psychiatric Epidemiology 32, 222–229.CrossRefGoogle ScholarPubMed
Carta, M.G., Coppo, P., Reda, M.A., Mounkuoro, P.P. & Carpiniello, B. (1999). Psychopathology in the Dogon plateau: an assessment using the QDSM and principal components analysis. Social Psychiatry and Psychiatric Epidemiology 34, 282–285.CrossRefGoogle ScholarPubMed
Carta, M.G., Carpiniello, B., Dazzan, P. & Reda, M.A. (2000). Depressive symptoms and occupational role among female groups: a research in a south-east African village. Psychopathology 32, 240–245.CrossRefGoogle Scholar
Collignon, R. (1982). Expression corporelle et milieu cultural. La Revue du Praticien 32, 937–944.Google ScholarPubMed
Collomb, H. (1965). Assistence psychiatrique en Afrique: experience senegalaise. Psychopathologie Africaine 1, 41–54.Google Scholar
Collomb, H. (1978). Les aspects culturels des depressions. Revue du Praticien, 28, 3025–3031.Google Scholar
Collomb, H. & Collignon, R. (1974). Les coduites suicidaires en Afriques. Psychopathologie Africaine 10, 55–113.Google Scholar
Coppo, P. (1984). Syndromes nevrosiques et retard mental dans une communaute rurale africaine: enquete epidemiologique. Psychologie Medical 16, 1273–1276.Google Scholar
Coppo, P. (1993). Essai de Psychopathologie Dogon. CRTM: Perugia.Google Scholar
Coppo, P. & Keita, A. (1990). Medicine Traditionaille. Acteurs et Itineraires Terapeutiques. Edizioni E: Trieste.Google Scholar
Coppo, P. & Keita, A. (1993). Essai de Psychopathologie Dogon. CRMT: Bandiagara, Mali,Google Scholar
Csikszentmihalyi, M. (1993). The Evolving Self. A Psychology for the Third Millennium. Harper Collins: New York.Google Scholar
De Ganays, S. (1941). Les Denises des Dogons. Institut d'Etnologie: Paris.Google Scholar
Dhadphale, M., Ellison, R.H. & Griffin, L. (1983). The frequency of psychiatric disorders among patients attending semi-urban and rural general out-patients clinic in Kenya. British Journal of Psychiatry 142, 379–383.CrossRefGoogle ScholarPubMed
Diop, M.C. (1982). Le fenomene associatif mouride en ville: expression du dynamisme confrerique. Psychopathologie Africaine 17, 293–318.Google Scholar
Ebin, V. (1991). Laissez venir a moi vos peuples, vos emigrants extenue, Psychopathologie Africaine 23, 365–386.Google Scholar
Field, L. (1960). Search of Secutity. North Western University Press: Boston.Google Scholar
Giel, R. & Van Lujik, J.N. (1968). Psychiatric morbidity in a rural village in South-Western Ethiopia. International Journal of Social Psychiatry 115, 149–162.Google Scholar
Gillis, L.S., Lewin, S.B. & Slebbet, M. (1968). Psychiatric disorders among the coloured of the Cape Peninsula. British Journal of Psychiatry 114, 1575–1587.CrossRefGoogle ScholarPubMed
Griaule, M (1948). Dieu d'Eau. Fayard: Paris.Google Scholar
Guidano, V.F. (1988). Selfhood Processes and Life Span Development. Guilford: New York.Google Scholar
Harding, T.W., De Arango, M.V., Baltazar, J., Climent, C, Ibrahim, H.H. A., Ladrido-Ignacio, L., Srinivasa Murthy, R. & Wig, N. (1980). Mental disorders in primary health care: a study of their frequency and diagnosis in four developing countries. Psychological Medicine 10, 231–241.CrossRefGoogle ScholarPubMed
Hollifield, M., Katon, W., Spain, D. and Pule, L. (1990). Anxiety and Depression in Village in Lesotho, Africa: A comparison with the Unites States. British Journal of Psychiatry 156, 343–350.CrossRefGoogle Scholar
Kebede, D. & Alem, A. (1999a). Major mental disorders in Addis Ababa, Ethiopia. II. Affective disorders. Acta Psychiatrica Scandinavica, Supplementum No. 397, 18–23.CrossRefGoogle Scholar
Kebede, D. & Alem, A. (1999b). Major mental disorders in Addis Ababa, Ethiopia. III. Neurotic and somatoform disorders. Acta Psychiatrica Scandinavica, Supplementum No. 397, 24–29.CrossRefGoogle Scholar
Kiev, A. (1972). Transcultural Psychiatry. Free Press: New York.Google Scholar
Kleiner, R.I. & Parker, I. (1979). Social psychological aspects of migration. In Behaviour in New Environments (ed. Brody, E.D.). Sage: Beverly Hills, CA.Google Scholar
Kohn, R., Dohrenwend, B.P. & Mirotnik, J. (1998). Epidemiological findings on selected psychiatric disorders in the general population. In Adversity Stress and Psychopathology (ed. Dohrenwend, B.P.). Oxford University Press: Oxford.Google Scholar
Koumare, B., Diaoure, R. & Miguel Garcia, E. (1992). Definition d'un instrument de depistage des trouble psychique. sychopathologie Africaine 24, 229–242.Google Scholar
Leff, J. (1990). The new cross cultural psychiatry. A case of the baby and the bathwater. British Journal of Psychiatry 156, 305–307.CrossRefGoogle ScholarPubMed
Leighton, A.H., Lambo, T.A., Hughes, C.C., Leighton, D.C., Murphy, J. & Mac Macklin, B.D. (1963). Psychiatric Disorders among the Yoruba. Cornell University Press: New YorkGoogle Scholar
Lemoine, P., Cappadoro, R. & Marie Cardine, M. (1981). La depression chez les travailleurs maghrebin immigres. Psychopathologie Africane 17, 160–170.Google Scholar
Littlewood, R. (1990). From categories to context: a decade of the new cross cultural psychiatry. British Journal of Psychiatry 156, 308–327.CrossRefGoogle ScholarPubMed
Louiz, H., Ben Nasr, S., Salhi, J.E., Ghaoui, S. & Ben Hadji Ali, B. (1999). Delirium and allucination in depression: cultural aspects. Encephale 25, S3, 22–25.Google ScholarPubMed
MacLachlan, M., Maluwa Banda, D. & McAulifer, E. (1995). Epidemic disturbances in a malawian secondary school: a case study in social change. Psychology and Developing Societies 7, 79–90.CrossRefGoogle Scholar
Makanjoula, J.D.A. & Olaifa, E.A. (1987). Masked depression in Nigerians treated at the neuro-psychiatric hospital Aro, Abeokuta. Acta Psychiatrica Scandinavica 76, 480–485.CrossRefGoogle Scholar
Mavreas, V.G. & Bebbington, P.E. (1988). Greeks, British Greeks Cypriots and Londoners: a comparison of morbidity. Psychological Medicine 18, 433–442.CrossRefGoogle ScholarPubMed
Montgomery, S.A. & Asberg, M. (1979). A new depressed scale designed to be sensitive to change. British Journal of Psychiatry 134, 382–389.CrossRefGoogle ScholarPubMed
Murphy, H.B. (1978). The advent of guilt feeling as common depressive symptom: a historical comparison on two continent. Psychiatry 41, 229–249.CrossRefGoogle Scholar
Murphy, H.B. (1980). Depression nerveuse croyance a la Sorcellerie et development du surmoi. Psychopathologie Africaine 16, 171–194.Google Scholar
Nathan, T. (1996). Principi di Etnopsicoanalisi. Bollati Boringhieri: Torino.Google Scholar
Neeleman, J. & Wessely, S. (1999). Ethnic minority suicide: a small area geographical study in London. Psychological Medicine 29, 429–436.CrossRefGoogle Scholar
Orley, J. & Wing, J.K. (1979). Psychiatric disorders in two African villages. Archives of General Psychiatry 36, 513–520.CrossRefGoogle ScholarPubMed
Patel, V., Musara, T., Butau, T., Maramba, P. & Fuyane, S. (1995). Concepts of mental illness and medical pluralism in Harare. Psychological Medicine 25, 485–493.CrossRefGoogle ScholarPubMed
Pisani, L., True, M. & Walet Oumar, F. (1990). Colloque Medicine Traditionaille. CMRT: Bamako.Google Scholar
Reda, M. (1986). Sistemi Cognitivi Complessi e Psicoterapia. La Nuova Italia Scientifica: Roma.Google Scholar
Rudas, N. (1991). L'emigration envisge comme perte. Psychopathologie Africaine 3, 287–304.Google Scholar
Sylla, O. & Mbaye, M. (1991). Psychopathologie e migration: a propos d'un cas de Wotal. Psychopathologie Africaine 23, 353–364.Google Scholar
Tafari, S., Aboud, F.E. & Larson, C.P. (1991). Determinants of mental illness in a rural Ethiopian population. Social Science and Medicine 32, 2, 197–201.CrossRefGoogle Scholar
Zempleni Rabain, J. (1979). L'Enfant du Lignage. Du Sevrage a la Classe d'Age chez les Wolof. Payot: Paris.Google Scholar