Case Conference

Why this case?

Cultural influences on a human being, particularly among those suffering from personality disorders.

(Perspective)

Biological - Psychological – Social

35 years old female came to the clinic with low mood , easy fatigability and sleeplessness …..

Perspective

Biological - Psychological – Social

35 years old female with borderline personality disorder came to the clinic with low mood , easy fatigability and sleeplessness….

Perspective

Biological - Psychological – Social

35 years old female with borderline personality disorder came to the clinic with low mood , easy fatigability and sleeplessness due to cultural pressure of ……

A Question?

How the cultural trends which can precipitate an illness on axis I in a

predisposed (including axis II) population can be addressed ?

Discussion

Non-marriage rates Why non-marriage rates are high or

getting high? Culture “Control Mechanism” Belongingness hypothesis Cultural materialism My patient

Past

3 decades ago, non-marriage could be considered an aberration in the family-centered world of South-East and East Asia.

(Jones, 1994: Chapter 3)

1970 - 1990 Women remaining single at age 30-34 rose

from 2 % to 1 1 %Taiwan; from 8 % to 14 % in Thailand; from 6 %to 15 % in Peninsular Malaysia; and from 9 % to 1 9 % in Myanmar in 1990

Increased proportion of women in the better educated categories having higher non-marriage rates.

(National institute of statistics et al., 2001)

Reactions to the rise in non-marriage

lack potential partners lack of opportunity to meet potential

partners in favorable settings. Demise of the arranged marriage

system

(Simon, 1991)

Why non-marriage rates are high or getting high?

1. Where the economic feasibility of marriage is high, prevalence and timing of marriage will be affected

2. Where marriage is highly desirable particularly for females, it will not be earlier

3. Practicalities of living 4. Revolution in female education &

employment opportunities for women(Watkins, 1984; Dixon, 1978; Smith, 1983)

Cont.

1. Waiting for potential partners over an extended period will not only raise age at marriage but also reduce prevalence.

2. Wherever marriage decisions are controlled by parents, marriage will be more prevalent.

3. A desire by women for greater equality in marital relations

(Watkins, 1984; Dixon, 1978; Smith, 1983)

Behavioral perspective

The increasing prevalence of notions of individualism and growing acceptability of non-marital relationships.

Gavin W.Jones, 2005

Culture

Cultures are more than language, dress & food customs. Cultures are like underground rivers that run through our lives and relationships, giving us messages that shape our perceptions, attributions, judgments and ideas of self and other.

Michelle LeBaron, 2003

“Control Mechanism”

A unique set of regulating ideas-that shapes the individual into a unique kind of individual.

Every culture is made up of symbolic devices for the behavioral control, for giving life goals, set of definitions for himself and of others.

Clifford Geertz, 1966

Belongingness hypothesis

Human beings have a pervasive drive to form and maintain at least a minimum quantity of lasting, positive, and significant interpersonal

relationships.

Roy F. Baumeister. 1995

Cultural Materialism

The notion is based on the assumption that human culture is now primarily shaped by the economic needs and opportunities, and so historical, anthropological, sociological, and other cultural patterns should mainly be analyzed with reference to economic causes.

Harris, 1974

Cultural trends in South East Asia

Peer pressure Social enquiry Collectivism versus individualism

The Psychiatric Consequences of Social Norms

Frustration Anger Depression Abandonment Isolation Rebellion

What is our role here?

Psychopharmacology Psychotherapy (Cognitive structures)

Social remedy?

Thank you