GLOBAL PERSPECTIVES ON PSYCHOPATHOLOGY
1. A global perspective on psychopathology involves understanding how mental disorders
are defined, perceived, and treated across different cultures and societies.
2. This approach recognizes that mental health and illness are influenced by a wide range of
factors, including cultural norms, socioeconomic conditions, political environments, and
historical contexts.
3. A global perspective on psychopathology highlights the complexity and diversity of
mental health issues across the world.
4. It underscores the importance of considering cultural, socioeconomic, and political
contexts in understanding and addressing mental health.
5. By acknowledging these differences and working towards inclusive and culturally
competent mental health systems, we can better meet the needs of diverse populations
globally.
I. Cultural Definitions and Perceptions of Mental Illness
1. Cultural Relativity
• Definition Variability: Mental illness definitions vary widely across cultures. What one
culture considers a disorder may be seen as normal in another.
• For instance, hearing voices is often seen as a sign of spiritual communication in some
cultures, while it is typically considered a symptom of psychosis in Western medicine
(Watters, 2010).
• A study by Kirmayer et al. (2014) highlighted that cultural concepts of distress influence
the way symptoms are reported and understood, leading to different diagnostic practices.
2. Stigma and Discrimination
• Impact of Stigma: Stigma associated with mental illness can lead to social exclusion and
prevent individuals from seeking help. This stigma varies by culture, affecting how
mental health is addressed (Corrigan, Druss, & Perlick, 2014).
• Yang et al. (2007) found that stigma related to mental illness in China leads to significant
social disadvantages, including reduced marriage prospects and employment
opportunities.
3. Cultural Syndromes
• Culture-Specific Disorders: Certain mental health conditions are unique to specific
cultures. For example, "koro" is a syndrome in some Asian cultures involving the fear
that one’s genitals are retracting into the body (Prince, 2009).
• Research Example: Kleinman (1988) described "neurasthenia" in China, a condition
characterized by fatigue, weakness, and emotional disturbance, which aligns with
depression but is culturally framed differently.
II. Diagnostic Criteria and Classification Systems
1. Western Models
• DSM and ICD: The DSM-5 and ICD-11 are primary classification systems used
globally. However, their Western-centric development means they might not fully
capture mental disorders in other cultural contexts (Patel, 2014).
• Research Example: A study by Kohrt et al. (2014) discussed the limitations of DSM-
5 in diagnosing PTSD in non-Western contexts, highlighting the need for culturally
adapted criteria.
2. Indigenous Systems
• Traditional Diagnoses: Various cultures have indigenous systems for diagnosing and
treating mental illness. For example, Ayurveda in India and traditional Chinese medicine
offer holistic approaches to mental health (WHO, 2013).
• Research Example: Patel et al. (2016) reviewed how traditional healers in African
countries diagnose and treat mental disorders, often incorporating spiritual beliefs.
III. Epidemiology of Mental Disorders
1. Prevalence Rates
• Global Variability: The prevalence of mental disorders varies due to genetic,
environmental, and cultural factors. For instance, depression is more prevalent in
high-income countries, while schizophrenia shows consistent rates worldwide (Vos et
al., 2016).
• Research Example: The WHO’s Global Burden of Disease study (2017) provides
comprehensive data on the prevalence of mental disorders globally, showing
significant variations.
2. Impact of Socioeconomic Factors
• Socioeconomic Influence: Poverty, conflict, and limited access to healthcare
exacerbate mental health issues. Countries with ongoing conflicts, like Syria, report
high rates of PTSD and depression (Steel et al., 2009).
• Research Example: Lund et al. (2011) found a strong correlation between poverty
and mental health disorders in low- and middle-income countries.
IV. Treatment and Interventions
1. Biomedical Treatments
• Access to Care: Biomedical treatments, including medication and psychotherapy, are
common in high-income countries but less accessible in low-income countries
(Thornicroft et al., 2010).
• Research Example: Saxena et al. (2007) discussed the treatment gap in mental health
services, highlighting that up to 85% of people with severe mental disorders in low-
income countries receive no treatment.
2. Traditional and Complementary Therapies
• Role of Traditional Healers: In many cultures, traditional healers are the primary
mental health care providers. Their practices often include herbal remedies, spiritual
rituals, and community support (Patel et al., 2016).
• Research Example: A study by Nortje et al. (2016) reviewed the effectiveness of
traditional healing practices in sub-Saharan Africa, finding them integral to mental
health care in the region.
3. Community-Based Approaches
• Task-Shifting: Training non-specialists to deliver mental health care is an effective
strategy in resource-limited settings. This approach, known as task-shifting, expands
access to care (Patel et al., 2011).
• Research Example: Van Ginneken et al. (2013) demonstrated the success of task-
shifting in delivering mental health interventions in low- and middle-income
countries.
V. Global Mental Health Initiatives
1. WHO Initiatives
• WHO Programs: The WHO’s mhGAP provides guidelines and resources to scale up
mental health services in low-resource settings (WHO, 2010).
• Research Example: Eaton et al. (2011) evaluated the mhGAP program, showing its
positive impact on mental health care availability in several low-income countries.
2. International Collaborations
• Global Efforts: Organizations like the Global Mental Health Alliance work to reduce
the global burden of mental disorders through research, policy advocacy, and capacity
building (Lancet Global Mental Health Group, 2007).
• Research Example: The Lancet Commission on Global Mental Health and
Sustainable Development (2018) called for integrating mental health into universal
health coverage and sustainable development goals.
VI. Challenges and Barriers
1. Resource Limitations
• Funding and Infrastructure: Many countries lack adequate funding and
infrastructure for mental health services, leading to significant care gaps (WHO,
2013).
• Research Example: A report by the WHO (2014) highlighted the disparity in mental
health funding, with low-income countries spending less than 1% of their health
budget on mental health.
2. Cultural Barriers
• Cultural Competence: Effective mental health care requires cultural competence to
understand and respect diverse cultural beliefs and practices (Kirmayer, 2001).
• Research Example: Kleinman and Benson (2006) emphasized the need for cultural
competence in global mental health care to ensure appropriate and effective treatment.
3. Policy and Advocacy
• Mental Health Policies: Strong policies and advocacy are needed to improve mental
health awareness and integrate mental health into primary care (Patel et al., 2018).
• Research Example: The Mental Health Atlas (WHO, 2017) provides data on global
mental health policies, showing significant variation in policy development and
implementation.
VII. Future Directions
1. Research and Data Collection
• Culturally Sensitive Research: More research is needed to understand the cultural
nuances of mental disorders and develop appropriate interventions (Patel et al., 2014).
• Research Example: Bolton (2001) advocated for ethnographic methods in mental
health research to capture cultural specifics and improve intervention outcomes.
2. Integration of Services
• Primary Care Integration: Integrating mental health services into primary care is
crucial for improving access and reducing stigma (WHO, 2013).
• Research Example: Patel et al. (2018) discussed the benefits of integrating mental
health into primary health care systems, particularly in low- and middle-income
countries.
3. Education and Awareness
• Reducing Stigma: Increasing awareness and education about mental health can
reduce stigma and encourage individuals to seek help (Corrigan et al., 2014).
• Research Example: Thornicroft et al. (2016) reviewed anti-stigma campaigns and
their effectiveness in changing public attitudes towards mental illness.
Virtual Autism
1. Virtual autism, sometimes referred to as screen-based autism, is a term used to describe
the overuse or misuse of electronic gadgets and virtual platforms among children.
2. The term was popularized by Dr. Marius Zamfir, a Romanian clinical psychologist, who
observed an increase in autism-like symptoms among children with high screen time
(Zamfir, 2014).
3. This overexposure can lead to social isolation, behavioral issues, and inadequate
emotional growth.
4. The prevalence of virtual autism has increased due to the growing popularity of video
games and social media platforms among children.
5. The accessibility and immersive nature of these digital platforms have contributed to the
rise in screen time and its potential impact on social and communication skills.
6. Children with virtual autism often experience difficulties in processing non-verbal social
cues, maintaining eye contact, using appropriate facial expressions, and engaging in
reciprocal conversations.
7. These challenges in social interactions can lead to difficulties in building and maintaining
relationships.
8. Additionally, excessive screen time can contribute to behavioral issues such as
aggression, irritability, and impulsivity.
9. Sleep disturbance is also commonly observed in children who are constantly engaged
with virtual platforms.
10. Understanding the definition, prevalence, and symptoms of virtual autism is crucial for
identifying and addressing the challenges associated with excessive screen time.
11. By recognizing the signs and effects of virtual autism, parents and caregivers can take
proactive measures to promote a healthy balance between virtual interactions and real-life
social experiences.
Global perspectives on VA
Across the world, children are spending more time on screens. A report by Common Sense
Media (2019) found that children under eight in the United States spend an average of over
two hours per day on screens.
Cultural Variations: Parenting Practices: Different cultures have varying practices and
norms regarding screen use. In some Asian countries, for instance, high screen time is often
observed due to educational apps and e-learning platforms (Dong et al., 2020).
Socioeconomic Influences: In low-income countries, access to screens may be less
prevalent, potentially reducing the incidence of virtual autism. However, as technology
becomes more accessible, these regions might see a rise in related issues
Parental Supervision: In families where parents are working long hours or multiple jobs,
children might be left with screens for prolonged periods, increasing the risk of developing
virtual autism symptoms.
DSM and Language Change
DSM-IV (1994) and DSM-IV-TR (2000)
• Gender Identity Disorder: Continued to be used, but with growing criticism for
pathologizing transgender identities.
• Critical Reception: Advocates and researchers argued that the term "disorder"
implied that being transgender was inherently pathological, contributing to stigma and
discrimination (Drescher, 2010).
DSM-5 (2013)
• Gender Dysphoria: The term "Gender Identity Disorder" was replaced with "Gender
Dysphoria." This change was significant for several reasons:
o Focus on Distress: The new terminology aimed to shift the focus from the
identity itself being a disorder to the distress caused by the incongruence between
experienced gender and assigned sex. This change was intended to reduce stigma
and emphasize the clinical need to alleviate distress (American Psychiatric
Association, 2013).
o Improved Access to Care: By maintaining a diagnostic category, individuals
could still access necessary medical and psychological care, such as hormone
therapy and counseling.
Telepsychology
1. Telepsychology is the process of providing psychological services through
telecommunication technologies.
2. Distance therapy is psychotherapy that is not performed in face-to-face sessions but
instead provided through telephone, videoconference, or audioconference.
3. E-therapy is a form of distance therapy conducted through a webcam, text messaging,
email, or chat rooms.
Providers can use telepsychology to treat a wide variety of issues. For example, the APA
has cited studies noting that it can be effective in treating:
Providers can use telepsychology to treat a wide variety of issues. For example, the APA has
cited studies noting that it can be effective in treating:
a) Adjustment disorder
b) Anxiety
c) Depression
d) Eating disorders
e) Post-traumatic stress disorder
f) Substance use
The APA has cautioned, however, that more research is necessary to determine whether
telepsychology is effective in treating serious mental illnesses such as psychotic disorder or
schizophrenia. Similarly, more research is necessary on its effectiveness when conducting
group therapy or in treating individuals with comorbidities (multiple disorders).
The benefits of telepsychology are numerous. A 2020 Medical News Today report noted that
it has:
1. Increased access to care, for example, for clients who live where it is difficult to obtain
services or for clients who have mobility challenges
2. Reduced client costs associated with receiving care, such as transportation or child care
3. Strengthened clients’ sense of privacy by eliminating the need to sit in waiting rooms
4. Helped reduce the spread of COVID-19 by allowing clients to remain in their homes
Providers themselves also have benefited. For example, telepsychology can:
1. Expand a provider’s client base
2. Reduce a provider’s cost of doing business (for example, by eliminating the need to lease
an office and pay for the cost of utilities)
The APA also has noted that telepsychology can reduce the stigma that some clients may feel
about physically entering an office to receive care; as a result, it can serve as a new entry
point to help ease clients into obtaining care.
Widespread Adoption
• Pandemic Acceleration: The COVID-19 pandemic necessitated a rapid shift to
telepsychology globally as lockdowns and social distancing measures limited in-
person interactions.
• Geographic Reach: Telepsychology has enabled access to psychological services in
remote and underserved areas, where mental health resources are often scarce (Ghosh
et al., 2020).
Challenges
Technological Barriers
• Digital Divide: Access to reliable internet and suitable devices is not uniform
globally, creating disparities in the availability and quality of telepsychology services
(Van Daele et al., 2020).
• Technical Issues: Connectivity problems, software glitches, and lack of technical
proficiency among users can hinder effective service delivery (Stoll et al., 2020).
Privacy and Confidentiality
• Data Security: Ensuring the confidentiality and security of patient data is a major
concern. There is a risk of data breaches and unauthorized access to sensitive
information (Luxton et al., 2016).
Future Directions
Hybrid Models
• Combining Approaches: Hybrid models that combine telepsychology with in-person
sessions could provide a balanced approach, leveraging the strengths of both methods
(Totten et al., 2016).
• Flexible Care: Offering flexible care options can accommodate patient preferences
and logistical needs, potentially enhancing engagement and outcome
APPLICATION AND METHODS
1. Early Intervention: Enables prompt action, preventing problems from worsening and
improving outcomes.
2. Treatment Planning: Guides the development of individualized treatment plans to address
specific needs.
3. Objective Assessment: Provides standardized measures of symptoms and functioning,
reducing bias.
4. Progress Tracking: Allows monitoring of symptom changes over time to evaluate
treatment success.
5. Research and Evaluation: Helps researchers understand the prevalence, causes, and
effects of mental health issues.
6. Stigma Reduction: Normalizes mental health concerns by presenting them as treatable
conditions.
Types of Screening Measures
1. Self-Report Measures: Individuals complete questionnaires about their own symptoms
and experiences (e.g., BDI, GAD-7).
2. Parent/Teacher Report Measures: Parents or teachers report on a child's behavior and
emotional state (e.g., CBCL, YSR).
3. Standardized Interviews: Clinicians administer structured interviews to gather detailed
information (e.g., Diagnostic Interview Schedule).
4. Observational Measures: Clinicians or researchers observe behavior in a controlled
setting (e.g., during play therapy).
Behaviour Health Screening Tools
Adolescent Domain Screening Inventory (ADSI) The ADSI is lpeer, and school. It is self-
administered in around 10 minutes. Scoring indicates kids who are at-risk and high-risk in
each of the four areas, as well as on the overall scale. Columbia Depression Scale (CDS) The
Columbia Depression Scale (DCS) is a 22-item self-report that screens adolescents aged 11
and above for depression and suicide. Questions focus on feelings and actions over the
previous four weeks. There are instruments for both adolescents and parents. Scoring
directions indicate the amount of risk and the percentage of adolescents who score in each
risk area. Columbia Teen Screen owns the rights to this tool, however it can be used for free
with the creators' consent.
NIAAA Screening Questions for Alcohol Abuse T
he National Institute on Alcohol Abuse and Alcoholism (NIAAA) provides a two-question
screener for alcohol abuse. An age-specific risk chart informs the classification of low,
moderate, and high risk. More information is available in the National Institute of Health
press release "NIH releases clinician's guide for screening underage drinkers". NIAAA also
publishes Alcohol Screening & Brief Intervention for Youth: A Practitioner's Guide.
Pediatric Symptom Checklist (PSC)
The Pediatric Symptom Checklist (PCS) is a 35-item self-administered instrument for
detecting cognitive, emotional, and behavioral disorders in children and teens aged 4 to 16.
There are two versions: parental and kid. The entries on each checklist are parallel. The
parent checklist may be used with children as young as four years old. The youth checklist
can be given to teenagers as young as 11 years old. The PSC is accessible in sixteen
languages.
