Body, mind, culture

Отделение психиатрии, школа медицины Га- i                                                вайского университета

Культура принадлежит к уникальным паттернам поведения и образа жизни, разделяемым группой людей, которые отличают ее от других. Центром культуры является система ценностей. Культуре научаются посредством приобщения к культурным ценностям, и она передается через поколения.

Body, Mind, and Culture: General Issues . Culture refers to the unique behavior patterns and lifestyle shared by a group of people, which distinguishes it from others. The core of culture is value system. Culture is learned by the process of enculturation and is transmitted through generations.

Culture defines the interpersonal relationship, including how to greet properly in social setting, as well as the boundary and distance of body need to be maintained between people of the same or different sex. For some culture it is expected to maintain proper physical distance while others it is permitted to be very close and intimate.

Culture perceives the erotic zone of body differently, and defines to what extent the body can be exposed – some are very permissive while others very conservative. People manipulate their body based on how they perceive beauty in their culture at a given time.

Culture may influence the perception and sensitivity to pain, and may perform self-injury of body for special psychological and cultural purpose.

Concept of Body and Mind in (Chinese) Traditional Medicine . Some traditional medicine, exemplified by the Chinese medicine, based on their medical knowledge in the past, hold unique views of the anatomy of body which is different from the knowledge of modern anatomy.

The concept of Yin and Yang is hold and the importance of balance between them is emphasized. In addition, there is the Five Elements Concept for categorizing everything, including the physical surrounding, the weather, the body organs, and the human emotion. It holds the concept of correspondence between macrocosm and microcosm, viewing the human body as a part of the total universal existence.

Most important is that, there is conceptual difference for relation between «mind» and «body. « For Eastern traditional view, mind is seen as closely related to body, a part of the whole. This is different from contemporary Western view that mind is sepa- rated from body, and mind is more superior hierarchically than body.

Body-Mind-Related Special Medical Issues . Pain Management – Pain is one of the most common complaints made by patients. However, pain is a difficult somatic complaint to assess, due to its entirely subjective nature. The complaint of pain subjects to the patients personality, innate tolerance of pain, attitude toward pain, style of presenting suffering to others, and possible gains for presenting such suffering. There is wide individual variation in the response to pain stimuli. The cultural background of the patient can be influential in this regard (Tseng & Streltzer, 2008).

Cosmetic Surgery – Culture perceives the beauty of body differently and some people may perform cosmetic surgery, such as of eye lids, nose, cheek, or breast, to meet such cultural perception of beauty. Removal of certain sex-related organ, such as breast or uterus may have severe psychological impact pending how culture perceives the importance of such sex-related part of body.

General Surgery – Based on unique cultural beliefs, some patients may have specific psychological reactions to certain surgical procedures.

Blood Transfusion . While it is common for people to be concerned about how much blood will be lost during an operation, in some cultures, blood is considered particularly vital, and there might be a strong wish to conserve it as much as possible. In such a case, blood transfusion is welcome to gain the needed vital body fluid. In contrast, certain religions, such as Jehovahs Witnesses, based on their cultural view of blood, might lead its members to refuse to accept a blood transfusion, even as a life-saving treatment.

Amputation of Extremities . Based on unique cultural beliefs, some patients may react strongly about the loss of their extremities. To lose a part of ones body may be interpreted as a loss of ones integrity.

Organ Donation and Transplantation: In spite of the remarkable medical technology that now exists for organ transplantations, relatively few people volunteer to donate their organs after death. The low rate of organ donation is observed among some ethnic groups. Lack of medical knowledge, reluctant to discuss death, and the belief that a body should be preserved intact are some of the major cultural factors limiting organ donation. Based on culture factor, people react differently regarding from whom to receive the organ for transplantation. For people of some culture, they prefer only from their own family members but not from the strangers (particularly from the criminals).

Autopsy – People of some cultures stress the importance to preserve the whole body without damage after the death. Therefore, it may be difficult to obtain agreement from the surviving family for the autopsy of the deceased.

Psychological Concept of Disorders of Body . Examples from Culture-Related Specific Psychiatric Syndromes.

Definition of Culture-Related Specific Psychiatric Syndromes – Culture-related specific psychiatric syndromes, (also called culture-bound syndromes), refer to certain psychiatric syndromes whose occurrence or manifestations are significantly related to cultural factors and thus warrant understanding and management primarily from a cultural perspective. Furthermore, its presentation is usually unique, with «specif-ic» clinical manifestation, thus, it is called a culture-related specific psychiatric syndrome (Tseng, 2001, pp. 211—263).

Primarily Body-Concerned Culture-Related Specific Psychiatric Syndromes:

Frigophobia (Fear of excessive cold): Based on Yin and Yang concept, the patient suffers from morbid fear of catching cold.

Koro (Genital-retraction anxiety): The patient is morbidly concerned that his penis is shrinking excessively and dangerous consequences (such as death) might occur.

Voodoo death (Magic-fear-induced death): The sudden occurrence of death associated with taboobreaking or curse fear.

Clinical Implications of Assessment, Interaction, and Examination . Patients Presentation of Problems – How to present problems and to describe symptoms subjects to various factors including the patients educational level, medical knowledge, motivation for treatment, as well as culturally patterned modes of problem presentation. It is important to be aware that whether a patient focuses more on somatic symptoms or psychological problems will be influenced by his understanding of the suffering, his motivation for seeking care, but also will be shaped by the cultural influences (Tseng, 2003).

Doctor-Patient Relation and Interaction – Culturerelevant doctor-patient physical interaction and interpersonal relationship needs to be stressed (Tseng, 2003).

The Physical Examination – Most patients understand and accept the intrusion on their personal boundaries that occur during a medical examination, even when they would not accept such bodily contact in any other situation. Sometimes, however, cultural considerations become important not only related to the perception and reaction to the intrusion of personal boundaries, but also the meaning of the parts of the body, including which parts are considered «pri-vate» or «erotic».

Implications for Psychotherapy . For the practice of healing of mind, it is important to be aware conceptually of the hierarchical distinction of body and mind versus holistic view of body and mind. Competent therapists need to understand symbolic meaning of body organs and somatic symptoms, and be familiar with and understanding of «body lan-guage» expressed by the patients. As therapeutic procedure, it is essential to maintain holistic approach including body, mind, and interpersonal aspects.