Standard psychiatric criteria for depression developed in the United States and United Kingdom are increasingly used worldwide to establish the prevalence of clinical disorders and to help develop services. However, these approaches are rarely sensitive to local and cultural expressions of symptoms or beliefs about treatment. Mismatch between diagnostic criteria and local understanding may result in underreporting of depression and underutilization of services. Little such research has been conducted in Malaysia, despite the acknowledged high rate of depression and low access to services. This study examines depression in Moslem Malay women living in Johor Bahru, Southern Peninsular Malaysia, to explore depression symptoms using the Structured Clinical Interview for DSM-IV. The 61 women interviewed were selected on the basis of high General Health Questionnaire scores from a large questionnaire survey of 1,002 mothers. The illustrative analysis looks at descriptions of depressed mood, self-depreciation and suicidal ideation, as well as attitudes toward service use. The women gave full and open descriptions of their emotional symptoms, easily recognizable by standard symptom categories, although somatic symptoms were commonly included, and the spiritual context to understanding depression was also prevalent. However, few women had knowledge about treatment or sought medical services, although some sought help from local spiritual healers. Attending to such views of depression can help develop services in Malaysia.
Turner's concepts of structure and anti-structure are applied to the culture-bound syndromes to demonstrate that they are dialectical aspects of cultural reality, The Malay cases of amok, latah and possession hysteria are discussed as instances of anti-structural behaviors that dramatize role-reversals and role-enhancement. The performers of these behaviors are not subjected to the Malay code of moral conduct. The supernatural ethos in Malay culture plays an important role in shaping tolerance towards them. Although this tolerance has been gradually eroded as a result of the introduction of Western psychiatry, the anti-structural status of these syndromes has not faded away but has assumed new meanings in terms of psychopathology.
The phenomenon of amok is reviewed in order to demonstrate the heuristic value of an ethno-behavioral model of culture-bound syndromes. The notion that culture-bound syndromes share underlying common disease forms is rejected. Instead, the ethno-behavioral model postulates that culture-bound syndromes consist of culturally specific behavioral repertoires legitimated by culturally sanctioned norms and concepts, but with both behavior and norms acquired in accordance with basic principles of human learning universal to all cultures. Consistent with this model, amok is shown to be a common behavioral pathway for multiple precipitants (which may or may not include disease pathology), but with a distinct form and conceptualization which can be traced to the social learning practices and beliefs of the Malay.
This paper examines the symbolic properties and cultural relevance of latah, a behavioral state noted in Malay and Indonesia since the 19th Century. Most interpretations of latah have been psychological, latah being perceived as a 'mental disorder.' In the following, it is concluded that latah is intimately related to other aspects of Malayo-Indonesian culture and that it is a well-known cultural pattern and not a mental disorder as such, though it may occur among persons, largely women, in a socially and psychologically marginal situation. Latah is a symbolic representation of marginality, and it is as appropriate to certain mythological and religious figures to the socially marginal.
The authors present evidence of an indigenous diagnostic system by which Malay culture defines Amok, and of the disparate relations between individual conceptualization, behavior, and tradition which contributes to the labeling process. Amok is viewed as a cultural prescription for violent behavior in response to a given set of conditions. It is not a disease but rather a behavioral sequence, perceived as illness, that may be precipitated by various etiological factors. Finally, evidence is presented to support the hypothesis that traditional forms of Amok are being replaced by new variants in which psychopathology is increasingly evident.
There is significant variation in the expression of schizophrenia across ethnically different populations, and the optimal structural and diagnostic representation of schizophrenia are contested. We contrasted both lifetime frequencies of DSM-IV criterion A (the core symptom criterion of the internationally recognized DSM classification system) symptoms and types/content of delusions and hallucinations in transethnic schizophrenia populations from Australia (n = 776), India (n = 504) and Sarawak, Malaysia (n = 259), to elucidate clinical heterogeneity. Differences in both criterion A symptom composition and symptom content were apparent. Indian individuals with schizophrenia reported negative symptoms more frequently than other sites, whereas individuals from Sarawak reported disorganized symptoms more frequently. Delusions of control and thought broadcast, insertion, or withdrawal were less frequent in Sarawak than Australia. Curiously, a subgroup of 20 Indian individuals with schizophrenia reported no lifetime delusions or hallucinations. These findings potentially challenge the long-held view in psychiatry that schizophrenia is fundamentally similar across cultural groups, with differences in only the content of psychotic symptoms, but equivalence in structural form.
The present study has explored the folk knowledge about the phenomenon of sleep paralysis in Pakistani society. The research aimed to gain a nuanced glimpse focusing on three major factors, culture, religion, and gender, that influence the lived experiences of those who face sleep paralysis. In this qualitative research, to have a holistic perception of indigenous knowledge about it, we selected both male and female participants who have experienced sleep paralysis. The findings indicate that there is an influence of Pakistani culture and religion regarding the experiences of the people with sleep paralysis, and gender is linked with the folklore on creatures that were linked to fairy tales and Islamic teachings. The study also revealed that Pakistani ethnic diversity has created a pool of versatility for identifying different experiences regarding sleep paralysis. These experiences were not just a part of the medical situation but portrayed the multicultural facets that are embedded in the individuals throughout their lives. Lastly, the study suggests that there is a complexity within the interactions between culture, religion, and gender on sleep paralysis. This needs to be further investigated to create culturally appropriate therapies that may have a favorable effect on both physical and mental health outcomes.