The lead author of the chapter, Cultural Consonance, Consciousness, and Depression: Genetic Moderating Effects on the Psychological Mediators of Culture, is Dr. William W. Dressler, a professor of Anthropology at The University of Alabama. His work on culture and health has taken place in many settings including urban Great Britain, the Southeast U.S., and, in particular, Brazil where he has conducted research for over 30 years. Two of his main collaborators in Brazil are Dr. Mauro C. Balieiro and Dr. José Ernesto dos Santos, the co-authors of this piece.

Dr. Mauro C. Balieiro is a professor in the Psychology department at The Paulista University (UNIP), a Brazilian university based in São Paulo. His research topics include clinical psychology, psychoanalysis, and depression.

Dr. José Ernesto dos Santos is a professor of Internal Medicine at the University of São Paulo. His skills and expertise include nutrition, metabolism, insulin resistance, and metabolic diseases to name a few.

Overview

Dressler, Balieiro, and dos Santos (2012) focus on gene-environment interactions with a particular emphasis on the environmental aspect of this interplay. The primary research described in the chapter takes place in urban Brazil and centers around how cultural consonance, a measure of how much people actually embody the prototype of a shared cultural model (described in detail below), interacts differently with individuals who possess variants of a genetic polymorphism that codes for a receptor in the serotonin system. Overall, the researchers found a significant relationship between an individual’s genotype and how strongly cultural consonance impacted depressive symptoms. This research provides preliminary evidence for how  genotype can influence the impact of stressful life experiences on an individual and also demonstrates the importance of looking closely at the “environment” in gene-environment interactions.

Cultural Consonance

Dr. William Dressler first described the theory of cultural consonance which measures the degree to which individuals live up to the shared model of prototypical beliefs and behaviors within a culture. In order to determine what is prototypical, cultural domain analysis and cultural consensus analysis are employed as the first steps in this research design.

Cultural domain analysis begins with individuals free listing terms that they associate with an area of life that has importance to them (e.g., lifestyles, social support, family life, national identity). Participants are then asked to sort these responses into piles so that terms that are similar are grouped together. The researcher does not specify the number of piles so it is up to each participant to decide how related the different responses are to one another. Through multidimensional scaling and cluster analysis, researchers can then graphically display how the terms are seen as similar and different.

The next step is to determine how much individuals agree on these groupings through cultural consensus analysis. The basic presumption here is that when individuals respond similarly to a set of questions, they are drawing on a shared knowledge base. By looking at correlations between participant’s responses, the researchers can then infer how much an individual understands the culture (referred to by the researchers as cultural competence).  

The results of the cultural consensus analysis are then used by the researchers to create a measure of cultural consonance for each domain. For example, when examining the cultural domain of family life, participants report how many of the items or behaviors apply to their family that were identified as being important in the cultural consensus analysis. A participant’s cultural consonance in a particular domain is then compared to some type of outcome variable, commonly depression. Research has found that individuals with lower cultural consonance tend to score higher on measures of depression and other negative health outcomes.

Gene-Environment Interactions

Dressler et al.’s research in Brazil looks at how  a single nucleotide polymorphism in the 2A receptor in the serotonin system (-1438G/A) interacted with cultural consonance in family life to predict depressive symptoms. The researchers found that cultural consonance in family life had a larger effect on individuals with the A/A variant as compared to those with the G/A or G/G variant. These results suggest that negative aspects in one’s social environment may result in some genotypes being more vulnerable to developing depressive symptoms than other genotypes. Importantly, in this situation it is neither the genotype nor the environment that is working in isolation; rather, it is the interaction of gene and environment that is important.

My Thoughts

I was very impressed with how the Dressler et al. chapter presented genetic research in a highly accessible manner. As we have discussed throughout this semester, creating writing that can be understood by a variety of audiences is crucial to interdisciplinary research. For instance, many of us struggled with the Balsters et al. article from earlier in the semester because it was written in a more technical language. If neuroanthropology is going to achieve its goal of uniting fields such as neuroscience and anthropology, it is important to make sure that there are pieces available that skip over some of the more complex aspects and summarize the main points.

With that being said, I would say that one drawback of cultural consonance research is that it can be a bit hard at first to wrap your mind around all of the terms due to the similarities of the words being used. For instance, it took me a little while when I first started reading this research to be able to discern the difference between cultural consensus vs. competence vs. consonance. I find this interesting because the concepts are not actually that hard to grasp and once you do get them sorted out in your mind, you cannot really understand where the confusion initially came from. However, I have noticed that I have to be careful when I am describing these ideas to people who are not familiar with this work because I can see the looks of confusion when I start using the terms too quickly. I am curious, did others who weren’t familiar with the cultural consonance literature find themselves confused with the terminology at first as well?

Discussion Questions

1.  What is the best way to define culture?
2.  How can Dressler et al.’s research be used to help individuals with depression?
3.  What did you think about the limitations of the Dressler et al. study and how could this research be improved?
4.  How could future research further test the link between “culture, consciousness, neurophysiology, and depression”?
5.  How does embodiment theory relate to cultural consonance?

Authors

This article, Applying Nepali Ethnopscyhology to Psychotherapy for the Treatment of Mental Illness and Prevention of Suicide Among Bhutanese Refugees, was co-written by two MDs, a photographer, and a medical anthropologist with a PhD and an MD. Brandon Kohrt and James L. Griffith both currently hold positions as medical doctors at the George Washington University School of Medicine and this is likely where their decision to collaborate on this study stemmed from.

Brandon Kohrt has both an MD and a PhD. He earned both of these degrees at Emory University in 2009 and has been working in Nepal since 1996. His work in Nepal has included conducting research and aiding victims of war. He is a medical anthropologist and a psychiatrist. Since 2006, Kohrt has worked with the Transcultural Psychosocial Organization and in 2010 he became a consultant to The Carter Center Mental Health Program Liberia Initiative. He currently holds an adjuct associate professor of psychiatry and behavioral sciences at Duke University and a medical faculty associate position at George Washington University in Washington DC.

James L. Griffith is an MD in psychiatry that he received at the University of Mississippi School of Medicine in 1976. He also received an MS in Neurophysiology from the same university in 1979. He is currently a professor and the chair of the Department of Psychiatry and Behavioral Sciences at George Washington University School of Medicine in Washington DC.

Sujen M. Maharjan is a photographer in Nepal.

Damber Timsina at the time that this study was published held a position at Grady Memorial hospital in Atlanta Georgia.

Background on the Conflict

If you’re like me and only somewhat remember talking about the Bhutanese during high school history but you don’t remember a whole lot about it then this section is for you. Bhutan is a small country in Asia that is settled between India and China and next to Nepal. During the 1990s, there was an effort made by the Bhutanese government to rid the country of Lhotshampas, or ethnic Nepalis. An elitist political group in Bhutan viewed this group of people as a cultural threat. During this time, Lhotshampas were beaten, attacked, and killed until the ethnic group was forced to flee Bhutan to neighboring Nepal. By 1996, over 100,000 Bhutanese refugees were living in camps in Nepal. This ethnic group has not been able to return to Bhutan since.

Overview

This article addresses the importance of personalized mental health treatment and the necessity of understanding a person’s background and culture when discussing delicate topics. The authors address how ethnographic practices can be integrated into neuroscience to make treatments more successful.

Part One: Neuroanthropology and Psychotherapy

Neuroanthropology is emphasized throughout this article as a means to bridge the gap between medical care and individual people. It is defined as “the enculturation of the nervous system”. Psychotherapy is the other important concept put forth in this article as a way to use psychological methods to help a person heal. The main components of psychotherapy are laid out as the hope for change, environmental and contextual factors, the relationship with the therapist, and a specific plan. Neuroanthropology steps in to explain the enculturation of a particular person so that a personalized plan can be draw up and so that the therapist knows how to interact with their patient to build a better relationship.

Part Two: From Ethnography to Ethnopscyhology

Ethnography is the primary fieldwork method utilized by cultural anthropologists. It’s a way for the anthropologist to tell the story of the particular culture that they are studying. This section of this article is explaining the process in which psychology has been able to take notes from cultural anthropology and create mental health treatment plans best suited for individuals from cultures other than that of the therapist. The ethnopschological work done for this study includes defining the divisions of self within the Nepali culture. These divisions include heart-mind, brain-mind, and soul. Without an understanding of these divisions, the Nepali refugees would have been unable to receive the help that they needed from their therapists.

One of the most important divisions in Nepali culture that of the brain-mind and the heart-mind. The heart-mind is related to emotional feelings such as sadness and depression while the brain-mind is focused on behavioral control issues. Ailments of the heart-mind that go untreated can often affect the brain-mind. Brain-mind disorders carry heavy social stigma in Nepali culture and knowledge of how to approach this cultural idea is imperative to properly treating mental health issues with Nepali patients.

Part Three: Psychotherapy for Nepali and Bhutanese Patients

Cognitive behavior therapy, interpersonal therapy, and dialectical behavior therapy are three methods that are commonly used with Ethnopscyhology because of how easily these methods can be adapted to fit the needs of the patients. An advantage of Ethnopscyhology is that the therapist is able to act as an ethnographer, meaning that they can communicate with their patient in a way that puts them as ease when discussing their home culture and allows both the patient and therapist to design a treatment plan that best fits the individual.

Cognitive Behavior Therapy

A technique designed by Aaron Beck to treat depression, the basic idea of this method is to tackle the ‘automatic thoughts’ associated with negative experiences. The example given in the article was that of a man who suffered seizures after his mother had a stroke and after he was relocated away from his parents upon entering the US. Through CBT, the man and his therapist were able to determine that his seizures were caused by his thoughts that if anything were to happen to his parents that it would be his fault. Through treatment, he was able to overcome these thoughts and develop healthier ways to handle his thoughts of guilt.

Interpersonal Therapy

Harry Stack Sullivan was the man who created the method of interpersonal therapy because he understood the importance of culture and saw the need to address relationships in psychiatric treatment. Based on the ethnographic data collected, the therapists working with the Nepali refugees are aware that issues regarding mental health often affect social status and family relationships. This method of therapy works to reduce relationship disputes and interpersonal sources of distress rather than focusing solely on the individual.

Dialectical Behavior Therapy

This method was developed by Marsha Linehan to help people who engaged in self-harm and suicidal behavior. The rate of suicide among the Nepali refugees is 35 of 100,000, which is higher than the national average of 21 of 100,000. At the point that this paper was written this method had not been directly applied to a Nepali refugee. The basic idea of this method is to alter the perceptions the patient has of their emotions and sensations of their stress. The main goal of this treatment method is to lower the rate of self-harm and suicidal behavior.

Part Four: Can Ethnopsychology Usefully Inform Mental Health Interventions in Other Populations?

 

Due to the understanding of Nepali culture, more personalized psychiatric treatment plans can be implemented. During treatment, the therapist was able to work with a fuller knowledge of the patient’s culture and was able to develop a plan that would treat the mental health issue at hand while lowering the social stigma of the disorder for the patient. Ethnopsychology can be used to create personalized treatment plans for patients of all cultures. Generalizations can be made from culture to culture while still altering certain aspects as needed to properly treat a patient.

Summary

It’s very important that the therapist is able to communicate with the patient to work through the issues that the patient is experiencing. In the case of the Nepali refugees, cognitive behavior therapy and interpersonal therapy have proven to be effective in improving the lives of the refugees following their move to the US. Using the same ethnographic processes of learning about new cultures and determining what is socially unacceptable and how the body is divided within these cultures is extremely important in developing the best treatment plan for a patient.

Discuss

1. How do you think the social stigma of certain mental illnesses impacts treatment here in the United States?
2. Explain how you would create a treatment plan for a refugee using Dialectical Behavior Therapy.
3. Where do you think the most stigma lies in our culture and which psychotherapy methods presented here in this article would be most useful in treating mental health illnesses here in our country?
4. Are there other places in our medical system that could benefit from ethnographic practices and an understanding of different cultures?