ETHOLOGY• Ethology is the systematic study of animal

behavior.• In 1973 theNobel Prize in psychiatry and

medicine was awarded to three ethologists, Karl von Frisch, Konrad Lorenz, and Nikolaas Tinbergen.

• Those awards highlighted the special relevance of ethology, not only for medicine, but also for psychiatry.

Konrad Lorenz

• Born in Austria, Konrad Lorenz is best known for his studies of imprinting.

• Imprinting implies that, during a certain short period of development, a young animal is highly sensitive to a certain stimulus that then, but not at other times, provokes a specific behavior pattern.

• Lorenz is also well known for his study of aggression. He wrote about the practical function of aggression, such as territorial defense by fish and birds.

• Aggression among members of the same species is common, but Lorenz pointed out that in normal conditions, it seldom leads to killing or even to serious injury. Although animals attack one another, a certain balance appears between tendencies to fight and flight, with the tendency to fight being strongest in the center of the territory and the tendency to flight strongest at a distance from the center.

NIKOLAAS TINBERGEN

• Born in the Netherlands, Nikolaas Tinbergen, a British zoologist, conducted a series of experiments to analyze various aspects of animals' behavior.

• He was also successful in quantifying behavior and in measuring the power or strength of various stimuli in eliciting specific behavior.

• Lorenz and Tinbergen described innate releasing mechanisms, animals' responses triggered by releasers, which are specific environmental stimuli. Releasers (including shapes, colors, and sounds) evoke sexual, aggressive, or other responses. For example, big eyes in human infants evoke more caretaking behavior than do small eyes.

KARL VON FRISCH

• Born in Austria, Karl von Frisch is most widely known for his analysis of how bees communicate with one another that is, their language, or what is known as their dances.

• His description of the exceedingly complex behavior of bees prompted an investigation of communication systems in other animal species, including humans.

CHARACTERISTICS OF HUMAN COMMUNICATION

• A human's communicative operations are based on two fundamentally different symbolization systems:

1. Nonverbal communication rests on the analogue principle, and

2. Verbal codification rests on the digital principle.

SUBHUMAN PRIMATE DEVELOPMENT

• An area of animal research that has relevance to human behavior and psychopathology is the longitudinal study of nonhuman primates. Monkeys have been observed from birth to maturity, not only in their natural habitats and laboratory facsimiles but also in laboratory settings that involve various degrees of social deprivation early in life. Social deprivation has been produced through two predominant conditions: social isolation and separation.

TREATMENT OF ABNORMAL BEHAVIOR

• Stephen Suomi demonstrated that monkey isolates can be rehabilitated if they are exposed to monkeys that promote physical contact without threatening the isolates with aggression or overly complex play interactions.

INDIVIDUAL DIFFERENCES

• Recent research has revealed that some rhesus monkey infants consistently display fearfulness and anxiety in situations in which similarly reared peers show normal exploratory behavior and play.

• Long-term follow-up study of these monkeys has revealed some behavioral differences between fearful and nonfearful female monkeys when they become adults and have their first infants.

• Fearful female monkeys who grow up in socially benign and stable environments typically become fine mothers, but fearful female monkeys who have reacted with depression to frequent social separations during childhood are at high risk for maternal dysfunction

EXPERIMENTAL DISORDERS

STRESS SYNDROMES

• Several researchers, including Ivan Petrovich Pavlov in Russia and W. Horsley Gantt and Howard Scott Liddell in the United States, studied the effects of stressful environments on animals.

• Pavlov produced a phenomenon in dogs, which he labeled experimental neurosis, by the use of a conditioning technique that led to symptoms of extreme and persistent agitation.

• Gantt used the term behavior disorders to describe the reactions he elicited from dogs forced into similar conflictual learning situations.

• Liddell described the stress response he obtained in sheep, goats, and dogs as experimental neurasthenia, which was produced in some cases by merely doubling the number of daily test trials in an unscheduled manner.

LEARNED HELPLESSNESS

• The learned helplessness model of depression, developed by Martin Seligman, is a good example of an experimental disorder. Dogs were exposed to electric shocks from which they could not escape. The dogs eventually gave up and made no attempt to escape new shocks. The apparent giving up generalized to other situations, and eventually the dogs always appeared to be helpless and apathetic.

• In connection with learned helplessness and the expectation of inescapable punishment, research on subjects has revealed brain release of endogenous opiates, destructive effects on the immune system, and elevation of the pain threshold.

UNPREDICTABLE STRESS• Rats subjected to chronic unpredictable stress

(crowding, shocks, irregular feeding, and interrupted sleep time) show decreases in movement and exploratory behavior; this finding illustrates the roles of unpredictability and lack of environmental control in producing stress. These behavioral changes can be reversed by antidepressant medication. Animals under experimental stress become tense, restless, hyperirritable, or inhibited in certain conflict situations.

DOMINANCE

• Being more dominant than peers is associated with elation, and a fall in position in the hierarchy is associated with depression.

TEMPERAMENT• Temperament mediated by genetics plays a role in behavior.• For example, one group of pointer dogs was bred for

fearfulness and a lack of friendliness toward persons, and another group was bred for the opposite characteristics. The phobic dogs were extremely timid and fearful and showed decreased exploratory capacity, increased startle response, and cardiac arrhythmias.

• Benzodiazepines diminished these fearful, anxious responses.

• Amphetamines and cocaine aggravated the responses of genetically nervous dogs to a greater extent than they did the responses of the stable dogs.

BRAIN STIMULATION

• Catecholamine production increases with self-stimulation of the brain area, and drugs that decrease catecholamines decrease the process.

• The centers for sexual pleasure and opioid reception are closely related anatomically.

• Heroin addicts report that the so-called rush after intravenous injection of heroin is akin to an intense sexual orgasm.

PHARMACOLOGICAL SYNDROMES

• With the emergence of biological psychiatry, many researchers have used pharmacological means to produce syndrome analogues in animal subjects.

• Two classic examples are the reserpine (Serpasil) model of depression and the amphetamine psychosis model of paranoid schizophrenia.

SENSORY DEPRIVATION

• The history of sensory deprivation and its potentially deleterious effects evolved from instances of aberrant mental behavior in explorers, shipwrecked sailors, and prisoners in solitary confinement.

PSYCHOLOGICAL THEORIES

• Anticipating psychological explanation, Sigmund Freud wrote: “It is interesting to speculate what could happen to ego function if the excitations or stimuli from the external world were either drastically diminished or repetitive. Would there be an alteration in the unconscious mental processes and an effect upon the conceptualization of time?”

• Indeed, under conditions of sensory deprivation, the abrogation of such ego functions as perceptual contact with reality and logical thinking brings about confusion, irrationality, fantasy formation, hallucinatory activity, and wish-dominated mental reactions.

COGNITIVE

• Cognitive theories stress that the organism is an informationprocessing machine, whose purpose is optimal adaptation to the perceived environment. Lacking sufficient information, the machine cannot form a cognitive map against which current experience is matched. Disorganization and maladaptation then result.

PHYSIOLOGICAL THEORIES

• The maintenance of optimal conscious awareness and accurate reality testing depends on a necessary state of alertness. This alert state, in turn, depends on a constant stream of changing stimuli from the external world, mediated through the ascending reticular activating system in the brainstem. In the absence or impairment of such a stream, as occurs in sensory deprivation, alertness drops away, direct contact with the outside world diminishes, and impulses from the inner body and the central nervous system may gain prominence.

ANTHROPOLOGY AND CROSS-CULTURAL PSYCHIATRY

4.6

• Anthropology is the study of human beings. The relationship between anthropology and psychiatry are mainly limited to cultural psychiatry: the definition of culture, interaction between it and the individual, culture-specific syndromes, and crosscultural differences in definitions of health, illness, and healing.

• In psychiatry, the increasingly acknowledged evidence of biological factors has altered the view of persons as largely determined by the outcome of relationships shaping children's earliest years. And, although anthropological cross-cultural studies have focused on differences as well as similarities in human beings, some anthropologists have emphasized that people cannot be independent of their cultures and that even the attempt to study cross-cultural behavior is a culturally bound viewpoint.

PSYCHOANALYTICAL THEORY

• Beginning with Sigmund Freud, psychoanalysts have applied their insights to cultural data. In his 1913 work Totem and Taboo, Freud described the earliest humans as a group of brothers who killed and devoured their violent primal father.

• This criminal act and the so-called totem meal made the brothers feel guilty. Consequently, they formulated rules to prevent similar acts from occurring, and these rules were the beginning of social organization.

MARGARET MEAD• In her Coming of Age in Samoa, published in 1928, Mead

described a society in the South Pacific in which adolescent turmoil “widely believed at the time to be universal” appeared not to exist. This was the result, she argued, of the unusual Samoan culture that nurtured open, nonpossessive sexual relationships among adolescents, encouraged communal child rearing, and denigrated aggressiveness and competitiveness.

• Her Coming of Age in Samoa (published in 1928) gave a favorable picture of many aspects of life in a “primitive” society and was influential in establishing an attitude of cultural relativism among many scientists and thinkers.

PSYCHOSOCIAL GROWTH

• The effects of early life experiences on adult mental health and the explanations for deviance or maladaptive behavior are still controversial issues. Psychodynamic psychiatrists and theorists rely on historical data about adverse experiences to explain later behavior; but new work shows that few experiences are irreversible. Some affection-deprived children described by John Bowlby were able to grow up capable of forming attachments if other experiences later in life were favorable. Similarly, many successful adults come from deprived or otherwise toxic homes and appear to be, or are, invulnerable to these stressors.

CROSS-CULTURAL DIAGNOSIS

• Jane Murphy and Alexander Leighton studied the incidence of psychiatric disorders cross-culturally.

• Certain conclusions emerged: (1) both the general category of psychologicaldeviance and at least several major syndromes appear to be characteristic of all cultures for which information is available;(2) some psychiatric disorders appear to be relatively or largely culture-specific; and (3) it is extremely difficult, if not impossible, to compare incidence or prevalence of most disorders cross-culturally.

MEDICAL ANTHROPOLOGY

• The sick role, whether in relation to psychological or physical illness, occurs in all cultures, but carries many different meanings and expectations.

CROSS-CULTURAL PSYCHIATRY• Cross-cultural psychiatry as practiced by both anthropologists and

psychiatrists has consisted of three closely related enterprises: (1) psychological anthropology, using psychodynamic and other psychological theory to interpret the relationship

among elements of society and culture; (2) comparative psychiatry, using formal epidemiological or less formal observational and clinical methods to describe

and analyze cross-cultural variations in incidence or prevalence of syndromes and symptoms; and

(3) medical anthropology, using traditional anthropological methods to elucidate cross-cultural variation in the social

and cultural construction of illness from disease, and in the elaboration of healing or care-taking roles and relationships.

• The text revision of the fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IVTR) provides an outline for a cultural formulation designed to assist in the systematic evolution and treatment of patients. The formulation calls for data on (1) the cultural identity of the patients, including ethnicity, involvement with original and host cultures, and language abilities; (2) the cultural explanations and idioms of distress used by patients and their community concerning their illness or situation; (3) the cultural factors impacting patients' social situations, including work, religion,and kin networks; (4) the cultural and social status differences between the patient and clinician that may affect assessment and treatment, including problems with communicating, negotiating a patient-clinician relationship, and distinguishing between normal and pathological behaviors; and (5) the formulation of an overall cultural assessment for diagnosis and care.

DEFINITIONS AND KEY CONCEPTS

CULTURE• Culture is a vast, complex concept that is used

to encompass the behavior patterns and lifestyle of a society, a group of persons sharing a self-sufficient system of action that is capable of existing longer than the life span of an individual and whose adherents are recruited, at least in part, by the sexual reproduction of the group members. Culture consists of shared symbols, artifacts, beliefs, values, and attitudes.

• Culture is learned through contact with family, friends, classmates, teachers, significant persons, and the media; the term for this process is enculturation.

• Adults, such as migrants or refugees, who only in part adopt the culture of a host society are said to be assimilated, whereas those who assume a new cultural identity consonant with that of the host culture are said to be acculturated.

SCOPE OF CULTURE

• Although the manifestations of culture are sufficiently broad to be considered almost infinite, the noted American anthropologist George P. Murdock described a long list of features considered to be universally present in the hundreds of societies studied by contemporary anthropologists.

RACE AND ETHNICITY

• Traditionally, race denotes human groupings that are biologically (and, in theory, genetically) determined. In fact, other contemporary biologists consider race to be poorly correlated with any measurable biological or cultural phenomenon. Although some characteristics of a given racial group (e.g., skin color) may appear phenotypically compelling, the use of the race to aggregate individuals displaying that characteristic may convey a false sense of distinctiveness and may imply the existence of a biological basis for such classification systems.

• On the other hand, ethnicity, a term increasingly preferred by cross-cultural researchers, connotes groups of individuals sharing a sense of common identity, a common ancestry, and shared beliefs and history.

CULTURE AND PSYCHOPATHOLOGY

• Culture is an all-pervasive medium for humans. It is driven by the human brain's unique ability to create images and symbols and structure them into complex wholes that, in turn, can drive brain function to produce defined behaviors and modulate instinctually driven ones. The ability to mediate biologicalfunctions via symbolic (and image) representation and manipulation is dramatically expanded in humans by the function of awareness or consciousness leading to the notion of the self.

CULTURAL IDENTITY

• DSM-IV-TR recommends that in assessing an individual's cultural identity, clinicians should note the individual's ethnic or cultural reference group.

• For immigrants and ethnic minorities, they should assess the degree of involvement with both culture of origin and host culture.

• The process of acculturation is once again key to understanding the psychological distress and psychopathology of immigrants. The three major sources of stress in the migration experience are (1) entry into the host society, frequently at lower occupational and social levels; (2) disruption of interpersonal relationships; and (3) the acculturation process.

CULTURE-BOUND SYNDROMES

• Extreme diversity is seen among the peoples of the world concerning the recognition, classification, and understanding of mental behavior symptoms.

• Western psychiatrists classify mental diseases according to the DSM-IV-TR and the tenth edition of the International Classification of Diseases (ICD-10), which are thought to reflect scientific categories.

• The DSM-IVTR and ICD-10 are not universally applicable; psychopathological syndromes exist, especially in non-Western cultures that do not fit the scientific nomenclature unless they are placed into the typicalcategory. These syndromes are perceived to be more influenced by culture than are most Western syndromes and, therefore, have been labeled culture bound.