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Depression and social change. From transcultural psychiatry to a constructivist model

Published online by Cambridge University Press:  11 October 2011

Mauro Giovanni Carta ,
Piero Coppo ,
Mario Antonio Reda ,
Maria Carolina Hardoy  and
Bernardo Carpiniello
Mauro Giovanni Carta*
Affiliation:
1Psychiatric Unit, Department of Public Health, University of Cagliari, Cagliari, Italy
Piero Coppo
Affiliation:
1Psychiatric Unit, Department of Public Health, University of Cagliari, Cagliari, Italy
Mario Antonio Reda
Affiliation:
2Institute of General and Clinical Psychology, University of Siena, Siena, Italy
Maria Carolina Hardoy
Affiliation:
1Psychiatric Unit, Department of Public Health, University of Cagliari, Cagliari, Italy
Bernardo Carpiniello
Affiliation:
1Psychiatric Unit, Department of Public Health, University of Cagliari, Cagliari, Italy
*
Indirizzo per la corrispondenza: Professor M.G. Carta, Unità di Psichiatria, Dipartimento di Salute Pubblica, Università di Cagliari, Via Liguria 13, 09127 Cagliari. Fax: +39-070-496.295 E-mail: mgcarta@tiscalinet.it
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Summary

Based on the findings of previous studies carried out by our group, which will be briefly summarised, the present paper puts forward several hypotheses to account for the evolution of depressive symptoms and the possible increase observed in risk of depression subsequent to social changes. The particular mood disorders presented by Senegalese emigrants and several protective factors which appear to determine a low risk in these populations, such as a strong social support, will be examined. Based on a previous investigation carried out by our group, which seems to indicate the presence of depressive pictures among poorly westernised populations such as the Peul nomads or Dogon farmers from the Sub-Saharian regions, the hypothesis that “westernalisation” (considered as the loss at an individual level of traditional ways of life, working habits, cultural patterns and languages in favour of different attitudes influenced by western culture) may represent a risk factor for depressive illness, in its clinical expressions commonly observed in western contexts, has been considered. In these populations, with the exception of educated individuals, the albeit rare depressive symptoms appear to be secondary to serious somatic disorders. Research performed identified two well-defined means of clinical expression, which has been termed, respectively, “western style” or “guilty” and “traditional” or “dislocation from the group”. Further studies carried out in rapidly changing areas seem to indicate how environmental factors are able to influence the evolution of depressive symptoms from the first form to the latter and to modify the threshold of onset of emotive, behavioural and depressive patterns. It has been hypothesised that rapid changes in the social organisation tend to exacerbate attitudes of “compulsive hyper-responsibilisation”, a cognitive set of basic assumptions which may be considered at the same time both as a product of “westernalization” at an individual level and a risk factor for depression. Individuals who possess these basic characteristics, subsequent to the opportunities afforded by the social changes, tend to develop new complex systems of interpreting reality, causality, controlling of events and ways of expressing emotions. Accordingly, we herewith propose a reviewal of the entire threshold concept and provide a means of interpreting the transformation in depressive phenomena in view of the fact that, although the new levels of knowledge and learning better equip subjects to face the new situations, they also render them more vulnerable to depression.

Riassunto

Sulla base di precedenti studi del nostro gruppo i cui risultati verranno sintetizzati, il lavoro avanza alcune ipotesi sull'evoluzione della sintomatologia depressiva e sul possibile incremento del rischio depressivo legato alle modificazioni sociali. Vengono esaminati i disturbi dell'umore in emigrati senegalesi ed i fattori protettivi quali uno stretto supporto sociale che sembrano determinare un basso rischio in queste popolazioni. Verrà analizzata l'ipotesi che l'“occidentalizzazione”, intesa come la perdita a livello individuale dello stile di vita tradizionale, delle abitudini lavorative, dei valori culturalmente determinati, della lingua, a favore delle attitudini influenzate dalla cultura occidentale, possa rappresentare un fattore di rischio per i disturbi depressivi, almeno nelle espressioni cliniche comuni nei contesti occidentali. Precedenti ricerche del nostro gruppo, sembrano infatti indicare la presenza di quadri depressivi in popolazioni scarsamente occidentalizzate quali i nomadi Peul o i contadini Dogon del Sub-Sahara, ma, in questo contesto, tuttavia, i sintomi depressivi, peraltro rari, appaiono secondari a disturbi somatici gravi, tranne che in individui scolarizzati. Le ricerche rilevano due distinte e contrapposte modalità di espressione clinica che vengono definite rispettivamente “occidentale” o della “colpa” e “tradizionale” o della “dislocazione dal gruppo”. Ulteriori indagini condotte in aree in rapida trasformazione sembrano indicare che i fattori ambientali possano influenzare l'evoluzione dei sintomi depressivi dall'una all'altra forma e modificare la soglia di scatenamento di schemi emotivo comportamentali depressivi. E' supposto che le perturbazioni dell'assetto sociale rendano adattive attitudini alia “iperesponsabilizzazione compulsiva”, una serie di convinzioni profonde che possono essere considerate allo stesso tempo come un prodotto dell'“occidentalizzazione” e come fattore di rischio depressivo. Gli individui dotati di tali caratteristiche di base, attraverso opportunità di vita offerte dal cambiamento sociale maturerebbero sistemi complessi e innovativi di interpretazione della realtà, di attribuzione della causalità e del controllo degli eventi, di vivere le emozioni. A partire da tale modello viene proposta una ridiscussione del concetto di soglia e una chiave di lettura della trasformazione della fenomenologia depressiva, se si ipotizza che i nuovi sistemi organizzativi della conoscenza, pur capaci di rispondere alle esigenze emergenti, espongano ad una maggiore vulnerability depressiva.

Keywords

transcultural psychiatrydepressionsocial changeAfricacognitive approachpsichiatria transculturaledepressionecambiamento socialeAfricaapproccio cognitivista.
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 10 , Issue 1 , March 2001 , pp. 46 - 58
Copyright
Copyright © Cambridge University Press 2001

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