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This chapter focuses on the evidence regarding the social and cultural determinants of mental health. It examines the role of culture in psychiatry, and the historical evolution of research on the cultural influences on psychiatric concepts and classification. The study of culture on mental health has been profoundly influential in guiding the clinician in managing psychiatric disorders in persons of different culture. The chapter considers four major social determinants of mental disorders: poverty, gender, conflict and the marginalisation experienced by indigenous communities across the world. From a public health perspective, an understanding of mechanisms of the relationship between social adversity and mental health can inform primary and secondary preventive strategies. The chapter ends with a critical evaluation of the contemporary understanding of the role of cultural influences on the aetiology, clinical presentation, treatment and outcome of mental disorders.
Polarisation of biological and psychosocial aspects of psychiatry has promoted a form of Cartesian dualism. Current knowledge of the interaction between biology and psychology makes it possible to consider a truly integrative approach to treatment.
The aim of this overview is to consider conceptual models of how psychotherapy may affect the brain.
The literature discussing the mutual influence of genes and environment is surveyed. Relevant data involving the influence of psychotherapy on the brain are also reviewed.
Research findings suggest that the brain responds to environmental influence through the alteration of gene expression; that psychotherapy has specific measurable effects on the brain; and that implicit memory may be modified by psychotherapeutic interventions.
Advances in neuroscience research have led to a more sophisticated understanding of how psychotherapy may affect brain functioning. These developments point the way towards a new era of psychotherapy research and practice in which specific modes of psychotherapy can be designed to target specific sites of brain functioning.
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