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Biomedical subjects

H Fabrega

Publications and source records attributed to H Fabrega.

At least 19 recordsLinked to original sources
PubMed1992

The role of culture in a theory of psychiatric illness.

A medical theory of phenomena thought of as psychiatric would rely on concepts and seek explanations that pertain to the concerns of biomedicine. A social theory of the psychiatric needs concepts and seeks explanations that pertain to concerns of the social and cultural sciences. Some of the requirements of such a social theory are reviewed with an emphasis on why and how the concept of culture is important. The Western medical bias of psychiatric illness needs to be faced as well as the problem of cultural relativism. The paper discusses the heuristic usefulness of a concept of human behavioral breakdowns. The many ways in which culture influences knowledge and practice of biomedical psychiatry are examined critically. The scope of a social theory of the psychiatric is also outlined.

Anthropology, Cultural↗
PubMed1992

Culture, social structure, and quandaries of psychiatric diagnosis: a Vietnamese case study.

In contemporary psychiatry diagnosis is arguably the most important concern of a clinical evaluation insofar as it operates as a scaffolding for therapeutic plans and recommendations. Implicit in the theory and lore of diagnosis is that disorders exist as naturalistic entities possessed of a distinctive form and course. In the event of a complex clinical presentation, a psychiatrist resorts to multiple diagnoses and the use of a rule-out diagnosis, (or several rule-outs). The first practice reflects the dictum of comorbidity. Rule-out diagnoses, on the other hand, support the idea that in some instances extensive anamnesis, observation, and laboratory examination are required in order to establish the true identity of a clinical presentation. The way psychiatrists use the system of diagnosis when examining persons from their own society has been shown to reveal commonalities that conform to a systemic culture pattern (Fabrega et al. 1990a). With these subjects, then, our system of diagnosis works in the sense that it supports widely held assumptions and rationales. In this paper we present a case of a Vietnamese male patient. Its analysis from the standpoint of culture and social structure is used to illustrate some of the problems of reaching diagnoses in persons from other societies and the limitations of our theory about diagnosis.

Acculturation↗
PubMed1992

On the descriptive validity of DSM III schizophrenia.

The study sample is drawn from patients seeking evaluation in a psychiatric intake facility. It concentrates on those who are assigned a diagnosis of psychosis as stipulated in DSM III. The aim is to elucidate the distinguishing characteristics of patients diagnosed as Schizophrenia Disorder. The descriptive validity of this disorder is pursued by systematically comparing clinical and demographic characteristics of patients with this disorder to those diagnosed as Paranoid Disorder, Atypical Psychosis, Brief Reactive Psychosis, Schizoaffective Disorder and Schizophreniform Disorder. These comparisons uncover special characteristics pertaining to the demography and impact of schizophrenia. The results obtained are explained using generalizations drawn from the epidemiology, natural history and clinical manifestations of schizophrenia and other psychoses.

Adult↗
PubMed1991

Characterizing organic delusional syndrome.

We present a first comprehensive description of the clinical features of patients with organic delusional syndrome. This description is based on information from 39 patients with organic delusional syndrome among 14,889 patients who presented for initial evaluation over a 5-year period at our institution. This description includes an enumeration of the common clinical symptoms of this syndrome and the respective prevalence and mean severity of each symptom. The severity of the symptoms of organic delusional syndrome are compared with those of schizophrenia to determine which symptoms distinguish between these two diagnostic categories. Patients with organic delusional syndrome demonstrated significantly more symptoms of "acquired intellectual impairment," "impaired sensorium," and "hallucinations of smell, taste, or touch," while schizophrenic patients demonstrated more "flat affect," "emotional coldness," and "thought disorganization." In addition, associated factors are presented concerning demographics, modes of treatment, level of functioning, and current physical problems associated with organic delusional syndrome.

Delusions↗
PubMed1991

Can multiaxial diagnosis predict future use of psychiatric hospitalization?

Demographic and diagnostic intake data on about 10,000 patients at a public psychiatric facility were used to assess whether information recorded on various DSM-III axes could predict the frequency of patients' psychiatric hospitalizations over a follow-up period. Compared with patients who had been hospitalized only once or not at all, patients with three or more hospitalizations during the study period were more likely to be single and black and to come from lower social classes. They were more likely to have an axis I diagnosis of an alcohol-related disorder, a substance use disorder, or a psychotic disorder. When samples from the patient groups were matched on key demographic variables and primary axis I diagnosis, the multiaxial resources of DSM-III were not helpful in predicting future use of hospitalization. The results reinforce the importance of axis I diagnosis and demographic characteristics in assessing course and prognosis.

Adult↗
PubMed1990

DSM III as a systemic culture pattern: studying intracultural variation among psychiatrists.

DSM III is viewed as embodying a pool of information pertaining to a systemic culture pattern of psychiatry and attempts are made to describe how psychiatrists understand and apply it using ideas from cognitive anthropology. Each of seven psychiatrists evaluated a group of patients in an intake setting. Seven broad categories of Axis I diagnoses were formed and the frequencies with which psychiatrists used these categories were computed. In addition, twelve arithmetical measures pertaining to the five axes of DSM III and a current functioning axis and the decision regarding disposition were also computed. Using these dependent variables, the study analyzes the similarities and differences among psychiatrists in the way they formulate intake evaluations. Psychiatrists' selections of Axis I diagnoses were highly intercorrelated but they differed greatly among themselves in the way they coded many of the axes of DSM III. Group correlations among diagnostic measures indicated a patterning among diagnostic measures and the nature of this patterning is discussed. Each psychiatrists' set of correlations among the twelve diagnostic measures was itself correlated with that of others and this showed a very high level of interpsychiatrist agreement. Deductions drawn from the cultural consensus model suggest that psychiatrists share an underlying 'grammar' that references the pool of information pertaining to DSM III.

Cultural Characteristics↗
PubMed1990

Females and males in an intake psychiatric setting.

It is generally acknowledged that some psychiatric disorders are more commonly found among members of one sex rather than the other (e.g., Dohrenwend and Dohrenwend 1976; Gove and Tudor 1973; Kass et al. 1983; Robins et al. 1984; Rosenfield 1980; Weissman and Klerman 1977). Females, moreover, are consistently overrepresented in treatment populations of different sorts, and various reasons involving responses to illness and inclination to seek treatment have been offered to account for this (Finkler 1984; Kessler et al. 1981; Nathanson 1975; Verbrugge and Wingard 1987). In contrast to accepted gender differences in prevalence, incidence and inclination to use services, a prevailing view about psychopathology is that the actual content or manifestations of a disorder should be "culture free" or universal. In the theory of psychopathology (e.g., implicit in DSM-III), general descriptors of the person (i.e., demographic and cultural) play a comparatively minor role in the stipulation of the manifestations of psychiatric illness. Among socially and culturally oriented psychiatrists, on the other hand, such descriptors are considered important clues to origins of psychopathology. However, in such analyces, sociocultural is usually equated with altogether different symbolic/language traditions (e.g., Finkler 1985; Lieban 1978), although reports exist of sex differences in symptom expression in Western societies (Brown and Harris 1976; Hinkle et al. 1960; Nathanson 1979). Feminist critics assert that even within the sociocultural tradition linked to Anglo-American society, a bias exists with respect to how psychopathology is shaped, defined and handled (Kaplan 1983; Showalter 1985). The topic of gender differences in psychiatric morbidity is thus of considerable general interest and one that can be approached from a number of different perspectives. In this study we compare psychopathology in males and females who were referred to an intake setting. The DSM-III formulations and level and type of symptoms were the focus of analysis. The results are interpreted in light of findings in psychiatric epidemiology and social psychiatry.

Adult↗
PubMed1990

Psychiatric practice and the exigencies of the state: an ethnomedical view.

The purpose of this paper is to illustrate the powerful role that the state has in the practice of psychiatry in contemporary American society. An ethnomedical frame of reference is adopted, which is to say that psychiatric practice is looked at culturally and comparatively. In any society social and cultural characteristics condition and structure medical practice. In this sense, psychiatric practice provides an example to be analyzed in relation to other systems of medical practice. The ways in which the modern state, an omnipresent and compelling social structure, can intrude into the dynamics of psychiatric practice is illustrated by means of two case analyses. These draw attention to unique ethnomedical properties of psychiatric practice and to the potentially tragic effect that the state can have on its conduct. Analysis of the material presented is conducted against the background of information from the anthropological and social historical study of medicine and from medical practice in the Soviet Union.

Adult↗
PubMed1990

An ethnomedical perspective of medical ethics.

Ethnomedicine is the field that analyzes medical traditions comparatively. An ethnomedical approach is used in the essay to analyze the topic of medical ethics. General properties of medical ethics as realized in different societies are outlined. These pertain to the healer's relations with clients, with other healers, and with the group or society. The conditions of medical practice and the influence of social and political factors that affect them are discussed in relation to medical ethical questions. Unique developments of contemporary medical science that affect and condition practice and raise new ethical questions are examined in light of ethnomedical generalizations. The essay aims to clarify the cultural bases of medicine generally and ethical aspects of medical practice and care more specifically.

Attitude to Health↗
PubMed1989

Interpreting the structure of diagnosis in initial evaluations: primary, auxiliary and rule out patterns.

The study evaluates DSM III as a natural taxonomy, a system of categories devised for identifying complex objects represented as clinical conditions. Adults seeking initial evaluations constitute the study's population. An individual's clinical condition is examined in terms of a diagnostic format consisting of primary, auxiliary and rule out positions in Axis I and presence and number of diagnoses in Axis II. Each clinical condition thus differs with respect to complexity and diagnostic formats of such conditions are analyzed quantitatively. Differences between the sexes and the races with respect to number of Axis I and Axis II diagnoses are presented. The frequency of use of a diagnostic category is analyzed with respect to position on Axis I, and Axis II, and ratings of the perceived salience and efficacy of treatment plans of the disorders referenced by the category. The number of symptoms in conditions that differ with respect to level of complexity (i.e., number of diagnoses) are compared. An attempt is made to understand how Axis I and Axis II of the DSM III system are used by clinicians and also how they operate as devices to codify clinical information under conditions of relative uncertainty.

Adult↗
PubMed1989

On the significance of an anthropological approach to schizophrenia.

Psychotic disturbances like those termed schizophrenia are universal in human groups. Anthropological and social historical studies underscore the varied appearance and significance of such disturbances. In contemporary psychiatry, neurobiological emphases and the exigencies of positivistic research have tended to standardize the picture of schizophrenia. This is reflected in the rationale, methodology and results of the International Pilot Study of Schizophrenia (IPSS), which have tended to support the validity of diagnostic criteria that have evolved in modern Western European societies. Thus, contemporary psychiatric theory appears to stipulate a homogeneous picture of a phenomenon that abounds with social, cultural and psychological complexity as well as human poignancy. There are reasons for challenging this picture of schizophrenia and the biases and limitations in it. Reductionistic and standardized accounts may further immediate, short-range, and practical needs, but they be-cloud academic questions having wide-ranging significance in psychiatry, the social sciences, and the humanities.

Anthropology, Cultural↗
PubMed1989

The self and schizophrenia: a cultural perspective.

Much of what is known about schizophrenia necessarily reflects and deals with what is expected of and known about the self and human subjectivity. Schizophrenia is a disorder that by definition affects individual perception and cognition, and compromises social identity and functioning. The changes wrought by schizophrenia affect the self in a broad context, encompassing such things as self-concepts, self-awareness, self-functioning, and self-career. Thus, schizophrenia erodes and undermines the organization and functioning of the self, and because of this, schizophrenia and self/subjectivity are integrally linked. However, our knowledge of self and human subjectivity is a Western European-influenced knowledge. A basic assumption of this article is that there exist other, non-Western varieties of selves and human subjectivities that provide essential information for understanding human psychological and social behavior. The aim of this article is to show how an account of such alternative psychologies through cross-cultural anthropological studies may contribute to a fuller understanding of schizophrenia and the self in a cultural and cross-cultural perspective.

Cross-Cultural Comparison↗
PubMed1989

Cultural relativism and psychiatric illness.

Psychiatry has had a long-standing association with sociology and, especially, cultural anthropology. These social sciences have been influential in developing the concept of cultural relativism and applying it to psychiatry, sometimes in a challenging way and with much detriment. The concept has been used by some antipsychiatrists in attempts to discredit psychiatric practice. Contemporary psychiatrists endorsing a form of biological determinism have tended to either disregard the concept or judge it as trivial if not nonsensical. This study describes the concept of cultural relativism, reviews its applications to illness, and analyzes its implications from a historical and theoretical point of view. Its varied aspects, power, and limitations are discussed.

Cross-Cultural Comparison↗
PubMed1989

DSM-III disorders in a large sample of psychiatric patients: frequency and specificity of diagnoses.

This study examined certain nosological features of DSM-III axis I diagnostic categories and subcategories as applied to 11,292 general psychiatric patients presenting for care, using a semistructured assessment procedure. The most frequently used major categories were affective, substance use, childhood-onset, and adjustment disorders. Secondary diagnoses were given to 26% of the patients. Male patients predominated in the categories of impulse-control, psychosexual, and substance use disorders, and female patients predominated in the categories of anxiety, affective, and somatoform disorders. Of the 329 five-digit subcategories available in DSM-III, 296 (90%) were actually used. Sixteen percent of the patients were given unspecific primary diagnoses.

Adolescent↗