CULTURE AND SYMPTOMS

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CULTURE AND SYMPTOMS

• James G. Anderson, Ph.D.

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Social Institutions

• In human societies, biological processes acquire
  social and cultural significance and become
  institutions regulated by cultural and social
  norms.

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Social Cultural Factors

• Not all social cultural groups respond to pain
  the same way
• How individuals respond to pain is influenced by
  social cultural factors
• How individuals communicate pain to others is
  influenced by social cultural factors

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Pain Behavior

• Biological pain is culture free
• The significance of pain is socially and
  culturally defined
• Acceptance of pain varies (e.g., child birth)
• Seeking assistance is socially and culturally
  determined (e.g., faith healers, doctors)
• Treatment of pain varies (e.g., prayer,
  alternative remedies)
• Communication of symptoms is affected by social
  cultural factors

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Social Aspects of Pain

• The individual's willing ness to reveal pain is
  influenced by the likely response, social costs
  and benefits
• The individuals response is conditioned by
  societys major values, by religious beliefs,
  etc.
• The response to pain is learned in childhood

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The Presentation of Public Pain Research Setting

• Kingsbridge Veterans Hospital, Bronx, NY

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Data Collection

• 31 Jew
• 24 Italians
• 11 Irish
• 26 Old Americans
• 11 others

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Jewish Patients

• Emotional
• Exaggerated pain experience
• Concerned about threats to heath
• Reluctant to accept drugs
• Skeptical of doctors
• Depressed and worried even after pain relief
• More demanding and complaining at home
• Calmer in the hospital
• Prefer home to hospital treatment

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Italian Patients

• Emotional
• Exaggerated pain
• Concerned about relieving pain
• Presented many symptoms
• Readily accept analgesic drugs
• Trust doctors
• Males tend to avoid complaining at home
• More verbal and emotional in the hospital
• prefer home to hospital treatment

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Old American Patients

• Unemotional
• Objective description of pain
• Withdraw when they express pain
• Minimize pain in the presence of family members
• Try to avoid being a nuisance
• Cooperate with health providers
• View body as a machine which can be fixed
• Anxiety is relieved when something is being done
  to treat the cause of the pain
• Prefer hospital to home treatment

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Irish Patients

• Denied pain
• Described their chief problem in terms of
  specific dysfunction
• Presented fewer symptoms

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Patients Presenting Complaints

• A selective process is operating in what symptoms
  are brought to the physician.
• Two factors that influence the perception of
  symptoms are prevalence and congruence with the
  major value orientations.

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Research Setting

• Massachusetts General Hospital
• Massachusetts Eye and Ear Infirmary

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Data Collection

• 63 Italians (34 females, 29 males)
• 81 Irish (42 females, 39 males)

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Clinic Admissions by Location of Chief Complaint
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Clinic Admissions by Presence of Pain
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Clinic Admissions by Physical Difficulty
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Clinic Admissions by Number of Presenting
Complaints
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Effect of Symptoms on Interpersonal Behavior
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Examples
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Conclusions

• The Italians use dramatization as defense
  mechanism against illness.
• The Irish ignore bodily complaints in dealing
  with illness.

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Implications

• The way that bodily conditions are perceived and
  communicated to health care practitioners is
  highly related to ethnic group membership.
• Dominant value orientations significantly affect
  perception of symptoms and communication of
  complaints.
• Defense mechanisms -- the way individuals deal
  with stresses and strains are determined by
  value orientations.

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Discussion Questions

• 1. How do you cope with pain, bodily ailments,
  and illness?
• 2. Is your approach emotional, intellectual,
  denial, independent/dependent?
• 3. To what extent were your defense
  mechanisms conditioned by your family
  upbringing religion nationality racial or
  ethnic group membership?
• 4. Does the way you cope with illness facilitate
  or hinder your contacts with health care
  providers?