de Figueiredo John M, Gostoli Sara
Department of Psychiatry, Yale University School of Medicine, New Haven, Conn., USA.
Adv Psychosom Med. 2013;33:75-87. doi: 10.1159/000348735. Epub 2013 Jun 25.
In most societies, members of a culture have attempted to help each other in times of trouble with various types of healing methods. Demoralization - an individual experience related to a group phenomenon - responds to certain elements shared by all psychotherapies. This article has three objectives: (1) to review the theoretical background leading to our current views on culture and demoralization in psychotherapy, (2) to discuss the methodological challenges faced in the cross-cultural study of demoralization and psychotherapy, and (3) to describe the clinical applications and research prospects of this area of inquiry. Demoralization follows a shattering of the individual's assumptive world and it is different from homeostatic responses to a stressful situation or from depressive disorders. Only a few comparative studies of this construct across cultures have been undertaken. The presentation of distress may vary widely from culture to culture and even within the same culture. To avoid 'category fallacy', it is important to understand the idioms of distress peculiar to a cultural group. A cultural psychiatrist or psychotherapist would have to identify patient's values and sentiments, reconstruct his/her personal and collective ambient worlds, and only then study demoralization. The limitations of our current diagnostic systems have resulted in methodological challenges. Cultural clinicians should consider using a combination of both 'clinimetric' and 'perspectivistic' approaches in order to arrive at a diagnosis and identify the appropriate intervention. The presenting problem has to be understood in the context of the patient's individual, social and cultural background, and patients unfamiliar with Western-type psychotherapies have to be prepared to guide their own expectations before the former are used. Future research should identify the gaps in knowledge on the effectiveness of cultural psychotherapy at reversing or preventing demoralization.
在大多数社会中，一种文化的成员在遇到麻烦时会尝试用各种治疗方法互相帮助。失序感——一种与群体现象相关的个体体验——对所有心理治疗共有的某些要素会产生反应。本文有三个目标：（1）回顾导致我们目前对心理治疗中的文化和失序感看法的理论背景；（2）讨论失序感与心理治疗跨文化研究中面临的方法学挑战；（3）描述这一研究领域的临床应用和研究前景。失序感源自个体假设世界的破碎，它不同于对压力情境的稳态反应或抑郁症。目前仅开展了少数关于这一概念的跨文化比较研究。痛苦的表现可能因文化而异，甚至在同一文化中也会有很大差异。为避免“范畴错误”，了解特定文化群体特有的痛苦表达方式很重要。文化精神科医生或心理治疗师必须识别患者的价值观和情感，重构其个人和集体的周遭世界，然后才能研究失序感。我们当前诊断系统的局限性导致了方法学挑战。文化临床医生应考虑结合使用“临床测量”和“视角”方法，以便做出诊断并确定适当的干预措施。必须在患者的个人、社会和文化背景下来理解呈现出的问题，不熟悉西式心理治疗的患者在使用前者之前必须做好调整自身期望的准备。未来的研究应找出文化心理治疗在逆转或预防失序感方面有效性的知识空白。
