CULTURAL CONSIDERATIONS
What a culture considers acceptable strongly influences the expression
of anger. The nurse must be aware of cul-tural norms to provide culturally
competent care. In the United States, women traditionally were not permitted to
express anger openly and directly because doing so would not be “feminine” and
would challenge male authority. That cultural norm has changed slowly during
the past 25 years. Some cultures, such as Asian and Native American, see
expressing anger as rude or disrespectful and avoid it at all costs. In these
cultures, trying to help a client express anger verbally to an authority figure
would be unacceptable.
Ethnic or minority status can play a role in the diagno-sis and
treatment of psychiatric illness. Patients with dark skin, regardless of race,
are sometimes perceived as more dangerous than light-skinned patients, and
therefore more likely to experience compulsory hospitalizations, increased use
of restraints, higher doses of medication, and so forth. One study found that
Caucasian children and adolescents were more often diagnosed with depression or
substance abuse disorders, while African-American and Hispanic/ Latino patients
received psychotic or behavioral disorder diagnoses (Muroff, Edelsohm, Joe,
& Ford, 2008). The European Board of Medical Specialists recognizes
cultural awareness issues as a core component of psychiatry train-ing, but few
medical schools provide training in cultural issues (Qureshi, Collazos, Ramos,
& Casas, 2008). These authors propose that education to develop cultural
competence is needed to provide quality care to immi-grants and minority group
patients.
Hwa-Byung or hwabyeong is a culture-bound syndrome that literally translates as anger
syndrome or fire illness, attributed to the suppression of anger (Choi &
Lee, 2007). It is seen in Korea, predominately in women, and is char-acterized
by sighing, abdominal pain, insomnia, irritabil-ity, anxiety, and depression.
Western psychiatrists would be likely to diagnose it as depression or
somatization disorder.
Two culture-bound syndromes involve aggressive behav-ior. Bouffée delirante, a condition observed
in West Africa and Haiti, is characterized by a sudden outburst of agitated and
aggressive behavior, marked confusion, and psychomo-tor excitement. These
episodes may include visual and auditory hallucinations and paranoid ideation
that resemble brief psychotic episodes. Amok is a dissociative episode
characterized by a period of brooding followed by an out-burst of violent,
aggressive, or homicidal behavior directed at other people and objects. This
behavior is precipitated by a perceived slight or insult and is seen only in
men. Origi-nally reported from Malaysia, similar behavior patterns are seen in
Laos, the Philippines, Papua New Guinea, Polynesia (cafard), Puerto Rico (mal de
pelea), and among the Navajo (iich’aa)
(Moitabai, 2005).
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