According to experts in the field of crosscultural psychology (e.g., Draguns, 1987; Kleinman & Good, 1985), major psychological disorders are found universally, but their form and content are modified by culture. In addition, the expression of psychosocial distress is largely shaped by cultural values and beliefs. As the United States becomes increasingly multicultural, nurses in all settings need to be knowledgeable of cultural influences on symptoms related to mental health.
One major example is the degree of somatization reported by persons with psychological disorders and psychosocial distress. In particular, Hispanics have been noted anecdotally to somatize more than people from other U.S. cultures. Although this phenomenon has been observed clinically, little research has been conducted to determine the validity of these observations. In this article, somatization in general is defined, and then the literature related to Hispanics and somatization is presented and discussed.
The predominant clinical picture in somatization is of physical symptoms or irrational anxiety about physical illness. At the same time there are neither organic findings nor physical illness patterns that account for the degree of symptoms (Katon, Ries, & Kleinman, 1984). In psychology, somatic expression is traditionally viewed as one end of a continuum whose other end is psychological expression. Cognitive processes are thought to be externalized in somatization (Escobar, Randolph, & Hill, 1986). In addition, anthropologists have noted that somatization constitutes a powerful coping mechanism for psychosocial distress in many societies (Escobar et al., 1986; Katon, Kleinman, & Rosen, 1982a). Moreover, physical symptoms, besides communicating psychosocial distress, provide cues for obtaining care, sympathy, love, time off, and time out as well. Thus, somatization can also be a powerful mechanism for manipulating relationships (Katon et al., 1982a; Katon, Kleinman, & Rosen, 1982b). Utilizing both psychological and anthropological tenets, Katon and associates (1982a, 1984) operationally defined somatization as one of the following:
1 . The selective focus on the somatic components of a psychological disorder, such as depression, that has cognitive, affective, and somatic symptoms.
2. Psychological or social gain in the person with organic illness who amplifies the symptoms. (An example of psychological gain is using somatic symptoms as a defense against underlying intrapsychic conflict. Examples of social gains are disability payments and the fulfillment of dependency needs.)
3. Psychological or social gain in the person with no organic illness.
4. The selective focus on psychophysiological symptoms, such as back pain or migraine headaches, that are actually secondary to stressful life events, with denial of the role of these stressful life events on the symptoms.
5. The expression of physical symptoms as a culturally sanctioned idiom of psychosocial distress to indirectly implicate family, school, work, financial, and other social problems. In summary, then, somatization may be a component of a psychological disorder, a method of psychological or social gain in persons with or without organic disease, a focus on the physical effects of psychosocial distress without acknowledgment of the relationship between the two, or a culturally approved manner of blaming social problems for psychosocial distress.
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