Indigenous forms of mental illness are being bulldozed by disease categories and treatment made in the USA
DSM (Manual of Mental Disorders)-bible of the profession
Biomedical approach will reduce the stigma of mental illness and that our drugs of the best we can offer. We are certain that by throwing off traditional social roles and engaging in individualistic quests for introspection they will be more mentally healthy.
ETHNIC PSYCHOSES
- amok (extended period of brooding and murderous rage)
- koro (s asia-genitals are retracting into their bodies)
- zar (spirit possession bringing about dissociative episodes)
WHAT ARE OUR MOTIVATIONS?
- drug company profits
- the science behind our drugs and illness categories and theories of mind have put the field beyond the influence of constantly shifting cultural trends and beliefs
BUT: The experience of mental illness cannot be separated from culture, whatever the cause, we rely on cultural beliefs and stories to understand what is happening.
- influence is always local and intimate
- we should WORRY ABOUT THE LOSS OF THIS DIVERSITY OF VISION in exactly the same way that we worry about the loss of biological diversity in nature.
- modes of healing and culturally specific beliefs about how to achieve mental health can be lost to humanity.
THE IDEAS BEHIND FEMALE BODY IMAGE IN HONG KONG
- young women worshiped in some contexts for their attractiveness
- in other situations vilified
- Chinese anorexia was unlike that found in the West. CHARACTERISTICS:
- no fear of fatness did not see themselves as overweight (body dysmorphia)
- connected to failed or unrequited relationships
- little stigma in China surrounding larger body shapes
- larger shapes and ability to eat is to have "luck"
- later onset of puberty compared to the West
- girls spoke of their desire to get back to their normal body weight
- refusal to eat attributed to:
- bloating, blockages in throat or digestion, feeling of fullness in stomach
- feeling of no appetite
- from poor families and the lower achievers in school
- no hint of moral superiority often found in anorexics in the West.
YIN YANG & CHI
traditional diagnosis is that there is a blockage of Qi
GLOBAL SPREAD
- Lee knew that he had to understand anorexia at two different levels
- why women began the behavior of self-starvation
- what happened to their mind and body as the regimen of starvation gained momentum in their daily life.
- feeling of hyper-alertness and sense of mastery over the body
- feeling superior to others who were ruled by their need for food
- getting on a train even if it was going in the wrong direction
- Origins in Victorian Culture
- HYSTERIA (part of popular magazines and popular culture)
- Epidemics of vomiting
- refusal of food
- self-starvation
- 1873: received formal recognition in medical community (hysterical anorexia)
- What are illnesses like Anorexia?
- unconscious mind trying to speak in a language of emotional distress that will be understood in its time and place (culture)
- symptom is a distillations of emotions translated into a culturally recognized signal of suffering
- patient is unconsciously striving for recognition and legitimization of internal distress-drawn to symptoms which will achieve that ends.
- why naming an illness is perilous
- ILLNESS NEGOTIATION-patients and doctors create a CULTURAL FEEDBACK LOOP that further establishes the legitimacy of a new symptom and provide scientific validation for it.
- illnesses become widespread after they have an agreed upon cultural expression
- MENTAL ILLNESSES DO NOT EXIST INDEPENDENT OF SOCIAL AND HISTORICAL CONTEXT
- historically looked to bodily sensations to indicate psychological distress (somatisizing)
- no Cartesian distinction between mind and body
- ADOLESCENTS are most vulnerable to "catching" these disorders...they are most consumers of Western pop culture
- thinness is not highly valued traditionally
- anorexia is a threat to young women who are prone to anxiety or depression or facing problems in school or with their families
- severe food restriction in young women should be read as a cry for help
- shifting ideas about thinness and beuty are also contributing
- fat phobia and a distorted body image defined the illness
- usually attacks the most promising young women
- well to do families
- PROBLEM: many of these Western assumptions had little menaing for most of the anorexics Lee saw in his practice
- biomedical categories IMPERIL ILLNESS NEGOTIATION and curtail local healing opportunities
- as symptoms became known, it became ever more likely that a teenager would try food restriction as a method of communicating internal distress (fashionable)
- SHOULD HEAR COMPLEX TRUTHS instead of adopting these assumptions -women's voices are being drowned out by Western narratives about the power of fashion, dieting and pop culture
- DSM and Western categories of disease have gained dominance
- POPULAR WRITERS as the carriers of a disease!!!!
- glamorize disease
- elevate the social role of the sufferer
- create fashionable expressions of angst
PTSD in Sri lanka
Bringing PTSD to Sri Lanka after the Tsunami
Assumption: the psychological reaction to horrible events is fundamentally the same around the world.
Assumption: the psychological reaction to horrible events is fundamentally the same around the world.
- a victim processes a traumatic event as a function of what it means drawn from their society and culture and this shapes how they seek help and their expectation of recovery
- The assumption that traumatic reactions exist outside and unaffected by culture
- “We were spreading these ideas around the globe so effectively that PTSD was becoming the way the entire world conceived of psychological trauma,” said Allan Young, a medical anthropologist at McGill University
- The idea that people from different cultures might have fundamentally different psychological reactions to a traumatic event is hard for Americans to grasp.
- PTSD Culture: calls for solidarity with the survivors of violence; incitements to share an enlightened moral outrage against the atrocities of war and social injustice;
- Traumatologists have also advanced the idea that psychological rehabilitation is best managed by mental health experts Western
- trauma must be SPOKEN to be dealt with
- against these assumptions---“A victim processes a traumatic event as a function of what it means,” they wrote. meaning is drawn from their society and culture and this shapes how they seek help and their expectation of recovery.”
- competition among plethora of AID groups for the attention of the children (especially)
- ZOLOFT
- Ganesan noted a key difference between the aid groups offering medicine, food, and shelter and those offering trauma counseling. The groups focusing on basic material needs would immediately meet with local officials and families to try to assess what the community was lacking. Was shelter the first priority, or food, or first aid? In contrast, those setting up PTSD counseling services seldom asked leaders in the local community what they needed or desired in terms of help.
- that the Sri Lankans—because of their intimate familiarity with poverty, hardship, and war had evolved a culture better able to integrate and give meaning to terrible events.
- the shared ethnocultural belief in spirits and the palpable nearness of the spirit world. Often closely tied to religious traditions is a wide variety of healing customs. Health
- The lines between these practices, delineating, for instance, traditional healing from modern medicine, are not clearly drawn. A Sri Lankan often consults two or more of these traditions in search of relief from illness or psychological distress.
- Sri Lankans had culturally distinct reactions to traumatic events as well as culturally specific modes of healing. She believed that unless these local idioms of distress were understood, appropriate interventions could not be formulated. Without a deep understanding of the illness, in other words, it would be impossible to treat the disease. Fernando took on the task of trying to understand the local meaning of trauma in post-tsunami Sri Lanka. She began by gathering a sample of local informants from a rural area in the southern province of the country. All were Sinhalese Buddhists, most from poor families. All had personally witnessed the tsunami, and fifteen of the twenty had lost family members. Instead of quizzing these subjects with a predetermined set of PTSD symptoms, Fernando asked each person to tell her two open-ended stories in their own language.
- Unlike the PTSD symptomatology, Sri Lankans were much more likely to experience physical symptoms after horrible events. Sri Lankans who lost family members or whose lives were otherwise devastated by the tsunami were more likely to complain of aches in the joints or muscles or pain in the chest.
- reacted to the disaster as if they had experienced a physical blow to the body. In addition to these somatic symptoms, there was another, more subtle and pervasive difference. By and large Sri Lankans didn’t report pathological reactions to trauma in line with the internal states (anxiety, fear, numbing, and the like) that make up most of the PTSD symptom checklist. Rather Sri Lankans tended to see the negative consequences of an event like the tsunami in terms of the damage it did to social relationships.
- The failure to manage one’s social responsibilities—to find and fulfill a place in the group—was identified as the primary symptom of distress and not a consequence of an internal psychological problem.
- Sri Lanka’s, an emphasis on healing the individual away from the group, particularly in one-on-one counseling with strangers, is problematic.
- But the medical records of war veterans kept over the past centuries show that the manifestation of the injury is always tied up with cultural beliefs contemporaneous to the time.
- The unconscious mind of a soldier latches onto culturally current symptoms of distress (chest pain for the Civil War soldier and muscle spasms for the World War I soldier)
- “Most of the disasters in the world happen outside of the West,” says Arthur Kleinman, a medical anthropologist from Harvard University. “Yet we come in and we pathologize their reactions. We say: ‘You don’t know how to live with this situation.’ We take their cultural narratives away from them and impose ours. It’s a terrible example of dehumanizing people.”
- According to this belief it is not witnessing violence that is destructive. Rather, the moments of terror that come from violence leave one vulnerable to being afflicted by the gaze.
- central tenet of Western trauma counseling—that traumatic experiences must be retold and mastered—ran counter to the local customs regarding the use of euphemistic speech. Rural health care workers were suddenly insisting that experiences of trauma be spoken about directly.
- By isolating trauma as a malfunction of the mind that can be connected to discrete symptoms and targeted with new and specialized treatments, we have removed the experience of trauma from other cultural narratives and beliefs that might otherwise give meaning to suffering.
SCHIZOPHRENIA IN ZANZIBAR
Why did people diagnosed with schizophrenia in developing nations have a better prognosis over time than those living in the most industrialized countries in the world?
- Because our emotions come into our consciousness unbidden and often surprise us with their intensity, we often assume that they are not influenced by cultural cues or social scripts. But with careful study, anthropologists have learned that emotions are not like muscle reflexes; rather, they are communications with deep and sometimes obscure meanings.
- what we know about culture and schizophrenia is… [that] culture is critical in nearly every aspect of schizophrenic illness experience:
- Kimwana was allowed to drift back and forth from illness to relative health without much monitoring or comment by the rest of the family.
- Kimwana felt little pressure to self-identify as someone with a permanent mental illness.
- Social stress is a known trigger for psychotic episodes, and a number of studies testing diastolic blood pressure, skin conductance, and electrodermal reactivity all pointed to the connection between high-expressed-emotion relatives and increased feelings of stress in a patient.
- spirit possession in Zanzibar was not an uncommon or necessarily an extreme experience. As Amina explained to McGruder, we all have “creatures in our heads.” JINNS
- A spirit handed down from one’s ancestor is generally thought to have a protective effect for the person who carries it. Such an entity will cause difficulties only if it is ignored or not properly appeased.---LESS STIGMS ASSOCIATED WITH ANTI-SOCIAL BEHAVIOR
- “conception of the illness as nervios enables the maintenance of close identification of family members by fostering the view that the relative is ‘just like us only more so.’” The label and its connotations allowed family members to keep the relative within the fold.
- European Americans are indeed “more individualistic—valuing personal independence more.… To contemporary Americans, being an individualist is not only a good thing; it is a quintessentially American thing.”
- “Mental illness is feared and has such a stigma because it represents a reversal of what Western humans have come to value as the essence of human nature,”
- McGruder believes. “Because our culture so highly values self-control and control of circumstances, we become abject when contemplating mentation that seems more changeable, less restrained and less controllable, more open to outside influence, than we imagine our own to be
- Which cultural beliefs tend to exclude the sufferer from the social group and which allow the ill individual to remain part of the group?
- the fact that healthy people do not dwell on the “brain chemistry” story as an explanation for their own moods and feelings should be an indication of how unappealing and
DEPRESSION IN JAPAN:THE DRUG COMPANIES
that every culture has a type of experience that is in some ways parallel to the Western conception of depression: a mental state and set of behaviors that relate to a loss of connectedness to others or a decline in social status or personal motivation. But he had also found that cultures have unique expressions, descriptions, and understandings for these states of being.
- Nigerian man might experience a culturally distinct form of depression by describing a peppery feeling in his head. A rural Chinese farmer might speak only of shoulder or stomachaches. A man in India might talk of semen loss or a sinking heart or feeling hot. A Korean might tell you of “fire illness,” which is experienced as a burning in the gut. Someone from Iran might talk of tightness in the chest, and an American Indian might describe the experience of depression as something akin to loneliness.
- In one culture someone feeling an inchoate distress might be prompted to search for feelings of unease in his gut or in muscle pain; in another place or time, a different type of symptom would be accepted as legitimate. This interplay between the expectations of the culture and the experience of the individual leads to a cycle of symptom amplification. In short, beliefs about the cause, symptomatology, and course of an illness such as depression tended to be self-fulfilling.
- culturally distinct symptoms often hold precious clues about the causes of the distress.
- feelings and symptoms that an American doctor might categorize as depression are often viewed in other cultures as something of a “moral compass,” prompting both the individual and the group to search for the source of the social, spiritual, or moral discord.
- By applying a one-size-fits-all notion of depression around the world, Kirmayer argued, we run the risk of obscuring the social meaning and response the experience might be indicating.
- The clinical presentation of depression and anxiety is a function not only of patients’ ethnocultural backgrounds, but of the structure of the health care system they find themselves in and the diagnostic categories and concepts they encounter in mass media and in dialogue with family, friends and clinicians.
- In the globalizing world, he reported, these conceptions are in constant transaction and transformation across boundaries of race, culture, class, and nation.
- In this context, it is important to recognize that psychiatry itself is part of an international subculture that imposes certain categories on the world that may not fit equally well everywhere and that never completely captures the illness experience and concerns of patients.
- WESTERN VIEW: suicide in Japan was an indicator of undertreated depression; that Western SSRIs represented proven scientific advances in treatment; that primary care physicians should use simple three-minute surveys to help diagnose mental illness; that patients not meeting the criteria for depression should still be considered sick; and that the Japanese should be helped to reconceive social stress related to work and industrialization as signs of depression that should be treated with SSRIs.
- Cultures are most susceptible to outside ideas about the nature of the human mind at times of social change and upheaval, and the second half of the nineteenth century was just such a time in Japan.
- neurasthenia came not only from the mental health professionals of the time but from popular culture as well.
- Indeed, because neurasthenia was at first considered an illness of the elites, the diagnosis became somewhat trendy.
- Fueling the rise of the neurasthenia diagnosis was a popular idea that some Japanese were too pure of heart to live with the conflicts, compromises, and demands of modern life.
- It wasn’t until after World War II that depression became a disease category of its own.
- “According to this model, the depressed person is like someone carrying a psychotic time bomb, for whom depression begins when the internal clock goes off and ends after it runs its course,”
- JAPANESE: someone with a melancholic personality possessed a highly developed sense of orderliness as well as “exceptionally high demands regarding one’s own achievements.”
- in the late twentieth century no word in Japanese had the same connotations as the word “depression” in English. Consider the various words and phrases that have often been translated into English as “depression.”
- Utsubyô describes a severe, rare, and debilitating condition that usually required inpatient care and thus was not much of a match for the common English word “depression.”
- Yuutsu , which describes grief as well as a general gloominess of the body and spirit, was in common use. There was also ki ga fusagu , which refers to blockages in vital energy.
- Similarly, ki ga meiru is the leakage or loss of such energy.
- Although each of these words and phrases had overlaps with the English word “depression,” there were also critical differences.
- Not only did Japanese ideas of sadness include both the body and the mind but, metaphorically at least, they sometimes existed beyond the self.
- The top ten word associations for the native Japanese were
- 1. Rain
- 2. Dark
- 3. Worries
- 4. Gray
- 5. Suicide
- 6. Solitude
- 7. Exams
- 8. Depressing
- 9. Disease
- 10.
- Tiredness For the Caucasian Americans, the top ten word associations were
- 1. Sad or sadness
- 2. Lonely or loneliness
- 3. Down
- 4. Unhappy
- 5. Moody
- 6. Low
- 7. Gloom
- 8. Failure
- 9. Upset
- 10. Anxious
- Comparing these answers, Tanaka-Matsumi saw a notable difference. In the responses given by the Japanese natives, only a few of the words (such as “worries” and “solitude”) were related to internal emotional states. On the other hand, the majority of the word associations supplied by the American students related to internal moods. The Japanese, in short, were looking outward to describe yuutsu , and the Americans were looking inward to describe depression.
- Feelings that we might pathologize as depressive were often thought of in Japan as a source of moral meaning and self-understanding.
- Buddhist belief that suffering is more enduring and more definitive of the human experience than transient happiness.
- This cultural embrace of sadness, Lock believes, might have been motivated by society’s discouragement of other emotional states.
- karoshi, death from overwork,...This form of depression was different from the endogenous depression in the Japanese psychological literature because it hadn’t resulted from an inherited defect in Oshima’s brain; rather it was brought on by the circumstances of his life.
- Yet the Japanese public remained split as to whether suicide was an intentional act with moral or philosophical meaning or a desperate act of a mentally ill person.
MARKETING OF DEPRESSION;ZOLOFT
- First, it implied that utsubyô was not the severe condition it was once thought to be and therefore should carry no social stigma. Who would think less of someone for having a cold?
- Second, it suggested that the choice of taking a medication for depression should be as simple and worry-free as buying a cough syrup or an antihistamine.
- Third, the phrase communicated that, like common colds, depression was ubiquitous. Everyone, after all, from time to time suffers from a cold.
- represented the proud march of scientific progress across the world.
- turns out that there is currently no scientific consensus that depression is linked to serotonin deficiency or that SSRIs restore the brain’s normal “balance” of this neurotransmitter. The--CULTURALLY SHARED STORY
- drug companies first started ghostwriting scientific papers for university researchers in the 1950s.--funded them too
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