The Americanization of Mental Illness

[Showbread]

http://www.nytimes.com/2010/01/10/magazine/10psyche-t.html?pagewanted=1&_r=0

I had to read this for a class. I thought it was an interesting idea and would love to hear your perspectives.

 

[prplchknz]

I've been torn about it for awhile. i mean how much are we (the west) right and how are they (tribal cultures) right? is the west to gung-ho to dx everyone? and it depends on what you're dxed with depression people tend to be more accepting than other disorders. i don't know i did read all 6 pages. I wasn't gonna reply because i feel to bias. but i really want to hear people's perspectives as well.

 

[kyuuei]

Swimming against the biomedical currents of the time, they have argued that mental illnesses are not discrete entities like the polio virus with their own natural histories. These researchers have amassed an impressive body of evidence suggesting that mental illnesses have never been the same the world over (either in prevalence or in form) but are inevitably sparked and shaped by the ethos of particular times and places.

This seems like just a crock of shit right here. I don't think any scientists anywhere are trying to affirm that mental illnesses are ALL stand-alone easily-recognizable and identifiable illnesses the way viruses are. There is research showing similarities that cross cultural bounds--like the distinct small percentage of gray matter in the brains of schizo patients--but I wouldn't at all mistake that sort of research with anyone saying that everyone experiences mental illness the same way.

The article goes on to state several cultures experiencing what it creates the illusion of being separate culturally-related illnesses.. but in fact all the things described transcend culture and are experienced in many cultures.

Then it takes these two misleading statements, and affirms that Americans are not only spreading different Americanized treatments to other cultures and countries--but that we're bringing new disorders such as.. depression? No one but Americans were depressed before America started doing all of this? No one experienced PTSD? I'll eat my hat before I believe that for even a second.

Giving names to things doesn't change what they are--only how people identify them. Autism isn't a NEW thing.. part of the reason it and ADD/ADHD spread like 'wildfire' is because we had no idea what it was before it had a name. Of course Americans are going to affirm we do things the American way. It's our way. We say treat PTSD patients well, and with respect, and that therapy and cognitive behavioral therapy can help a lot. That isn't going to stop a superstitious person from putting a dream catcher above their bed. Usually what happens is people see something that works and melds it into their own culture... rather than completely replacing their culture with the new ideas. Eventually it all squishes together into one vague mass of gray lines and borders.

TLDR: The article sounds like a hippy crock of shit that wishes shamans still had a prominent foothold in the Americas besides the tourist attracting spell kits sold in NOLA.

 

[Showbread]

TLDR: The article sounds like a hippy crock of shit that wishes shamans still had a prominent foothold in the Americas besides the tourist attracting spell kits sold in NOLA.

Yeah, I had a similar response. I think it's an interesting concept that I had never considered before. But ultimately, probably not terribly valid. I'll be interested to see what my classmates think on friday.

 

[Mole]

Tribal people do not have an individual psychology, or an individual psyche. Tribal people share the tribal psyche with which they are continuously in touch. We noticed this when we administered the tribal people of Papua New Guinea.

It is only literate individuals who have an individual psychology and an individual psyche.

The literate individual though has the illusion that everyone has an individual psyche. This is called parochialism.

So of course when literate Americans meet a suffering person, who is not suffering from a physical disease or leison, they see the suffering through the lens of the individual psyche, and individual psychology.

So it is not the Americanisation of mental illness, but mental illness due to the individual psyche.

 

[Totenkindly]

one but Americans were depressed before America started doing all of this? No one experienced PTSD? I'll eat my hat before I believe that for even a second.

Giving names to things doesn't change what they are--only how people identify them. Autism isn't a NEW thing.. part of the reason it and ADD/ADHD spread like 'wildfire' is because we had no idea what it was before it had a name. Of course Americans are going to affirm we do things the American way. It's our way. We say treat PTSD patients well, and with respect, and that therapy and cognitive behavioral therapy can help a lot. That isn't going to stop a superstitious person from putting a dream catcher above their bed. Usually what happens is people see something that works and melds it into their own culture... rather than completely replacing their culture with the new ideas. Eventually it all squishes together into one vague mass of gray lines and borders.

Yeah, I relate to that. Same thing with gender dysphoria and other conditions -- it's always been around, but once people recognize it as something, it gets labeled and knowledge suddenly begins to be applied. Sure, conditions can be overdiagnosed as well, but it's more the danger of inexperience / armchair psychology (like people on the Internet having read some descriptions they relate to and suddenly trying to diagnose themselves as having a full-fledged personality disorder, whereas an actual disorder in practice is far more debilitating and a practiced clinician would recognize the severity of a real disorder).And cultures do "mash" things in; it's how human psychology works; we typically "meld" a new idea into our current existing framework rather than completely ditching our framework and doing a wholesale swap of everything cleanly.

 

[skylights]

Interesting article. To be honest, I am actually sort of surprised that there would be any conflict over the idea that a culture would have an impact on the way that illness is presented and interpreted. Like @kyuuei, I do believe that in biomedical terms, there are certain aspects of certain illnesses that have underlying genetic, chemical, and biological components that will be the same or at least similar worldwide. That said, it is also widely recognized that many mental health disorders are more on a sliding scale than being clearly extant or not, and because thought process - cognition, perception, judgment - can play into how the symptoms are perceived and interpreted by the person who is experiencing it, it seems to be fairly self-evident that mental illnesses would not present the same or be responded to the same across cultures with huge variation in terms of language, concepts, history of medical care, values, and ideals.

I think the article's point that Americans pushing their interpretation of disease on other cultures may cause us to lose the wisdom that those cultures may contain in terms of dealing with illness is indeed a valuable thought. At the same time, I also am well aware that for the good that some cultures may contain in terms of going with certain mental illnesses, other mental illnesses may be treated in a way that is tantamount to abuse. So, I think it would be worthwhile to take a balanced view point of attempting to study and extract - and to respect - what wisdom and positive tactics and perspective other cultures have developed in terms of dealing with mental health problems. However, I also believe that there is value to the Western biomedical model, in particular in terms of sanitation, as well as stripping disorders down to what may at their baseline be a genetic or chemical problem. Some mental illnesses, even though they're influenced by culture, may well be treated very effectively with pharmaceuticals alone - or at least, beginning treatment with pharmaceuticals can open the door for psychosocial work to follow. Unless I do not remember correctly, I believe that most mental illness is best treated by a combination of chemical medication and psychoanalytic therapy.

 

[kyuuei]

I think the biggest problem I have with the article is that it doesn't really state anything new or revolutionary--but it bends the truth of other aspects of scientists studying mental illnesses and social interaction with them to create something that sounds revolutionary and exposing.

It's over the top writing with little validity and thesaurus vomit sprinkled everywhere to help make something sound more established.

Of course culture has an impact on people.. and as culture changes, so too will the responses. In a bare bones sort of barney assessment.. when you're studying something (i.e. what women say when they're experiencing anorexia), and an invading force (i.e. American explanations of anorexia in their country) comes in and starts muddling your research.. it doesn't validate your research more. It invalidates it. Because you can't tell if what you were doing was objective data anymore. There's a new element in it.

Even in the very first example.. it is impossible to tell if culture was blocking people from describing their true symptoms to the doctor before American explanations came through and showed other women suffered from this.. Or if Chinese culture helped protect women from those symptoms or even worse: discouraged women to report symptoms. Given that the article openly admits that they suffered from anorexia nervosa before going forward, I'm going to say it wasn't really the positive aspects.

 

[Bush]

Western mental-health practitioners often prefer to believe that the 844 pages of the DSM-IV prior to the inclusion of culture-bound syndromes describe real disorders of the mind, illnesses with symptomatology and outcomes relatively unaffected by shifting cultural beliefs. And, it logically follows, if these disorders are unaffected by culture, then they are surely universal to humans everywhere. In this view, the DSM is a field guide to the world’s psyche, and applying it around the world represents simply the brave march of scientific knowledge.

At the core, there's no more separate 'Chinese' and 'American' (e.g.) bipolar disorder any more than there is 'male' and 'female' math.

 

[Magic Poriferan]

To the extent that an illness has some direct biological cause, like genetic inheritance, or being caused by excess blood levels of mercury, illness is not going to vary by culture.

On the other hand, both would we choose to respond to things and how we judge the sensibility of others is strongly influence by culture, so there's no way culture isn't creating different ideas of mental illness and even, in a sense, some different mental illnesses. I don't know about you, but when I look through the DSM, I often think (what a poorly organized lot of arbitrary bullshit). I know they must be getting at describing something real, but that doesn't mean the way they do it is particularly accurate, and the DSM and ICD can't even agree with each other. Culture is obviously at work in how these are drawn up.

Or consider this; I had psychology professor who had also worked doing in-patient care and as a prison therapist (what a life). He told me about what he called the Oprah Effect, which is that if a mental illness is given attention by some highly popular instrument of the media, the rates of people claiming to have it and even the rates of doctors diagnosing it spikes. That's some pretty flimsy authority right there.

I once read of a psychologist who, due to geography and word of mouth, acquired multiple Amish clients. He quickly found that it was challenge to attempt his profession as he was trained to do when dealing with people who lived in such a dramatically different culture. You can't necessarily suggest they do or not do all the things you'd tell someone to do or not do in typical American society.

We can't even agree on what a mental illness is here. Try to define mental illness itself. Go ahead.

So to say that mental illnesses are not discrete things like Polio strikes me as blatantly obvious.

 

[Mole]

It will probably come as no surprise to you to discover that Dr Sigmund Freud did make a signal mistake.

Some of his patients did complain to him of child sexual abuse. At first he believed them, but when he tried to talk about it publicly, he met such virulent opposition, he made the very great and signal mistake of changing his mind.

So rather than revealing child sexual abuse to the world and ending his career, he said that child sexual abuse was childhood fantasy.

Freud did make a terrible mistake but just consider, Australia had to wait until we elected an atheist as Prime Minister before we could get a National Royal Commission into Institutional Child Abuse. And also consider that the United States of America will never elect an atheist as President and so America will never have a National Judicial Enquiry into Institututional Child Abuse.

Dr Sigmund Freud did make a terrible mistake and betrayed the trust of children, and the United States of America is continuing to make the same mistake to betray the trust of children.