Culture and Mental Illness

[Golden Applesauce]

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

Interesting (albeit long) article.  A lot of mental illness are restricted to a particular culture; a lot more are expressed differently in different cultures, and all of them are treated differently in different cultures.  The article is about the exporting of Western notions of what mental diseases are, and whether that's a good thing or not.

Some excerpts:

Mental illnesses, it was suggested, should be treated like "brain diseases" over which the patient has little choice or responsibility. This was promoted both as a scientific fact and as a social narrative that would reap great benefits. The logic seemed unassailable: Once people believed that the onset of mental illnesses did not spring from supernatural forces, character flaws, semen loss or some other prescientific notion, the sufferer would be protected from blame and stigma. This idea has been promoted by mental-health providers, drug companies and patient-advocacy groups like the National Alliance on Mental Illness in the United States and SANE in Britain. In a sometimes fractious field, everyone seemed to agree that this modern way of thinking about mental illness would reduce the social isolation and stigma often experienced by those with mental illness. Trampling on indigenous prescientific superstitions about the cause of mental illness seemed a small price to pay to relieve some of the social suffering of the mentally ill.

But does the "brain disease" belief actually reduce stigma?

In 1997, Prof. Sheila Mehta from Auburn University Montgomery in Alabama decided to find out if the "brain disease" narrative had the intended effect. She suspected that the biomedical explanation for mental illness might be influencing our attitudes toward the mentally ill in ways we weren't conscious of, so she thought up a clever experiment.

In her study, test subjects were led to believe that they were participating in a simple learning task with a partner who was, unbeknownst to them, a confederate in the study. Before the experiment started, the partners exchanged some biographical data, and the confederate informed the test subject that he suffered from a mental illness.

The confederate then stated either that the illness occurred because of "the kind of things that happened to me when I was a kid" or that he had "a disease just like any other, which affected my biochemistry." (These were termed the "psychosocial" explanation and the "disease" explanation respectively.) The experiment then called for the test subject to teach the confederate a pattern of button presses. When the confederate pushed the wrong button, the only feedback the test subject could give was a "barely discernible" to "somewhat painful" electrical shock.

Analyzing the data, Mehta found a difference between the group of subjects given the psychosocial explanation for their partner's mental-illness history and those given the brain-disease explanation. Those who believed that their partner suffered a biochemical "disease like any other" increased the severity of the shocks at a faster rate than those who believed they were paired with someone who had a mental disorder caused by an event in the past.

"The results of the current study suggest that we may actually treat people more harshly when their problem is described in disease terms," Mehta wrote. "We say we are being kind, but our actions suggest otherwise." The problem, it appears, is that the biomedical narrative about an illness like schizophrenia carries with it the subtle assumption that a brain made ill through biomedical or genetic abnormalities is more thoroughly broken and permanently abnormal than one made ill though life events. "Viewing those with mental disorders as diseased sets them apart and may lead to our perceiving them as physically distinct. Biochemical aberrations make them almost a different species."

Unfortunately, at the same time that Western mental-health professionals have been convincing the world to think and talk about mental illnesses in biomedical terms, we have been simultaneously losing the war against stigma at home and abroad. Studies of attitudes in the United States from 1950 to 1996 have shown that the perception of dangerousness surrounding people with schizophrenia has steadily increased over this time. Similarly, a study in Germany found that the public's desire to maintain distance from those with a diagnosis of schizophrenia increased from 1990 to 2001.

Researchers hoping to learn what was causing this rise in stigma found the same surprising connection that Mehta discovered in her lab. It turns out that those who adopted biomedical/genetic beliefs about mental disorders were the same people who wanted less contact with the mentally ill and thought of them as more dangerous and unpredictable. This unfortunate relationship has popped up in numerous studies around the world. In a study conducted in Turkey, for example, those who labeled schizophrenic behavior as akil hastaligi (illness of the brain or reasoning abilities) were more inclined to assert that schizophrenics were aggressive and should not live freely in the community than those who saw the disorder as ruhsal hastagi (a disorder of the spiritual or inner self). Another study, which looked at populations in Germany, Russia and Mongolia, found that "irrespective of place . . . endorsing biological factors as the cause of schizophrenia was associated with a greater desire for social distance."

Nowhere are the limitations of Western ideas and treatments more evident than in the case of schizophrenia. Researchers have long sought to understand what may be the most perplexing finding in the cross-cultural study of mental illness: people with schizophrenia in developing countries appear to fare better over time than those living in industrialized nations.

This was the startling result of three large international studies carried out by the World Health Organization over the course of 30 years, starting in the early 1970s. The research showed that patients outside the United States and Europe had significantly lower relapse rates — as much as two-thirds lower in one follow-up study. These findings have been widely discussed and debated in part because of their obvious incongruity: the regions of the world with the most resources to devote to the illness — the best technology, the cutting-edge medicines and the best-financed academic and private-research institutions — had the most troubled and socially marginalized patients.

Trying to unravel this mystery, the anthropologist Juli McGruder from the University of Puget Sound spent years in Zanzibar studying families of schizophrenics. Though the population is predominantly Muslim, Swahili spirit-possession beliefs are still prevalent in the archipelago and commonly evoked to explain the actions of anyone violating social norms — from a sister lashing out at her brother to someone beset by psychotic delusions.

McGruder found that far from being stigmatizing, these beliefs served certain useful functions. The beliefs prescribed a variety of socially accepted interventions and ministrations that kept the ill person bound to the family and kinship group. "Muslim and Swahili spirits are not exorcised in the Christian sense of casting out demons," McGruder determined. "Rather they are coaxed with food and goods, feted with song and dance. They are placated, settled, reduced in malfeasance." McGruder saw this approach in many small acts of kindness. She watched family members use saffron paste to write phrases from the Koran on the rims of drinking bowls so the ill person could literally imbibe the holy words. The spirit-possession beliefs had other unexpected benefits. Critically, the story allowed the person with schizophrenia a cleaner bill of health when the illness went into remission. An ill individual enjoying a time of relative mental health could, at least temporarily, retake his or her responsibilities in the kinship group. Since the illness was seen as the work of outside forces, it was understood as an affliction for the sufferer but not as an identity.

For McGruder, the point was not that these practices or beliefs were effective in curing schizophrenia. Rather, she said she believed that they indirectly helped control the course of the illness. Besides keeping the sick individual in the social group, the religious beliefs in Zanzibar also allowed for a type of calmness and acquiescence in the face of the illness that she had rarely witnessed in the West.

[Brotep]

Holy crap, an actually interesting article from a news provider.  I tried to read CNN.com the other day and the Avatar thread was the result 

a mental illness is an illness of the mind and cannot be understood without understanding the ideas, habits and predispositions — the idiosyncratic cultural trappings — of the mind that is its host

This is good stuff.  It endlessly frustrates me that knowledge is so compartmentalized in our culture.  There are so many "experts" out there who only know one thing, one subject.  If only psychologists were more familiar with social anthropology...


A constructivist critique of the classifications of mental illness is a pretty solid angle of attack.  Spirit possession occurs far more frequently in cultures where possession is a mainstream concept, for instance.

[Cain]

This is really good stuff.  I've read bits and pieces on culturally bound mental illnesses before now, but its nice to see the case for it laid out so well.

I'll make some comments later.

[Richter]

Good find!  I wrote a few papers on this sort of thing back in college.  I can see why they focused on cross - cultural mental illnesses, but there are several culture sepcific ones that are not quite as rationaly dealt with as the examples from GA's quote.  The Japanese disorder of paralyzing fear that your body odor may offend someone, or the "vanishing testicles" dellusion from central Africa that usually touch of violent witch hunts come to mind.

[LMNO]

Interestingly enough (or, part of a book tour), NPR had a recent show on this:
http://www.npr.org/templates/story/story.php?storyId=122490928

Author Ethan Watters thinks that America is "homogenizing the way the world goes mad." In Crazy Like Us: The Globalization of the American Psyche, he describes how American definitions and treatments of mental illness have spread to other cultures around the world.
"[McDonald's] golden arches do not represent our most troubling impact on other cultures," Watters writes. "Rather, it is how we are flattening the landscape of the human psyche itself. We are engaged in the grand project of Americanizing the world's understanding of the human mind."
Watters talks with NPR's Rebecca Roberts about the cultural diversity of mental illness — and how that diversity is quickly disappearing.

[Bebek Sincap Ratatosk]

That is an awesome article GA, thanks for posting it!!

[Cramulus]

yes, very interesting

also: dead god, I love experiments in which they get people to administer electric shocks to one another.

[Kai]

Thanks for posting this. Very very interesting.

[Golden Applesauce]

yes, very interesting

also: dead god, I love experiments in which they get people to administer electric shocks to one another.

Sadly, I think most of those experiments only involve telling people they're administering electric shocks.

[Mesozoic Mister Nigel]

Wow, this is really interesting! Also I like that it explores some of the pathology-as-identity ideas that we in the US have embraced over the last few decades.

[P3nT4gR4m]

It goes beyond mental illness. Americas whole culture is spreading like a bowel virus, everything from "HAVE A NICE DAY" to "FREEDOM^tm" and the War on Terror.

Who gives a fuck - your beer will nevar catch on.