Social anxiety disorder among White Americans

The health disparity I chose is social anxiety disorder.  I chose this because I have experience with it in my family. The bars on the far left represent social anxiety disorder.

According to the Mayo Clinic, social anxiety disorder is a chronic mental health condition in which everyday interactions cause irrational anxiety, fear, self-consciousness, and embarrassment.  This disorder has psychological symptoms like fear, avoiding situations, worry, etc., and physical symptoms like increased heart rate, nausea, muscle tension, etc.  While most people experience this from time to time like when giving a big presentation, for example, social anxiety disorder is chronic and the affected person knows that their feelings are irrational.  Like many other mental health cases, the cause of social anxiety disorder is not simple.  It is the result of both genetics and environmental experiences.  Treatment plans often include counseling, SSRIs, and learning techniques to control stress.  These are often done in combination, though not all are needed.

It has often been seen in the past that anxiety disorders are less common in minority groups.  According to Asnaani et al.  “Several studies have noted the differences between levels of anxiety in communities aligning themselves with more collectivistic values, where focus on maintaining harmony within the group is of the highest priority, as compared to those adhering the more individualistic cultural attitudes, where individual achievement are most highly valued and rewarded by the rest of the social group.” Breslau et al. suggests that ethnic identification and religious participation may be protective factors that could explain the lower risk of psychiatric disorders in general.  Like most psychiatric disorders, social anxiety disorder is very complex and it will take a lot of research to understand the differences in prevalence rates.

The relationship between race, genetics, and health is complex and often misunderstood.  In the past it was believed that different races were actually different species.  This is not a popular theory today but it is often assumed that there are distinct genetic differences between races.  This is leading to the racialization of medicine.  One example of this is the heart drug Bidil, which was advertized as being specifically for African Americans.  The research on this is questionable as to how they proved its increased efficacy in African Americans compared to other races.  There are several other non-genetic factors that can cause health disparities, which have trends along socially constructed racial lines.  These include socio-economic status, education, income, wealth, and neighborhood.  These socially constructed racial lines are often confused with “genetic racial lines”.

http://www.mayoclinic.com/health/social-anxiety-disorder/DS00595

JOSHUA BRESLAU, SERGIO AGUILAR-GAXIOLA, KENNETH S. KENDLER, MAXWELL SU, DAVID WILLIAMS and RONALD C. KESSLER (2006). Specifying race-ethnic differences in risk for psychiatric disorder in a USA national sample. Psychological Medicine, 36 , pp 57-68 doi:10.1017/S0033291705006161

ANU ASNAANI, J. ANTHONY RICHEY, RUTA DIMAITE, DEVON E. HINTON, and STEFAN G. HOFMANN (2010). A cross-ethnic comparison of lifetime prevalence rates of anxiety disorders. Journal of Nervous and Mental Disease, 198, pp 551-555 doi: 10.1097/NMD.0b013e3181ea169f

Applied Approach

I picked the applied approach as being the most useful for studying health because of what it allows you to do. This approach is a more hands-on than the other five.  It allows you to choose between going to foreign countries and viewing the health practices of the inhabitants in that country, you can work in a hospital and help provide physicians with different methods to treating their patients, you can be involved with the government in making new policies on health, or can work in industry giving advice on potentially new treatment methods.  To me the distinction between disease and illness is not obvious.  They are two words that describe the same thing.  For example, if you are infected with E. coli, yes, you have a disease but you are also going to be ill because of it.

The culture that Miner is discussing in the article is our own American culture.  His detailed discussion of a number of the Nacirema’s rituals draws comparisons to some practices that our culture is involved in.  He talks about some of the measures that these people go through just to receive substances that are supposed to have healing powers, which draws comparisons to some practices that are performed in America.
The realization that Miner was referring to our culture came to me near the end when he was discussing the methods the Nacirema have for altering body image.  The holy-mouth-man applies substances to the villager’s teeth to avoid decay, much like how we go to a dentist to have our teeth looked at to avoid decay.  Miner also talks about the daily body ritual performed by everyone called a mouth-rite, which draws comparisons to American’s daily tooth brushing activity.  Finally, miner talks about the different methods the Nacerima go through in an effort to change people’s body image and draws comparisons to how vain the American culture can be about body image.

Ecological Approach

As a student interested in Healthcare Economics I think that the ecological approach to anthropology would be most useful to me in my study of health. The ecological approach takes many facets into consideration when examining health such as the interactions between humans, plants & animals, culture, natural resources, and political economy. Most human issues, at least the most pressing ones are complex and involve many determinants.

Disease and illness are issues that vary person to person and across populations depending on the interaction of the various facets anthropology examines. It is definitely useful to examine what we mean by the terms disease and illness. Our language in surrounding these terms hints at the cultural and psychological approach different people have towards health and wellness. So and so is “diseased” is different from he or she “has a disease”; the latter describes something one possesses while the former is defining someone with a disease. “I feel ill” is different than “I am ill” with one being subjective and the other being rather more objective, respectively.  While many people overlook these distinctions wryly as mere semantics but language, terminology and definitions are important to reach a critical understanding. Disease and illness are distinguished in terms of direction; disease is an outward manifestation generally of physical structure/function, while illness is an inner human experience/perception of the change in health and largely depends on the sociocultural context. As someone who needs to be applied and practical in my line of work that is the economics and management of healthcare it’s easy to forget about subjective or qualitative experience and be immersed in quantities, facts and figures. I certainly see the difference and while it may not be obvious at first it is certainly clear when examined.

The Nacerima article was a great article that examined American medicine as an outsider not immersed in its cultural context. I myself have wondered what future civilizations would make sense of our remnants during their archeological excavations of cities such as Manhattan and D.C. Most things besides the colossal and stone structures would not be around several thousand years from now; how would they make sense of the Superdome, Washington Monument, and Mt. Rushmore? Would they be able to distinguish them from Coliseums, the Great Pyramids, or the Sphyinx? I was able to tell that Miner was describing America when I read about the chopping down of a cherry tree. I was able to use my understanding of American Culture to make sense of the rituals he described. The way hospitals are described as though they are temples is very fitting. Many people try to use medical knowledge to obtain some sort of idealized body image reminiscent of a stone sculpture of a Greco-Roman god or goddess. In our times these can be seen between the glossy pages of popular magazines and late night surfing through television channels. The shamanistic description of drug use makes me think of how primal our behaviors are even with such profound advances in technology. While our hunter gatherers may have come across magic plants in the rainforest along the Amazon many in our times score drugs in concrete jungles between Bourbon and Canal street.

Biological

I think the biological approach is the most useful in the study of health. It is the most logical in understanding what happens with the organ systems when they are affected by disease. When the normal healthy state of the body is not in balance, changes occur in the body to compensate.  I believe this approach definitively shows what happens when there is a state of disease or recovery from surgery.  It is kind of a domino effect.  When something happens with with one organ, the others are affected in a similar manner.

I believe illness is an altered state of well being. A disease needs to be treated to affect a cure. Miner is talking about a culture so full of rituals that it was hard to see how the Nacirema ever were to get anything done in their daily lives.  Magic plays a huge part in their rituals, which are private as are their shrines. They do have a successful economy which is hard to comprehend since they spend most of their time performing these rituals.

Most of the people do the mouth-rite, have a shrine and there is a ritual that involves scraping the skin of the face with a sharp instrument–a kind of sadistic torture. The kind of ritual these people are put through could cause disease such as infections, decay of the teeth. They have a ritual in which they pull their teeth apart if there is no decay and put “magic” dust in the pulled apart areas.  It is true that this is a severe instance to what a culture will do to enforce their beliefs on each other.  Miner states that they believe their bodies are ugly and disease and decline is the body’s natural tendency.  He also says that they believe so devoutly in these rituals to help change the body’s natural state and the only way to do this is through rituals and ceremonies.

Ecological Approach

Out of the six approaches the one that I think will be most useful to me in studying health is the ecological approach. The ecological approach is important because it is a branch of biology that deals with the relationship between an organism and their physical environment.  People are basically a product of the environment. Humans have the ability to contract and spread diseases within their environment. Our society also plays a role in pollution and people make unhealthy eating choices as well. When it comes to pollution in our society this has a negative impact on people and our environment because it can open the door to new diseases that did not exist before. According to the video the ecological approach is based on the relationship between organisms and their total environment.

It is through their relationship that our society can understand how diseases develop and spread through a population. The goal of any eco-system is to maintain balance. Balance is symbolic in a sense because in life people strive to have balance to live a healthy and successful lifestyle. In turn if humans do not take care their environment then it will have a negative impact on their health. We need to continue to replenish and invest in our environment instead of depleting our natural resources and polluting our environment with waste. I picked this approach because the ecological approach can help us increase our awareness about our environment. The ecological approach can also help us improve our environment, our natural resources like water and the air we breathe. As a result this positively impact human health by improving the environment we live. There is a direct correlation between a person and their physical environment.

I do not believe there is legitimate distinction between disease and illness. They are both intertwined and mean the same thing. In our society illness is classified as a disease and in some cases this term is used interchangeably with disease to describe different health conditions. When it comes to disease in our society it usually represents the overall alignment or disorder that the person is experiencing. But, this could be said for illness as well. I believe there is no real distinction between disease and illness and it is not obvious to me because their meanings are closely related. What Miner is talking about in the Nacerima article is about American culture and our health wellness concepts that we use. I realized this in the second paragraph Miner stated that “the chopping down of a cherry tree in which the Spirit of Truth resided”. This statement showed how our society relies on our natural resources and spiritual practices to promote good health in our society. Miner’s statement brings back the ecological approach and shows us how people are a product of their environment and use their physical environment like chopping down a tree to better their health.

 

Critical Approach

I find this to be the most interesting and useful approach for studying Anthropology for me because of the way I am able to relate. Being a Philosophy major, I have an interest in ethics of all realms. Using cultural foundations of medicine as well as science to understand why things are done the way they are, and are culturally acceptable in some communities but unacceptable in others is a great way for me to grasp Anthropology in a way that I have some previous understanding of.

Illness and disease seems a bit difficult to grasp but I think I understand. Illness is something that is influenced or effective by “the human experience” allowing cultural norms to be factored in. Disease is influenced by western civilization. It is more of a physical problem with no factoring of cultural influences.

Miner is talking about the cultural background of North America as described in the second paragraph of the article and then clarified once again when talking about George Washington.

It mentions that the rich are concerned with their appearance and that includes that of their house. In rich families they can afford stone for their “shrine rooms” but poor people often try to “imitate” such rooms with look a like stone. I think this shows that the rich are valued in the community and the poor are not internally happy with their life and are constantly seeking approval or a way to become like those they admire.

Also they talk about the importance of medicine men and how if they were not around no one would understand how to read the ingredients that are needed to better one’s appearance. They are crucial in this process.

The importance of the mouth’s appearance is also necessary in this society. I do see this being a realistic claim as it is emphasized in our culture to take care of this from the moment we are born. It just goes back to the focus on our looks to be a good, accepted member of society.

Ethnomedical

I chose the ethnomedical approach because I think that the meanings of health and illness are truthfully in the eye of the beholder.  Different cultures see illness and disease differently and have different treatments.  Every culture and nation does not know about “western” medicine.  Even within the united states, doctors treat patients that may not agree with the treatment that the doctor prescribes or may not understand the implications of a diagnosis.  Much of this does depend of the level of education, but it also depends on the traditional beliefs of a culture and the resources available to them.  An example that makes an argument for the ethnomedical approach would be in the case of Lia Lee. Her story is told in the book “The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures” by Anne Fadiman.  Lia’s family members are Hmong refugees from Laos.  Lia is also epileptic and there is a clash between her family’s spiritual beliefs of the disease and the doctors scientific approach.  Her family doesn’t understand the true implications of her epilepsy, the reasons that she has to take the medicine. The doctors have no understanding of the Hmong culture and how to communicate to Lia’s family the seriousness of her condition. This misunderstanding of both sides causes Lia’s condition to worsen over time.

I think that disease and illness are sometimes interpreted as being the same, but I do that I understand how they are different.  Disease is considered the physical abnormalities and biological symptoms seen clinically.  Illness is based more on the cultural beliefs and experiences of a person and their perceptions of what is healthy.

The culture that Miner is talking about it American culture.  I had a little chuckle after reading through the second paragraph. As I was reading about the location I had an inkling that it was the United States and then when it talked about George Washington that is when I definitely knew.

Miner talks about how people have shrines to avert ugliness and the more affluent a family is the more shrines they have in their household.  These shrines would be bathrooms.   Americans are all about cleanliness and the bathroom is where you get clean. It’s were you take care of your appearance.  The part I found interesting is how Miner interpreted the dentist. Personally, I am always looking at people’s teeth.  Having a good teeth that are healthy is way of telling if a person is in good overall health, it ups the attractiveness of a person, and also can show the social standing of a person.  At the end Miner talks about how human sexuality is taboo, but in other cultures it is not. He also talks about how Americans actively use family planning methods and pregnant women wear clothes to cover up their pregnant bodies.  In other cultures, people are more open about sexuality, pregnancy is openly displayed because it is a sign of health, and less is understood about conception.

Flu

I define health as the nonappearances of disease and the body maintains homeostasis. When a person is in good health the mind, body, and well-being should be too. My ideas of health come from many sources for example my family, media, school, friends, and doctors as well. They all play a factor for me defining health the way I do. Especially in the media we see  so many ads about getting healthy to live a longer life. Illness is a sense of not being normal and healthy. The deciding factors for my definition of illness are friends, books, media, teachers, and doctors.

First is anxiety I believe it can be consider an illness because it is pondered to be a mental illness. Anxiety is a “distress of uneasiness of the mind caused by fear of danger or misfortune”. The definition alone is the reason why I say it can be could an illness. People I believe with anxiety don’t feel normal and my definition of illness is not feeling normal and healthy.

Second is sadness it was kind of hard for me to decide whether it’s an illness or it’s not because sadness is emotion. Also if you’re sad you could have a perception of your not being healthy. So I say sadness can be considered to be an illness. Sadness is defended as being affected by unhappiness or grief. Sadness can affect your health cause some people might not eat when they are sad causing themselves to become sick.

Third is the Flu I believe it can be considered to be an illness. The Flu also known as influenza is a viral infection that affects the respiratory system. When you have the flu your body is not in the stage of health. The Flu I believe more in the disease category more than it is in the illness category.

Ethnomedical Approach

I picked the approach of ethnomedical because I believe that it really focuses on the understanding of illness in relation to the cultural definition and how those illnesses are treated based on cultural practices. This approach allows for the comparison of defining what each culture constitutes as a disease and illness and how multiple approaches to the topic affects each individual’s physical being. For example, when I am sick I seek help from a respected medical physician. However, some Native American tribes seek health treatments from a medicine man or a respected spiritual tribal leader. Though, we seek medical treatment from different people we do share a common goal of getting help from someone that is known within the community as a respected member that possesses the ability to enable better health. The way that we experience disease and illness is different because of our differences in cultural representation. Disease and illness fall under the umbrella of sickness but each one as different constructs of sickness. The disease aspect is the outward expression of your physically altered state whereas illness is our individual interpretations of physical ailment.

In Miner’s article about the Narcerima people, he is describing a culture that focuses on health through the understanding of magical and spiritual belief. I realized this when he started talking about how each family has an alter room that they store their potions and relics in a box in the wall. Their belief in the power of magic explains why they provide gifts to the medicine men and use potions to ward off disease and illness. The fact that these people still experience all the ailments that they believe magic will alleviate shows just how deep of a cultural bond they have to their understanding and experience with illness.

There are a few rituals that demonstrate their cultural beliefs of health and the influence of medicine. One ritual is exorcisms. The belief that a witch doctor can exercise evil out of an individual shows a high value on spiritual healing. There is an importance on the cleansing of the spirit and that evil can cause harm to one’s health if allowed. Another ritual is unclothing of sick individuals as they enter the imposing temple. Since nudity is so taboo within this culture, the stripping off of the clothing and allowance of others to wash them shows how strong the beliefs are put into the healers of this temple. The faith that they have in their healers parallels the faith we put into doctors and the medical system. The last ritual is the packing of the gums with magical relics and potions. This ritual is to stop gum decay and even though individuals still experience this decay and disease, the fact that they continue to go and have this practice done continues to demonstrate the belief that these healers and medical men know all and that all faith is put into spiritual healing.

Biological Approach

I think that the Biological Approach will be the most useful to me in studying health. I feel that the Biological approach covers many factors that can influence an individual, such as their environment, their genetics, and even personal choices that they make. I believe that these three factors are very important to an individual’s health, and it is for this reason that I believe the Biological Approach will be the most useful. I do not believe that the other approaches will not be useful, just that the Biological Approach will be the most useful.

I do not believe there is a distinction between disease and illness. I believe that the difference is effectively a matter of semantics, since there is not a universally accepted definition for the difference between the two. If I had to make a distinction, I would say that illness refers to the patient’s perception of his or her disease, or that illness refers more to the symptoms and visible effects of the disease, while the term disease refers more to the overall condition.

I believe that Miner is talking about American culture in the Nacirema article. I first came to suspect this when it was mentioned that their folk hero chopped down a cherry tree. I was much surer of this after reading the third paragraph, which mentions that the Nacirema have a highly developed market economy and engage in many ritual activities.

The three rituals I decided to talk about from the article are the box of charms and potions acquired from medicine men, the holy-mouth-men, and the latipso. The box of charms and the medicine men that provide them represent prescription medicine in our health care system. In our health care system, one must pay for a doctor’s visit (whether through insurance or out of pocket) to receive a prescription, and then pay for the prescription as well. In the Nacerima culture, the prospective patient must give a gift to both the medicine man and the herbalist. Our system does not always do a good job of keeping the patient informed of decisions, and this is represented by the Nacerima’s people fear to use medicine on their own owing to the fact that they cannot remember what they are used for. The Holy-Mouth-Men clearly represent dentists. In the Nacerima article, the natives willingly visit a holy-mouth-man once or twice a year despite the pain it puts them through, believing that the holy-mouth-man can prevent tooth decay. While the article heavily satirizes the effectiveness of dentists, it is true that few people enjoy visiting the dentist but go anyway because they believe that it will keep their teeth health. The final ritual I will talk about is the latipso. This represents a hospital. What stuck out for me was the mention that the treatments are incredibly harsh, and that it is considered a place where people go to die by the uninitiated. This is clearly a reference to heroic medicine and the harsh treatments of old that were the norm for the majority of medical history, and to the fact that for the majority of the existence of medicine it did not really help people in any appreciable way.