W2: Mental Illness Across Cultures

From Week 2’s lecture, “Explanatory Models” and Interpretive Theory: Learning about Health through Ethnography, it explained how doctors and physicians are trained to ask a series of questions to get to the right diagnosis. What is surprising, is that they are not trained to ask questions about their social, political, emotional, psychological, and community health. How has this came to be? Recently, there has been scientific findings showing that illness is a biological and chemical unbalance in the brain. Unfortunately, individuals sometimes forget that humans will ALWAYS be cultural, social creatures who create meaning. Doctors often do not hear the patient correctly because they are trained to only ask certain questions regarding their “health”, and the patient often does not hear the doctor correctly because they are irritated that the doctor is not listening to their other issues.

Week 2’s lecture also mentions that individuals and cultures from all over the world view mental health very differently. Traditional Chinese medicine incorporates the social, economic, emotional, psychological, and community that makes up ones health. Doctor Arthur Kleinman, pioneer of the idea that physicians could do a better job at healing patients if they listened more fully and more for meaning, which he eventually termed illness narratives, is a way that a patient can communicate many of their ideas. Understanding the diagnosis and treatment in the context of the person’s life, and understanding the explanatory model of the patient will be the best. Kathryn Montgomery, wrote a book called How Doctors Think, and it differentiates between the science of medicine (how most doctors and physicians understand health), and the art of medicine (how some psychologists, anthropologists, and socialists understand health). She discusses how clinical judgment is not as precise as a randomized control trail. An example, two patients have been diagnosed with the same disorder, but patient A can swallow pills and patient B cannot, therefore, patient A takes a different drug than patient B. Prescribing different medications for the same diagnosis should be based off of the patients overall health rather than whether they can swallow a pill or not.

Throughout history, our perception of what mental illness is has changed dramatically, and it will continue to change. The lecture also describes that during the 1900’s through 1950’s, polio infected millions of individuals that changed their perception of health. Individuals during that time thought of germs as an identifiable enemy that lived outside of the body and attacked the body trying to get inside of it. But during the time of AIDS, individuals thought of health completely different. Bodies and the immune system were, and still are, depicted as more open and fluid in magazines. Mental illness also changed over the years for psychologists. The lecture, History of the DSM, the DSM 1 contained 106 disorders, and the DSM 5, the most recent DSM, contains more than 300 disorders. Although, these books describe the disorders and symptoms, this only pertains to the American culture. Different cultures explain depression and schizophrenia very differently and treat them very differently. Just how talking to spirits is normal and healthy to some cultures, and to others it is found to be an illness.

One example of the explanatory model, is from the clip that (Metzl) called The Protest Psychosis. He documents the alleged finding of an increased incidence of schizophrenia in African American males, but argues that this change occurred during the 60’s and early 70’s to undermine the Civil Rights Movement. He mentions how there are numerous studies that show that schizophrenia in cultural perception is also an illness that is not only racialized in a particular way, it is also assumed to be a violent disorder. A particular study found that by just adding the word “schizophrenia” to a sentence, changed police officers perception of violence.

Another example of the explanatory model, is from the article that (McGruder) named Madness in Zanzibar: An Exploration of Lived Experience. The article examines five individuals with schizophrenia within three families. The first and second family saw the mental illness as a blessing and showed low-expressed emotion that appears to have benefited both of them. There was also little evidence of emotional overinvolvement. The individuals that suffered from schizophrenia within these families seemed to be pretty comfortable around their families and not too much at ease. Unfortunately, the third family saw the illness completely different, and therefore, treated it completely differently. The daughter was sent to the hospital as punishment, Abdulridha was very mean and controlling towards her, and Ruhaida would threaten to send her away forever. With this negative expressed emotion and over involvement, Shazrin suffered and cried most days.

With these views on mental health, one is either going to suffer or survive; if we learn how to treat these disorders correctly, individuals from all around the world will be much healthier. From the clip, Last Week Tonight with John Oliver: Mental Health, John explains how mental health is a touchy topic that individuals do not like to talk about. Individuals with mental illness are sometimes described as “crazy”. With this negative perception and stigma on mental illness, doctors and others stay far from it and ignore it. Hopefully, one day individuals will realize that mental health is not something to be scared of and also something that we should take seriously.

Book TV: Jonathan Metzl “The Protest Psychosis

LastWeekTonight. “Last Week Tonight with John Oliver: Mental Health (HBO)”. Filmed [October 2015]. YouTube video, 11:54. Posted [October 2015]. https://www.youtube.com/watch?v=NGY6DqB1HX8.

McGruder, Juli. Chapter 10 – “Madness in Zanzibar: An Exploration of Lived Experience” in Schizophrenia, culture, and subjectivity : the edge of experience, edited by Janis Hunter Jenkins.

6 thoughts on “W2: Mental Illness Across Cultures

  1. If a doctor wished to be effective he must include social, political, emotional, psychological, and community health that contributes to health. I agree with that completely. However, I wish to posit the fact that medicine in the United States has been moving in the direction for a while. Furthermore, you can also look at osteopathic medicine and see that its purpose, when it was initial founded, was to address the factors that you have put forth as it needs to be addressed because at the time the standard practice was very much around the biomedical sphere. While the biomedical approach is still very strong among many U.S. physicians I believe they are making the transition to a more holistic approach to medicine. We have to remember that the biomedical approach does have its advantages, we just have to remember to incorporate the good from multiple different approaches in the best interest of the patient.
    Just a point I wish to tack on to your argument. I believe it is clear that the way an individual views a mental disease can profoundly influence his treatment options for a mental disease. If the view point is entirely biomedical or entirely cultural social, in both cases treatment options have been limited. The best discourse is to take a middle approach.

  2. I think it is a problem that doctors have been trained in the past to only ask questions about a patient’s physical health when they should also be asking how the patient feels mentally, emotionally, and socially as well. I also believe that doctors could in fact do a better job at treating a patients needs if they asked more questions and really listened. Two people can have the same diseases or illness but need to be treated in different ways based on other factors in their lives such as where they live and there culture/lifestyles, religion, etc. Ultimately illness and disease affect different people in different ways all across the world. Just like you stated while some people think talking to spirits can be considered a part of an illness, other people think it’s normal and healthy. Also in the study in Zanzibar, a couple of the families thought positively of schizophrenia, while others found it to be a burden. The families that thought of it in a positive way were able to help the patient cope while others who thought negatively of the disease actually made coping worse for the patient. I think it’s important to support people with illness or disease to help make coping and healing easier for them.

  3. When I was younger, going to the doctor’s meant that I was sick. There was something wrong with me biologically. To go to the doctor’s is to fix whatever bug was inside me. That was how I grew up; I never even considered the idea that everyone else in the doctor’s office was dealing with something different and that we all grew up in completely different households and completely different cultures. Now that I have gone through considerable amount of schooling, I agree with you when you say it’s surprising that doctor’s are never trained to ask about anything other than the sickness. I struggled to understand the idea that some people, still, think of an illness as JUST a biological issue. I like how you incorporated the viewpoints of different career paths (doctors vs. anthropologists). It helps to prove the point that there are different ways to go about thinking and looking at things, which therefore means there are different ways to go about treating these things. I have come to understand that meditation and yoga helps to alleviate a lot of different stressors in life, which is a different approach, as opposed to a doctor, who might just prescribe a pill to help you calm down.

  4. I think it is very useful for a doctor to look at all aspects of a persons life and not just the biological illness itself. It is important to understand ones background and culture and also the symptoms. Since everyone is unique and two people could have the same disease but different mindsets and cultures, it is when one is empathic and goes deeper into that persons head, when a mental illness is treated most efficiently. I remember when I was younger I was asked more about how I felt internally and it was more personable when going to the doctor. Pediatricians seem to know how to seek out ones emotions better, since that is how little kids portray their pain mostly. Taking an ethnological approach, getting into someone else’s shoes, it the best way to treat a mental illness. After all, there is an important human behind every illness. I also want to point out how I agree with your statement on mental health, and how many people just look at those individuals as being crazy and not as being the same as everyone else, just with a chemical imbalance of the brain. I think it makes the stigma worse when certain individuals do not seek help and they deepen the stereotype of all individuals with any type of mental illness, serve or not because they are not getting the treatment they need.

  5. You stated how perceptions of mental illness have changed over time, do you think that people many years from now will be more understanding of mental illness? I think teaching people ( not only americans) about mental illness is just as important as learning about cancer. Most people know what people must do when they go through the horrible stages of cancer, and they even know about the different treatment methods. Almost every science class I have taken, has discussed the different forms of cancer treatment. I think we should make it more of a priority to teach people about the effects of mental illness and the ways we can help those suffering with these illnesses.

  6. Hi Taylor,
    Your post is so well written! Great example using Chinese medicine theories. That really is a great use of how culture effects the type of treatment people get with certain illnesses. Also, Chinese medicine, since it has a psychological focus, perhaps there are less people afflicted with certain mental illnesses there. On the other hand, maybe people are more hesitant to come out with mental illnesses because their treatment is supposed to be so all encompassing. Both interesting views to consider, but I enjoy how much of a contrast that is to American medicine/recovery. American treatment would be known to focus on the here-and-now and the current affliction. An approach that could be associated with patching up holes as they come up rather than fixing the whole boat. Interesting idea!

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