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.