W2: Stigmatization as an “explanatory model” for schizophrenia?

The way we understand mental illness (and all illness really) is influenced by the culture we live in. The McGruder (1) chapter we read discussed the way world views affected the explanatory models of schizophrenia through his study of three different Zanzibarian families. In Zanzibar, religious beliefs like “spirits caused madness” are common when associating with mental health. Treatments include both biomedical (like hospitalization with therapeutic treatments)  and traditional medicine (including herbal concoctions or religious rituals). What I also found interesting was how our world-views directly affected how we experience mental illness. Cultural norms, like the example given of the importance of keeping hatred to oneself and remaining cheerful to the exterior world, creates conflicts that differ from other cultures where norms might be switched. In McGruder’s description, anger and feelings that are to be kept to oneself are stored in the heart. One female patient studied said that she was most disturbed when she heard voices because it meant they could see into her heart (where she hid her “shameful” expressions). I think this study was so interesting because of the multifaceted approach to mental illness: the rich culture of Zanzibar had such direct influences over how they expressed emotion (emotions that are affected by mental illness), included in this culture was the religious belief that hardships are sent from Allah as obstacles to overcome, which increased the family’s support.

In contrast, the video we watched in class described the differences in the US’s explanatory model. The film discussed the effect ethnicity has on mental illness, comparing and contrasting white males with African American males (who are six times more likely to be diagnosed with schizophrenia) (2). What was most interesting about this video was how starkly stigmatized Americans view mental illness, specifically schizophrenia: cops are more likely to arrest someone if they think that they are schizophrenic. It’s sad how scared we are of mental illness, and is interesting when compared to Zanzibar where mental illness is treated on multiple levels. I think that the way the Zanzibar people use their culture to understand mental illness makes it less stigmatized in their culture. Compared to the U.S. where we choose to ignore this population because the defy cultural “norms”.

I found an interesting journal article that looked at how our beliefs can aggravate mental illness in the International Journal of Social Psychiatry (3). This study looked at the mentally ill population in India, and how different beliefs about what causes schizophrenia. These varying beliefs had a big impact on treatment of the disorder. Some beliefs involved stigmatization which correlated with poor or no treatment of the disorder.

What I gained from this section was the importance of fully understanding a disease from all aspects: biological and socially. I also learned how important family relations are within the mental illness sphere because it can help or hurt an individual’s access to treatment. Within the United States, I think it’s important to educate the public on the facts surrounding schizophrenia (mostly how they aren’t a danger to others). I think that many of us get scared when facing something that so directly challenges social norms, and it’s easy to choose to stigmatize, keeping many individuals from seeking treatment or receiving proper care.

  1. 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.
  2. Book TV: Jonathan Metzl “The Protest Psychosis”.
  3.  Charles, H., S.d. Manoranjitham, and K.s. Jacob. “Stigma and Explanatory Models Among People With Schizophrenia and Their Relatives in Vellore, South India.International Journal of Social Psychiatry 53, no. 4 (2007).

4 thoughts on “W2: Stigmatization as an “explanatory model” for schizophrenia?

  1. When looking at how culture affects our perception of an illness I never thought about how it affects whether it’s stigmatized. Good find, I agree with that. We here in the United States in most cases shun those who are considered “weird” or out of place, namely being those with schizophrenia and various other mental illnesses. I believe that this is what played into the over diagnoses with women and African Americans before and up to the sixties, the time period Dr. Metz focused on.

    The Zanzibarian culture seems to be relatively tight knit according to the piece we read, which tells can say a lot about their approach to the illness. Since in this case the village was a loving community there was no reason to discriminate against anyone, which in turn allows us to see that instead of hindering progress they help each other. America is so big and there’s so much political influence everywhere that it’s a bit easier to use things such as mental illness to help achieve social or political victories over other social or political groups. In many cases this almost gives us a reason to stigmatize illnesses like schizophrenia, whereas in the Zanzibarian culture it is seen as a test that all must band together to overcome.

    This class is really bringing out the point of “it depends on how you look at it” to a whole new level, but it makes sense. Good post, I really enjoyed reading it.

  2. I completely agree with what you wrote in your blog post. I find it interesting how in a place like the United States where there is so much focus on bio-medicine and we know how schizophrenia works on a mechanical level that we are still stigmatizing people who suffer from it. However, like you pointed out in Zanzibarian culture they are much more willing to embrace the person suffering from schizophrenia to help them even though part of their explanatory model is that it could be demon possession. I don’t know, but I would think that if you believed someone could be possessed by a demon you would be less willing to help them out, but the other facets of their explanatory model actually make it more compelling to help their families. I think your article that you found about India really sums up a lot of what you were already saying in your post, that stigmatization hurts the affected person more than it helps them. So you are absolutely right that we need to defy social norms and embrace people instead of stigmatizing them, and hopefully that would eventually lead to a change in our explanatory model as Americans.

  3. Lindsey,
    I’m glad that you brought up the stigma surrounding mental illnesses. Originally when I was going to write a response to your post, I planned on arguing against your statement, however after further readings I do agree that many outpatients and those undiagnosed with schizophrenia are alienated and treated very differently because of it. Schizophrenia is a horrifying disease, leaving many patients scared to ask for help and support from their family. As a director of psychology, Faith Dickerson and her partners conducted an outpatient survey surrounding the stigmatism against schizophrenic outpatients. As many as 70% of the outpatients were worried of being treated differently because of their illness, and 55% had heard offensive statements about psychiatric disorders (Dickerson et. al). I think that lack of education causes the stigma around these illnesses, and it is important for especially families of patients should be educated on what schizophrenia is and why the symptoms occur. Maybe if the public were more aware as well, the treatment of the afflicted wouldn’t be so negative. I disagree that society is scared of schizophrenia and other psychiatric diseases because it is different from the social norm, but rather it is unpredictable and hard to empathize with the sufferers. As an outsider, we can see how it affects the patient, but we don’t know the extent to which they suffer from because much of it happens internally, such as the hearing of voices or buzzing sounds. It makes the outsider worried because they never know if the sufferer’s mood will change in a split second, or what the afflicted are thinking about.

    Dickerson, Faith B., Jewel Sommerville, Andrea E. Origoni, Norman B. Ringel, and Frederick Parente. Experiences of Stigma Among Outpatients with Schizophrenia. Baltimore: Oxford University Press, 2002. http://schizophreniabulletin.oxfordjournals.org/content/28/1/143.short.

  4. Lindsey,
    I love that you focus on stigmas affecting treatment of mental illness, because it seems to be something I’ve been noticing more and more lately. Until recently, it was never something I had considered, because it was always simply the way things were, and I had never questioned it. However, I was recently involved in a study regarding the lifestyles of college students with mental illness, and many of the questions had me thinking about the influence of others (especially family) on mental health. I was asked a question about being a target to harassment because of a mental illness, which is something I never experienced myself, but the fact that the question was part of the study made me realize that people must be negatively judged for a huge variety of mental illnesses constantly.
    As for your topic of family playing a role in treatment, I know several people who were incapable of getting the treatments needed for mental illness during adolescence, simply because parents either refused to believe there was a problem in the first place, or they believed the child would, “get over it.” It’s not until several years later, usually once in college, that these people can seek out the treatment they need as independent adults.
    I would be interested to learn more about where the American stigma of mental illness originated, but no matter what the cause, something needs to be done about it so every person can have the help they need to reach their maximum potential.

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