W2: What Is Mental Illness? (It depends on who you ask)

As Kleinman argues in “The Illness Narratives”, explanatory models play a vital role in determining health outcomes. Doctors and their patients must both effectively communicate their respective explanatory models to each other in order to reach a mutual agreement in regard to treatments and expected health outcomes. However, if the doctor doesn’t take the patient’s perspective into consideration, the results can range from disrespect at best to negative health outcomes at worst (Kleinman: 122). One such example of how the doctor’s biomedical explanatory model can supersede that of the patient’s is the creation of the patient history and medical record. Information provided to the practitioner is translated into some form of standardized biomedical language and the practitioner’s personal biases and beliefs may be transferred as well. This official record is often reinterpreted by other health professionals and the original context provided by the patient may be lost, having social and political ramifications (Kleinman: 131).

As we saw in “The Protest Psychosis”, Metzl argues that the perception of a mental illness may have a significant impact on how it is treated, both in the hospital and in the public eye. Metzl uses the example of schizophrenia to portray that mental illnesses that are perceived as “violent illnesses” are treated with much harsher actions. According to a study of police officers’ perceptions, adding schizophrenic to the perpetrator’s description raised the officers’ perceptions of needing to restrain or incarcerate the individual from 15-19% to ~60% on a similar, minimally violent altercation (Metzl, 2010).

Other cultures tend to view mental illness a little differently. For example, in “Madness in Zanzibar: An Exploration of Lived Experience” McGruder notes that many mental illnesses are believed to be caused by spirits and are often treated with traditional and religious healing methods such as “botanical remedies, therapeutic uses of the Qur’an, and spirit ritual” (McGruder, 2003: 258). In Japan, there is a stigma surrounding mental illness, and mental illness is believed to be caused by “weakness of personality”, “rather than biological factors” (Ando et al. 2013: 471). In fact, the stigma is so profound that roughly 67% of sufferers never seek professional help (Ando et al. 2013: 472). The discrimination and lack of resources for those suffering from mental illness have dramatic social and health outcomes. These outcomes may include low self-esteem, dissolved familial ties and relationships (including marriages), unemployment, loss of social opportunities  and even being unable to find housing (Ando et al. 2013). Japan’s case is unfortunate because many of these socioeconomic outcomes could be avoided by eliminating the stigma surrounding mental health through educational programs and social support systems (Ando et al. 2013).

Therefore, I would argue that the treatment of those with mental illness and their respective outcomes are directly impacted by how their society defines their illness. If a society believes the cause is biological, they suggest biomedicine. If a society believes the cause is spiritual, they seek religion. If there is a stigma, they isolate and avoid them. Whatever the case may be, each society has its own way of answering “What is Mental Illness?”.

Ando, Shuntaro, Sosei Yamaguchi, Yuta Aoki, and Graham Thornicroft. “Review of Mental-health-related Stigma in Japan.” Psychiatry and Clinical Neurosciences 67, no. 7 (November 2013): 471-82. October 25, 2013. Accessed July 15, 2016. doi:10.1111/pcn.12086.

3 thoughts on “W2: What Is Mental Illness? (It depends on who you ask)

  1. Cory, great post! When you mention the translated description from the patient to the doctor, with codes and symbols, it reminds me of the game of telephone I used to play as a child. The original message at the beginning is totally misinterpreted at the end of the line of people transporting the language to the next person. Who would have known a child hood game would be ever so present in our medical lives. I wish that Doctors were better trained to spend longer times with each patient to actually dig deep into their personal lives to treat each patient as a living, interdependent being, as opposed to a body.
    It is interesting to hear about the weakness of personality stigma in Japan. Depending on society’s preconceived views about diseases and symptoms, the patient’s own medical decisions are influenced as you have mentioned. The patient will refuse to get help in fear of hurting his own reputation even though the disease may be taking over his mind, body, environment, etc. It sickens me how strong society influences the people that create it. I bet if an individual in America experienced the same exact symptoms as a mentally ill patient in Japan, the patient living with Western culture would seek treatment right away because he/she would automatically think that something in her brain is wrong. He/she would ask for medication to fix the perceived chemical imbalance.

  2. Hi Cory!
    I loved your thoughts here and I think we have a very similar view on the topic. I liked that you brought up the stigma of things. I think that this places a larger part in the process than many of us think. A negative stigma could hold someone back from the the proper treatment and sometimes from any help at all. I can see how you made this a cause and effect type situation. Where the cause of the illness, in the mind of that culture, can very strongly effect the model they are going to follow. I think in the US we are moving towards a common ground between a biomedical and more cultural viewpoint. This is most likely because of the diversity of many of our patients. Mental health can be tricky for some to understand because they cannot physically see what is wrong and the awareness of illness is sometimes lacking. Mental health is a prime example of the reason why there is not a single treatment to cure everyone who has the same thing wrong with them. Also, mental health is usually not singularly based. By this I mean that often, multiple illnesses can be present in the symptoms of a patient. It really is tricky but I am glad we are constantly making updates and improving our knowledge.

  3. Hi Corey, very well said. I agree with what you said. It is frustrating when people to not seek treatment for something because they do not want to be perceived as week or abnormal as a result of the stigma placed on it. It is alarming that sixty seven percent of people in Japan do not seek out treatment. I do believe in the United States more people seek out treatment, but the one thing I would add is that even in the US we need to do more to combat mental illness. I think there still is stigma in the US as well although there are different awareness programs trying to combat it. However, when we see in the news all the time about a mentally ill patient shooting and killing innocent people clearly there is more work to be done towards treating mental illness. I think this is a reason why the police officers responding to the schizophrenic call said they needed to be restrained or arrested more so than the non-schizophrenic calls. I don’t necessarily think this is a good thing or right per se, however I also don’t think there is much reason to read into it. Schizophrenia can potentially make a person dangerous and I think the police officers involved were just taking percautions for their own safety and civilians safety.

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