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.