Concept of Mental Illness - Term Paper Example

?Concept of Mental illness The concept of mental illness depends on what behavior is accepted by a culture as normal or abnormal. Each culture has social standards or norms that are considered normal or general. Some cultures may accept a wider range of behavior outside of a culture's standards than others do. Cultures do more or less recognized systematic delusional behavior and tend to deal with it in different ways. But what may be seen as delusional in one culture may not be seen as delusional in another. Haviland et al write of the extreme behavior, according to Western standards, that an Indian Hindu man must adopt to become a sadhu, or holy man (p. 142-143). The candidate must separate from his people and adopt estranged behavior as if preparing for his own death. He reaches the point where he has adopted a different identity as if born again. But the habits he then picks up may find him living near cremation sites and even eating dead flesh. Such behavior, accepted in India or Nepal, would be seen as outside the norm in the United States or Europe. Anthropologists look across cultures to determine what is social conformity and how personalities are evaluated and accepted within its range. There may be forms of mental illness or disorder occurring across culture. This may well be the case of schizophrenia, which seems to appear in other cultures and represent individuals with extreme delusions. Such individuals may hear voices which others don't hear and then go into extreme isolation or withdrawal from the trust of others (Haviland et al, p. 150). As explained below, other cultures may even treat schizophrenia different than American and European cultures. One concept of mental illness in the United States addresses such illnesses as psychosomatic ailments. These ailments indicate illnesses rooted in the mind that may not have direct and or obvious physiological causes. In the Euramerican tradition these illnesses may be treated under the biomedicine system. This system is based on the dualistic mind-body theory rooted in Western philosophy and psychology. The biomedicine system has been seen as an effective one in America. It has resulted in a large pharmaceutical industry that has virtually developed medication for all kinds of mental illnesses. Yet other cultures may approach psychosomatic ailments differently, reflecting their own healing systems. Immigrants or people from other countries in European and North American societies may respond differently to the cultural pressures of their new lands. They may also respond differently to the medication issued under the biomedical system. Other lands and cultures may not have such theories dominated by a scientific mind body bias. They may respond more to, for example, certain spiritual beliefs of their own cultures. Anthropologists have been investigating some of these cross cultural differences and may help eventually integrate the concept of biomedical approaches in the West with workable approaches from other countries. Culture bound Syndromes Researchers and anthropologists have noted examples of ethnic psychoses appearing specific to certain cultures. Sometimes referred to as culture bound syndromes, these forms of psychoses denote mental disorders that appear bound to unique combinations of environmental settings and cultural practices. They are specific to particular ethnic or cultural groups. In several places in Southeast Asian and Africa, some men suffer from koro, a belief that their genital organs are retracting back into their bodies (Watters, 2010). The feeling is extreme enough that some patients feel they may die due to possible causes of too much sex or masturbation (Haviland et al). Certain Algonquian Indians have demonstrated the malady of falling into a trancelike state inducing fear in others that they are cannibals. Different cultures across the world tend to have their own specific maladies that are usually related to narratives and stories of their own countries. However, in this present day of mass market communication and global technology, some of these maladies and mental disorders may spread from one location or country to another. Watters (2010) demonstrates how the mental illnesses of one country may be transferred to another. This appears to have been the case of the transfer of anorexia from the United States to Hong Kong. At one point in the mid-nineties, a Hong Kong psychiatrist saw the occurrence of his anorexia patients increase from two to three a year to that same amount per month. This increase appeared to have occurred after one young teenager had died from anorexic and her case was suddenly sensationalized across the Hong Kong media. Although the teenager's case of anorexia had been different from those reported in America, the Hong Kong media adapted American criteria in describing the case. Soon teenagers were reporting anorexia causes related to fat phobia. These events represented a clear transfer of an American disorder to Hong Kong. Watters explains that "in the process of teaching the rest of the world to think like us, we've been exporting our Western "symptom repertoire" as well. How Cultures Respond In the United States, psychiatrists, psychologists and mental health workers use the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV TR) to group and analyze symptoms of that define mental illnesses. There are many categories and subcategories. For example under depression, one may be afflicted with one of several types of major depressive disorder (MDD) that range from severe depressive illness to seasonal affective disorder. The DSM-IV TR is a large book of 844 pages, of which some five pages list under foreign ethnic psychoses under "culture-bound syndromes". Pharmaceutical companies have made a mine field of competition to reap profit from developing medicines to meet all the different kinds of mental illness. They have become global and international in their need to keep profit coming into their biomedical manufacturing frame from local markets all over the world. Watters reports that a recent World Health Organization study found that treatment of people in developing countries treated for schizophrenia outside the industrial countries of the United States and Europe had a two-thirds lower relapse rate. The significance of these findings underline two important points. First, approaches to mental illnesses in different cultures are decidedly different. Secondly, it is important to understand that cultural factors, the "ideas, habits and predispositions" of a people may influence not only the framing of mental illness in particular cultures, but they may also offer valuable ways in which those cultures meet and resolve the challenges of mental illnesses. Watters writes of the research of anthropologist Juli McGruder who sought to understand how the people in Zanzibar dealt with schizophrenics. She found the approach was family-centered and based on the family not excluding the schizophrenic from its needs. This is more or less in contrast to the biochemical basis of the Western world. One could also say that Zanzibar represents a much simpler culture in relation to the more fast-paced industrialized West. Yet the emphasis on family in the Zanzibar cultural frame does offer real lessons. In the West, the culture seems mainly based from the perspective of the individual who is responsible for taking care of his or herself, with mental illness staining any relationship to the family. To adapt Zanzibar to a biochemical frame would probably have immeasurable effects on breaking up their substantial family ties which, as an example, the West so sorely needs. Anthropologists of medical practices such as McGruder offer much insight comparing the practices of different cultures to the West. The Zanzibar example is about the importance of narrative to a family. A family's narrative comprises a story in which everyone shares an essential part in making. Anthropologist Karine Vanthuye (2003) provides a good understanding of this approach through the lenses of several writers on cultural identity. She points out how Ricoeur speaks of "illness identity talk" under which an individual seeks to integrate their selfhood with their sameness. The latter reveals the unchanging characteristics of an individual which allows others to identify him or her. Both of these concepts are complementary narrative strategies made possible by the field of interrelationships defined by one's culture idiom. How much the culture idiom accepts one's ability to change determines how much that culture can accept integration of the selfhood. Crapanzano, notes Vanthuye, identifies a cultural idiom as "standardized lines through which experience is articulated" (Vanthuye, p. 414). These idioms are yet hierarchical and often define power relationships. Using insights from Foucault, an individual's adjustment of selfhood into sameness involves negotiating among various "truth games" to find that free space where they can express their own truth and have it accepted. Those people hearing voices outside their experience, as in the case of schizophrenics, will have difficulty arranging a narrative framework through which their disorder may be integrated. How can the concept of self and sameness engage in a narrative be seen in the Zanzibar example above. The difference here is that there is no "truth game". It appears more that there is, if any kind of game, a "sustaining game", one in which the family has come together to support the story of the individual disempowered from normality, to "empower" them back into the comfort of the family. The Zanzibar family has not separated their "sameness" from the self of the disordered individual. They are not under any heavy obligation by pharmaceutical companies in a biomedial atmosphere to do so. Anthropologist Vanthuye continues in her study by viewing three domains of discourse under which people served by mental health facilities in Quebec seem to draw out narratives of their experiences of mental health problems. She seeks to determine how the cultural idioms are defined and portrayed. It is interesting that from the postmodern view she also considers how the mode of discontinuity is introduced into dealings. The first domain defines the psychiatric idiom and essentially allows the mentally ill individual to "name" their ailment, under psychiatric treatment, and essentially master it and normalize it under treatment. Hence an individual may be able to say, "I suffer under bipolar affective disorder and take these drugs for it." Vanthuye says this allows people to empower themselves. But the problem, she admits is not this sense of normalizing to accepted diagnoses "flattens the decentering force these problems carry with them" (p. 424). Vanthuye next describes and emotional idiom in which one seeks to explore how people feel "from within" to gauge how emotions are affected that rendered their larger emotional life. "Original and singular" ways of facing and dealing with the emotional illness may come out and stands as an internal investigation into the sameness of one's selfhood. People "are invited to open up spaces of discontinuity into their existence (when they are reassured of their capacity to transcend these problems" (p. 426). This observation perhaps is closer to the Zanzibar example where support is provided to the individual to continue, with their disorder, with the family, but only strengthened by the family. Anthropologist McGruder noted that the Zanzibar family wrote particular Quran scriptures on the drinking cup of the mentally ill individual so that they may read them and be encouraged "to transcend these problems" with the family (Watters). The political idiom is the last discourse Vanthuye discusses. It is defined as the outside structural elements, the larger context, which the mentally impaired individual must go through as citizen and social agent. Her main comment here is that there is a risk that enlarging the mentally ill person into this kind of discourse may "ignore the more immediate suffering of the person” (p. 427). Conclusion The cross cultural analyses of anthropologists Vanthuye and McGruger have much to say on appreciating the different ways in which mental illnesses are viewed in the developed and developing countries. Vanthuye is able to use postmodern concepts from Ricoeur and Foucault to draw out three cultural discourses or narratives applied in the Western world, of which one, the emotional discourse could possibly be viewed in sympathy with McGruger’s model of the Zanzibar family narrative. The question remains does the biomedicine nature of the Western approach to mental illness unduly affect the approach of other countries? It has been seen how this has happened in Hong Kong in the described case of anorexia. Further, there are issues in the Western cultural model that deal with the ways in which drugs for medical illnesses are developed and tested. Some observers have claimed that such extreme medical disorders such as schizophrenia are being overly or even wrongly medicated (Whitaker, 2002). Robert Whitaker has drawn wide attention for his writings on a profit-driven pharmaceutical drug culture. He reported how the FDA had dismissed the safe and effective claims for new drugs recently introduced for the treatment of schizophrenia . He wrote how the British medical journal Lancet stated that the drug industry had clearly manipulated the invention and marketing of those particular drugs. Researcher Loren Mosher, a high official with the National Institute of Mental Health, was forced out of his position for a study he conducted in the 1970s that found that schizophrenics not under drug treatment had better recovery results than those who were receiving drugs. Certainly the biomedicine pharmaceutical drug industry should serve more as a medical culture for further investigation by cultural anthropologists. And they should continue their work with other cultures, subcultures within the United States and without. Anthropologist Derek Milne (2000) reported that although the American Navajo Indians have continued their religious healing traditions, all of them still accepted biomedicine treatment. It is possible that the postmodern concept of discontinuity can accept the fact that practices of different cultures can coexistent and the values of each, if not appreciated, are at least not, for cultural reasons, unduly changed. Works Sited Haviland. W., Prins, H., Walrath, D., and McBride, B. (2011), Cultural Anthropology: The Human Challenge (13th ed.). Thomas Wadsworth. Milne, D. (2000). Rethinking the Role of Diagnosis in Navajo Religious Healing. Medical Anthropology Quarterly, 14(4), p. 543-570. Vanthuyne, K. (2003). Searching for the Words to Say It: The Importance of Cultural Idioms in the Articulation of the Experience of Mental Illness. Watters, E. (2010). The Americanization of Mental Illness. New York Times. January 8, 2010. Accessed at http://www.nytimes.com/2010/01/10/magazine/10psychet. html?pagewanted=all. Whitaker, Robert. (2002). Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. Philadelphia, Perseus. Ethos, 31(3), pp. 412-433. Read More