Sunday, January 10, 2010

Can We MAKE You Crazy?

In today's NY Times Magazine, Ethan Watters discusses cultural influences in the etiology and expression of mental illnesses in his article entitled "The Americanization of Mental Illness." Watters is not a big a big proponent of the idea that psychiatric disorders are brain-based diseases, and he points to ways that Western ideas have changed the incidence and thinking in other parts of the world. Watters writes:

Western mental-health practitioners often prefer to believe that the 844 pages of the DSM-IV prior to the inclusion of culture-bound syndromes describe real disorders of the mind, illnesses with symptomatology and outcomes relatively unaffected by shifting cultural beliefs. And, it logically follows, if these disorders are unaffected by culture, then they are surely universal to humans everywhere. In this view, the DSM is a field guide to the world’s psyche, and applying it around the world represents simply the brave march of scientific knowledge.

Of course, we can become psychologically unhinged for many reasons that are common to all, like personal traumas, social upheavals or biochemical imbalances in our brains. Modern science has begun to reveal these causes. Whatever the trigger, however, the ill individual and those around him invariably rely on cultural beliefs and stories to understand what is happening. Those stories, whether they tell of spirit possession, semen loss or serotonin depletion, predict and shape the course of the illness in dramatic and often counterintuitive ways. In the end, what cross-cultural psychiatrists and anthropologists have to tell us is that all mental illnesses, including depression, P.T.S.D. and even schizophrenia, can be every bit as influenced by cultural beliefs and expectations today as hysterical-leg paralysis or the vapors or zar or any other mental illness ever experienced in the history of human madness. This does not mean that these illnesses and the pain associated with them are not real, or that sufferers deliberately shape their symptoms to fit a certain cultural niche. It means that a mental illness is an illness of the mind and cannot be understood without understanding the ideas, habits and predispositions — the idiosyncratic cultural trappings — of the mind that is its host.

Watters then goes on to ask if the medicalization of mental illness does in fact lead to destigmatization. He cites a study where college students give bigger shocks to test subjects trying to learn a new task if they believe the test subject has a mental illness caused by a biological problem rather than a childhood problem. I'll skip even thinking about this study, but why do so many studies have college students shocking each other? Shouldn't they just hit each other with baseball bats?

Watters goes on to conclude:

CROSS-CULTURAL psychiatrists have pointed out that the mental-health ideas we export to the world are rarely unadulterated scientific facts and never culturally neutral. “Western mental-health discourse introduces core components of Western culture, including a theory of human nature, a definition of personhood, a sense of time and memory and a source of moral authority. None of this is universal,” Derek Summerfield of the Institute of Psychiatry in London observes. He has also written: “The problem is the overall thrust that comes from being at the heart of the one globalizing culture. It is as if one version of human nature is being presented as definitive, and one set of ideas about pain and suffering. . . . There is no one definitive psychology.”


moviedoc said...

Classification of physical illness is not culturally neutral either. In fact if you read George Lakof's Women, Fire and Dangerous Things, you will see that, from a linguistic perspective categories vary from culture to culture. As for mental "illnesses" even DSM calls them disorders. Bottom line is real people need help for their problems.

The Silent Voices in my Mind said...

Some perspectives purport that absolutely nothing in our realm of experience can be separated from the culture in which it is experienced. Even the most undebatable "facts" are seen through the filter of the culture that subscribes to them. As new facts are discovered, they are often rejected by their societies and the individuals that promote them even persecuted for their assertions. Think about the resistance to a scientific principle as "basic" as the movement of the stars. Societies reject ideas they cannot tolerate regardless of the evidence to support it.

This is not to say that a cultural filter is always a bad thing. It is simply an unavoidable thing. Nothing exists in a vacuum of experiences and ideas that influence all other experiences and ideas.