Re: [xmca] NY Times: The Americanization of Mental Illness

[Larry Purss <lpurss@shaw.ca>]

Peter
I am in full agreement with your articulation of the way mental health discourses are constructed and it speaks to the parallel ways that the sociology of knowledge and the psychology of knowledge are a single process at different levels of analysis.  Your mention of our experience and concepts of "mental" dis-ease as embedded in particular social practices and not located inside our bodies I agree with.  I've wondered how connected are our constructions of encapsulated individualism and notions of the STATE.  They seem to have emerged at the same time.  What gets collapsed and moves to the background in this social practice is a devaluing of forms of allegiance that mediate between the individual and the state.  Our perceptions of what we feel "connected to" have a profound effect on our sense of "mental health".  As psychology focuses more and more on individual "health" as de-contextualized ideals we get our current culturally defined notions of "mental illness" 

Larry 

----- Original Message -----
From: Peter Smagorinsky <smago@uga.edu>
Date: Monday, January 11, 2010 3:32 am
Subject: [xmca] NY Times: The Americanization of Mental Illness
To: 'mca' <xmca@ucsd.edu>, 'Leslie Cook' <cookls@appstate.edu>

> The Americanization of Mental Illness 
> 
> http://www.nytimes.com/2010/01/10/magazine/10psyche-t.html?em
> 
> o 
> 
> By ETHAN WATTERS
> 
> Published: January 8, 2010 
> 
> AMERICANS, particularly if they are of a certain leftward-leaning,
> college-educated type, worry about our country's blunders into other
> cultures. In some circles, it is easy to make friends with a 
> rousing rant
> about the McDonald's near Tiananmen Square, the Nike factory in 
> Malaysia or
> the latest blowback from our political or military interventions 
> abroad. For
> all our self-recrimination, however, we may have yet to face one 
> of the most
> remarkable effects of American-led globalization. We have for 
> many years
> been busily engaged in a grand project of Americanizing the world's
> understanding of mental health and illness. We may indeed be far 
> along in
> homogenizing the way the world goes mad. 
> 
> This unnerving possibility springs from recent research by a 
> loose group of
> anthropologists and cross-cultural psychiatrists. Swimming 
> against the
> biomedical currents of the time, they have argued that mental 
> illnesses are
> not discrete entities like the polio virus with their own 
> natural histories.
> These researchers have amassed an impressive body of evidence 
> suggestingthat mental illnesses have never been the same the 
> world over (either in
> prevalence or in form) but are inevitably sparked and shaped by 
> the ethos of
> particular times and places. In some Southeast Asian cultures, 
> men have been
> known to experience what is called amok, an episode of murderous rage
> followed by amnesia; men in the region also suffer from koro, 
> which is
> characterized by the debilitating certainty that their genitals are
> retracting into their bodies. Across the fertile crescent of the 
> Middle East
> there is zar, a condition related to spirit-possession beliefs 
> that brings
> forth dissociative episodes of laughing, shouting and singing.
> 
> The diversity that can be found across cultures can be seen 
> across time as
> well. In his book "Mad Travelers," the philosopher Ian Hacking 
> documents the
> fleeting appearance in the 1890s of a fugue state in which 
> European men
> would walk in a trance for hundreds of miles with no knowledge 
> of their
> identities. The hysterical-leg paralysis that afflicted 
> thousands of
> middle-class women in the late 19th century not only gives us a 
> visceralunderstanding of the restrictions set on women's social 
> roles at the time
> but can also be seen from this distance as a social role itself -
> the
> troubled unconscious minds of a certain class of women speaking 
> the idiom of
> distress of their time. 
> 
> "We might think of the culture as possessing a 'symptom 
> repertoire' - a
> range of physical symptoms available to the unconscious mind for the
> physical expression of psychological conflict," Edward Shorter, 
> a medical
> historian at the University of Toronto, wrote in his book 
> "Paralysis: The
> Rise and Fall of a 'Hysterical' Symptom." "In some epochs, 
> convulsions, the
> sudden inability to speak or terrible leg pain may loom 
> prominently in the
> repertoire. In other epochs patients may draw chiefly upon such 
> symptoms as
> abdominal pain, false estimates of body weight and enervating 
> weakness as
> metaphors for conveying psychic stress."
> 
> In any given era, those who minister to the mentally ill - 
> doctors or
> shamans or priests - inadvertently help to select which symptoms 
> will be
> recognized as legitimate. Because the troubled mind has been 
> influenced by
> healers of diverse religious and scientific persuasions, the 
> forms of
> madness from one place and time often look remarkably different 
> from the
> forms of madness in another. 
> 
> That is until recently. 
> 
> For more than a generation now, we in the West have aggressively 
> spread our
> modern knowledge of mental illness around the world. We have 
> done this in
> the name of science, believing that our approaches reveal the 
> biologicalbasis of psychic suffering and dispel prescientific 
> myths and harmful
> stigma. There is now good evidence to suggest 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. That is, we've been 
> changing not only
> the treatments but also the expression of mental illness in 
> other cultures.
> Indeed, a handful of mental-health disorders - depression, post-
> traumaticstress disorder and anorexia among them - now appear to 
> be spreading across
> cultures with the speed of contagious diseases. These symptom 
> clusters are
> becoming the lingua franca of human suffering, replacing 
> indigenous forms of
> mental illness.
> 
> DR. SING LEE, a psychiatrist and researcher at the Chinese 
> University of
> Hong Kong, watched the Westernization of a mental illness 
> firsthand. In the
> late 1980s and early 1990s, he was busy documenting a rare and 
> culturallyspecific form of anorexia nervosa in Hong Kong. Unlike 
> American anorexics,
> most of his patients did not intentionally diet nor did they 
> express a fear
> of becoming fat. The complaints of Lee's patients were typically 
> somatic -
> they complained most frequently of having bloated stomachs. Lee 
> was trying
> to understand this indigenous form of anorexia and, at the same 
> time, figure
> out why the disease remained so rare.
> 
> As he was in the midst of publishing his finding that food 
> refusal had a
> particular expression and meaning in Hong Kong, the public's 
> understandingof anorexia suddenly shifted. On Nov. 24, 1994, a 
> teenage anorexic girl
> named Charlene Hsu Chi-Ying collapsed and died on a busy 
> downtown street in
> Hong Kong. The death caught the attention of the media and was 
> featuredprominently in local papers. "Anorexia Made Her All Skin 
> and Bones:
> Schoolgirl Falls on Ground Dead," read one headline in a Chinese-
> languagenewspaper. "Thinner Than a Yellow Flower, Weight-Loss 
> Book Found in School
> Bag, Schoolgirl Falls Dead on Street," reported another Chinese-
> languagepaper. 
> 
>  
> <http://www.nytimes.com/2010/01/10/magazine/10psyche-
> t.html?pagewanted=2&em#secondParagraph> Skip to next paragraphIn 
> trying to explain what happened to
> Charlene, local reporters often simply copied out of American 
> diagnosticmanuals. The mental-health experts quoted in the Hong 
> Kong papers and
> magazines confidently reported that anorexia in Hong Kong was 
> the same
> disorder that appeared in the United States and Europe. In the 
> wake of
> Charlene's death, the transfer of knowledge about the nature of 
> anorexia(including how and why it was manifested and who was at 
> risk) went only one
> way: from West to East. 
> 
> Western ideas did not simply obscure the understanding of 
> anorexia in Hong
> Kong; they also may have changed the expression of the illness 
> itself. As
> the general public and the region's mental-health professionals 
> came to
> understand the American diagnosis of anorexia, the presentation 
> of the
> illness in Lee's patient population appeared to transform into 
> the more
> virulent American standard. Lee once saw two or three anorexic 
> patients a
> year; by the end of the 1990s he was seeing that many new cases 
> each month.
> That increase sparked another series of media reports. "Children 
> as Young as
> 10 Starving Themselves as Eating Ailments Rise," announced a 
> headline in one
> daily newspaper. By the late 1990s, Lee's studies reported that 
> between 3
> and 10 percent of young women in Hong Kong showed disordered eating
> behavior. In contrast to Lee's earlier patients, these women 
> most often
> cited fat phobia as the single most important reason for their
> self-starvation. By 2007 about 90 percent of the anorexics Lee treated
> reported fat phobia. New patients appeared to be increasingly 
> conformingtheir experience of anorexia to the Western version of 
> the disease.
> 
> What is being missed, Lee and others have suggested, is a deep 
> understandingof how the expectations and beliefs of the sufferer 
> shape their suffering.
> "Culture shapes the way general psychopathology is going to be 
> translatedpartially or completely into specific 
> psychopathology," Lee says. "When
> there is a cultural atmosphere in which professionals, the 
> media, schools,
> doctors, psychologists all recognize and endorse and talk about and
> publicize eating disorders, then people can be triggered to 
> consciously or
> unconsciously pick eating-disorder pathology as a way to express that
> conflict."
> 
> The problem becomes especially worrisome in a time of 
> globalization, when
> symptom repertoires can cross borders with ease. Having been 
> trained in
> England and the United States, Lee knows better than most the 
> locomotiveforce behind Western ideas about mental health and 
> illness. Mental-health
> professionals in the West, and in the United States in 
> particular, create
> official categories of mental diseases and promote them in a 
> diagnosticmanual that has become the worldwide standard. 
> American researchers and
> institutions run most of the premier scholarly journals and host top
> conferences in the fields of psychology and psychiatry. Western drug
> companies dole out large sums for research and spend billions 
> marketingmedications for mental illnesses. In addition, Western-
> trainedtraumatologists often rush in where war or natural 
> disasters strike to
> deliver "psychological first aid," bringing with them their 
> assumptionsabout how the mind becomes broken by horrible events 
> and how it is best
> healed. Taken together this is a juggernaut that Lee sees little 
> chance of
> stopping. 
> 
> "As Western categories for diseases have gained dominance, micro-
> culturesthat shape the illness experiences of individual 
> patients are being
> discarded," Lee says. "The current has become too strong." 
> 
> Would anorexia have so quickly become part of Hong Kong's 
> symptom repertoire
> without the importation of the Western template for the disease? 
> It seems
> unlikely. Beginning with scattered European cases in the early 
> 19th century,
> it took more than 50 years for Western mental-health 
> professionals to name,
> codify and popularize anorexia as a manifestation of hysteria. 
> By contrast,
> after Charlene fell onto the sidewalk on Wan Chai Road on that 
> late November
> day in 1994, it was just a matter of hours before the Hong Kong 
> populationlearned the name of the disease, who was at risk and 
> what it meant. 
> 
> THE IDEA THAT our Western conception of mental health and 
> illness might be
> shaping the expression of illnesses in other cultures is rarely 
> discussed in
> the professional literature. Many modern mental-health 
> practitioners and
> researchers believe that the scientific standing of our drugs, 
> our illness
> categories and our theories of the mind have put the field 
> beyond the
> influence of endlessly shifting cultural trends and beliefs. 
> After all, we
> now have machines that can literally watch the mind at work. We 
> can change
> the chemistry of the brain in a variety of interesting ways and 
> we can
> examine DNA sequences for abnormalities. The assumption is that these
> remarkable scientific advances have allowed modern-day 
> practitioners to
> avoid the blind spots and cultural biases of their predecessors. 
> 
> Modern-day mental-health practitioners often look back at previous
> generations of psychiatrists and psychologists with a thinly 
> veiled pity,
> wondering how they could have been so swept away by the cultural 
> currents of
> their time. The confident pronouncements of Victorian-era 
> doctors regarding
> the epidemic of hysterical women are now dismissed as cultural 
> artifacts.Similarly, illnesses found only in other cultures are 
> often treated like
> carnival sideshows. Koro, amok and the like can be found far 
> back in the
> American diagnostic manual (DSM-IV, Pages 845-849) under the heading
> "culture-bound syndromes." Given the attention they get, they 
> might as well
> be labeled "Psychiatric Exotica: Two Bits a Gander." 
> 
> 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 
> representssimply 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-
> culturalpsychiatrists 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. 
> 
> EVEN WHEN THE underlying science is sound and the intentions 
> altruistic, the
> export of Western biomedical ideas can have frustrating and unexpected
> consequences. For the last 50-odd years, Western mental-health 
> professionalshave been pushing what they call "mental-health 
> literacy" on the rest of the
> world. Cultures became more "literate" as they adopted Western 
> biomedicalconceptions of diseases like depression and 
> schizophrenia. One study
> published in The International Journal of Mental Health, for instance,
> portrayed those who endorsed the statement that "mental illness 
> is an
> illness like any other" as having a "knowledgeable, benevolent, 
> supportiveorientation toward the mentally ill." 
> 
> Mental illnesses, it was suggested, should be treated like 
> "brain diseases"
> over which the patient has little choice or responsibility. This was
> promoted both as a scientific fact and as a social narrative 
> that would reap
> great benefits. The logic seemed unassailable: Once people 
> believed that the
> onset of mental illnesses did not spring from supernatural 
> forces, character
> flaws, semen loss or some other prescientific notion, the 
> sufferer would be
> protected from blame and stigma. This idea has been promoted by
> mental-health providers, drug companies and patient-advocacy 
> groups like the
> National Alliance for the Mentally Ill in the United States and 
> SANE in
> Britain. In a sometimes fractious field, everyone seemed to 
> agree that this
> modern way of thinking about mental illness would reduce the social
> isolation and stigma often experienced by those with mental illness.
> Trampling on indigenous prescientific superstitions about the 
> cause of
> mental illness seemed a small price to pay to relieve some of 
> the social
> suffering of the mentally ill. 
> 
> But does the "brain disease" belief actually reduce stigma?
> 
> In 1997, Prof. Sheila Mehta from
> <http://topics.nytimes.com/top/reference/timestopics/organizations/a/auburn_
> university/index.html?inline=nyt-org> Auburn University 
> Montgomery in
> Alabama decided to find out if the "brain disease" narrative had the
> intended effect. She suspected that the biomedical explanation 
> for mental
> illness might be influencing our attitudes toward the mentally 
> ill in ways
> we weren't conscious of, so she thought up a clever experiment. 
> 
> In her study, test subjects were led to believe that they were 
> participatingin a simple learning task with a partner who was, 
> unbeknownst to them, a
> confederate in the study. Before the experiment started, the partners
> exchanged some biographical data, and the confederate informed 
> the test
> subject that he suffered from a mental illness. 
> 
> The confederate then stated either that the illness occurred 
> because of "the
> kind of things that happened to me when I was a kid" or that he 
> had "a
> disease just like any other, which affected my biochemistry." 
> (These were
> termed the "psychosocial" explanation and the "disease" explanation
> respectively.) The experiment then called for the test subject 
> to teach the
> confederate a pattern of button presses. When the confederate 
> pushed the
> wrong button, the only feedback the test subject could give was 
> a "barely
> discernible" to "somewhat painful" electrical shock. 
> 
> Analyzing the data, Mehta found a difference between the group 
> of subjects
> given the psychosocial explanation for their partner's mental-illness
> history and those given the brain-disease explanation. Those who 
> believedthat their partner suffered a biochemical "disease like 
> any other" increased
> the severity of the shocks at a faster rate than those who 
> believed they
> were paired with someone who had a mental disorder caused by an 
> event in the
> past. 
> 
> "The results of the current study suggest that we may actually 
> treat people
> more harshly when their problem is described in disease terms," 
> Mehta wrote.
> "We say we are being kind, but our actions suggest otherwise." 
> The problem,
> it appears, is that the biomedical narrative about an illness like
> schizophrenia carries with it the subtle assumption that a brain 
> made ill
> through biomedical or genetic abnormalities is more thoroughly 
> broken and
> permanently abnormal than one made ill though life events. 
> "Viewing those
> with mental disorders as diseased sets them apart and may lead 
> to our
> perceiving them as physically distinct. Biochemical aberrations 
> make them
> almost a different species."
> 
> In other words, the belief that was assumed to decrease stigma 
> actuallyincreased it. Was the same true outside the lab in the 
> real world?
> 
> The question is important because the Western push for "mental-health
> literacy" has gained ground. Studies show that much of the world has
> steadily adopted this medical model of mental illness. Although these
> changes are most extensive in the United States and Europe, 
> similar shifts
> have been documented elsewhere. When asked to name the sources 
> of mental
> illness, people from a variety of cultures are increasingly 
> likely to
> mention "chemical imbalance" or "brain disease" or "genetic/inherited"
> factors. 
> 
> Unfortunately, at the same time that Western mental-health 
> professionalshave been convincing the world to think and talk 
> about mental illnesses in
> biomedical terms, we have been simultaneously losing the war 
> against stigma
> at home and abroad. Studies of attitudes in the United States 
> from 1950 to
> 1996 have shown that the perception of dangerousness surrounding 
> people with
> schizophrenia has steadily increased over this time. Similarly, 
> a study in
> Germany found that the public's desire to maintain distance from 
> those with
> a diagnosis of schizophrenia increased from 1990 to 2001. 
> 
> Researchers hoping to learn what was causing this rise in stigma 
> found the
> same surprising connection that Mehta discovered in her lab. It 
> turns out
> that those who adopted biomedical/genetic beliefs about mental 
> disorderswere the same people who wanted less contact with the 
> mentally ill and
> thought of them as more dangerous and unpredictable. This unfortunate
> relationship has popped up in numerous studies around the world. 
> In a study
> conducted in Turkey, for example, those who labeled 
> schizophrenic behavior
> as akil hastaligi (illness of the brain or reasoning abilities) 
> were more
> inclined to assert that schizophrenics were aggressive and 
> should not live
> freely in the community than those who saw the disorder as 
> ruhsal hastagi (a
> disorder of the spiritual or inner self). Another study, which 
> looked at
> populations in Germany, Russia and Mongolia, found that 
> "irrespective of
> place . . . endorsing biological factors as the cause of 
> schizophrenia was
> associated with a greater desire for social distance."
> 
> Even as we have congratulated ourselves for becoming more 
> "benevolent and
> supportive" of the mentally ill, we have steadily backed away 
> from the
> sufferers themselves. It appears, in short, that the impact of 
> our worldwide
> antistigma campaign may have been the exact opposite of what we 
> intended. 
> 
> NOWHERE ARE THE limitations of Western ideas and treatments more 
> evidentthan in the case of schizophrenia. Researchers have long 
> sought to
> understand what may be the most perplexing finding in the cross-
> culturalstudy of mental illness: people with schizophrenia in 
> developing countries
> appear to fare better over time than those living in 
> industrialized nations.
> 
> 
> This was the startling result of three large international 
> studies carried
> out by the
> <http://topics.nytimes.com/top/reference/timestopics/organizations/w/world_h
> ealth_organization/index.html?inline=nyt-org> World Health 
> Organization over
> the course of 30 years, starting in the early 1970s. The 
> research showed
> that patients outside the United States and Europe had 
> significantly lower
> relapse rates - as much as two-thirds lower in one follow-up 
> study. These
> findings have been widely discussed and debated in part because 
> of their
> obvious incongruity: the regions of the world with the most 
> resources to
> devote to the illness - the best technology, the cutting-edge 
> medicines and
> the best-financed academic and private-research institutions - 
> had the most
> troubled and socially marginalized patients. 
> 
> Trying to unravel this mystery, the anthropologist Juli McGruder 
> from the
> University of Puget Sound spent years in Zanzibar studying 
> families of
> schizophrenics. Though the population is predominantly Muslim, Swahili
> spirit-possession beliefs are still prevalent in the archipelago and
> commonly evoked to explain the actions of anyone violating 
> social norms -
> from a sister lashing out at her brother to someone beset by psychotic
> delusions. 
> 
> McGruder found that far from being stigmatizing, these beliefs served
> certain useful functions. The beliefs prescribed a variety of socially
> accepted interventions and ministrations that kept the ill 
> person bound to
> the family and kinship group. "Muslim and Swahili spirits are 
> not exorcised
> in the Christian sense of casting out demons," McGruder 
> determined. "Rather
> they are coaxed with food and goods, feted with song and dance. 
> They are
> placated, settled, reduced in malfeasance." McGruder saw this 
> approach in
> many small acts of kindness. She watched family members use 
> saffron paste to
> write phrases from the Koran on the rims of drinking bowls so 
> the ill person
> could literally imbibe the holy words. The spirit-possession 
> beliefs had
> other unexpected benefits. Critically, the story allowed the 
> person with
> schizophrenia a cleaner bill of health when the illness went 
> into remission.
> An ill individual enjoying a time of relative mental health 
> could, at least
> temporarily, retake his or her responsibilities in the kinship 
> group. Since
> the illness was seen as the work of outside forces, it was 
> understood as an
> affliction for the sufferer but not as an identity.
> 
> For McGruder, the point was not that these practices or beliefs were
> effective in curing schizophrenia. Rather, she said she believed 
> that they
> indirectly helped control the course of the illness. Besides 
> keeping the
> sick individual in the social group, the religious beliefs in 
> Zanzibar also
> allowed for a type of calmness and acquiescence in the face of 
> the illness
> that she had rarely witnessed in the West.
> 
> The course of a metastasizing cancer is unlikely to be changed 
> by how we
> talk about it. With schizophrenia, however, symptoms are inevitably
> entangled in a person's complex interactions with those around 
> him or her.
> In fact, researchers have long documented how certain emotional 
> reactionsfrom family members correlate with higher relapse rates 
> for people who have
> a diagnosis of schizophrenia. Collectively referred to as "high 
> expressedemotion," these reactions include criticism, hostility 
> and emotional
> overinvolvement (like overprotectiveness or constant 
> intrusiveness in the
> patient's life). In one study, 67 percent of white American 
> families with a
> schizophrenic family member were rated as "high EE." (Among British
> families, 48 percent were high EE; among Mexican families the 
> figure was 41
> percent and for Indian families 23 percent.)
> 
> Does this high level of "expressed emotion" in the United States 
> mean that
> we lack sympathy or the desire to care for our mentally ill? 
> Quite the
> opposite. Relatives who were "high EE" were simply expressing a 
> particularlyAmerican view of the self. They tended to believe 
> that individuals are the
> captains of their own destiny and should be able to overcome 
> their problems
> by force of personal will. Their critical comments to the 
> mentally ill
> person didn't mean that these family members were cruel or 
> uncaring; they
> were simply applying the same assumptions about human nature 
> that they
> applied to themselves. They were reflecting an "approach to the 
> world that
> is active, resourceful and that emphasizes personal 
> accountability," Prof.
> Jill M. Hooley of
> <http://topics.nytimes.com/top/reference/timestopics/organizations/h/harvard
> _university/index.html?inline=nyt-org> Harvard University 
> concluded. "Far
> from high criticism reflecting something negative about the 
> family members
> of patients with schizophrenia, high criticism (and hence high 
> EE) was
> associated with a characteristic that is widely regarded as 
> positive." 
> 
> Widely regarded as positive, that is, in the United States. Many 
> traditionalcultures regard the self in different terms - as 
> inseparable from your role
> in your kinship group, intertwined with the story of your 
> ancestry and
> permeable to the spirit world. What McGruder found in Zanzibar 
> was that
> families often drew strength from this more connected and less 
> isolatingidea of human nature. Their ability to maintain a low 
> level of expressed
> emotion relied on these beliefs. And that level of expressed 
> emotion in turn
> may be key to improving the fortunes of the schizophrenia sufferer.
> 
> Of course, to the extent that our modern psychopharmacological 
> drugs can
> relieve suffering, they should not be denied to the rest of the 
> world. The
> problem is that our biomedical advances are hard to separate 
> from our
> particular cultural beliefs. It is difficult to distinguish, for 
> example,the biomedical conception of schizophrenia - the idea 
> that the disease
> exists within the biochemistry of the brain - from the more 
> inchoate Western
> assumption that the self resides there as well. "Mental illness 
> is feared
> and has such a stigma because it represents a reversal of what Western
> humans . . . have come to value as the essence of human nature," 
> McGruderconcludes. "Because our culture so highly values . . . 
> an illusion of
> self-control and control of circumstance, we become abject when
> contemplating mentation that seems more changeable, less 
> restrained and less
> controllable, more open to outside influence, than we imagine 
> our own to
> be." 
> 
> 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 
> globalizingculture. 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."
> 
> Behind the promotion of Western ideas of mental health and 
> healing lie a
> variety of cultural assumptions about human nature. Westerners 
> share, for
> instance, evolving beliefs about what type of life event is 
> likely to make
> one psychologically traumatized, and we agree that venting 
> emotions by
> talking is more healthy than stoic silence. We've come to agree 
> that the
> human mind is rather fragile and that it is best to consider 
> many emotional
> experiences and mental states as illnesses that require professional
> intervention. (The National Institute of Mental Health reports 
> that a
> quarter of Americans have diagnosable mental illnesses each 
> year.) The ideas
> we export often have at their heart a particularly American 
> brand of
> hyperintrospection - a penchant for "psychologizing" daily 
> existence. These
> ideas remain deeply influenced by the Cartesian split between 
> the mind and
> the body, the Freudian duality between the conscious and 
> unconscious, as
> well as the many self-help philosophies and schools of therapy 
> that have
> encouraged Americans to separate the health of the individual 
> from the
> health of the group. These Western ideas of the mind are proving as
> seductive to the rest of the world as fast food and rap music, 
> and we are
> spreading them with speed and vigor. 
> 
> No one would suggest that we withhold our medical advances from other
> countries, but it's perhaps past time to admit that even our 
> most remarkable
> scientific leaps in understanding the brain haven't yet created 
> the sorts of
> cultural stories from which humans take comfort and meaning. 
> When these
> scientific advances are translated into popular belief and 
> cultural stories,
> they are often stripped of the complexity of the science and become
> comically insubstantial narratives. Take for instance this Web 
> site text
> advertising the antidepressant
> <http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics
> /paxil_drug/index.html?inline=nyt-classifier> Paxil: "Just as a 
> cake recipe
> requires you to use flour, sugar and baking powder in the right 
> amounts,your brain needs a fine chemical balance in order to 
> perform at its best."
> The Western mind, endlessly analyzed by generations of theorists and
> researchers, has now been reduced to a batter of chemicals we 
> carry around
> in the mixing bowl of our skulls.
> 
> All cultures struggle with intractable mental illnesses with 
> varying degrees
> of compassion and cruelty, equanimity and fear. Looking at 
> ourselves through
> the eyes of those living in places where madness and 
> psychological trauma
> are still embedded in complex religious and cultural narratives, 
> however, we
> get a glimpse of ourselves as an increasingly insecure and 
> fearful people.
> Some philosophers and psychiatrists have suggested that we are 
> investing our
> great wealth in researching and treating mental illness - 
> medicalizing ever
> larger swaths of human experience - because we have rather 
> suddenly lost
> older belief systems that once gave meaning and context to 
> mental suffering.
> 
> 
> If our rising need for mental-health services does indeed spring 
> from a
> breakdown of meaning, our insistence that the rest of the world 
> think like
> us may be all the more problematic. Offering the latest Western
> mental-health theories, treatments and categories in an attempt to
> ameliorate the psychological stress sparked by modernization and
> globalization is not a solution; it may be part of the problem. 
> When we
> undermine local conceptions of the self and modes of healing, we 
> may be
> speeding along the disorienting changes that are at the very 
> heart of much
> of the world's mental distress. 
> 
>  
> 
>  
> 
> _______________________________________________
> xmca mailing list
> xmca@weber.ucsd.edu
> http://dss.ucsd.edu/mailman/listinfo/xmca
> 
_______________________________________________
xmca mailing list
xmca@weber.ucsd.edu
http://dss.ucsd.edu/mailman/listinfo/xmca