Global, Cultural Influences on Mental Health

Culture plays a role in mental life. Our thoughts and perceptions are shaped by the books we read, by the movies we see; by the language we speak.

Perhaps less obviously, culture plays a role in mental disorder as well.

The health-language we use predicates many of the symptoms and illnesses available to us.

Just think back to those black and white films with women fainting so often. People were always fainting.

Why?

The answer is cultural expectation.

Hysteria too was once a real mental disorder.

What happened to that?

Hysteria went away for the same reason that fainting did. People stopped believing in it.

The idea of culturally oriented mental disorder raises some interesting questions about the proliferation of mental disease in our society today.

America became a leader in the fields of psychology and psychiatry over the course of the 20^th century. Universities and colleges across the nation have departments dedicated to the study of the history, the science, the treatment, and the effects of mental health and mental disorder.

The focus has been less on mental health and more on mental disorder. Famously, the "big book of psychiatry", the Diagnostic and Statistical Manual of Psychiatry, has become such a prolific list of symptoms describing mental illness that it is impossible to flip through the book and without diagnosing yourself with numerous mental illnesses.

No matter how healthy you are, there is a mental illness that describes you in the DSM. (When healthy people are "sick" too, we should begin to ask questions about the industry producing these illnesses...)

The American tendency toward diagnosing and medicating mental disorder in a "scientific" manner has become very popular over the last several decades. However, this trend has not escaped scrutiny.

A recent New York Times magazine article became big news when it attacked the "Americanization of the global mental health" discussion. The article was lauded and derided with equal fervor by cultural pundits.

Criticized for its lack of depth and for setting its views in language that displayed the same type of ego-centric perspective that it set out to analyze, the article was also hailed as a challenge to the basic perceptions of science and mental illness as being divorced from the culture that produce them.

The article has now become a book - Crazy Like Us: The Globalization of the American Psyche, by Ethan Watters.

A review by Andrew Rasmussen in Stats.org, characterizes the book in this way:

Watters' central thesis goes something like this: by expanding their realm through the forces of globalization, American mental health professionals are harming other societies by introducing Western symptoms into the way people in other cultures express their distress and replacing the local explanations for mental health problems with Western scientific models.

To offer a simple (exaggerated) example, the book seems to suggest that where a man with a headache in central India once would have thought he must have eaten something bad, now, thanks to American model symptoms, he thinks he is developing schizophrenia.

(For more of Rasmussen's review, follow this link. )

American medical culture, according to Crazy Like Us is infecting the world's mental health-language, helping to spread Western conceptions of disease.

Is the export of the conceptions of disease tantamount to spreading the diseases themselves? The answer is not as simple as yes or no. The point here is not to come to any conclusions but to encourage more questions, the right questions, to be asked in our discussion of mental health.

When we begin to assess the history of psychiatry, our line of questioning takes us back to the very origins of the field.

Watters' challenge to the psychiatric establishment is not the first.

The arenas of psychology and psychiatry have long been controversial. Over a hundred years ago, Sigmund Freud became the father of psychotherapy. However, this was not the beginning of psychology and psychiatry. It was simply a turn toward mental modes of investigating and treating illness.

The renowned scholar Michel Foucault argued that the origins of psychiatry can be boiled down to an almost accidental set of circumstances.

Leprosy was widespread across Europe after the middle ages. In the 1600's institutions were created to house those who suffered from this debilitating disease. Some time after asylums were erected across the "Continent", leprosy mysteriously went away, but the buildings remained. So they were filled with crazy people. This is a paraphrasing of Foucault's work Madness and Civilization: A History of Insanity in the Age of Reason (1965).

A possible implication of Foucault's ideas is that the physical fact of the buildings led to the decision to put people into them. If there had been no asylums (built for lepers), perhaps mental disorders and mental diseases would have dealt with, identified, and studied in a completely different way.

One might say that the cures for insanity preceded the identification of the disease. First there was an insane asylum, then came the creation of insanity, then came the diagnosis and the identification of the disease in actual people.

Though this notion is disturbing, a very similar dynamic continues today with medicines replacing the leper asylums of old.

Today medicines are created, applications discovered, and diseases, perhaps, created after the fact.

The mind is a complex organism, not entirely understood. For a long while the industry of psychiatry has been identifying modes of mental illness with apparent disregard for the work of defining what it means to be mentally healthy.

Three facts are worth considering when we try to parse out the dynamics that have led and continue to lead to more and more identified mental diseases.

Doctors need sick people.

Healthy people do not need doctors.

Acting against one's best interests is unnatural.

This is meant to suggest the complex relationship of doctors to disease and not meant to suggest that illness and disease is in any way unreal. Many mental conditions have been mapped by brain scans and scientifically demonstrated.

However, there seems to be plenty of room for nuance and questioning.

There is a big difference between a broken arm and a compulsive disorder, and that should be clear.

When habits become diseases and insecurities are parlayed into disorders, we should at least raise the question as to how the habits and insecurities might be culturally oriented, culturally defined, and perhaps even culturally curable.

If hysteria can just disappear, then maybe OCD can too.

I am not saying that people with OCD are imagining it. The suggestion here is that doctors might do well to consider the idea that science and mental life are both married to culture in a way that is deep, profound, and from which there can be no divorce.