The Americanization of Mental Illness

Last week's New York Times had a fascinating article called "The Americanization of Mental Illness" which postulates that unlike physical disease, mental illness has not been historically the same across cultures and time.  What we see as anorexia, schizophrenia and bipolar disorder, with a particular set of symptoms for example, may not have always existed in a way that would be recognizable to psychiatrists of today.  In fact, the article says, mental illness is culturally specific.

Various countries, cultures and times have given rise to very different types of mental illnesses.  In some cultures in South East Asia, men sometimes suffer from amok, which is described as "murderous rage followed by amnesia."  In the 1890's some European men became labeled as "Mad Travelers" because they would travel on foot for hundreds of miles in a trance-like state, not knowing who they were.  Women in the same time period became afflicted with "hysterical" paralysis of the legs.

Now however, the instantaneous speed of world wide communication along with technological advances in medicine have exported the medical model of mental illness across the globe.  Mental illness is now seen as a result of a biochemical imbalance in the brain.  This perspective has overtaken the once prevalent psychosocial/environmental model of mental illness.  Along with this change, it was assumed that a medical model of mental illness as a brain disorder would increase compassion in the way those who suffer are treated by the outside world.

What is shocking is that recent studies have shown this not to be the case.  In fact, the medical model of mental illness may indeed be doing just the opposite.  A study in Turkey, for example, showed that people who believed schizophrenia was a "disorder of the spiritual or inner self" (ruhsal hastagi) were more likely to view those suffering from schizophrenia as less aggressive and more willing to agree that they should live in the community than those who labeled the disorder as "an illness of the brain or reasoning abilities" (akil hastaligi).

Another surprising finding is that patients in the United States and Europe are found to relapse more often than those in other countries.  The article suggests that in third world countries, mental illness is seen as something outside the patient and therefore not as integral to their identities as people.  Westerners see the brain as "the self".  A brain disease means the person is somehow no longer...a person.  The article  says that we in the "first world" are "hyperintrospective" and tend to "psychologize (our) daily existence".  Non western countries do not over medicalize every aspect of the human experience as we do in the west.  "Normal" is becoming a smaller and smaller box that our society wants to force each of its members to fit into.

The article ends by saying that "we are investing our great wealth in researching and treating mental illness...because we have rather suddenly lost older belief systems that once gave meaning and context to mental suffering."  The effect of this loss of a spiritual outlook has been to increase the mental illness label (and the fear that accompanies it in the greater social group) while decreasing compassion and acceptance of those who are labeled as "different."

Societies as old as civilization have had spiritual explanations and remedies for many things, including mental illness.  Throwing away this spirituality as superstitious is counter productive and ineffective.