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Paul Grobstein's picture

depression, illness, culture, and cultural change

Interesting conversation last night.  Some thoughts that stuck in my mind, that I want to mull further, maybe return to in conversation at some point ....

I was struck by the extent to which the argument that disabilities/mental "illnesses" as a function of interactions between individuals and cultures was't useful because, while perhaps true, cultures are what has been collectively created/agreed to and can't in any case be changed.  My own sense is that acquiring the ability to be critical of cultures one is familiar with is an essential element of being a scientist, or for that matter of being a responsible citizen of any kind.  And it seems to me demonstrably not true that cultures can't be changed.  Both the civil rights movement and the gay rights movement are relatively recent examples of cultural change generated by people able/willing to not only look critically at culture but to act on the critique.  Disability rights has also begun to be an effective culture changing movement.   Perhaps we could contribute to some culture change re "mental illness"?

Along those lines, I was intrigued by the thinking we did together about reasons why calling mental health problems "brain illnesses" might not be the best way to go.  "Illness" labels tend to isolate people from the larger culture (create a "them" as distinct from an "us"), to diminish their identities (s/he is bipolar, as opposed to s/he is someone with bipolar characteristics), and to, relatedly, diminish their perceived agency (you need to cede power to an authority).

I think there are real possibilities in an alternative that emerged from our discussion: to speak not of "disability" or "illness" but rather of "difference."  That, along with a recognition that we are all different in various ways, might avoid the tendency to dissociate people from the larger culture and make it easier to treat characteristics as aspects of their identity rather than the totality of it.  Acknowleding that we all cede authority to other people at various times for various reasons (we all need "help") could as well help with the perception (by both others and ourselves) of diminished agency.  

On a somewhat more local scale, I think there were some intriguing possibilites opened for some alternative research into depression (and perhaps other mental "illnesses").  I'd very much like to know whether in fact "mood variation" (and personal discomfort) is secondary to low energy and low motivation, and is perhaps a less characteristic feature of depression in cultures that are less competitive/"rigorous"/demanding.  And I'd like to know to what extent various aspects of depression can be exacerbated/alleviated by various kinds of interpersonal interaction.  I'd also like to see some serious followup of suggestions that aspects of depression may in fact be "productive" rather than "detrimental" (with appropriate attention to variations in cultural definitions of these terms).  

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