Brain and cognition: the significance of culture?

The discussion of the role of culture in mental illness struck me as a fairly circular argument. Culture creates the normal, those who violate the normal are mentally ill, if we change culture we change the normal and thus change what we view as mental illness. What was more interesting to me were the so-called “nontraditional” approaches to mental healthcare such as the way an African tribe viewed schizophrenia as a demonic possession and not an illness of that particular person. This allowed the person’s symptoms to be treated without any sort of judgment about the actual patient. The author argued this was beneficial in that these person’s were able to easily re-enter community life in times of remission and thus suffered none of the socio-cultural isolation and stigmatization that is such an issue in westernized mental healthcare.   Interestingly, it seems that our own mental health establishment has possessed these notions many years ago when “a cruise around the world” was the preferred treatment for depression. 

                These two seemingly unrelated treatments are really the same idea, rather than focus all interventions on changing the disorder; these treatments instead change what is “normal”. Instead of bending patients to fit society these societies bend to fit their patients. This approach requires a very active “population” which has the motivation and flexibility to accommodate the differing needs of its members but that does not necessarily make it a dead end for modern treatment. I am not quite sure how this methodology could be integrated with modern care but perhaps some form of family training should accompany an individual’s recovery plan. Especially in disorders such as schizophrenia where the emotional affect style of a patient’s family has been shown to play such a role in relapse rates it is crucial that the treatment extend beyond just the patient.        

 As I could not make it to the last class discussion, I have instead taken notes on as much of the reading as I could and then compiled them into something more coherent here – hopefully it will be of interest and not an impenetrable block of text.

I think our discussion about culture added an interesting new dimension to our larger discussion of mental illnesses as it brought into perspective factors of mental health that are beyond the individual. It was interesting to think of culture as the source of mental illness. I believe that mental illnesses do have a biological basis, however, I also believe that culture can act to exacerbate any underlying mental conditions. As shown in the example of Hong Kong and anorexia, media/culture plays a huge role in determining what people know and how they think about themselves—including how they think about their current state of health. Culture defines and makes people more sensitive to any deviations they may display from the societal norm, and this hypersensitivity can exacerbate the symptoms they display. This is why I wonder if depression levels are as high or depression symptoms are as severe in societies that have not placed an emphasis on or have never heard of this condition.

The labels that cultures give mental illness and how these labels strictly compartmentalize a set of behaviors as being indicative of an illness also increase the stigma against mental illness. Like Professor Grobstein mentioned, these labels emphasize how these people are different from the rest of society, and the fear of the different/unknown is what I believe fuels the stigma against mental illness. However, at the same time, I feel that labels are necessary to define illness in order to make them “legitimate” conditions that require treatment and research. Labels, while separating people as being different, at the same time give them the recognition that they have a medical condition that is not a sign of weakness or something that can be changed on their own. Thus, while I agree that it is entirely wrong to define a person by a mental health label, these labels are needed to treat and, in a sense, legitimize a condition.
 

I think it's worth considering how the brain may be responsible for influencing its own health.  We've already talked about just talking can cause changes in the brain.  Can thinking in a particular way influence the progress of mental illness?  Suppose a person had a few mild symptoms of depression.  He might not quite meet the time and severity specifications in the DSM-IV to get a diagnosis of depression, but he knows he doesn't feel right.  Could reading or hearing about depression through the media influence his symptoms?  Could he think that, because his symptoms are kind of like the ones described in the Wikipedia entry on depression, he must have it, and actually cause his symptoms to get worse just because he believes they should?  Our discussion last Monday brought up the idea of depression being "en vogue" right now.  Depression and anti-depressants are the subjects of numerous articles and news stories.  Most people probably know at least one person on anti-depressants.  It seems to me that mild depression that could be overcome without drug therapy might become more serious and long-term if the sufferer believes that his symptoms are going to continue to get worse until they match the descriptions of serious depression found in the media.  If he interprets his symptoms as only the beginning of true depression, then he could be creating a self-fulfilling prophecy.  In this way, a culture's media could actually shape the way a particular mental illness presents.

Given the facts that 1. Culture/society shapes our reality and 2. Everything we perceive about our realities is constructed by our minds/brains, isn't it natural to assume that culture is to blame for the stigma associated with mental health disorders? As Professor Grobstein pointed out, cultures and cultural values can be changed. Nothing exists in a vacuum. There is a constant interplay between society and the individuals that comprise it. Society is evolving just like everything else- it is only what we make of it. As stated in class, accepting individual differences would be the first step in correcting the skewed perception of "normalcy" which our society tends to assume. But that would only happen in a perfect world. I agree with Allie that society definitely serves a purpose, although I'm not sure that the majority of individuals in our society are well-represented by our value systems. I believe a relatively small group of people hold the majority of the power in our culture and for this reason certain topics are considered taboo.  
I greatly enjoyed the discussion in class about why our culture/society values productivity above all other qualities. It made me realize how capitalistic our society truly is. In these reports: http://www.ncbi.nlm.nih.gov/pubmed/12813119 and http://depression.about.com/b/2010/01/25/depressed-workers-less-productive-even-with-antidepressant-treatment.htm productivity is the means in which a workers' worth is measured. The term 'lost productive time' (in the first report) refers specifically to time not spent furthering the company agenda. Ultimately, the company does not earn as much money as they could have and that is to be avoided when possible. Which means, companies can refuse to hire, fire, or deny requests for time off from work from people with a mental illness based on the information gleaned from the report by the media. So a common cultural assumption is that a person taking time off from work is a detriment to society. It could be argued that removing a person with depression from his/her job is more productive because the corporate machine can continue on with employees that are ready to "join society and make stuff". Clearly if the individual with depression lacked the drive to succeed, the company would be better off giving that individual some vacation time instead of forcing them to adhere to company policy. Our own culture engenders the negative attitude toward mental health illnesses because of its product-driven behavior.

Greetings -- I write as a visitor to this thread to share appreciation of the need to question the medical model of mental  illness.  My own education in this questioning was advanced significantly when I read Thomas Szasz's  1960 book "The Myth of Mental Illness."  In it, Szasz writes, " When you call a rock a rock, nothing happens to it; but when you call a person a schizophrenic, something happens to him."  Anyone who has been or who has loved someone in the mental health care system has a feeling for this.  It definitely connects with the isolating, dominating, totalizing, and diminishing of people that Paul references above.  To Paul's highlighting its "tendency to dissociate people from the larger culture," I would add that the medical model obscures the ways in which people's suffering is itself a manifestation of that culture, makes cultural sense -- not always, but I think often. 
 
 

     Although this is a cavalier perspective on depression, if I could enjoy a European cruise for a few years paid for by my health insurance, I just might pretend to have depression. David's question about how our society would feel about some individuals being "productive" and others healing themselves, either physically or mentally, for prolonged periods of time seems to bring us back to our original discussion concerning the differences between physical and mental illnesses. 

     If a member of my community was in a terrible accident and my tax money was used to reattach a limb or if it's used for a child who is trapped in bed with leukemia, I am okay with that.  And I believe most people would be as well.  I don't know how I feel about my money being used for a European cruise for someone who lost their spouse 5 years ago but still doesn't sleep and says he has thoughts of killing himself.  Perhaps because mental illnesses, due to our smaller body of knowledge and its less quantifiable symptoms, are easier to mimic and people can manipulate the system better. The symptoms listed in the DSM are not the chemical imbalances recent studies have shown to be linked to depression but symptoms such as changes in weight, changes in hours slept and other symptoms that a person can easily control or lie about. But I understand the hesitancy many feel about the recent change in the health care system to treat physical and mental illnesses the same. Yes, we want everyone healthy and reenergized but to what extent can mental illnesses open the system to abuse? No one wants to manipulate the system when the treatment is unpleasant like electric shock therapy but when it's therapy or just "time off," the incentive for lying is high.

 Some points that I found most surprising is how strong the media is when it comes to the spread of diseases. It seemed very accurate that it was due to the media’s influence that anorexia, an internal mental issue in my belief, spread so quickly across Hong Kong because people just decided that their symptoms and problems had to be associated with that. My older sister works at Boston children’s hospital and her stories also give me the same idea of the media. When the H1N1 virus broke out every parent that heard a slight cough come from their child ran to the hospital proclaiming that their child had the virus when 80% of the kids did not. If there was no media coverage on the H1N1 scare than most parents would treat the cough, as a normal cold and only when the sickness got a lot worse would try run to a hospital.

Now with this power of media I ask whether the media should take more responsibility and say in this case advise parents to not take evasive actions unless the child had been sick for a certain period of time instead of over crowding the hospitals and taking away from the patients that really need the help.     

Professor Grobstein's reflection on what has been hinted at in class - that depression may in part be productive - is a really interesting thought, particularly in the context of cultural variation. It is certainly a contentious suggestion; there seems to be a certain visceral repulsion to the idea that a condition that causes so much discomfort could in any way be framed so callously, but maybe that is precisely the problem: that our notion of "productivity" is a calloused one.

To assess something for its "productive" value implies a certain end to be fulfilled, where the subject at hand is described relative to his/her/its ability to contribute towards that end. That end, however, may, and in fact is likely to, differ drastically between cultures. The Western idea of productivity, as someone in class so eloquently put it, seems to be a lot about "making stuff," or improving the efficiency of the "machine" that is our goods-producing culture. The very English word "productivity" contains within it the notion of manufacturing or creating products. Thus, in this context, depression seems to be an inherently unproductive condition: to lose energy and motivation to work for this cultural machine is to slow its progress, hinder its ends, and therefore to be a "malfunctioning unit." As has been mentioned in other discussions, this notion appears to permeate the current psychiatric paradigm; patients with depression are often assessed in terms of and treated with the goal of improving their "functionality," or ability to rejoin society as a contributing member.

But might productivity be defined differently in alternative cultures? As the readings indicated, many Eastern cultures harbor much more collective mentalities. It is not clear from this, however, that those with depression in these societies wouldn't suffer from many of the same problems as those in Western cultures. Although perhaps less individualized, there remains a focus on becoming integrated into culture, and thus someone with "low motivation" may feel similarly excluded and alienated.

Is it feasible to imagine a culture in which the ends of "productivity" were defined on an individual basis? Where to be the most productive is to deal with problems and personal tragedies in one's own way, and to the fullest extent necessary? In this case, depression as a coping mechanism may in fact play a productive role: to recuperate energy in recovering from emotional trauma. What if the end of a culture was for its members to attain the most accurate, objective view of the world possible? Then the realism that accompanies depression may also play a productive role. But it seems like the question then becomes: are these worlds that we would want to live in? Would we feel comfortable assuming the responsibilities of sustenance (e.g., hunting and gathering food) while others cope with a death for years after? Would we want to live in a world where our perceptions and estimates were accurate but bleak? Or more generally, would we want to live in a world where depression is a productive construct?