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Exploring Mental Health:
A Working Group

"The Culture of Our Discontent: The Medical Model of Mental Illness

Participants: Laura Cyckowski (BMC student), Natsu Fukui (BMC student), Paul Grobstein (BMC Biology), Katia Belova (BMC student), Amy Rives (BMC student), Laura Socol (BMC student),

Following on earlier discussions of the importance of taking into account the significant role that culture plays in "mental health", the group's discussion was based on Chapter 6 ("Running Amok in a Brain Fog") and Chapter 7 ("Cursed and Haunted") of Meredith Small's The Culture of Our Discontent: The Medical Model of Mental Health (National Academies Press, 2006).

As in earlier conversations, there was general agreement that those seeking assistance with "mental health" concerns found the current situation in the United States confusing at best, with a bewildering array of specialists offering different kinds of help and no good way, beyond more or less random experimentation, of finding the kind of help one wanted/needed. In other cultural contexts, an additional problem (still present to some extent in the United States) is that "mental health" problems may be viewed with considerable suspicion so that people are reluctant to seek assistance with such issues. In at least some cultures, the very concept of "mental health" as distinct from other ways of characterizing people's behaviors and experiences may be absent altogether. While this does not necessarily mean that individuals do not have problems of the kind that would cause them to seek "mental health" care in our culture, nor that there aren't in such cultures mechanisms for dealing with such problems, it does draw further attention to the importance of thinking about "mental health" in multiple cultural contexts.

After discussing various "conditions" in several different cultures (Indonesia, Japan, Russia, the US) it seemed clear that there are indeed relatively "culture-bound" syndromes, ie that different terms and significances for various notable behavioral patterns/feelings may be used in different cultures and that the frequency of such noteworthy behavioral patterns/feelings may also differ in different cultures. It is less clear whether there are any behavioral patterns/feelings that are completely unique to particular cultures. An alternative possibility is that particular sets of behavioral patterns/feelings may exist to one degree or another in all cultures but that different cultures

  • identify as noteworthy ("odd") different sets of behavioral patterns/feelings
  • create different constraints on what behavioral patterns/feelings are permitted to be publicly displayed
  • make more or less likely the occurrence of different behavior patterns/feelings
This alternative possibility is encouraging to those who might want to try and create a cross-cultural perspective on mental health while still regarding culture as an essential context for and contributor to thinking about mental health in any given context. The key here would be to try and develop a general characterization of varying "behavior patterns/feelings", perhaps in terms of brain function, while acknowledging cultural differences in both contributing to them and valuing them.

At this point, the conversation returned to the possibility of defining mental health in terms of process, as facilitating a "natural growth of process" rather than alleviation of particular "abnormalities/deficits". The parallels to a recent book by Annette Lareau, Unequal Childhoods (University of California Press, 2003) were noticed, and the suggestion was made that there were important common features among child-rearing, mental health care, and education in that all three might be seen alternatively as efforts to alleviate certain deficiencies or to promote ongoing individual (and necessarily individualized) development. One might, in all three cases, recognize two kinds of "care seekers", those who want to be "fixed" and those who want support for evolution (and, correspondingly, two kinds of "care givers", those who prefer to "fix" and those who prefer to participate in shared evolution.

This distinction too may be cross-cultural. In thinking about "shamans" (Chapter 6 of Small's book), it seemed likely that some are "fixers" while others are evolution-sharers. It was noted that "fixing" may in fact be subsumed under "evolving" in the sense that some conditions may prevent evolution and so need correcting to allow the evolution process to continue. The problem with focusing only on "fixing" is that it tends to make the care-giver the posture of regarding any compromised function in a particular culture as a "disorder" and hence of being, consciously or unconsciously, a supporter of particular cultures whether or not they facilitate ongoing individual evolution.

If cultures are inevitably "intolerant of human differences" (as per our discussion of Culture of Disability, then it may follow that mental health workers (as well as parents and teachers) must necessarily be not only fixers of individuals but challengers of cultures as well?

For our next meeting, on 28 January, the group agreed to leave "culture" for the moment and turn to the second of the issues posed in "expanding the view" on mental health: the role of individuals themselves in that process. Two articles by Eric Kandel, A New Intellectual Framework for Psychiatry (1998) and Biology and the Future of Psychoanalysis: A New Intellectual Framework for Psychiatry (1999) seem like a good starting place for thinking about that issue. Both appeared in the American Journal of Psychiatry, and should be accessible through the Bryn Mawr (and other academic) computer networks through the links provided.

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