Mental health is one of the most neglected fields of healthcare. There is so much suffering related to mental health all over the world, which is either not recognized or goes untreated because of lack of expertise or other resources. Although stress and distress have been important topics in medical anthropology, respectively mental health itself has not received sufficient attention in either anthropology or public health.This issue has assumed international importance with the emergence of marked increases in psychiatric and behavioral problems, in tandem with exponentially increasing numbers of refugees worldwide and escalating disruption of social structure such as family and local communities.More over mental health problems and behavior problems are closely related to health problems of both infectious and chronic nature, therefore unraveling the basis of mental health and physical health risk, and thus the extension of such research to developing efficient treatment and preventative measures demands a combination of both biological and psychosocial approaches. Preliminary results from the world’s largest survey on mental health indicates that mental health is widespread and untreated and that wealthy people with mental illness receive more and better treatment than poor people with severe mental illness.One to five percent of the population of most countries surveyed had serious mental illness according to the findings, published in The Journal of the American Medical Association, and in most of the countries nine to seventeen percent of those interviewed had some episode of mental illness in the last year, whether serious or less severe.
Around the world it was found that mental illness causes as many days of work lost as any physical problems such as cancer, heart attack, or back pain.The level of role impairment that was found associated with serious mental disorders was staggering: more than a month in the past year when the respondents reported totally unable to work. In poor countries, about eighty percent of serious cases went untreated, but even in rich countries thirty-five to fifty percent of cases had not been treated.
The surveys asked about treatment not just by psychiatrists and psychologists but family practitioner, members of the clergy, shamans and herbalists. The findings were based on 60,643 face to face interviews with adults in each country.Eight countries were defined as rich: The United States, Germany, France, Italy, Belgium, Spain, The Netherlands, and Japan. Six were deemed poor or nearly poor: Mexico, Columbia, Ukraine, China, Lebanon, and Nigeria. Within each country whether rich or poor, the study took into account the economic status of the participants. The ninety minute interviews assessed a wide range of ills, including agoraphobia, obsessive-compulsive disorders, post-traumatic stress syndrome, bi-polar disorder, bulimia, major depression and alcohol and drug abuse.The study did not try to diagnose schiziophrenia because that requires a psychiatrist (Compared with diagnostic criteria for all other mental illness, criteria for diagnosing schiziophrenia is always evolving.
) Researchers of this study acknowledged that methodology needed refinement. There were some general trends that were clear and there were widespread unexplained disparities. Twenty-six percent of Americans were judged to have mental illness compared with four percent of the residents of Shanghai and five percent of Nigerians. The differences were even more extreme in smaller categories.The Dutch were found to have thirty more times the drinking problems than the Italians had and four times the problem of the French. Eighteen percent of Americans had anxiety disorders versus twelve percent of the French, eleven percent of Lebanese and about ten percent of Columbians. Europeans other than the French were in the seven percent range while Nigerians and Chinese were the calmest.
The data above represents current medical diagnosis of mental illness. If the understanding of different cultural views of mental illness were take into account these numbers would change dramatically.Emphasis needs to be accounted for in regards to the importance of understanding cultural and social forces affecting mental illness. Embarrassment about disclosing mental illness varies from country to country. Nigerian women were reluctant to admit being depressed, but might say that their mother had been. This is a response that gave interviewers a clue about the rates. When conducting interviews, language and word meanings become a barrier.
The main outcome measures the DSM-IV disorder severity and treatment were assessed with the WMH version of the WHO Composite of theInternational Diagnostic Interview (WMH-CID), a fully structured administered psychiatric interview. Conclusion: reallocations of treatment resources could substantially decrease the problem of the need for treatment of mental disorders among serious cases. Structural Barriers exists to this reallocation. Careful consideration needs to be given to the value of treating some mild cases, especially those at risk for progressing to more serious disorders.
Different cultures have different concepts of what constitutes mental illness. In Japan suicide rate, in most cases, is not considered problematic.Rather, it can be an honorable act to save face for a noble cause. Similarly, the Koran prohibits suicide, and “suicide bombers” are not generally considered “suicide” by their zealous supporters- they are martyrs for their cause. In North America, someone who attempts suicide will likely be diagnosed with some sort of psychological problems. Some cultures are more susceptible to certain types of illness than others. In most cultures, stigmatization is especially harmful because the stigma is often attached to the entire family as well as the mentally ill individual.The result is often resentment, fear, and maltreatment of the mentally ill.
For example the Vietnamese believe in karma. Someone affected by mental illness is either being punished for a wrong doing in a previous life or by an angry ancestor who has returned to possess him or her. To avoid disgrace, the family will hide the mentally ill family member from the public. It is said that Vietnamese psychiatrists are ridiculed rather than respected and forced to work shorter hours than other doctors out of fear they too might become possessed by whatever has contaminated or invaded their patients.
Mental Illness is present in all societies. However, the frequencies of different types of mental illness vary as do the social connotations. What is defined as a mild form of a mental illness in one culture may be defined as normal behavior in another. For instance, people in western societies who regularly carry on animated conversations with dead relatives or other supernatural beings are generally considered mentally ill. The same behavior is likely to be considered healthy and even enviable in a culture that has an indigenous world view. Such a person would be thought of as fortunate for having direct communication with the supernatural world.
Traditionally among Native American societies, dreams and the visionary world were, in a sense more real and certainly more important than ordinary world’s humans. Among the Saora tribe of Orissa State in India, young men and women sometimes exhibit abnormal behavior patterns that Western trained mental health specialists would likely define as a mental disorder. They cry and laugh at inappropriate times, have memory loss, pass out, and claim to experience the sensation of being repeatedly bitten by ants when no ants are present.These individuals are usually teenagers or young adults who are not attracted to the ordinary life of a subsistence farmer. They are under considerable psychological stress from social pressure placed on them by their relatives and friends. The Saora explain the odd behavior of these individuals as being due to the actions of supernatural beings who want to marry them.
The resolution to this situation is to carry out a marriage ceremony in which the disturbed person is married to the spirit.Once the marriage has occurred, the abnormal symptoms apparently end and the young person becomes a Shaman responsible for curing people. In the eyes of society, he or she changes status from a peculiar teenager to a respected adult who has valuable skills as a result of supernatural contacts. This Saora example suggests that some minor mental illness, could be viewed as ways of dealing with impossible social situations, in other words they are coping mechanisms. What a culture defines as abnormal behavior is a consequence of what defines a modal personality.People who exhibit abnormal behavior in Western societies are usually labeled as being eccentric, mentally ill or even dangerous and criminal. Which label is assigned may depend on the subculture, gender and socioeconomic level of the individual exhibiting abnormal behavior. In North America public acts of poor mentally ill males are sometimes seen as being criminal.
This is especially true if they are ethnic minorities or living on the streets. In contrast, similar abnormal behavior in rich males is likely to find them viewed as being eccentric.In the former Soviet Union, important people who publically opposed government policy were sometimes considered mentally ill and were placed in mental institutions where they were kept sedated “for their own good” (Meaning the good of the state). The standards that define normal behavior for any culture are determined by that culture itself. Normalcy is a nearly meaningless concept cross-culturally.
For instance in the Yanomam Indian culture of South America, highly aggressive, violent men are considered normal and such individuals are often respected community leaders.In contrast the same behavior among the Pueblo Indians in Southwestern United States was considered abnormal and dangerous for society. People who exhibited these traits were avoided and even ostracized.
While mental illness is found in most, if not all societies, there are unique culture influenced forms that these illnesses can take. They are cultural bound syndromes. An example is the Windigo psychosis. The condition was reported among the Northern Algonquian language group of Indians (Chippewa, Ojibwa, and Cree) living around the Great Lakes of Canada and The United States.Windigo psychosis usually developed in the winter when families were isolated by heavy snow for months in their cabins and had inadequate food supplies. The initial symptoms of this form of mental illness were usually poor appetite nausea and vomiting.
Subsequently, the individual would develop a characteristic delusion of being transformed into a Windigo monster. These supernatural beings eat human flesh. People who have Windigo psychosis increasingly see others around them as being edible.
At the same time they have an exaggerated fear of becoming cannibals.Modern medical diagnosis of this condition might label it paranoia because of the irrational perceptions of being persecuted. In this case it is the Windigo monsters who are the persecutors- they are trying to turn people into monsters like themselves. In contemporary North American culture, the perceived persecutors of paranoids are more likely to be other people or perhaps extra terrestrial visitors.
Victims of the Windigo psychosis experienced extreme anxiety and sometimes attempted suicide to prevent themselves from becoming Windigo monsters.In the last ten years cultural psychopathology research has been a significant force. Its focus on the social world holds promise to make significant inroads in reducing suffering and improving people’s everyday lives. Psychosocial anthropology is a hybrid field of study. It combines the classic concerns of Euro-American psychology-personality, childhood development, and mental illness-with evidence from other cultures and distinctive groups of the west.
Psychological anthropology carries out debate between relativism between universalism.It connects experience to shared cultural symbols; it shows individual minds and collective traditions-psyche and culture-depend on each other. The question we need to include when conducting research of mental illness should be, is there universal human nature which underlies diverse cultural forms? This should be the first question we try to answer, with understanding of the society being studied and their views and beliefs of what mental illness is to them. It is through these culturally sensitive methods that we can hope to gain understanding of human conditions and move forward to do the least harm and strive for the most good.