CHAPTER 8: MENTAL HEALTH AND ILLNESS
Unlike other kinds of illnesses, which present relatively consistent symptoms and clear biological evidence, mental health disorders are experienced and treated differently cross-culturally. While the discipline of psychiatry within Western biomedicine applies a disease-framework to explain mental illness, there is a consensus in medical anthropology that mental health conditions are much more complicated than the biological illness model suggests. These illnesses are not simply biological or chemical disorders, but complex responses to the environment, including the web of social and cultural relationships to which individuals are connected.
Medical anthropologists do not believe there are universal categories of mental illness.[33] Instead, individuals may express psychological distress through a variety of physical and emotional symptoms. Arthur Kleinman, a medical anthropologist, has argued that every culture frames mental health concerns differently. The pattern of symptoms associated with mental health conditions vary greatly between cultures. In China, Kleinman discovered that patients suffering from depression did not describe feelings of sadness, but instead complained of boredom, discomfort, feelings of inner pressure, and symptoms of pain, dizziness, and fatigue.[34]
Mental health is closely connected with social and cultural expectations and mental illnesses can arise as a result of pressures and challenges individuals face in particular settings. Rates of depression are higher for refugees, immigrants, and others who have experienced dislocation and loss. A sense of powerlessness also seems to play a role in triggering anxiety and depression, a phenomenon that has been documented in groups ranging from stay-at-home mothers in England to Native Americans affected by poverty and social marginalization.[35]
Schizophrenia, a condition with genetic as well as environmental components, provides another interesting example of cross-cultural variation. Unlike anxiety or depression, there is some consistency in the symptom patterns associated with this condition cross culturally: hallucinations, delusions, and social withdrawal. What differs, however, is the way these symptoms are viewed by the community. In his research in Indonesia, Robert Lemelson discovered that symptoms of schizophrenia are often viewed by Indonesian communities as examples of communication with the spirit world, spirit possession, or the effects of traumatic memories.[36] Documenting the lives of some of these individuals in a film series, he noted that they remained integrated into their communities and had significant responsibilities as members of their families and neighborhoods. People with schizophrenia were not, as often happens in the United States, confined to institutions and many were living with their condition without any biomedical treatments.
In its multi-decade study of schizophrenia in 19 countries, the World Health Organization concluded that societies that were more culturally accepting of symptoms associated with schizophrenia integrated people suffering from the condition into community life more completely. In these cultures, the illness was less severe and people with schizophrenia had a higher quality of life.[37] This finding has been controversial, but suggests that stigma and the resulting social isolation that characterize responses to mental illness in countries like the United States affect the subjective experience of the illness as well as its outcomes.[38]
