Comments for Thandi; Week 11

Ran out of time slightly, sorry! But it does mean less marking for you so yay! 🙂

 

http://dybanneediu.wordpress.com/2011/12/08/are-psychology-studies-all-that-worth-it/#comment-23

http://laf1993.wordpress.com/2011/12/09/animal-ethics/#comment-29

http://tinastakeon.wordpress.com/2011/12/09/must-the-need-for-documented-ethics-procedures-hinder-research-progress/#comment-34

Globalisation and Psychology (this is a pretty long one, sorry guys!)

Usually when we think of globalisation we think of: the spread of capitalism, or the fact that no matter where you go in the world you will always be able to find a McDonalds (which is great, if you like Mc Donalds; I personally can’t stand it, but that’s just me).  But it is interesting to think that globalisation is also having an effect on mental illnesses. Western views on psychology and mental illness are spreading to other cultures and, not only causing our old friend bias, but also changing the manifestation and prevalence of mental illnesses across the world.

There is a trend in America and Europe towards promoting the idea that mental illness is a disease just like any other except that it affects the mind. This idea was, and is, promoted so heavily in order to reduce the social stigma against mental illness that stemmed from ignorance, or the belief that mental disorders are caused by demons (either supernatural or personal). This is of course a highly commendable endeavour but, as with everything, the west is now disseminating its supposedly enlightened ideas across the world. Psychiatry and psychology across the globe now uses definitions of mental illness based on those found in the DSM, which contains categories and descriptions of mental illness that have mainly been observed and researched in Europe and the US. Do I really need to say the word bias here? Mental illnesses are heavily influenced by culture both in how common they are and how they manifest themselves; so to have a global standard for diagnosis based mostly on information from one culture is completely illogical and may have a detrimental effect.

Mental illnesses are in many ways very subjective and so a shift in culture or cultural opninion/knowledge can change the illness completely. A psychiatrist in Hong Kong, Dr Sing Lee, was researching a form of anorexia nervosa that was specific to Hong Kong and parts of China in the ‘80s and ‘90s. Patients with this form of anorexia did not express any fears about being fat or worries about their weight at all, nor were they intentionally dieting. Instead they complained of a bloating sensation that made it hard for them to eat (NB: there was no physical cause for the sensation). At the time anorexia was extremely rare in Hong Kong and only the indigenous form was present. But in 1994 an anorexic teenage girl collapsed and died on a busy street in Hong Kong, resulting in a media frenzy around the subject. Because the disease was so rare, local reporters drew on American definitions to explain what had happened so within a few days most of Hong Kong was aware of anorexia in terms of the American definition. By the end of the ‘90s rates of anorexia in Hong had increased dramatically and 90% of the patients diagnosed reported the American symptom set.

“Culture shapes the way general psychopathology is going to be translated partially or completely into specific psychopathology,” Lee says. “When there is a cultural atmosphere in which professionals, the media, schools, doctors, psychologists all recognize and endorse and talk about and publicize eating disorders, then people can be triggered to consciously or unconsciously pick eating-disorder pathology as a way to express that conflict.”

So simple exposure to information can affect how an entire culture perceives mental illness, which is one of the reasons why western cultures should be more cautious about spreading their views on disease as it can be detrimental. For example social isolation often leads to higher relapse rates in patients with a mental illness; add to this the emerging pattern that viewing mental illness as a disease seems to be correlated with increasing social stigma against mental illness around the world. Some cultures that view mental disorders as spiritual issues are very supportive of the person afflicted and this is correlated with significantly lower relapse rates in those cultures.

In other words the Western perspective may be spreading like wildfire but it is not necessarily correct or beneficial. To illustrate the limitations of the Western perspective it’s worth noting what the DSM-IV describes as “Culture-bound syndromes”. These are syndromes or disorders that are only found in a specific culture; two of the best known are amok (a brief period of violent, sometimes murderous, rage, often followed by amnesia and usually seen in men after a traumatic event and is specific to Malaysia) and koro (belief that their genitals are inexorably retreating into their bodies, associated with extreme anxiety and is most commonly seen in males, specific to Southeast Asia). The ever-so brief section on these syndromes in the DSM-IV can be found in an appendix near the end of the book, despite the fact that many of these syndromes are extremely important within their specific cultures. Also some of the syndromes seem more connected to religious/cultural beliefs and practices than psychological disorders; for example one syndrome specific to Korea (shinbyeong) is a necessary part of initiation as a shaman in Muism (or Mugyo). The DSM says that it is a condition typified by loss of appetite, weakness, pain, anxiety and dissociation from reality, but according to Muism the shinbyeong is a religious experience/transformation that is necessary to become a shaman. Whether the shinbyeong is or is not a psychiatric disorder, it still raises the question of why it is included in the list of syndromes when things like Jerusalem syndrome or stigmata are not. (Not that I’m saying that an American publication would be biased towards Christianity or anything…. Of course not!).

To conclude I think that the globalisation of western ideas about psychology and psychiatry is probably not a good thing, however well-intentioned it may be. It can clearly cause problematic biases leading to over generalisation of theories and can lead to the glossing over of important psychological issues or misinterpretation of culture-specific phenomena.

 

A lot of links:

http://www.nytimes.com/2010/01/10/magazine/10psyche-t.html?pagewanted=1

http://www.sciencedirect.com/science/article/pii/027795369400305D

http://bjp.rcpsych.org/content/179/5/460.2.full

http://bjp.rcpsych.org/content/179/1/1.full?ijkey=929aa501de900b17503e76268205090142f4f4d5&keytype2=tf_ipsecsha

http://journals.cambridge.org/action/displayAbstract;jsessionid=C72D626D431E470E392701B4B1C081AD.journals?fromPage=online&aid=5070364

http://en.wikipedia.org/wiki/Culture-specific_syndrome

http://en.wikipedia.org/wiki/Korean_shamanism

http://rjg42.tripod.com/culturebound_syndromes.htm