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The Americanization of Mental Illness: The world according to DSM-ETC




Enviado por Felix Larocca



  1. Resumen
  2. Blind
    ostriches in an avalanche of
    contradictions
  3. Observations
  4. Bibliography

Resumen

Gracias a la globalización, y a
la tendencia que tantos tienen a seguir todo lo que es americano
a pie juntillas. Los psiquiatras, por todas partes del mundo, han
adoptado, sin juicio crítico — como hemos adoptado los
fast food — esa aberración de la nomenclatura
estadounidense conocida (ahora preñada y en espera de dar
nacimiento a su nuevo vástago DSM-V en el 2013) como
DSM-IV-TR.

En mi caso, es una repetición
del "I told you so…"

Abstract:

Thanks to DSM-ETC, the American
Psychiatric Association (APA) have for many years been busily
engaged in a grand project of Americanizing the world"s
understanding of mental health and illness. They may indeed be
far along in homogenizing the way the world goes
crazy.

AMERICANS, particularly if they are the
college-educated type, worry about their country"s awesome
blunders into other cultures.

For all the self-recrimination, however,
the world may have yet to face one of the most remarkable effects
of American-led globalization. They have for many years been
busily engaged in a grand project of Americanizing the world"s
understanding of mental health and illness. By now, they may
indeed be far along in homogenizing the way the world goes
mad.

This unnerving possibility springs from
recent research by a loose group of anthropologists and
cross-cultural psychiatrists. Swimming against the biomedical
currents of the time, they have argued that mental illnesses are
not discrete entities like the polio virus with their own natural
histories. These researchers have amassed an impressive body of
evidence suggesting that mental illnesses have never been the
same the world over (either in prevalence or in form) but are
inevitably sparked and shaped by the ethos of particular times
and places, as I have said in countless occasions.

In some Asian cultures, people have been
known to experience what is called amok, an episode of murderous
rage followed by amnesia; men in the region also suffer from
koro, which is characterized by the debilitating certainty that
their genitals are retracting into their bodies.

The diversity that can be found across
cultures can be seen across time as well.

The hysterical-leg paralysis that afflicted
thousands of middle-class women in the late 19th century not only
gives all a visceral understanding of the restrictions set on
women"s social roles at the time but can also be seen from this
distance as a social role itself — the troubled unconscious
minds of a certain class of women speaking the idiom of distress
of their time.

Monografias.com

They did it in similar vein as Susan Sontag
expressed in her book Illness as a metaphor.

In any given era, those who minister to the
mentally ill — doctors, shamans or priests — unwittingly help
to select which symptoms will be recognized as legitimate.
Because the troubled mind has been influenced by healers of
diverse religious and scientific persuasions, the forms of
madness from one place and time often look remarkably different
from the forms of madness in another.

Enters DSM-ETC

For more than a generation now, the
American Psychiatric Association have aggressively spread its own
conception of mental illness around the world.

It has done this in the name of science,
believing that their narrow approaches reveal the biological
basis of psychic suffering and dispel prescientific myths and
harmful stigma. There is now good evidence to suggest that in the
process of teaching the rest of the world to think like they tell
us, they have been exporting their self styled "symptom
repertoire" as well.

That is, they have been changing not only
the treatments but also the expression of mental illness in other
cultures. Indeed, a handful of mental-health disorders —
depression, post-traumatic stress disorder and anorexia nervosa
among them — now appear to be spreading across cultures with
the speed of contagious diseases.

Notably in this regard, is how DSM-ETC has
kept all hands off obesity and its related behavioral
complications.

These symptom clusters are becoming the
lingua franca of human suffering, replacing indigenous forms of
mental illness.

In a story that appeared in an important US
periodical, DR. SING LEE, a psychiatrist and researcher at the
Chinese University of Hong Kong, watched the Westernization of a
mental illness firsthand. In the late 1980s and early 1990s, he
was busy documenting a rare and culturally specific form of
anorexia nervosa in Hong Kong. Unlike American anorexics, most of
his patients did not intentionally diet nor did they express a
fear of becoming fat. The complaints of Lee"s patients were
typically somatic — they complained most frequently of having
bloated stomachs. Lee was trying to understand this autochthonous
form of anorexia and, at the same time, figure out why the
disease remained so rare.

As he was in the midst of publishing his
finding that food refusal had a particular expression and meaning
in Hong Kong, the public"s understanding of anorexia suddenly
shifted. On Nov. 24, 1994, a teenage anorexic girl named Charlene
Hsu Chi-Ying collapsed and died on a busy downtown street in Hong
Kong. The death caught the attention of the media and was
featured prominently in local papers. "Anorexia Made Her All
Skin and Bones: Schoolgirl Falls on Ground Dead
," read one
headline in a Chinese-language newspaper. "Thinner Than a
Yellow Flower
, Weight-Loss Book Found in School Bag,
Schoolgirl Falls Dead on Street
," reported another
Chinese-language paper.

In trying to explain what happened to
Charlene, local reporters often simply copied out the famous
American diagnostic manual, DSM-IV. The mental-health experts
quoted in the Hong Kong papers and magazines confidently reported
that anorexia in Hong Kong was the same disorder that appeared in
the United States and Europe.

These Westernized ideas did not simply
obscure the understanding of anorexia in Hong Kong; they also
changed the expression of the illness itself. As the general
public and the region"s mental-health professionals came to
understand the American diagnosis of anorexia, the presentation
of the illness in Lee"s patient population appeared to transform
into the more virulent American standard. Lee once saw two or
three anorexic patients a year; by the end of the 1990s he was
seeing that many new cases each month. That increase sparked
another series of media reports. "Children as Young as 10
Starving Themselves as Eating Ailments Rise
," announced a
headline in one daily newspaper. By the late 1990s, Lee"s studies
reported that between 3 and 10 percent of young women in Hong
Kong showed disordered eating behavior.

What is being missed, Lee and others have
suggested, is a deep understanding of how the expectations and
beliefs of the sufferer shape their suffering. "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."

The problem becomes especially worrisome in
a time of globalization, when symptom repertoires can cross
borders with ease.

Mental-health professionals in the West and
in the United States in particular, create official categories of
mental diseases and promote them in a diagnostic manual that has
become the worldwide standard. American researchers and
institutions run most of the premier scholarly journals and host
top conferences in the fields of psychology and psychiatry.
Western drug companies dole out large sums for research and spend
billions marketing medications for mental illnesses.

Would anorexia have so quickly become part
of Hong Kong"s symptom repertoire without the importation of the
Western template for the disease? It seems unlikely.

THE IDEA THAT DSM-ETC conception of mental
health and illness might be shaping the expression of illnesses
in other cultures is rarely discussed in the professional
literature, unless you visit
www.monografías.com.

Blind ostriches in an
avalanche of contradictions

Western mental-health practitioners often
prefer to believe that the 844 pages of the DSM-IV prior to the
inclusion of culture-bound syndromes describe real disorders of
the mind, illnesses with symptomatology and outcomes relatively
unaffected by shifting cultural beliefs. And, it logically
follows, if these disorders are unaffected by culture, then they
are surely universal to humans everywhere. In this view, the DSM
is a field guide to the world"s psyche, and applying it around
the world represents simply the brave march of scientific
knowledge.

Something, that any serious scientific mind
will find an atrocious misconception in all respects.

Mental illnesses, it was suggested, should
be treated like "brain diseases" over which the patient has
little choice or responsibility. This was promoted both as a
scientific fact and as a social narrative that would reap great
benefits. The logic seemed unassailable: Once people believed
that the onset of mental illnesses did not spring from
supernatural forces, character flaws, semen loss or some other
prescientific notion, the sufferer would be protected from blame
and stigma. But does the "brain disease" belief actually reduce
stigma?

CROSS-CULTURAL psychiatrists have pointed
out that the mental-health ideas America exports to the world are
rarely unadulterated scientific facts and never culturally
neutral.

Behind the promotion of Western ideas of
mental health and healing lie a variety of cultural assumptions
about human nature. Westerners share, for instance, evolving
beliefs about what type of life event is likely to make one
psychologically traumatized, and they seem to agree that venting
emotions by talking is more healthy than stoic
silence.

The ideas they export often have at their
heart a particularly American brand of hyperintrospection — a
penchant for "psychologizing" daily existence.

No one would suggest that the APA should
withhold American medical advances from other countries, but it"s
perhaps past time to admit that even the most remarkable
scientific leaps in understanding the brain haven"t yet created
the sorts of cultural stories from which humans take comfort and
meaning. When these scientific advances are translated into
popular belief and cultural stories, they are often stripped of
the complexity of the science and become comically insubstantial
narratives.

Take for instance a Web site text
advertising the antidepressant Paxil: "Just as a cake recipe
requires you to use flour, sugar and baking powder in the right
amounts, your brain needs a fine chemical balance in order to
perform at its best."

Americans, even when thinking about
science, first think of food…

The American mind, endlessly analyzed by
generations of theorists and researchers, has now been reduced to
a batter of chemicals all carry around in the mixing bowl of
their skulls. As if the skull were an oven and the encephalic
mass, batter for cookies!

Observations

For many years many American psychiatrists
— notable among them Paul McHugh — have been fulminating
against DSM-ETC (as I fancy to call it), its architects and its
purpose.

Having written extensively about this in
psikis.cl and in monografías.com

I can tell you now, why we reap the ugly
results.

Bibliography

Larocca, FEF: Las alucinaciones de William
Blake: Su significado para la psiquiatría moderna In
www.monografías.com and in this same site

Image

Dragon by William
Blake.

 

 

Autor:

Dr. Félix E. F.
Larocca

 

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