According to the World Health
Organization mental health is defined as, “not just the absence of mental
disorder. It is defined as a state of well-being in which every individual
realizes his or her own potential, can cope with the normal stresses of life,
can work productively and fruitfully, and is able to make a contribution to her
or his community”. With that being said, in this essay I will attempt to shed
light on mental health and inequality as a global health issue and how such
disparity can be widened by economic, cultural, and social factors. In today’s
society, mental health does not have the same degree of urgency compared to
other global health issues because it cannot be treated within a certain time
frame and is not life threatening to some degree. The article that is
addressing the issue of mental health is titled, “Some Thoughts on the
Anthropology of Mental Health and Illness in Special Reference to India”
written by Vinay Kumar Srivastava. I chose this article because India is such a
populous country with a myriad of cultures and religions that with each culture
or religion contains a different perspective or approach to mental health. And
in order to understand the inequalities that can cause mental health one must
also understand culture. When I think of mental health I usually think of the
neurobiological and biochemical aspects of it. As a science major this is the
firs thing that comes to my mind. But what about mental health and
inequalities? And how culture can shape or be a part these inequalities.
The Problem:
Social and
economic inequalities can affect one’s mental health and such inequalities can
be exacerbated by mental disorders (GHW: 172). One’s economic status may affect
an individual’s state of mental health. Failure to provide for one’s family or
the inability to make a substantial amount of money can be stressful especially
when there is this hierarchy of wealth that thrives on consumerism and
materialism. According to the Global Health Watch, anxiety about one’s
financial security can lead to feelings of hopelessness and shame, which the
can increase stress (GHW: 174). And these inequalities can increase the
likelihood of mental illness and can affect the quality of care one may
receive. It is worth mentioning that people from a developing country are
susceptible to stress and depression because of food insecurity (among other
things as well) whereas in wealthier nations stress can also be brought on by
consumerism and materialism.
The
Article:
India is second most populous
country in world with a population of more than 1.2 billion people. Although
India is a multicultural country, there are more similarities in culture than
there are differences. Most Indians believe that there is a clear distinction
between the mind and body in which the state of the mind can affect one’s body
(Srivastava: 2). And if an individual fails to meet the social norms in place
then they find themselves in a unhealthy state of mind that can be manifested
into physical suffering of one’s body. So when a person behaves differently
than one’s normal self, he or she is seen as mentally ill. However, Indians do
not believe that mental disorders should be attended to unless it takes a major
toll on the family and some may not even seek treatment for it. With such a
diversity of cultures there are also a diversity of causes of mental illnesses
Srivastava: 3). In peasant and tribal societies, mental illness is not
interpreted as a medical condition, but rather it is seen as supernatural
possession of one’s self. That is if an individual is possessed by a religious
entity it is not regarded as a mental illness. But if the supernatural power is
evil then the individual is seen as a mentally ill person. The article goes on
to stating that among other cultural explanations of mental illness, those who
are considered weak are more susceptible to mental illness. Women for example
are weak and oppressed. An improper upbringing, childlessness, alcoholism,
domestic unhappiness, protracted illness, and stresses at work can also
contribute to a poor state of mental health (Srivastava: 3). India, likewise
with other developing countries, is trying to achieve economic prosperity and
success. With such a fast rate of urbanization and industrialization, migratory
populations are also prone to mental illness because they find it difficult to
transition from their homes in the rural area to a more urban area. This
culture shock and vastly affect students from tribal societies and lose
interest in their existence.
The people of India do not hold
behavioral deviation as something to address, but it is seen as nothing more
than just a habit. Behavioral disorders such as muttering to oneself, speaking
to an invisible entity, acute violence, state of depression are not taken seriously.
They are addressed lightly by resting or through some mild form of punishment
(Srivastava: 6). Srivastava goes on to stating that Indians do not expect much
of the formal health care system, which partly contributes to the inequalities
of mental health such that the lack of formal education or one’s economic
status can lead one attain to the traditional healing system. The traditional
systems are hope generating according to Srivastava because in the example of
the Bala-ji temple, the “healers’ would tell the mentally ill that he or she
can be cured if they follow the religious rituals. And if the individual is not
cured, the family or the individual themself, are blamed for the lack of effort
in praying or etc. People have more faith in these “ethnopsychiatrists” or
traditional healers because they are inexpensive and abundant (Srivastava: 8).
Medical Anthropology can frame mental health and inequality
by attributing to how culture can shape such inequalities. According to Srivastava,
“culture can offer an explanation to the causes of mental illness”. Because it
can define what behaviors are considered to be positive or negative. It can
reward those who attain to good behavior or values and ostracize those who do
not. It is also the basis of: region, religion, language, and ecosystem.
(Srivastava: 2). For example, tribal and peasant societies believe that when an
individual is possessed by a supernatural force, depending on whether that
force is evil or not, the individual may not even be mentally ill in the first
place. If the supernatural force is a Goddess or some sort of religious entity
then the individual is not mentally ill, but instead they are blessed and have
the ability to heal others. But if the supernatural power is evil then the
individual is regarded as mentally ill.
In comparison to how the Global Health Watch approaches this issue, the
article has a larger emphasis on the social and cultural aspects of mental
health and inequalities and it is the values of the Indian culture that shapes
the inequalities. The Global Health Watch has a larger emphasis on economic
factors and the social factors surrounding financial insecurity that
contributes to the inequalities. The culture that contributes to the
inequalities in these peasant and tribal societies believe that there are
certain diseased substances that can be given to the individual that may cause
mental illness (if the supernatural power is evil). And that such evil remains
inside the body mentally and physically. Indians believe that certain foods
have the magical powers to remove such diseased substances from the body. Foods
such as milk, white colored sweetmeats, honey, and other foods that smell nice.
Women are taught not to wear perfume because it can attract evil spirits.
What is culture and how does one define it? In what ways are we as
human beings able to understand the various cultures that exist today? We are
able to understand culture in using the “social fabric” as a metaphor to
explain health in terms of social, economic, health care, cultural, and moral
fabric. It can be considered as a “safety net” or some sort of support network
that if it is broken it can resemble similar characteristics in identifying the
social fabric of health such that maintenance or repairs can be made. According
to the article read in class the fabric can be used by medical anthropologists
as a medium to explain, “health, illness, and healing that can be represented
in social and cultural images, society, and institutions, and ideas” (Janzen
1). I find it rather interesting that
all things medicine such as health, illness, and healing can be understood
culturally and socially. And according
to the article by Janzen, culture cannot be inherited, but rather it is learned
or taught via language. So in essence the social fabric, aside from being a
metaphor, means that in order to fully understand the healing process or
medicine, one must not only understand the science aspect, but also the
cultural aspect. Although in the Indian culture, their health seeking behaviors
may differ than that of Western cultures, does not mean that the two are
inherently different, but it lies in the fact the behavior exists at such a
state that makes it similar. The peasant and tribal societies may subscribe
themselves to shamans and healing centers for what they perceive to be mental
illness does not hold differently than if an American went to the hospital. It
is within the two completely different cultures that the action of seeking for
help is what is similar. This only re-emphasizes that culture can be used as an
analytical tool that to fully understand the healing process requires knowledge
of other cultures in their values and character.
In conceptualizing this global health problem reminds, it reminds me of one
of the class readings, “Living Through a Staggering World: The Play of
Signifiers in Early Psychosis in South India” discusses the role of culture in
psychosis. Interesting how we, in the western world, do not correlate culture
and mental health together. We often medicalize the issue of mental and
behavioral health, but do not see the cultural and social aspect of it. In the
case of schizophrenia, some may see patients with this disorder as delusional
or crazy. In other cultures, some may see it as a spiritual deity using the
patient as a medium to speak through. Thus the understanding such psychiatric
disorders may vary from culture to culture.
As a science major I understand to some degree the molecular or chemical
workings of the diseases or topics we have discussed in class. And as we
continued on the quarter, some of the medical anthropology concepts were new to
me and in shaping my previous knowledge of the topics. I hold to the fact that
the diseases I have learned in my science classes offer me no cultural, social,
political, and economic understanding of it. And it is important to understand
the real life applications of such diseases as well as the science behind it.
Just as we have discussed in class, biological or physical science cannot
understand certain concepts such as culture. We need to know how disease can
affect people in real life, whether it is through the understanding of the
historical contextualization or neoliberalism. It is the medical pluralism that
exist today that culture must be understood in order for biomedicine and modern
technology to be fully efficient in the health seeking processes.
In a more practical perspective of mental illness and inequality, it
seems that while there are knowledge to be gained from the understanding of the
Indian culture, one must also address the political and economic factors in
resolving the issue. Financial insecurity does contribute to inequalities and
perhaps may also have a role on the Indian culture because culture also adapts
to a changing environment. And with India’s growing economy, new urban cultures
are formed and old cultures die out or are adapting in order to meet the
demands of the global market. Some of which may not even be able to save
because of the cultural barriers that were in placed perhaps some time ago or
no longer applicable to today’s society and is pragmatic in health seeking. There
are more than 25 million people in need of psychiatric care in India and 7
million who suffer from a severe psychiatric disability. While some in India
may resort to modern allopathic medicine as their first choice, others may seek
help in local religious healers or shamans. The local healers may even
reference to modern medicine if all attempts to cure the individual has failed.
So in efforts to help these tribal and peasant societies in India one must
initiate contact with their local healers in emphasizing that if no recovery
were to be made then the last resort should be modern medicine and that they
should also explore other options that could potentially help cure the
individual. With the discourse in psychiatrists in more urban developed cities,
these local healers are only within reach for those in the village who seek
help. But because of social stigmas, people prefer not to visit government institutions
for help. There needs to be a change in the dispersion of psychiatrists in
India and should not be restricted to urban developed cities. In addition,
there should be more local community help in helping those who are mentally ill
because beggars and the mentally ill are categorize in the same social group.
Mental illness and inequality are often lumped together in a
social, economic, and political context. Inequalities can only contribute to
mental illness and often lead to more inequalities in some weird paradox. In
the western culture, mental illness is often medicalize and is not thought of
in a cultural or social aspect. And such interpretations depend on one’s
culture. Inequalities can only increase when mental disorders are present such
as stress and depression that ultimately affect one’s ability to function in
every day life activities. Mental illness, though interpreted differently by
culture, is still an illness whether or not the symptoms are manifested
physically and should be treated with seriousness. And I can only hope that one day I can be a part of this movement in delivering the message that mental health is just as important as other diseases. I know that through my lack of writing skills that it does not show how passionate I am about mental health and psychiatric care, I am nonetheless adamant about raising awareness and through this class I am able to understand it more in addition to my science courses.
Resources:
Resources:
Some Thoughts on the Anthropology of
Mental Health and Illness with Special Reference to India
Vinay Kumar Srivastava
Anthropos , Bd. 97, H. 2. (2002), pp. 529-541
Published by: Anthropos
Institute
Article Stable URL:
http://www.jstor.org/stable/40466051
Corin et.al. 2004. Corin Etal2004-Living through a staggering world-the play of signifiers in early psychosis in South India.pdf
Nice blog!
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