Comments on: Global Psychiatry

By: PJ

PJ — Tue, 06 Oct 2009 18:11:53 +0000

I’m not sure that ICD is totally Western dominated – it has neurasthenia (which is, admittedly, now considered a culture bound syndrome in DSM).

You could also, I think, make a good case for things like IBS, ME, and fibromyalgia being largely Western cultural specific somatisation syndromes.

In fact I’m not convinced that actually we’re not hiving off some of those somatising symptoms we talk about as prevalent in non-Western cultures into these conditions rather than accepting that they’re actually part of depression and anxiety. This is a highly culturally bound activity all due to ideas of what is socially acceptable.

Working in non-psychiatric medicine at the moment I’m really struck by how much of medicine and surgery is made up of people with at least a very large psychological component to their symptoms if not a full blown and highly recognisable psychiatric disorder. And yet these people are laparascoped and CTed and have their uterus whipped out, with nary a psychiatric opinion to muddy the waters.

Of course the really interesting question about the cultural-bound nature of psychiatric illness concerns psychosis and false beliefs. Why is it ok for someone from Nigeria to believe in evil spirits but not Surrey? Why is a belief in little black helicopters or 7ft lizard men a sign of mental illness when it is seemingly so widespread in the population?

By: NiroZ

NiroZ — Fri, 02 Oct 2009 01:54:44 +0000

Psychiatry, to my understanding, is mainly based around treating (sometimes neurological or) psychological disorders that cause harm to either themselves, others or both. Granted, some do try to zealously swat down any sign of any incoming deviation from the norm, I’ve been to one of them, but that doesn’t’ mean they all do it. Sure, they don’t always get things right, like with homosexuality, and undoubtedly there’s a cultural bias, but you could say that of all medicine, I mean, remember the 4 humours and blood-letting? I think that they’re willing to change is a powerful argument in favour of them.

The problem is not that western psychiatry is projecting it’s standards onto the world, but that the rest of the world’s psychiatric services are so far behind that they have to borrow from the west, which I suppose is better than nothing, and even if the symptomatology isn’t the same, at least they can borrow the framework, allowing them to develop theirs faster than the west did.

By: trying to be rational when drunk

trying to be rational when drunk — Fri, 02 Oct 2009 00:48:54 +0000

“Concepts of mental illness in non-Western cultures can be markedly different. Non-western cultures for instance appear often to emphasize somatic symptoms when presenting with a depression-like illness, perhaps because of beliefs about the integration of body and mind. ”

It seems to me that where we have progressed in understanding some of the complexities of the mind, many cultures still think that all “mad” people have been cursed by the devil, and that there is no hope for them other than feeding them some herbs. Not so much somatic as just delusion on a grand scale. Whether their government is to blame or not is another question, but many highly educated people still believe in the most stupid things when it comes to the mind.