Cultural Views of Mental Illness
Historically, most cultures (including those of the western world) have viewed mental illness in a religious or spiritual context blaming possession by a devil, curses, spirits, witches, or an attack of sorcery. In Morocco, for instance, it is thought that mental illness is caught, like a cold. While out walking you could absent-mindedly step on a bit of sorcery or accidentally drink it down. Blaming evil, in one sense, is positive because it implies that the victim is blameless. On the other hand, blaming a spirit also breeds fear, both of the person who is ill and of the possibility that you, too, can be become similarly afflicted.
There are, however, cultures that believe in possession but do not fear it. Certain Native Americans and Indian tribes of South America, Africa, and South and East Asia practice shamanism. People exhibiting symptoms that the Western world would attribute to schizophrenia or bipolar disorder are taught to become shamans; it is believed that they are being contacted by the spirits and have special powers. In general, however, mental illness is a globally stigmatized condition.
The Stigma of Mental Illness
In most cultures, stigmatization is especially harmful because the stigma is often attached to the entire family as well as to the mentally ill individual. The result is often resentment, fear, and maltreatment of the mentally ill.
For example, the Vietnamese believe in karma: someone afflicted by mental illness is either being punished for a wrongdoing in a previous life or by an angry ancestor who has returned to possess him or her. To avoid disgrace, the family will hide their mentally ill family member from the public. It is said that Vietnamese psychiatrists are ridiculed rather than respected and are forced to work shorter hours than other doctors for fear that they, too, might become possessed by whatever has contaminated or invaded their patients.
In India, where arranged marriages are still common, a history of mental illness in a person's family will reduce his or her opportunity to marry. Therefore, mentally ill people, especially women, are often sent away to less-than-adequate asylums by their families. As a side note, In 2001, in Tamil Nadu, 25 psychiatric patients, who'd been chained to their beds, died in a fire. The asylum was positioned next to a Muslim shrine in the hopes that the religious powers would help cure the patients.
In Japan, mental illness is construed as weakness of character. Because this sort of weakness is extremely undesirable, shame hinders people from seeking treatment. And since the Japanese are taught to repress their emotions in front of strangers, making a correct diagnosis is difficult even if they do seek help. Similarly, in China, mentally ill people are a source of humiliation for their families. Subsequently, both the Japanese and the Chinese tend to keep their mentally ill family members hidden away.
The World Health Organization (WHO) states that at any given time 450 million people worldwide are affected by mental, neurological, or behavioral problems. And according to the WHO, policy makers, insurance companies, health and labor policies, and the public at large discriminate between physical and mental problems. Therefore, mentally ill patients do not receive the same consideration for health and financial benefits
as do people with physical ailments.
You need only look at the number of homeless people with mental illness to know that social stigma is still rife in North America. In Canada, 20% to 30% of homeless people have psychiatric problems and roughly a third of them suffer from alcohol or drug abuse. Similarly in the United States, one third of the approximately 3.5 million homeless people suffer from severe mental illness.
Who is mentally ill, really?
One common misconception is that all mentally ill people are unpredictable and violent. Our society has an insatiable appetite for real-life horror stories about rapists, serial killers, and pedophiles, and the media is happy to provide us with them. As a result, we tend to put everyone with psychiatric problems under one label: crazy.
However, different cultures have different concepts of what constitutes a mental illness. Take suicide, for example. In Japan, suicide is, in most cases, not considered problematic, rather it can be an honorable act committed to save face or for a noble cause. Similarly, while the Koran prohibits suicide, "suicide bombers" are not generally considered "suicides" by their zealous supporters they are martyrs for their cause. But in North America, someone who attempts suicide will likely be diagnosed with some form of psychological problem.
Some cultures are more susceptible to certain types of illness than others. Anorexia and bulimia are largely afflictions of the western world, while Japan has a whole separate set of disorders, many of which stem from their cultural expectation of hard work. One commonly documented Japanese condition called hikikomori (similar to agoraphobia) is characterized by a withdrawal from society due to stress and is said to affect large numbers of teenaged boys.
What about addictions? In North America, we believe in possession of a different kind: drugs, gambling, alcohol, or food are thought of as diseases that take over the victim and are difficult to expel. Again, we remove blame, but is it accurate to put a gambling addiction on par with, say, schizophrenia?
Artistic Ability Linked to Mental Illness?
Some support groups list names of famous people who have suffered from (or who are believed to have suffered from) mental illness. It is believed, for example, that Ernest Hemingway, Winston Churchill, Virginia Woolf, Peter Tchaikovsky, and Vincent Van Gogh suffered from bipolar disorder. The book Famous Depressives Ten Historical Sketches by M.J. Lieburg identifies individuals such as Michelangelo, Martin Luther, Ignatius de Loyola, and Arthur Schopenhauer. (And, interestingly, a 1998 study in the journal Neurology found that frontotemporal dementia brings out startling artistic ability in some people, even as their brain deteriorates.) Such connections do help to lessen the stigma, show people they are not alone, and prove that it is possible to be successful despite mental illness.
According to the WHO, most middle- and low-income countries put less than 1% of their health expenditure toward mental health. And more than 680 million people (mainly in Africa and Asia) have access to less than one psychiatrist per million; therefore, many rely on the help of traditional healers (which is not necessarily a bad thing). In a paper in the Annals of Internal Medicine, entitled "Traditional Healers in Southern Africa," Mariana G. Hewson, PhD, notes: "Genuine human engagement and spirituality can be powerful tools in promoting well-being. The healers are intimately involved with their patients and their community, and they share in the results of their work." However, as the WHO recognizes, more research into the methods used by some traditional healers is needed. For example, traditional healers in Morocco have been seen beating mentally ill patients in an effort to "scare" the invading spirit out of the body.
Perhaps we have to look to the past to gain some perspective. The ancient Greeks believed that mental illness was curable, and they used religious rituals, diet, massage, and dance, among other therapies, to manage it. A lesson from them would help us all have a little more compassion and a little less fear.