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"The Americanization of Mental Illness ", a must read


"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."


“We might think of the culture as possessing a ‘symptom repertoire’ — a range of physical symptoms available to the unconscious mind for the physical expression of psychological conflict,” Edward Shorter, a medical historian at the University of Toronto, wrote in his book “Paralysis: The Rise and Fall of a ‘Hysterical’ Symptom.” “In some epochs, convulsions, the sudden inability to speak or terrible leg pain may loom prominently in the repertoire. In other epochs patients may draw chiefly upon such symptoms as abdominal pain, false estimates of body weight and enervating weakness as metaphors for conveying psychic stress.”


"There is now good evidence to suggest that in the process of teaching the rest of the world to think like us, we’ve been exporting our Western “symptom repertoire” as well. That is, we’ve 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 among them — now appear to be spreading across cultures with the speed of contagious diseases. These symptom clusters are becoming the lingua franca of human suffering, replacing indigenous forms of mental illness."


"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 indigenous 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.


In trying to explain what happened to Charlene, local reporters often simply copied out of American diagnostic manuals. 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. In the wake of Charlene’s death, the transfer of knowledge about the nature of anorexia (including how and why it was manifested and who was at risk) went only one way: from West to East.


Western ideas did not simply obscure the understanding of anorexia in Hong Kong; they also may have 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."

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De morrer em magenta a 10.01.2010 às 17:40

Se gostas destas temáticas devias ler (se já não conheceres) os trabalhos de Arthur kleinman, pai da psiquiatria cultural, byron good, entre outros.
Muitas contingências culturais não se revêm de todo no manual de diagnóstico da psiquiatria. Esta é um artefacto cultural ocidental sem dúvida, mas praticado globalmente...o que levanta muitas questões. Boa escolha no tema do post.
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De Aurea Mediocritas a 10.01.2010 às 18:46

Não conheço não e vou espreitar estes autores.
Sou até capaz de comprar o livro do senhor que escreveu isto, assim que sair.
Obrigado pelas sugestões.
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De F a 11.01.2010 às 13:44

Cada vez mais, tenho para mim, que TODAS as maleitas físicas de que o ser humano padece são fruto de um processo qualquer mental. Uma tradução biológica e química (bioquímica) de medos e processos mentais de resistência, de sobrevivência, de auto-imagem / valorização, de auto-afirmação, de incómodos vindos do exterior e filtrados / sentidos / interpretados, resultando em "feridas" físicas palpáveis, analisáveis, catalogáveis. Marcas prints ) físicas de impressões mentais.

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