Another Fail in Health & Wellness for America

“People are always selling the idea that people with mental illness are suffering. I think madness can be an escape. If things are not so good, you maybe want to imagine something better.”

-John Forbes Nash

When most people think of mental illnesses, just as John Nash describes, they assume one is suffering immensely. John Nash, a mathematician who had schizophrenia disproves this theory and states that his illness was an escape from reality. While many find this trivial, the world outside of Western societies agrees with his statement to some extent. Americans view schizophrenia as a more serious mental illness than other cultures and in general have greater stigma around mental illnesses. This stigma is something our culture needs to greatly improve upon. We must change the landscape and the future of mental illnesses for generations to come.

The Merriam-Webster definition of schizophrenia is a long-term mental disorder that involves the breakdown in the relation between thought, emotion, and behavior, which leads to a faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation. While schizophrenia is diagnosed all around the world, the disorder itself, the diagnosis, and the common symptoms of the mental illness are actually treated differently across these other cultures.

In The Sociology of Mental Illness, Gallagher writes that approximately one percent of the population in the United States is estimated to have schizophrenia, although some estimates range from as low as 0.2 percent to as high as 2 percent. The disorder begins early in life often during late adolescence. The median age at onset is in the late teens or early twenties for men and in the twenties or early thirties for women. Studies also unfortunately show that one out of every ten people with schizophrenia die by suicide. There are many different types of schizophrenia, which include disorganized (hebephrenic), catatonic, and paranoid. Disorganized schizophrenia is characterized by uninhibited behavior, which makes no sense to anyone other than the schizophrenic. Catatonic schizophrenia involves marked psychomotor disturbance, alternating between symptoms of excitement and withdrawal. Finally, paranoid schizophrenia is characterized by the presence of persecutory or grandiose delusions, often accompanied by hallucinations. Almost all studies show incidence rates per year of schizophrenia in adults within a range between 0.1 and 0.4 per 1000 population. The incidence of schizophrenia is quite similar in geographical areas.

The World Health Organization estimates that about 29 million people in the world live with schizophrenia, and 20 million of those live in developing or least developed countries. One of the most interesting findings from researchers in a 10-country study by the World Health Organization found that upon a two-year follow-up, the percentage of cases with full remission after a single schizophrenic episode ranged between 3% in the USA and 54% in India, while the cases with continuous psychotic illness varied between 2% in Nigeria and 33% in Japan. This study shows how environment plays a crucial role in the outcomes of those with schizophrenia and those in underdeveloped countries seemingly have higher improvement rates. It also clearly shows that something is wrong in America and other Western cultures in relation to the treatment of schizophrenia. It is not clearly defined why these countries improve better than developed countries, however better tolerance of the sick role, availability of suitable jobs, supportive family attitudes and extended family network have been suggested as explanations. These situational factors are often not available to those suffering from schizophrenia in America.

America views schizophrenia as an undesirable condition that has a lot of stigma surrounding it, while other cultures do not view it as such. Thus, underdeveloped countries treat schizophrenia patients in a more calm, appropriate way and with a non-stigmatized attitude in comparison to the United States. Schizophrenia is a mental illness that is correctly being diagnosed and treated in underdeveloped countries, but not being correctly diagnosed and treated in developed countries. Our country has much to learn from these cultures and needs to improve its views and treatments on schizophrenia and mental illnesses as a whole. Americans define schizophrenia as a mental illness and consider it to be one of the most undesirable and difficult to live with. As mentioned previously, most schizophrenics experience hallucinations and delusions, however the types of voices people perceive in other nations greatly differ, which is a direct reflection in how one’s environment is critical in the treatment and outcome of those with schizophrenia.

In a journal article written by Kamaldeep Bhui, it is described how “culture can influence the content of symptoms, for example the voices heard by a patient with first-rank symptoms, or the content of delusions, and perhaps even the nature of delusions – religious, scientific, or paranoid flavor.” Culture has a huge impact on the symptoms of those with schizophrenia. In a study conducted by The British Journal of Psychiatry, differences in voice-hearing experiences of people with psychosis in the USA, India, and Ghana were observed. The results found that “participants in the USA were more likely to use diagnostic labels and to report violent commands than those in India and Ghana, who were more likely than the Americans to report rich relationships with their voices and less likely to describe the voices as the sign of a violated mind.” Americans desire individuality and independence, and the voices were seen as an intrusion into a self-made mind. Eastern and African cultures, meanwhile tend to emphasize relationships and collectivism. In these cultures, a hallucination was more likely to be seen as just another point in the schizophrenic person’s already extensive social network. Some of the participants do not even consider themselves mentally ill. These observations prove that voice-hearing experiences with those suffering from schizophrenia are shaped by the culture and environment they are raised and live in. If Americans understood schizophrenia and observed it as a gift instead of a disorder, there could be much greater outcomes and better treatment from those suffering. However, our culture is systematically flawed, so it seems impossible to reach.

Diagnostic practices across ethnic groups shows much variation, and this could be explained by different system profiles in each culture. For instance, Bhui describes how Mukherjee et al. suggested that black and Hispanic patients in the USA were at greater risk than white patients of receiving a diagnosis of schizophrenia, despite the presence of affective symptoms. Clearly there is discrimination and racism involved in the diagnosis of patients with schizophrenia. Bhui also writes that studies show “discrimination is associated with illness, common mental disorder, and psychosis,” thus this “leads to poor mental health and an increased incidence of schizophrenia.” The system needs to change and in order to do so there needs to be attention to “developmental processes and systemic effects by which one ethnic, racial, or cultural group comes to have higher rates of illness, treatment, and, in psychiatric care, admissions and detentions against their will.” In Western cultures, something needs to change greatly in the systematic world of mental illnesses, especially schizophrenia.

The extended families that are found in more traditional, underdeveloped nations provide a particularly supportive environment for recovery and rehabilitation, while those in the United States, especially, vary greatly in their support systems. An article from PBS stated “the competitive nature of technologically advanced societies may impede the recovery of schizophrenia patients whose thought processes can be disrupted by the stress associated with the fast pace of industrialized life.” America experiences many different stresses when compared to underdeveloped countries. PBS noted that in developed countries there are stresses in the fast pace of industrialized life. In a country with roots in individualism and competition, it’s no wonder why those with mental illnesses move to the bottom of the totem pole. It is difficult to compete with others who only keep succeeding and do not have the burden or stigma associated with mental illnesses, which are often hidden and not easily observed much like those with physical illnesses.

The United States is an individualistic nation. Our roots began with our independence from Britain and moving away from our motherland to create a brand new country. Americans today are engrossed in technology and have begun texting and interacting with each other on social media instead of seeing each other in person. Americans’ values are rooted in competition and we struggle to ask for help when we need it. We are taught to fend for ourselves and work hard to succeed in life. These ideals do not align with the treatment, recovery, and rehabilitation that are necessary for those with mental illnesses. A country that is rooted in individualism is surely not helpful when a person suffering from schizophrenia only needs the collectivism and help from loved ones surrounding him or her. If a person has a mental illness, they need the help of others. Gallagher describes in the early chapters of his book that the best treatment for someone with a mental illness is social support. Thus, a society that lacks a strong social support system is not healthy or effective for someone with a disorder such as depression, anxiety, and even schizophrenia.

Developing countries and underdeveloped countries, such as Ghana and India value strong support systems and the importance of family in everyday life. Family always comes first and this is a necessary support system for those suffering from schizophrenia. This is a huge difference between cultures with schizophrenia patients. Thus, these countries have a better outlook on those suffering from this disorder and are better able to cope with family members and friends and help them during this difficult time during their life. This is a key difference in why cultures treat schizophrenia differently. It is rooted in one’s cultures goals, so those cultures that have values necessary for the rehabilitation of schizophrenia will obviously succeed much more.

Our American culture has its root in violence, thus hallucinations and delusions from American schizophrenia patients are more violent and evil. Since we know that environment plays a crucial role in the hallucinations and delusions one experiences, Western cultures such as ours experience harsher hallucinations and delusions that impact the way others view someone suffering. Those with less violent backgrounds in their culture do not have as much of a stigmatized view of people with schizophrenia and oftentimes they believe those with schizophrenia are gifted and have a better outlook on life.

There are clear examples in American culture that demonstrate violent behavior and influence. As one of the few countries with strong gun violence and a history of inequality and racism, violence has been in our history since our nation’s inception. These influences easily affect those across many different aspects of American life, including those who suffer from mental illnesses. As mentioned previously, we know that in the healthcare system racism and discrimination are key roles in the diagnosis of mental illnesses and this is due to the fact that America is rooted in racism, discrimination, and violence. These environmental factors play a large role in how those are treated and recover from mental illness.

Americans and Western cultures do not have a spiritual, holistic view on one’s wellbeing and do not consider the external factors of one’s health. Thus, in America we look at only the internal treatment and diagnosis of schizophrenia. As Bhui rationally concludes, “Research conducted in the field of culture and schizophrenia highlights the need for a holistic approach to be taken in order to understand and effectively respond to ethnic inequalities in service access, experience, and outcome. One cannot look solely through the lens of culture but, rather, should analyze how culture interlinks with internal and structural factors such as race, levels of integration, socio-economic status, and social capital. Effective diagnosis and treatment therefore needs to take into account not only the individual self, background, and personal history, but also external structural factors and psychosocial realities.” Bhui proposes that developed, Western cultures should aim for a more holistic approach to schizophrenia; one that is more inclusive and looks at the body and mid as a whole, connected to the outside world.

Although it is difficult to change beliefs and views that are systematically in our culture, there are a few ways mental health professionals and our culture can change. Development of new therapies for schizophrenia sufferers, such as developing relationships with hallucinated voices to negotiate with them is one example. We must treat mental illnesses as physical illnesses and break the stigma that is associated with schizophrenia and other mental illnesses. Improvement in education about mental illnesses will also be of assistance.

As discussed previously, the root cause in the way Western cultures diagnose and schizophrenia is due to the environment. Western cultures are developed, fast paced nations, often rooted in racism and discrimination. They lack support systems and holistic healing, and value societies of individualism and competition. With values like these, we know it is a systematic cause for the treatment and view of mental illnesses. As our cultures progress and as future generations grow older, it is essential for us to reduce the stigma of these mental illnesses. We must learn from our counterparts and treat those suffering from schizophrenia with different eyes and a different worldly view. If we do not make there changes our nation will have stigma around mental illness for generations and violence will remain rooted in our culture. Thus, underdeveloped countries treat schizophrenia patients in a more calm, appropriate way and with a non-stigmatized attitude in comparison to the United States. Schizophrenia is clearly being diagnosed and treated properly in countries and nations that are underdeveloped, and yet a country like the United States and other developed countries cannot succeed. This mental illness is yet another example of the failings of developed countries within the healthcare system and overall human wellness.

Sources

Anon. n.d. “The Teenage Brain: Culture And Schizophrenia.” PBS. Retrieved April 30, 2016

(http://www.pbs.org/wnet/brain/episode3/cultures/).

Barbato, Angelo. 1996. “Schizophrenia And Public Health.” World Health Organization: Division

of Mental Health and Prevention of Substance Abuse. Retrieved April 24, 2016

(http://www.who.int/mental_health/media/en/55.pdf?ua=1).

Bhui, Kamaldeep and Natasha Tsangarides. 2008. “Culture And Schizophrenia.” Psychiatry

(Abingdon, England) 7(11):454–57.

Gallagher, Bernard J. and Jessica Streeter. 2011. The Sociology of Mental Illness. Cornwall-on-

Hudson, NY: Sloan Pub.

British Journal of Psychiatry

Images

http://www.openculture.com/2012/06/john_nash_ia_brilliant_madnessi.html

http://www.webmd.com/schizophrenia/ss/slideshow-schizophrenia-overview

http://neurowiki2013.wikidot.com/individual:neural-substrates-of-hallucinations

http://keydifferences.com/difference-between-developed-countries-and-developing-countries.html