An interview with Meredith Small, author of The Culture of Our Discontent: Beyond the Medical Model of Mental Illness (Joseph Henry Press, 2006).
After reading anthropologist Meredith Small’s book, I thought perhaps she would reject our current Western model for treating mental illnesses such as depression and bipolar disorder. But when I asked her what kind of help she would seek if she were bipolar, she said she would find a good talk therapist, not necessarily a psychiatrist, and that she would try drug therapy if that was the suggested treatment.
This was a pretty mainstream answer for someone whose research included cultures where trance dancers going into altered states of consciousness without drugs were the “healers.” Or those where the religious leaders, or shamans, were chosen most often from the psychologically unstable. “Anthropologists have noted,” Small states, “that shamans in indigenous cultures are indeed akin to schizophrenics in Western culture, but the difference in how that mentality plays out lies in the way each society responds," (142).”
How a society responds is crucial to the diagnosis and treatment of mental illnesses. Every culture around the world decides what’s normal and what’s abnormal behavior, says Small. In some cultures, mental disabilities are blamed on witches. It helps a person who is suffering to know that their weird behavior is not something they are responsible for, but the result of a witch’s spell.
Being able to “lay blame” makes us feel better. When we are diagnosed with bipolar disorder, and told it’s a bio-chemical malfunction of our brains, we can breathe a sigh of relief that our messed up lives were not our fault. The Western medical model does provide this useful function, as well as potential treatment in the form of medication. But adhering strictly to this model is where Small thinks we are on the wrong track.
When she said she would go through the mainstream channel if she were bipolar, she also said that she wouldn’t stop there. She would research everything she could find on the topic through the internet, and read books about it. She would try to find many things that helped, not just one.
The trouble with our current medical model, according to Small, is that not everybody is helped. “We have a very complicated brain and it can go wrong,” she says. Bio-chemistry and genes are important explanations when this happens, but they are not the whole story. Environment and culture is just as important.
Interestingly, while some mental disabilities like depression and anxiety seem to occur in all societies, some are strictly culture bound. Anorexia, for example, doesn’t exist without the presence of bathroom scales and excess food production. When food is scarce, someone else will eat what you don’t.
A fascinating example of a classic culture-bound mental syndrome Small reports on is called Koro: "where men think their penis is growing smaller each day, retracting into the body, and ending in the man’s death when the penis finally disappears altogether" (119). This purely mind-generated fear tends to spread rapidly from person to person like an epidemic, and then just as quickly disappears - and everyone returns to normal.
After reading anthropologist Meredith Small’s book, I thought perhaps she would reject our current Western model for treating mental illnesses such as depression and bipolar disorder. But when I asked her what kind of help she would seek if she were bipolar, she said she would find a good talk therapist, not necessarily a psychiatrist, and that she would try drug therapy if that was the suggested treatment.
This was a pretty mainstream answer for someone whose research included cultures where trance dancers going into altered states of consciousness without drugs were the “healers.” Or those where the religious leaders, or shamans, were chosen most often from the psychologically unstable. “Anthropologists have noted,” Small states, “that shamans in indigenous cultures are indeed akin to schizophrenics in Western culture, but the difference in how that mentality plays out lies in the way each society responds," (142).”
How a society responds is crucial to the diagnosis and treatment of mental illnesses. Every culture around the world decides what’s normal and what’s abnormal behavior, says Small. In some cultures, mental disabilities are blamed on witches. It helps a person who is suffering to know that their weird behavior is not something they are responsible for, but the result of a witch’s spell.
Being able to “lay blame” makes us feel better. When we are diagnosed with bipolar disorder, and told it’s a bio-chemical malfunction of our brains, we can breathe a sigh of relief that our messed up lives were not our fault. The Western medical model does provide this useful function, as well as potential treatment in the form of medication. But adhering strictly to this model is where Small thinks we are on the wrong track.
When she said she would go through the mainstream channel if she were bipolar, she also said that she wouldn’t stop there. She would research everything she could find on the topic through the internet, and read books about it. She would try to find many things that helped, not just one.
The trouble with our current medical model, according to Small, is that not everybody is helped. “We have a very complicated brain and it can go wrong,” she says. Bio-chemistry and genes are important explanations when this happens, but they are not the whole story. Environment and culture is just as important.
Interestingly, while some mental disabilities like depression and anxiety seem to occur in all societies, some are strictly culture bound. Anorexia, for example, doesn’t exist without the presence of bathroom scales and excess food production. When food is scarce, someone else will eat what you don’t.
A fascinating example of a classic culture-bound mental syndrome Small reports on is called Koro: "where men think their penis is growing smaller each day, retracting into the body, and ending in the man’s death when the penis finally disappears altogether" (119). This purely mind-generated fear tends to spread rapidly from person to person like an epidemic, and then just as quickly disappears - and everyone returns to normal.
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