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.
It is somehow reassuring to know that there is more than one model of mental health on the planet, and that there are other ways of looking at our symptoms. This doesn’t mean that anorexia and Koro are not real, or that those who have them are somehow faking or making up the pain. We are stuck within our own culture, and that culture will guide what mental illnesses we get and which treatments will work. But knowing that there are alternative ways of being helps free up a bit of space to think differently about our own suffering.
One section of Small’s book is devoted to evolutionary psychiatry, which suggests that what we call mental disabilities today are actually more like defense mechanisms that were beneficial to our survival as a species. Like some monkeys, we are a "weed species" which means that we can thrive in many different environments because there are a variety of traits among us that are useful depending on the conditions we find ourselves in. “For all we know, our ancestors may have had better reproductive success not because they were smart, but because they were emotionally sensitive, dynamically moody, and ridden with anxiety,” (37).
If we suffer social anxiety every time we leave the house, we may see no useful benefit to it. But if we have it before a job interview or a dinner party at our boss’s house, the anxiety can serve to remind us how important our performance will be in determining our success. A little anxiety at the right time can make us perform better. It can even save our life, especially out walking in the jungle on a moonless night.
Knowing that our distressing symptoms might have had useful evolutionary purposes can help us think a little differently about them. So, too, can an acknowledgement of our needs as social animals. “Both monkeys and people need close attachments in order to be sane,” (59). In our individualistic culture, we are much more isolated, living far from our extended families and the support systems they offer. Small says that because of this, we need to form other social groups. Friends become our family. Or we join support groups made up of people like us, who can understand what we’re going through. It is not a weakness or failing to need this emotional support. It is simply a necessity for the species we evolved to be.
In taking the broadest view possible of mental illness, Small also looked into the research of psychiatrist and National Institutes of Health researcher Joseph Hibbeln, who has found that we are experiencing an epidemic in cases of depression. According to Hibbein, our brains were used to being fed a 50-50 ratio of omega-6 to omega-3 fatty acids, which essentially means eating a lot of fish. “But our modern Western diet has filled our brains with an imbalance of fats that actually hinders the brain’s electrical connections and lowers mood,” (75).
When I asked Small how relevant she thought this research was, she said "I was totally convinced by the data." Small has changed her own diet and her family’s to include more omega-3 and less omega-6 fats. "This is not easy," she said, "because omega-6 is in everything we buy in the supermarket." It won’t be easy, but for those of us suffering with depression, changing our diets is certainly worth a try.
To go back to my original question for Meredith Small about what she would do if she were bipolar, her idea of finding many things that will help rather than just one treatment is advice all of us can use. Even though we may share the same diagnosis, we are all different. Even though we may have a bio-chemical imbalance, we live in a culture and are social animals. What’s going on in these networks, what we are feeding our brains, how we are dealing with stress let’s put it all on the table and give ourselves the best chance possible for success.
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