Cultures with heavy bias against mental illness...

[Frazier]

From the collective experience of this forum, have you encountered any particular cultures that are heavily biased against individuals with mental illness?

For example, an attending was telling me a story about a patient that was conflicted to reveal his ailments to his family back in his home country...basically saying "I would be better off dead than ever revealing this to them."

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[FlowRate]

Some (more extreme) types of evangelical Christians believe mental illness is a sign of demon possession or sinfulness, in the sense that it's a sign the sufferer did something wrong to be that way.

 

[ChillDawg]

I'd say society in the former Soviet republics has a pretty strong stigma against psychiatry. I believe its a combination of being seen as 'weak' plus the use of psychiatric homes to stifle dissidents.

 

[clausewitz2]

Without being too broadly stereotypical, Confucian-influenced East Asian cultures tend to take a dim view of disclosing mental health issues to anyone outside of the family, so actually persuading someone to see a provider is often a struggle.

 

[birchswing]

I've seen in my own family the influence of Christian Science (not scientology) in causing aversion to medical care. It's not specifically regarding psychiatry, but I think psychiatry from a Christian Scientist's POV might have less legitimacy because 1) mental illness is more similar to generalized forms of suffering people seek spiritual answers to and 2) because mental illness is more easily regarded as something that can be treated with mind over matter than a bone sticking out of a person's leg.

 

[Shikima]

There are also microcultures which prevent people from seeking out help. It's not just ethnic or religious overtones which prevent people from seeking out help.

 

[Mad Jack]

There are also microcultures which prevent people from seeking out help. It's not just ethnic or religious overtones which prevent people from seeking out help.

Yeah, like medicine lol

 

[Shikima]

Yeah, like medicine lol

Medicine, Military... I'm sure there are others. Broadly sweeping it could be loosely applied to almost any circumstance across the globe. Some are more accepting, some are hard liners.
From what I gather, the ego is too weak.

 

[clausewitz2]

Medicine, Military... I'm sure there are others. Broadly sweeping it could be loosely applied to almost any circumstance across the globe. Some are more accepting, some are hard liners.
From what I gather, the ego is too weak.

Agreed, but I think there is a significantly greater challenge of access when it is not just your professional or peer group that stigmatizes mental health concerns, but also your entire extended family, your religious leaders, and almost everyone you know.

 

[Salpingo]

From the collective experience of this forum, have you encountered any particular cultures that are heavily biased against individuals with mental illness?

For example, an attending was telling me a story about a patient that was conflicted to reveal his ailments to his family back in his home country...basically saying "I would be better off dead than ever revealing this to them."

Off the top of my head, I can't think of a culture that DOESN'T stigmatize mental illness.

 

[Nasrudin]

Off the top of my head, I can't think of a culture that DOESN'T stigmatize mental illness.

Sure. But to a relative degree the OP has a point. 2 populations that I have experience working with that are strongly resistant to psychiatric intervention are black populations--more poignantly those involved in various liberation theologies, the worst being the various urban sects that spun off from Elijah Mohammed--although I've never treated a black israelite--i imagine they might be worse with the pseudo rastafarian naturopathicisms.

The others are Islamic cultures of the less urbane sort. For example, I'm treating a yemeni schizophrenic, from remote rural village, who speaks no english. And an arabic that cannot be understood by the vast majority of translators. His previous treatment history has amounted to being trapped in torturous, physically abusive environments with various exorcism rituals as his main treatment plan. (I wonder if they filled out their weekly treatment plans for chasing out demons and such. OMH would not be pleased with this lack of compliance and safety)

 

[clausewitz2]

Sure. But to a relative degree the OP has a point. 2 populations that I have experience working with that are strongly resistant to psychiatric intervention are black populations--more poignantly those involved in various liberation theologies, the worst being the various urban sects that spun off from Elijah Mohammed--although I've never treated a black israelite--i imagine they might be worse with the pseudo rastafarian naturopathicisms.

The others are Islamic cultures of the less urbane sort. For example, I'm treating a yemeni schizophrenic, from remote rural village, who speaks no english. And an arabic that cannot be understood by the vast majority of translators. His previous treatment history has amounted to being trapped in torturous, physically abusive environments with various exorcism rituals as his main treatment plan. (I wonder if they filled out their weekly treatment plans for chasing out demons and such. OMH would not be pleased with this lack of compliance and safety)

We had a black Israelite roll up in our psych ED at one point. On presentation he also believed he was Pharoah Amon XLI and was going to pilot a spaceship to a planet free of white oppressors. He did become significantly more lucid during his admission but the poor resident from a very white bread rural background had a hard time working our what things he was affirming were religious/cultural and what was lingering psychosis.

 

[clausewitz2]

Off the top of my head, I can't think of a culture that DOESN'T stigmatize mental illness.

I don't know, a lot of upper middle class coastal types are very forthcoming about seeing therapists. Of course there is still a set of "acceptable" mental illnesses that show you are refined and sensitive and those that are scary and frightening.

 

[HarryMTieboutMD]

Doctors. And psychiatrists in particular (among themselves).

 

[FlowRate]

Off the top of my head, I can't think of a culture that DOESN'T stigmatize mental illness.

Do those patient forums where people talk about their psych meds count?

 

[Salpingo]

I don't know, a lot of upper middle class coastal types are very forthcoming about seeing therapists. Of course there is still a set of "acceptable" mental illnesses that show you are refined and sensitive and those that are scary and frightening.

I think that's more socioeconomic than cultural. And often the people who are so open about their therapy are operating under the assumption of being coached as opposed to receiving a targeted treatment for mental illness. Similarly, reformed/secular Jews are open about neurotocism (see Allen, Woody), but that doesn't necessarily translate into open-mindedness towards severe mental illness.

Sure. But to a relative degree the OP has a point. 2 populations that I have experience working with that are strongly resistant to psychiatric intervention are black populations--more poignantly those involved in various liberation theologies, the worst being the various urban sects that spun off from Elijah Mohammed--although I've never treated a black israelite--i imagine they might be worse with the pseudo rastafarian naturopathicisms.

The others are Islamic cultures of the less urbane sort. For example, I'm treating a yemeni schizophrenic, from remote rural village, who speaks no english. And an arabic that cannot be understood by the vast majority of translators. His previous treatment history has amounted to being trapped in torturous, physically abusive environments with various exorcism rituals as his main treatment plan. (I wonder if they filled out their weekly treatment plans for chasing out demons and such. OMH would not be pleased with this lack of compliance and safety)

There's a difference between ignorance and stigma. For example, there are tons of mental health resources in the Orthodox/Hasidic community, but once your labeled as severely mentally ill, you are essentially marked for life. If you haven't married by time of diagnosis (or divorced), you will be matched to a similarly mentally person (which can be disastrous). While there's an overall tolerance and humane treatment, the stigma is still there -- its just less obvious.

 

[Salpingo]

Do those patient forums where people talk about their psych meds count?

Link?

 

[clausewitz2]

I think that's more socioeconomic than cultural. And often the people who are so open about their therapy are operating under the assumption of being coached

What is social class in practice if not a culture, exactly?


Good point about coaching v. mental illness, although sometimes the discussions involve comparing SSRI prescriptions as well, which starts to become a bit more of a grey area. Really it's a bit like the place neurasthenia occupied in the last century.

 

[clausewitz2]

Link?

Crazy-meds.us used to be the premier site for that sort of thing, but I know they recently underwent some kind of shakeup so I have no idea of how active it currently is. Honestly search the name of any psych med and a common side effect and you will find these forums discussing it.

 

[FlowRate]

Link?

http://forums.psychcentral.com/psychiatric-medications/

 

[Salpingo]

What is social class in practice if not a culture, exactly?

Good point about coaching v. mental illness, although sometimes the discussions involve comparing SSRI prescriptions as well, which starts to become a bit more of a grey area. Really it's a bit like the place neurasthenia occupied in the last century.

That's the novel thing with SSRI's -- they're pretty mild in their effect, and the majority of people prescribed them could be fairly functional with or without them. You don't hear people mentioning their court-mandated, long-acting injectable at cocktail parties (and if you do, I'm hanging out with the wrong people). In this context, SSRI's are a luxury of modern society, not a marker of mental illness.

http://forums.psychcentral.com/psychiatric-medications/

Awesome, thanks! From my experience, obsession over medication is more of a defense, a way of ignoring underlying issues like diagnosis and frustration (and maybe some internalized stigma). I have no idea if that applies to these forums, but I'm interested in reading more.

TO the OP, I would still assume that illness (mental or otherwise) is stigmatized in EVERY culture, even if its not totally apparent. You're basically being told you're a less than functional member of society. The easiest way to learn would probably be to ask any one of your patients how their community views mental illness.

 

[birchswing]

That's the novel thing with SSRI's -- they're pretty mild in their effect, and the majority of people prescribed them could be fairly functional with or without them. You don't hear people mentioning their court-mandated, long-acting injectable at cocktail parties (and if you do, I'm hanging out with the wrong people). In this context, SSRI's are a luxury of modern society, not a marker of mental illness.

When I was in college as a residential student, it seemed like everyone I knew was on an SSRI. This was 2001/2002. And they took them like multi-vitamins in that if they skipped a day they didn't care. I remember one friend who wasn't feeling well and asked me if I thought skipping his SSRI for a few days might be making him feel off.

As someone who is extraordinarily fastidious with doing things exactly the same every day, I couldn't believe the nonchalance, especially as someone whose doctor had previously cold-turkeyed him off Paxil and knew the horribleness of this. The friends I've stayed in touch with who were on them seemed to have gone off the SSRIs through attrition rather than intention.

I don't hear about people taking SSRIs as much anymore. Seems like the ADD drugs are more part of common parlance these days.

 

[Nasrudin]

I just realized I interpreted the question the way it interests me. That different cultures have an immune reaction to our culture. Whether that's cultural autoimmune dysfunction or attack against an alien infection. I'm not always entirely sure. There's something odd in our clockwork. I'm not entirely sure we haven't been coopted my viral alien memes.

Freud. Biologic reductionism. Medicating human experience. Filling out reams of safety forms.

You remember those little building dudes in fraggle rock. Just churning away. Building elaborate structures of odd, crystal plastic lattice work. With trains going somewhere dropping of more clear plastic sticks, for more structure. Utterly oblivious.

I think Henson nailed us with that scene.

But still. Black Israelites crack me the F up. C'non. I couldn't get that high to make that stuff up. Those guys can't be real can they? Medieval Ali Baba costumes? An abandoned sect of black jews? It's beautiful. I kind of like that lots of those people are anti-psych. It's comforting.

 

[DD214_DOC]

http://forums.psychcentral.com/psychiatric-medications/

What a strange forum.

 

[Ceke2002]

What a strange forum.

It's actually hosted in conjunction with the Psychology section of this forum, or at least it used to be (someone correct me if I've got that wrong).

 

[nancysinatra]

Medicine, Military... I'm sure there are others. Broadly sweeping it could be loosely applied to almost any circumstance across the globe. Some are more accepting, some are hard liners.
From what I gather, the ego is too weak.

But it's not culture or stigma that keeps people quiet in settings like the military or medicine. It's sheer practicality. If you reveal a mental illness, you'll lose your career in some of those fields (aviation is another one). If that's a "bias" it's a fairly open and unapologetic one - the military for example is very open about how they weed out people with mental illnesses of almost any kind. (Even seeing a counselor or marriage therapist is a flag on their applications.) We all know psychiatry residencies do the same thing, without being as open about it. In fact I am guessing that medicine as a whole is "biased" against people with illness of any kind. I mean, there are jobs in medicine that a disabled person could do, but how many disabled doctors do you know?

 

[Shikima]

But it's not culture or stigma that keeps people quiet in settings like the military or medicine. It's sheer practicality. If you reveal a mental illness, you'll lose your career in some of those fields (aviation is another one). If that's a "bias" it's a fairly open and unapologetic one - the military for example is very open about how they weed out people with mental illnesses of almost any kind. (Even seeing a counselor or marriage therapist is a flag on their applications.) We all know psychiatry residencies do the same thing, without being as open about it. In fact I am guessing that medicine as a whole is "biased" against people with illness of any kind. I mean, there are jobs in medicine that a disabled person could do, but how many disabled doctors do you know?

Thus, the stigma and macho bravado. We do the same thing with the lack of sleep.

 

[notdeadyet]

But it's not culture or stigma that keeps people quiet in settings like the military or medicine. It's sheer practicality. If you reveal a mental illness, you'll lose your career in some of those fields (aviation is another one).

Practicality breeds culture. Historically, one of the big reasons Latinos were underutilizes of mental health services was the feeling that issues like depression had religious implications and folks were often slow to access help out of fear of being perceived as a bad catholic. Practicality leads to culture.

Same with the military. Most folks hesitate to access mental health services not because they'll be grounded (like your good example of pilots) but because of the warrior culture and not wanting to show weakness. Most soldiers are well aware that the Army is quite capable of having folks with active PTSD still function as deployable infantrymen.

 

[lockian]

Salt-of-the-earth, pull-yourself-up-by-the-bootstraps midwestern farm-raised Lutherans is one group that hasn't been mentioned. I have my father-in-law on record from several years ago saying that he "doesn't believe in depression." He's since changed, though.

 

[NickNaylor]

Speaking broadly, I've found that African Americans, South Asians, and folks from South America seem to be the most resistant to accepting a diagnosis and recognizing the importance of continued psychiatric follow-up - both the patients themselves and their support systems (family).