The Situationist

Posts Tagged ‘Mental Health’

Inequality and the Unequal Situation of Mental and Physical Health

Posted by The Situationist Staff on May 21, 2010

Press release from University of Michigan:

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When people are under chronic stress, they tend to smoke, drink, use drugs and overeat to help cope with stress. These behaviors trigger a biological cascade that helps prevent depression, but they also contribute to a host of physical problems that eventually contribute to early death.

That is the claim of University of Michigan social scientist James S. Jackson and colleagues in an article published in the May 2010 issue of the American Journal of Public Health. The theory helps explain a long-time epidemiological puzzle: why African Americans have worse physical health than whites but better psychiatric health.

“People engage in bad habits for functional reasons, not because of weak character or ignorance,” says Jackson, director of the U-M Institute for Social Research. “Over the life course, coping strategies that are effective in ‘preserving’ the mental health of blacks may work in concert with social, economic and environmental inequalities to produce physical health disparities in middle age and later life.”

In an analysis of survey data, obtained from the same people at two points in time, Jackson and colleagues find evidence for their theory. The relationship between stressful life events and depression varies by the level of unhealthy behaviors. But the direction of that relationship is strikingly different for blacks and whites.

Controlling for the extent of stressful life events a person has experienced, unhealthy behaviors seem to protect against depression in African Americans but lead to higher levels of depression in whites.

“Many black Americans live in chronically precarious and difficult environments,” says Jackson. “These environments produce stressful living conditions, and often the most easily accessible options for addressing stress are various unhealthy behaviors. These behaviors may alleviate stress through the same mechanisms that are believed to contribute to some mental disorders—the hypothalamic-pituitary-adrenal cortical axis and related biological systems.”

Since negative health behaviors such as smoking, drinking alcohol, drug use and overeating (especially comfort foods) also have direct and debilitating effects on physical health, these behaviors—along with the difficult living conditions that give rise to them—contribute to the disparities in mortality and physical health problems between black and white populations.

These disparities in physical health and mortality are greatest at middle age and beyond, Jackson says. Why?

“At younger ages, blacks are able to employ a variety of strategies that, when combined with the more robust physical health of youth, effectively mask the cascade to the negative health effects,” Jackson said. “But as people get older, they tend to reduce stress more often by engaging in bad habits.”

Black women show heightened rates of obesity over the life course, he points out. In fact, by the time they are in their 40s, 60 percent of African American women are obese.

“How can it be that 60 percent of the population has a character flaw?” Jackson asks. “Overeating is an effective, early, well-learned response to chronic environmental stressors that only strengthens over the life course. In contrast, for a variety of social and cultural reasons, black American men’s coping choices are different.

“Early in life, they tend to be physically active and athletic, which produces the stress-lowering hormone dopamine. But in middle age, physical deterioration reduces the viability and effectiveness of this way of coping with stress, and black men turn in increasing numbers to unhealthy coping behaviors, showing increased rates of smoking, drinking and illicit drug use.”

Racial disparities in physical illnesses and mortality are not really a result of race at all, Jackson says. Instead, they are a result of how people live their lives, the composition of their lives. These disparities are not just a function of socioeconomic status, but of a wide range of conditions including the accretion of micro insults that people are exposed to over the years.

“You can’t really study physical health without looking at people’s mental health and really their whole lives,” he said. “The most effective way to address an important source of physical health disparities is to reduce environmentally produced stressors—both those related to race and those that are not. We need to improve living conditions, create good job opportunities, eliminate poverty and improve the quality of inner-city urban life.

“Paradoxically, the lack of attention to these conditions contributes to the use of unhealthy coping behaviors by people living in poor conditions. Although these unhealthy coping behaviors contribute to lower rates of mental disorder, over the life course they play a significant role in leading to higher rates of physical health problems and earlier mortality than is found in the general population.”

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To review a sample of related Situationist posts, see The Situation of Racial Health Disparities,” The Toll of Discrimination on Black Women,” The Physical Pains of Discrimination,” The Depressing Effects of Racial Discrimination,” The Cognitive Costs of Interracial Interactions,” and “Guilt and Racial Prejudice.” For a listing of numerous Situationist posts on the situational sources of obesity, click here.

Posted in Abstracts, Distribution, Emotions, Environment, Food and Drug Law, Life | Tagged: , , , , , | 2 Comments »

The Situation of Mental Illness

Posted by The Situationist Staff on January 26, 2010

From Wikipedia:

The Rosenhan experiment was a famous experiment into the validity of psychiatric diagnosis conducted by psychologist David Rosenhan in 1973.  It was published in the journal Science under the title “On being sane in insane places.” The study is considered an important and influential criticism of psychiatric diagnosis.

Rosenhan’s study consisted of two parts. The first part involved the use of healthy associates or “pseudopatients” who briefly simulated auditory hallucinations in an attempt to gain admission to 12 different psychiatric hospitals in five different states in various locations in the United States. All were admitted and diagnosed with psychiatric disorders. After admission, the pseudopatients acted normally and told staff that they felt fine and had not experienced any more hallucinations. Hospital staff failed to detect a single pseudopatient, and instead believed that all of the pseudopatients exhibited symptoms of ongoing mental illness. Several were confined for months. All were forced to admit to having a mental illness and agree to take antipsychotic drugs as a condition of their release.

The second part involved asking staff at a psychiatric hospital to detect non-existent “fake” patients. The staff falsely identified large numbers of genuine patients as impostors.

The study concluded, “It is clear that we cannot distinguish the sane from the insane in psychiatric hospitals” and also illustrated the dangers of depersonalization and labeling in psychiatric institutions. It suggested that the use of community mental health facilities which concentrated on specific problems and behaviors rather than psychiatric labels might be a solution and recommended education to make psychiatric workers more aware of the social psychology of their facilities.

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From the BBC MindChangers Series:

Listen now by clicking here (30 minutes).

Claudia Hammond revisits . . . David Rosenhan’s Pseudo-Patient Study, gaining access to his unpublished personal papers to discover how it changed our understanding of the human mind, and its impact 40 years on.

After Rosenhan published On Being Sane in Insane Places in the journal Science in 1973, the psychiatric profession went on the defensive to protest its diagnostic competence. The study struck at the heart of their attempts to medicalise psychiatry and be accepted as proper doctors. Its impact was felt when the third edition of the profession’s bible, the Diagnostic and Statistical Manual, came out in 1980: changes had been made which brought more rigour to the diagnostic process.

However, as Claudia discovers from Rosenhan’s unpublished papers, for him the study was less an experiment of diagnostic efficacy than an anthropological survey of psychiatric wards. In a chapter of the book he never finished, she reads his poignant account of his own first admission, and his sense that “minimal attention was paid to my presence, as if I hardly existed.”

Now suffering ill health and unable to speak, Rosenhan delegates his friends and colleagues professor of social psychology at Stanford University Lee Ross and clinical psychologist Florence Keller to speak to Claudia and show her the box containing previously unpublished material which throws new light on one of the most controversial and famous psychology experiments.

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From the New York Times, Ethan Watters (author of the forthcoming book, book “Crazy Like Us: The Globalization of the American Psyche”) recently wrote a fascinating article, titled “The Americanization of Mental Illness.”  Here are some excerpts.

Americans, particularly if they are of a certain leftward-leaning, college-educated type, worry about our country’s blunders into other cultures. In some circles, it is easy to make friends with a rousing rant about the McDonald’s near Tiananmen Square, the Nike factory in Malaysia or the latest blowback from our political or military interventions abroad. For all our self-recrimination, however, we may have yet to face one of the most remarkable effects of American-led globalization. We have for many years been busily engaged in a grand project of Americanizing the world’s understanding of mental health and illness. We may indeed be far along in homogenizing the way the world goes mad.

This unnerving possibility springs from recent research by a loose group of anthropologists and cross-cultural psychiatrists. Swimming against the biomedical currents of the time, they have argued that mental illnesses are not discrete entities like the polio virus with their own natural histories. 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. In some Southeast Asian cultures, men have been known to experience what is called amok, an episode of murderous rage followed by amnesia; men in the region also suffer from koro, which is characterized by the debilitating certainty that their genitals are retracting into their bodies. Across the fertile crescent of the Middle East there is zar, a condition related to spirit-possession beliefs that brings forth dissociative episodes of laughing, shouting and singing.

The diversity that can be found across cultures can be seen across time as well. In his book “Mad Travelers,” the philosopher Ian Hacking documents the fleeting appearance in the 1890s of a fugue state in which European men would walk in a trance for hundreds of miles with no knowledge of their identities. The hysterical-leg paralysis that afflicted thousands of middle-class women in the late 19th century not only gives us a visceral understanding of the restrictions set on women’s social roles at the time but can also be seen from this distance as a social role itself — the troubled unconscious minds of a certain class of women speaking the idiom of distress of their time.

“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.”

In any given era, those who minister to the mentally ill — doctors or shamans or priests — inadvertently help to select which symptoms will be recognized as legitimate. Because the troubled mind has been influenced by healers of diverse religious and scientific persuasions, the forms of madness from one place and time often look remarkably different from the forms of madness in another.

That is until recently.

For more than a generation now, we in the West have aggressively spread our modern knowledge of mental illness around the world. We have done this in the name of science, believing that our approaches reveal the biological basis of psychic suffering and dispel prescientific myths and harmful stigma. 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.

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What is being missed, . . .[some doctors] have suggested, is a deep understanding of how the expectations and beliefs of the sufferer shape their suffering. “Culture shapes the way general psychopathology is going to be translated partially or completely into specific psychopathology. . . . When[, for example,] there is a cultural atmosphere in which professionals, the media, schools, doctors, psychologists all recognize and endorse and talk about and publicize eating disorders, then people can be triggered to consciously or unconsciously pick eating-disorder pathology as a way to express that conflict.”

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THE IDEA THAT our Western conception of mental health and illness might be shaping the expression of illnesses in other cultures is rarely discussed in the professional literature. Many modern mental-health practitioners and researchers believe that the scientific standing of our drugs, our illness categories and our theories of the mind have put the field beyond the influence of endlessly shifting cultural trends and beliefs. After all, we now have machines that can literally watch the mind at work. We can change the chemistry of the brain in a variety of interesting ways and we can examine DNA sequences for abnormalities. The assumption is that these remarkable scientific advances have allowed modern-day practitioners to avoid the blind spots and cultural biases of their predecessors.

Modern-day mental-health practitioners often look back at previous generations of psychiatrists and psychologists with a thinly veiled pity, wondering how they could have been so swept away by the cultural currents of their time. The confident pronouncements of Victorian-era doctors regarding the epidemic of hysterical women are now dismissed as cultural artifacts. Similarly, illnesses found only in other cultures are often treated like carnival sideshows. . . .

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Of course, we can become psychologically unhinged for many reasons that are common to all, like personal traumas, social upheavals or biochemical imbalances in our brains. Modern science has begun to reveal these causes. Whatever the trigger, however, the ill individual and those around him invariably rely on cultural beliefs and stories to understand what is happening. . . . It means that a mental illness is an illness of the mind and cannot be understood without understanding the ideas, habits and predispositions — the idiosyncratic cultural trappings — of the mind that is its host.

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CROSS-CULTURAL psychiatrists have pointed out that the mental-health ideas we export to the world are rarely unadulterated scientific facts and never culturally neutral. “Western mental-health discourse introduces core components of Western culture, including a theory of human nature, a definition of personhood, a sense of time and memory and a source of moral authority. None of this is universal,” Derek Summerfield of the Institute of Psychiatry in London observes. He has also written: “The problem is the overall thrust that comes from being at the heart of the one globalizing culture. It is as if one version of human nature is being presented as definitive, and one set of ideas about pain and suffering. . . . There is no one definitive psychology.”

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To read the entirety of Waters’s fascinating article (including an illuminating discussion of how the “brain disease” concept of mental illness may have increased, not decreased, the stigma of mental illness and thus hurt the very people it was supposed to help), click here.  (Thanks to Situationist friend, Andrew Perlman for suggesting this article to us.)

For a sample of related Situationist posts, see “The Interior Situation of Complex Human Feelings,” “The Disturbing Mental Health Situation of Returning Soldiers,” “Imagine You Could Change Your Brain. Oops, You Just Did!,” and “Placebo and the Situation of Healing.”

Posted in Book, Classic Experiments, Cultural Cognition, Life | Tagged: , , | 1 Comment »

The Disturbing Mental Health Situation of Returning Soldiers

Posted by The Situationist Staff on April 30, 2008

The military conflicts in Iraq and Afghanistan have led to over 4,700 deaths of U.S. soldiers (in addition to over 1.2 million deaths of Iraqi and Afghan people) and tens of thousands of physical injuries to U.S. soldiers. As we know too well, some of those injuries are catastrophic.

The mental health of returning soldiers has received much less attention, no doubt in part because those injuries are less apparent, because many people still view mental illness as less serious than physical illness, and because of choice myth in the context of mental illness: there is a common presumption that mental illness reflects a weak will (as opposed to biological impairment) of the person and that it can be corrected by the person, if the person so chooses.

Given the horrific conditions of warfare, however, perhaps the mental illness of soldiers will receive more credibility. New revelations about the number of veterans attempting suicide will certainly draw attention to the issue: although the Veterans Health Administration recently claimed that 800 veterans are attempting suicide each year, newly-uncovered e-mails from government officials indicate the actual number of veterans attempting suicide each year is closer to 12,000.

Just released data about the number of soldiers who have returned, and will return, from Iraq and Afghanistan with very serious mental health-related problems should also raise public consciousness. A new study by the RAND Corporation entitled “Invisible Wounds of War,” indicates a truly jaw-dropping figure: 1 out of every 5 returning soldiers–or about 300,000 total soldiers to date–suffers from either post-traumatic stress disorder or major depression. Below we excerpt an article by Lizette Alvarez of the International Herald Tribune on this topic.

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One in five service members who have returned from Iraq or Afghanistan report symptoms of post-traumatic stress disorder or major depression, but little more than half of them have sought mental health treatment, according to an independent study of United States troops.

The service members and veterans who reported these symptoms represented about 19 percent of the 1.6 million service members who have deployed to war in the last five years, a figure consistent with the most recent findings by military researchers. A 2007 survey of combat army soldiers who had been home for several months found that 17 percent of active-duty troops and 25 percent of reservists had screened positive for symptoms of stress disorder.

The study, released on Thursday by the RAND Corporation, reported that about 19 percent of the troops said they might have experienced a traumatic brain injury, usually the result of powerful roadside bombs, yet a majority of those troops had never been evaluated for such an injury.

The 500-page study is the first exhaustive, private analysis of the psychological and cognitive injuries suffered by service members. The study sought to determine the prevalence of these injuries, gaps in treatment and the costs of treating, or failing to treat, the conditions.

RAND researchers conducted a telephone survey from last August to January 2008 with 1,965 service members, reservists and veterans who had deployed to Iraq or Afghanistan in the last five years. Some respondents had deployed more than once. The researchers also gathered data from focus groups. The survey was conducted in 24 communities with high concentrations of service members, reservists and veterans.

The Defense Department said that it was heartened that the data reflected its own findings on the prevalence of mental injuries, and that the study helped highlight the hurdles the military faces in helping veterans.

“We’re on a long journey, and we’ve come a long way, but we’ve got a long way to go,” said Colonel Loree Sutton of the army, head of the new Defense Center of Excellence for Psychological Health and Traumatic Brain Injury.

Lisa Jaycox, a senior behavioral scientist at RAND and a co-author of the new study, “Invisible Wounds of War,” said the findings also served to underscore the barriers, some of them self-imposed, that troops face in getting help. War veterans say they are often reluctant to seek treatment, in part out of fear that their medical information will be used to derail their careers. Commanders typically have access to a service member’s military medical records.

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For the rest of the article, click here. To access “Invisible Wounds of War,” click here. For related Situationist posts on the military conflicts in Iraq and Afghanistan, see The Situation of Soldiers, Our Soldiers, Their Children: The Lasting Impact of the War in Iraq,” “The Situation of a “Volunteer” Army,” “From Heavens to Hells to Heroes – Part I,” and “Looking for the Evil Actor.” For related Situationist posts on mental health, see “The Situation of Racial Health Disparities” and “Guilty or Not Guilty? Law & Mind Meet Hamlet.”

Posted in Choice Myth, Public Policy | Tagged: , , , , , , , | Leave a Comment »

 
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