Resumen
Gracias a la globalización, y a la tendencia que tantos tienen a seguir todo lo que es americano a pie juntillas. Los psiquiatras, por todas partes del mundo, han adoptado, sin juicio crítico — como hemos adoptado los fast food — esa aberración de la nomenclatura estadounidense conocida (ahora preñada y en espera de dar nacimiento a su nuevo vástago DSM-V en el 2013) como DSM-IV-TR.
En mi caso, es una repetición del "I told you so…"
Abstract:
Thanks to DSM-ETC, the American Psychiatric Association (APA) have for many years been busily engaged in a grand project of Americanizing the world"s understanding of mental health and illness. They may indeed be far along in homogenizing the way the world goes crazy.
AMERICANS, particularly if they are the college-educated type, worry about their country"s awesome blunders into other cultures.
For all the self-recrimination, however, the world may have yet to face one of the most remarkable effects of American-led globalization. They have for many years been busily engaged in a grand project of Americanizing the world"s understanding of mental health and illness. By now, they 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, as I have said in countless occasions.
In some Asian cultures, people 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.
The diversity that can be found across cultures can be seen across time as well.
The hysterical-leg paralysis that afflicted thousands of middle-class women in the late 19th century not only gives all 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.
They did it in similar vein as Susan Sontag expressed in her book Illness as a metaphor.
In any given era, those who minister to the mentally ill — doctors, shamans or priests — unwittingly 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.
Enters DSM-ETC
For more than a generation now, the American Psychiatric Association have aggressively spread its own conception of mental illness around the world.
It has done this in the name of science, believing that their narrow 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 they tell us, they have been exporting their self styled "symptom repertoire" as well.
That is, they have 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 nervosa among them — now appear to be spreading across cultures with the speed of contagious diseases.
Notably in this regard, is how DSM-ETC has kept all hands off obesity and its related behavioral complications.
These symptom clusters are becoming the lingua franca of human suffering, replacing indigenous forms of mental illness.
In a story that appeared in an important US periodical, DR. SING LEE, a psychiatrist and researcher at the Chinese University of Hong Kong, watched the Westernization of a mental illness firsthand. In the late 1980s and early 1990s, he was busy documenting a rare and culturally specific form of anorexia nervosa in Hong Kong. Unlike American anorexics, most of his patients did not intentionally diet nor did they express a fear of becoming fat. The complaints of Lee"s patients were typically somatic — they complained most frequently of having bloated stomachs. Lee was trying to understand this autochthonous form of anorexia and, at the same time, figure out why the disease remained so rare.
As he was in the midst of publishing his finding that food refusal had a particular expression and meaning in Hong Kong, the public"s understanding of anorexia suddenly shifted. On Nov. 24, 1994, a teenage anorexic girl named Charlene Hsu Chi-Ying collapsed and died on a busy downtown street in Hong Kong. The death caught the attention of the media and was featured prominently in local papers. "Anorexia Made Her All Skin and Bones: Schoolgirl Falls on Ground Dead," read one headline in a Chinese-language newspaper. "Thinner Than a Yellow Flower, Weight-Loss Book Found in School Bag, Schoolgirl Falls Dead on Street," reported another Chinese-language paper.
In trying to explain what happened to Charlene, local reporters often simply copied out the famous American diagnostic manual, DSM-IV. The mental-health experts quoted in the Hong Kong papers and magazines confidently reported that anorexia in Hong Kong was the same disorder that appeared in the United States and Europe.
These Westernized ideas did not simply obscure the understanding of anorexia in Hong Kong; they also changed the expression of the illness itself. As the general public and the region"s mental-health professionals came to understand the American diagnosis of anorexia, the presentation of the illness in Lee"s patient population appeared to transform into the more virulent American standard. Lee once saw two or three anorexic patients a year; by the end of the 1990s he was seeing that many new cases each month. That increase sparked another series of media reports. "Children as Young as 10 Starving Themselves as Eating Ailments Rise," announced a headline in one daily newspaper. By the late 1990s, Lee"s studies reported that between 3 and 10 percent of young women in Hong Kong showed disordered eating behavior.
What is being missed, Lee and others 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," Lee says. "When 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."
The problem becomes especially worrisome in a time of globalization, when symptom repertoires can cross borders with ease.
Mental-health professionals in the West and in the United States in particular, create official categories of mental diseases and promote them in a diagnostic manual that has become the worldwide standard. American researchers and institutions run most of the premier scholarly journals and host top conferences in the fields of psychology and psychiatry. Western drug companies dole out large sums for research and spend billions marketing medications for mental illnesses.
Would anorexia have so quickly become part of Hong Kong"s symptom repertoire without the importation of the Western template for the disease? It seems unlikely.
THE IDEA THAT DSM-ETC conception of mental health and illness might be shaping the expression of illnesses in other cultures is rarely discussed in the professional literature, unless you visit www.monografías.com.
Blind ostriches in an avalanche of contradictions
Western mental-health practitioners often prefer to believe that the 844 pages of the DSM-IV prior to the inclusion of culture-bound syndromes describe real disorders of the mind, illnesses with symptomatology and outcomes relatively unaffected by shifting cultural beliefs. And, it logically follows, if these disorders are unaffected by culture, then they are surely universal to humans everywhere. In this view, the DSM is a field guide to the world"s psyche, and applying it around the world represents simply the brave march of scientific knowledge.
Something, that any serious scientific mind will find an atrocious misconception in all respects.
Mental illnesses, it was suggested, should be treated like "brain diseases" over which the patient has little choice or responsibility. This was promoted both as a scientific fact and as a social narrative that would reap great benefits. The logic seemed unassailable: Once people believed that the onset of mental illnesses did not spring from supernatural forces, character flaws, semen loss or some other prescientific notion, the sufferer would be protected from blame and stigma. But does the "brain disease" belief actually reduce stigma?
CROSS-CULTURAL psychiatrists have pointed out that the mental-health ideas America exports to the world are rarely unadulterated scientific facts and never culturally neutral.
Behind the promotion of Western ideas of mental health and healing lie a variety of cultural assumptions about human nature. Westerners share, for instance, evolving beliefs about what type of life event is likely to make one psychologically traumatized, and they seem to agree that venting emotions by talking is more healthy than stoic silence.
The ideas they export often have at their heart a particularly American brand of hyperintrospection — a penchant for "psychologizing" daily existence.
No one would suggest that the APA should withhold American medical advances from other countries, but it"s perhaps past time to admit that even the most remarkable scientific leaps in understanding the brain haven"t yet created the sorts of cultural stories from which humans take comfort and meaning. When these scientific advances are translated into popular belief and cultural stories, they are often stripped of the complexity of the science and become comically insubstantial narratives.
Take for instance a Web site text advertising the antidepressant Paxil: "Just as a cake recipe requires you to use flour, sugar and baking powder in the right amounts, your brain needs a fine chemical balance in order to perform at its best."
Americans, even when thinking about science, first think of food…
The American mind, endlessly analyzed by generations of theorists and researchers, has now been reduced to a batter of chemicals all carry around in the mixing bowl of their skulls. As if the skull were an oven and the encephalic mass, batter for cookies!
Observations
For many years many American psychiatrists — notable among them Paul McHugh — have been fulminating against DSM-ETC (as I fancy to call it), its architects and its purpose.
Having written extensively about this in psikis.cl and in monografías.com
I can tell you now, why we reap the ugly results.
Bibliography
Larocca, FEF: Las alucinaciones de William Blake: Su significado para la psiquiatría moderna In www.monografías.com and in this same site
Image
Dragon by William Blake.
Autor:
Dr. Félix E. F. Larocca