On the Concept of “Mental Illness,” the Harms of Psychiatric Labeling, and the Most Unrecognized, Oppressed Minority Group in America

misconceptions, and true genesis and nature of “mental illness” – both in graduate school and beyond. My discussion here is based on sources such as 1) Possibly the most famous, cross-cultural, study in psychiatry’s history – the World Health Organization’s 25-year global tracking of individuals with schizophrenia, which found that people diagnosed with schizophrenia in poor or developing countries do far better over time than schizophrenics in Western, industrialized nations, 2) The large body of research conducted by “labeling theorists” such as Erving Goffman, Patrick Corrigan, Petra Kleinlein, Gerald O’Brian, Anthony Taylor and Palmer Reg Orovwuje, and 3) Ethan Watters’ magnificently-researched, 2010 book, Crazy Like Us  – which initially received a decent amount of notice by media (including an interview on NPR’s “Fresh Air”) but for some unfathomable reason has been severely overlooked ever since. I consider it one of the most important books in the field mental health today.

(You can read an excerpt of the book’s intro here, from the Jan. 8, 2010 issue of the New York Times Magazine). 

So let’s start this discussion with Watters’ chapter on schizophrenia, because his fascinating findings bear implications for how we view and treat any “mental illness” today. I could talk at length about this chapter’s research (his book also includes chapters on anorexia, PTSD, and depression) but will try to limit myself to briefly summarizing Watters’ chapter on schizophrenia here. (I really encourage you to get his book if you are interested in the role culture plays in “mental illness,” as my summary is far from adequate. Crazy Like Us includes chapters on anorexia, PTSD, and depression as well).

What Watters found, by spending time with the aforementioned McGruder, a cultural anthropologist who moved to Zanzibar years ago to study and solve the schizophrenia mental health conundrum, was this: 1) While Western psychologists almost-uniformly attribute schizophrenia’s causes to the purely biologic – abnormalities in brain structure, biochemistry, or genes – hence dooming those diagnosed with it to poor outcomes, there are in fact too many variations in experiences approximating schizophrenia globally to reduce its causes to the purely biologic. And 2) Watters learned that how families, treatment providers and local culture understand, view and explain a “schizophrenic’s” experience, and how they talk about and treat those family members as a result, plays a huge role in how the illness impacts a person’s behaviors and self-conception and, therefore, their long-term prognosis.

In Zanzibar, for example, McGruder found that most of its population, including its doctors, had not yet been contaminated (my wording) by the Western view that schizophrenia is a purely biological disease from which there is no escape. Zanzibar people are more likely to attribute the experience of schizophrenia instead to spirit possession or the “permeability of the human consciousness by magical forces,” Watters wrote. Spirit possession in Zanzibar is viewed as a relativiely common experience which everyone experiences at some point in their lives. For example, said Amina, a mother whose household included both an ex-husband and daughter (Kimwana) with schizophrenia, we all have “creatures in our heads.” Those with schizophrenia were seen to simply experience spirit possession more often and to a more extreme degree than others. Spirits were also known to to be rude and to violate social norms; thus when Kimwana acted out, it was seen as the spirit acting out, rather than her behaving badly. Amina harbored no judgment or frustration toward her daughter’s delusions, and never pressured Kimwana to display “normal” behaviors. She was not stigmatized, remained just as much a part of the family unit as any other member, and was allowed to fluctuate back and forth between health and periods of illness: “As such, Kimwana felt little pressure to self-identify as someone with a permanent mental illness. This stood in contrast with the diagnosis of schizophrenia as McGruder knew it was used in the West. There the diagnosis carries the assumption of a chronic condition, one that often comes to define a person,” wrote Watters.

To Watters Zanzibar families provided a quintessential example of how merely the way in which a culture names a disease can impact how the “disease” plays out in the person themselves. Mexican-Americans studied in Southern California, for example, have a way of labeling experiences approximating schizophrenia – called nervios – which keeps the family member stigma-free. Nervios, a “catchcall diagnosis for feelings of disquiet or distress” in that culture, does not bring with it the negative connotations associated with schizophrenia; it is viewed as something all people experience, in milder forms, at one time or another. It is also viewed as a transitory state. As one researcher put it, the Mexican-American families studied view individuals with “schizophrenia” as simply “just like us only more so.” Therefore, as in Zanzibar, the nervios framework kept the individual within the family and social group, as opposed to setting him/her apart as an “other” with a lower status level.

The normalizing frameworks families used by the above two culture lies in stark contrast to how families in industrialized Western societies – particularly Anglo-American families – view their schizophrenic members. Western families are more prone to view the individual as an ‘other” and to show what’s known in psycho-lingo as “high expressed emotion (EE)”. High EE, demonstrated by such things as over-intrusiveness into a family member’s life, expressions of self-sacrifice or burden, etc., has been associated in research studies with poorer outcomes for those with mental illness. 

Watters attributes the difference to the way in which families across cultures view and treat schizophrenic members to the ascendance of the biomedical model – also referred to as  simply the “medical model” as well as “biological reductionism” by those at odds with it – of mental illness. Having evolved over the past fifty years, the biomedical model, which now reigns throughout psychiatry, views mental illness primarily as a “brain disease” resulting from abnormalities in genes, brain structure or biochemistry.

Print this article | Print this page

4 comments

  1. Diane R. Anderson says:

    Good morning Jeanene,
    I am eager to read your entire article and I copied it into Words so I can have it with me at all times even when there is no internet access for me here.
    I did read the first page quickly and the last paragraph… My heart felt and my eyes are crying for the pain that you are going through. You are a wonderful writer and you have a lot to offer that the world sees and recognizes it or not. It takes more courage to fight and that is what you are doing right now. You have started a fight for you and to help others by making this disease more visible. Scientists can go to the moon but can’t figure out the intricacy of the human brain to cure mental illness. I can’t wait to dig further with you in understanding the dimension, the fears and the nutritional effects that could make a small difference.
    Always listening,
    Love,
    Diane

  2. Website says:

    Thanks for a marvelous posting! I definitely enjoyed reading it, you’re a great author.I will ensure that I bookmark your blog and may come back at some point. I want to encourage yourself to continue your great posts, have a nice day!|

  3. Jeanene, Just because we choose not to call it “mental illness” doesn’t mean we don’t believe the suffering exists. Your friend was using faulty logic. You did not state, “People aren’t really suffering.” What you did state, and I do too, is that we choose not to call this “illness.” We don’t deny the existence of suffering. As I said in my blog post, calling it “illness” actually diminishes our recognition of suffering, boxing us into categories and pre-determined “treatment.”

    As for the discrimination against ED, I see that everywhere. It even exists in the Movement. How many times have I heard, “My bipolar was real. Your eating disorder was a choice.” So a manic person doesn’t “choose” to waste thousands of dollars on a plane ticket to Hollywood, thinking he/she is having a love affair with a movie star due to either “I can’t help it it’s my illness” or “It’s not an illness but I was really suffering.” Either way, calling it “illness” or not, ED gets left between the cracks.

    Yes, ED impacts us physically and is often caused by something amiss in the body. How often have I heard, “After 20 years, I found out the cause was a food allergy.”? Or, “My kid wouldn’t eat, but we found out he had dental problems that made it impossible to chew.” The treatment centers don’t even address these things. They don’t care what the cause is, they only force-feed and monitor every function of the human body as if we are caged animals.

    I suffered from both anorexia and binge eating. The binge eating went ignored in the treatment center and the focus was on forcing food, or even fake food, into me. They assumed the binge eating came from hunger. If only they’d listen to patients and realize that it doesn’t. In fact, I’ve had uneducated doctors and well-meaning friends state that it’s good to binge because it puts weight on a person.

    Say, what? Is no one speaking out on this? I think there are more deaths from binge eating (stomach rupture, car accidents, suicide) than anyone wants to admit. I know that in 1986 and 2012, when I really did want to do myself in, it was because no one presented to me any reasonable solution to binge eating. I was either turned down, blamed repeatedly, or given pat answers by “staff” who really didn’t know what I and other men and women experience who do large-quantity binges.

    Even outpatient treatment is slavery. People with bipolar or OCD might see a therapist once a week, maybe twice, and the psychiatrist once a month, but with ED, you have to see not only a therapist who runs your life, but also a nutritionist, often weekly, and a PCP for the forced weigh-in, plus the psychiatrist. Some must endure the forced weigh-in twice weekly. For many, this means at least three appointments per week, and if you don’t show up for one, you risk sectioning, that plus living with constant threats, “If you don’t gain 1/2 pound by Friday, you’re sectioned!” That’s not a life. It’s hell. It’s treating an adult like kindergarten, basing “care” on distrust and suspicion. I’ve been told, “All ED’s lie.” That, too, isn’t true. We don’t lie any more than anyone else. When i see it in a young ED, it’s usually the result of repeated scaletime bullying.

    • Jeanene Harlick says:

      Julie, I can’t respond in full right now – but I am very much in agreement with so many of your points! I am not sure how people can be so clueless… Like I said on your blog – Western society is pathologizing what are natural human emotions and behaviors which stand outside what they deem “normal” – because they’re uncomfortable with people who choose to live authentic lives; who feel intensely; who are in touch with the true nature of world, being human, the faulty parameters of “success,” etc. I.E. people who are akin more to artists and seers, and choose not to take the easy route by trying to squeeze ourselves into the cookie-cutter living and emotional range that is considered “acceptable” today …. That’s one reason why it’s very informative to look back at the history of “mental illness” – by reading people like Foucault, Goffman, R.D. Laing, etc., and understand how much a construct mental illness labels are… And how society exacerbates what is actually normal human suffering – suffering which could be manageable if it weren’t stigmatized because we express it in unconventional ways…. That’s not to downplay that there is also a lot of struggle arising from past trauma, too, and that that is deserving of help and working-through — but not the stigma, labels, and prejudice which sometimes come with that…

Leave a Reply

Your email address will not be published. Required fields are marked *