Mental Health: Culture, Language and Power
Image credit: UN Photo/John Isaac
Today we’d like to announce the publication of Shipra Goel’s on the deplorable state of maternal and child health in India. Read it here.
Meanwhile, today’s blog is a reflection from Tiago Gameiro Inacio, 4th year medical student at Newcastle University, currently undertaking the Global Health Student Selected Component (SSC)
People grow in a process of socialisation which determines the way they perceive, incorporate and understand facts, feelings, illness and healing
In our Global Health SSC we have recently had a seminar entitled Mental Health: culture, language and power.
It is fascinating how the perceptions of mental health and healing vary so much across countries, continents and cultures. This seminar turned out to be a much deeper discussion and reflection on culture itself, its definition, components and variability and how those influence global mental health.
We embarked on a journey of self knowledge, discovery and reflection. The fact that we had people from different countries and cultures helped to add different points of view on experiences that unify different societies: death, bereavement, disease and mental health itself.
We discussed language. Being from a different background and having Portuguese as my native tongue I have several times struggled to find corresponding meanings to common symptoms in English and Portuguese. It gets particularly difficult if these symptoms represent emotions. In the seminar we went through what people would present with to their healers (ranging from medical professionals to shamans) and how many of these expressions had no translation and their deep meanings remained in the communities that created them.
The Portuguese language has stolen the word stress into its vocabulary like many other latin languages. The fact is there is no single word in my native language to my knowledge that transmits the exact concept of the word “stress” like the English word does. Why was there this need to incorporate this word? Did Portuguese people not suffer from stress before and thus never needed to create a word equivalent to it? Is it a fruit of the fervent Western Culture?
People grow in a process of socialisation which determines the way they perceive, incorporate and understand facts, feelings, illness and healing. Due to this people from different cultures perceive the same events differently and react differently. As medical professionals we must be aware of these patients in their communities, beliefs, values and then tailor mental healthcare accordingly. Otherwise our “help” could be catastrophic. In many communities the individual prioritises the community rather than himself and to deliver healthcare it is fundamental and more effective to approach the whole community. This has been practised for centuries by the healers of those communities who work depending on the cultural beliefs defined by the latter. Is it not futile to think that western medicine holds the answers for the care of these patients when these are happy with the services provided by traditional healers or shamans? Many psychological phenomena taking place in these communities are considered to be a result of magic or the will of gods or the devil. Many healers “treat” these conditions and the patients do recover. Science acknowledges the power of believing, as in the placebo effect, and its role in recovery but I believe there is much more to learn from the work of these healers. The way they integrate the individual in its family and community, taking into account dimensions like spirituality is remarkable and it might explain the primordial role of these therapies even in medicalized societies. This goes back to the holistic care promoted by Personal Development lectures that we do not see put into practise very often.
However we shall not undervalue the role of pharmacology in mental illness as in psychosis but reconsider its use in the whole spectrum of mental illness, where healers definitely play a role for understanding and addressing the needs of that specific population and its individuals. On the other hand we should perhaps reflect on what that teaches us about our own society. Perhaps we are optimising pharmacological sciences but neglecting basic elements in the core of mental health treatment. Furthermore, the treatment for a mental disorder, like a formula, follows a clustering of symptoms forming a diagnosis. In this formula there is very little space for socio-cultural factors and emotions become lost in translation.
This being the case, are we right in applying the celebrated scientific models of the Western world to these populations and their patients? By ignoring the cultural background that define these patients and their experience of illness and the illness itself are we not delivering an inadequate treatment as its based on false premises?
I hope to be able to incorporate these reflections in my practise. It is not realistic thinking this would not affect us unless we work overseas in a remote village in Africa. Globalisation will bring it to our rounds, clinics, home visits to people from very diverse origins and experiences. Many of these individuals will greatly require good healthcare, not only physically but also psychologically. It is our duty to ensure we provide this, taking into account all these dimensions of an individual which the fast paced Western model wants us to neglect.
Tiago Gameiro Inacio, 4th year medical student at Newcastle University
Email: tiago.gameiro-inacio@newcastle.ac.uk