Cultural Lens
Global Mental Health: Available Treatment
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Mental health services are available worldwide. However, they differ by country in how available they are as well as the nature of the services offered. In countries in which individuals have a higher income, such as the United States, Canada, England, Germany, France, Japan, and Australia, there are many more mental care workers, such as psychologists and psychiatrists, than in countries with lower income such as India, China, and much of Africa. Figure 1.3 shows the number of mental health professionals throughout the world. This map illustrates the number of psychiatrists, psychologists, nurses, and social workers per 100,000 people in the country.
High-income countries have the greatest number of mental health professionals, and low-income countries the least. Figure 1.4 shows the number of psychiatrists, psychologists, nurses, and social workers by income level. The governments of about one-third of all countries do not have a specific budget for mental health. In many countries, informal networks of families, friends, and other social networks are utilized to care for those with mental illness.
Figure 1.3 Where Are the Mental Health Workers Available for Those With a Mental Illness?
Source: Shekhar Saxena, Graham Thornicroft, Martin Knapp, and Harvey Whiteford, “Resources for Mental Health: Scarcity, Inequity, and Inefficiency,” The Lancet, 8 September 2007, Vol. 370, Issue 9590, Pages 878–889. Copyright © 2007, with permission from Elsevier.
Figure 1.4 Do High-Income Countries Have More Mental Health Workers?
Source: Shekhar Saxena, Graham Thornicroft, Martin Knapp, and Harvey Whiteford, “Resources for Mental Health: Scarcity, Inequity, and Inefficiency,” The Lancet, 8 September 2007, Vol. 370, Issue 9590, Pages 878–889. Copyright © 2007, with permission from Elsevier.
Thought Question: What are some ways mental health care professionals in both higher- and lower-income countries can work together to increase the availability and quality of mental health resources in the developing world?
In thinking about our evolutionary history, we can consider how one basic human process developed in relation to an earlier one. For example, in the same way that pain can be seen as a warning system to the body to protect it from tissue damage, anxiety may have evolved to protect the individual from other types of potential threats. In fact, an evolutionary perspective has led to neuroscience research findings that social processes such as feeling rejected use similar brain circuits as those processes involved in physical pain. Further, many of the outward expressions of social anxiety parallel what is seen in dominance interactions in primates. Submissive monkeys avoid contact with more dominant ones, just as humans experiencing social anxiety avoid more dominant individuals. Thus, one hypothesis would be that anxiety may have its evolutionary origins in dominance structures. If this were true, we might expect to see some relationship to sexual instinctual processes as is the case with dominance. Indeed, social anxiety begins to show just prior to the onset of puberty—around 8 years of age. Of course, this merely shows how evolution may be related to anxiety. The evolutionary perspective can help us think about the roots of psychopathology as well, and it will be a recurring theme of this text.
Is Psychopathology Universal?
If psychopathology is part of our human makeup, then we would expect to see similar manifestations of it worldwide. One classic study in this regard was performed by Jane Murphy (1976) of Harvard University. It dates from the 1970s when mental illness was considered to be related to learning and the social construction of norms. In fact, some suggested that mental illness was just a myth developed by Western societies. In this perspective, neither the individual nor his or her acts are abnormal in an objective sense. One important implication of this view was that what would be seen as mental illness in a Western industrial culture might be very different from what was seen as mental illness in a less developed rural culture. That is to say, mental illness in this perspective was viewed as a social construction of the society. The alternative to this perspective is more similar to other human processes such as emotionality, in which humans throughout the world recognize similar expressions of the basic emotions. If mental illness is part of our human history, as evolutionary psychologists suggest, then we would expect to find similar manifestations across a variety of cultures.
All cultures have terms to describe mental illness.
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Murphy first studied two geographically separate and distinct non-Western groups: the Eskimos (Inuit) of northwest Alaska and the Yorubas of rural tropical Nigeria. Although many researchers of that time would have expected to find the conceptions of normality and abnormality to be very different in the two cultures, this is not what Murphy found. She found that these cultures were well acquainted with disturbed thought and behavior processes in which a person was said to be out of his or her mind. This included the person doing strange things as well as hearing voices. Jane Murphy concluded that processes of disturbed thought and behavior similar to schizophrenia are found in most cultures and that most cultures have a distinct name in their language for these processes.
In addition, Jane Murphy reported that these cultures had a variety of words for what traditionally is referred to as neurosis, although today we would call it anxiety or depression. Mood disorders include feeling anxious, tense, and fearful of being with others as well as being troubled and not able to sleep. One Inuit term was translated as worrying too much until it makes the person sick. Thus, it appears that most cultures have a word for what has been called neurosis, what has been called psychosis, and what has been called normalcy. What is also interesting is that many cultures also have words for people who are out of their mind but not “crazy”: witch doctors, shamans, and artists.
To add evidence to her argument that psychopathology is indeed part of our human nature, Jane Murphy also reviewed a large variety of studies conducted by others that looked at how common mental illness was in different cultures. The implication here is that if its prevalence is similar in cultures across the world, then it is more likely to be part of the human condition rather than culturally derived. What these studies suggest is that many forms of mental illness such as schizophrenia are found at similar rates the world around. Overall, this research established that mental illness was not a created concept by a given culture, but rather part of the human condition in both its recognition and its prevalence. However, one’s culture plays a role in how it is manifested in a specific society.
Concept Check
What evidence would you cite to characterize the relationships among genetics, culture, and evolution in human development?
Is psychopathology universal? What kinds of evidence show that it is? What evidence is there for cultural differences in psychopathology?