Are there any countries or cultures where mental health is dealt with competently

Great Debates
1

I was watching Rosalind Carter on the Daily show talk about mental health, and she said things are just as bad, and in some ways worse than they were 40 years for mental health. We have better drugs and more research, but at the same time we have replaced primary health care and hospitals as the main source of treatment with jails and prisons. As a society we will pay higher taxes to incarcerate the mentally ill, but not higher taxes to offer them outpatient and inpatient treatment.

So are there any countries or cultures where mental health and mental illness are dealt with in a competent, mature, respectful fashion?

Cultures where brain diseases are treated as just as real and unfair as diseases of other organs? Or where there is almost no stigma towards the mentally ill? Or where people as a whole tend to realize the limitations of mentally ill people (ie, if someone has cancer or heart disease virtually nobody would ridicule them for being a bad athlete, but someone with autism or schizophrenia is going to be heavily ridiculed for having bad social skills)?

Personally, I doubt it. I think mental illness strikes at the core of people’s identity. Nobody identifies with their heart, arm or pancreas. So a disease of them isn’t really threatening to people’s worldview. But realizing a disease can change your opinions, emotions and behavior is something that seems to terrify people. So I think there is always going to be stigma and attempts to blame the victim out of fear of accepting what mental illness actually teaches us about the brain (that we are not independent souls in 100% control of our cognition, rather our cognition is a side effect of chemical reactions we really can’t control). The comforting belief most people want is that our feelings, opinions and behaviors are controlled by an etherical, autonomous force (a soul, a mind) that is more or less independent of our body. Mental illness forces us to confront how vulnerable our ‘mind’ really is. People can go from being brilliant with great social skills to barely able to function due to mental illness.

However some mental illnesses do seem to fare better than others with public attitudes, medical attitudes and government attitudes. Parkinsons and Alzheimers do not (from what I’ve seen) suffer the same stigma as depression. Depression and ADHD are not as stigmatized as schizophrenia or bipolar.

Do mental illnesses that affect the elderly (alzheimers, parkinsons) get treated with more humanity than those that strike people when they are young (schizophrenia, bipolar)?

What about the role of recovery in stigma? Is our stigma due in part due to the belief that people can never recover or get better? I would assume so, because the belief that mental illness is a lifelong downward spiral is obviously going to make people afraid to admit they or someone they know has one.

Either way. Are there cultures where these issues are dealt with in a responsible, mature and humane way? Or is it pretty much universal across cultures and governments that these issues are not?

2

The US has excellent mental health care, actually…if you can afford it.

3

But more than that, our justice and social system are extremely backwards on mental health. There are more mentally ill people in jail/prison than hospitals, and mental illness is heavily stigmatized in our culture.

I would guess the Scandinavian countries might have a decent system (they are usually at the forefront on issues of social justice from what I’ve seen) but I really don’t know.

Uganda supposedly has a functioning anti-HIV program with government and public working together towards a good cause. Supposedly so does Thailand. However with mental health I’ve never heard of a country or culture with a good program.

4

The Brits used to have a competent way: Warehouse 'em in Bedlam and charge the gentry to watch their antics! :wink:

5

We still have that. We just call it Congress.

The trouble with a lot of mental health issues is that we don’t always have a cure. And there is a lot of overlap between mental problems and ordinary problems.

Regards,
Shodan

6

The problem with our mental health system is that it’s wildly inconsistent. People get to declare themselves ‘‘experts’’ using treatments that haven’t been proven to work. In fact, most therapists in the U.S. do not practice evidence-based treatments–first place goes to psychodynamic therapists and second place goes to ‘‘eclectic’’ practice, god only knows what that means. So in the game of mental health, you’re statistically more likely to get unproven treatment than not.

On the other hand, if you know what you’re looking for and you suffer from a basic mood disorder, you can find exceptional treatment, and if you’re insured, you can find it at a reasonable price. Anxiety and depression are now highly treatable disorders with generally good prognoses. Axis II diagnoses are a bit more tricky because firstly, people with personality disorders don’t generally feel that anything is wrong with them, thus making lack of motivation for therapeutic change a significant impediment to progress, and secondly, the research is still in its earliest stages–we know what’s wrong but not how to fix it*. You can’t blame that on America, though – the reality is just that we’re still in the early stages of understanding the mechanisms that perpetuate these disorders. The field of clinical psychology has been dominated by psychodynamic pseudoscience for a century or more–the idea of testing theoretical constructs in a systematic and scientific way is actually quite new.

*With one MAJOR notable exception – Dialectical Behavioral Therapy has been identified as an empirically supported treatment for borderline personality disorder. BPD was once the kiss of death for a patient, and now we actually have a treatment that works for it, a treatment so robust that it’s showing promise in a half-dozen other areas too. This is a development made over the last 10 years, so I’d caution anyone who wants to declare the entire field of mental health ‘‘incompetent.’’ We have made stunning, rapid progress in a very short amount of time, considering how new clinical psychology is as a *science.
*
This inconsistency in the field is a trend that is changing. Based on personal observation, talking to practioners and students, and watching coverage in the media, it seems the method of ‘‘doing whatever the hell you want and calling it therapy’’ is on its way out. There is a huge tension between the old and the new generation, but the reality is the new generation is the future of psychology in America. The best and brightest ARE for the most part being trained to recognize junk science and use the highest standards of research when conducting clinical interventions. And that’s a very good thing.

I thought the OP might find this recent NY Times article interesting.

7

It is an axiom in psychiatry that prognosis in the developing world is better for psychotic illness than in the developed world.

This is based on 3 WHO studies on psychosis.

I’m not suggesting that the treatment is more humane, but the prognosis may be better- cultural factors play a part.
These include- the re-framing of psychosis in terms of spiritual or religious beliefs (possession by demons or gods, prophecy, communication with the supernatural), and the strong familial and community bonds that exist in many of these societies.

There has been much questioning of this axiom, but there is still evidence to support it.

Cites:

http://www.schizophreniaforum.org/for/live/detail.asp?liveID=59
http://pn.psychiatryonline.org/content/43/5/27.full
http://www.psychosocial.com/IJPR_12/The_Psychotic_Among_Us_Benning.html

8

Certainly here in Egypt and I agree with the poster above there is a very strong extended family tie.
There is also the belief that everything is God given so it is all God’s will. In this culture one cannot question God’s will but accept it. So a family who would have a member who has some kind of mental illness would almost certainly be treated within the home as a normal member of the family and with help from a doctor if they needed drugs and not looked away out of sight.
Because of the strong family unit there is incredible support. The family all rally round and are never far away if help is needed. There is always chatter going on at tables. TV is only rarely watched. People talk. The weekend is a full family affair where the whole lot of them either visit in one home for dinner or they all go out to a park or the beach or the Nile, year round. Every mealtime be it breakfast or dinner is a communal affair even with workers who share food.
Also because they believe in God there is no stigma attached to mental illness. They think God has done it for a reason and never question it.
Violent patients however who cannot be handled by the families can be sent to Abbaseya. There are few psychiatrists and therapists in Egypt, even fewer mental hospitals. You don’t get Egyptians running around shooting at school children or nurseries or disgruntled employers. Everything is Gods will so is then accepted.
When I was in many US cities I was amazed in your Yellow Pages some of your biggest sections are Attorneys and Therapists.

9

This fits somewhat with the article I linked to on the Americanization of mental illness. As one study noted in the article found, people who say they suffer from mental illness because of a neurochemical imabalance are actually more likely to be stigmatized than those who say they suffer due to a rough history, or some circumstantial misfortune. The theory, which is not hard to grasp, is that humans have a natural aversion to diseased populations, presenting the problem as biochemical serves to make it seem more permanent, more of a physiological flaw, whereas contextualizing a psych disorder within the environment or situation means that changes can be made. Not only that, it is more relatable. The idea that we ought to medicalize mental illness and treat it ‘‘just like’’ any other disease is specious. As that study suggests, it may do more harm than good.

Depression, anxiety, schizophrenia, etc. are not ‘‘just like’’ cancer and heart disease and diabetes. I understand WHY people in the movement felt it was necessary to put it this way in order to achieve parity and try to eliminate the stigma around mental illness, but ultimately I think it has been a counterproductive tactic.

I remember when I graduated from college with honors, after a two-year interruption and several years made difficult by severe depression and anxiety. I mention ‘‘with honors’’ because surviving college was the single hardest thing I ever did in my life. I fought tooth and nail for every grade, missed up to a month in some of my courses and even spent one part of my term in the psych hospital.

At commencement, they were honoring a woman who had graduated despite having a physical disability which required a lot of her time to compensate.

She was an admirable woman, really, but as I listened to her speak about her motivation to succeed despite the obstacles in front of her, I realized exactly why a physical disability is not the same as a psychological one. Depression did not only rob me of my energy and my time, it robbed me of my motivation, it took away my desire to succeed. Try to imagine having a chronic illness that not only hurts, but takes away your drive to overcome it. Imagine if one of the symptoms of diabetes was the impulse to deliberately eat as much sugar as possible, or if a symptom of cancer was the mortal fear of chemotherapy.

Mental health disorders are a kind of cannibalization of the self. They aren’t the same as any other illness and I would argue that they shouldn’t be approached in the same way.

10

The problem in the US is that we’re afraid of declaring someone ill and potentially locking them up against their will, or even letting their family do so. Our current system finds it too intolerable to allow the minimal chance that a system which allows officials or family to lock people away has too great a chance to be abused, and so people with mental illnesses are left to wander the streets or to be taken care of by family or anyone willing to do so out of compassion.

While I can sympathize with this fear of abuse, I would say that at the moment, the US is too concerned about it, to the level of just being silly.

It’s not a matter of locking someone out of sight, it’s about having options in your life beyond staying home caring for the ill. It might be better for the person with the mental illness to have a personal caretaker or four, but frankly what does a person with a mental illness add to society that is so worth burdening one to four people for a significant amount of their day? He’d be taken care well enough by a professional caretaker who splits time between 10 to 30 different patients operating in a facility intended expressly for the care of the mentally ill. In return that frees up the relatives to go to college, work late, and to have a better social life. And they earned that by doing good for the world and the rest of society. A mentally handicapped person who requires full or near full-time care just robs resources without giving anything back.

The real answer to mental illness will be to cure it and the faster that cure is found, the more people who will be saved. Egypt isn’t going to find that cure because they’re handicapped by convention, which takes the total number of people who could be searching for the cure down by the population of an entire country. That’s just sad. That we have people struggling as waiters and goat herders instead of going to college and doing something with their lives that builds towards the future of humanity because they have to sit home and take care of their crazy brother is sad. Ultimately, mental illness is just sad all around no matter what course of action you take. But the world is certainly better off when care is institutionalized, as harsh as that decision may be.

11

A friend of mine is a mental health professional working in community care. Last time I was talking to him he said that, at a recent union meeting he asked the union rep, “How come everyone talks about introducing best practice, meaning cost cutting, when they have 6 times as many mental health beds per head in Germany? Isn’t that really best practice?”

The union rep didn’t have an answer apparently.

12

I’ll throw a bone out there. If nobody in the whole world does it “right”, then where do we get the supposition from the OP that his way is the correct one, at least at a governmental level?

If this is so, perhaps government is not equipped to deal with mental health?

13

Sage Rat “what does a person with a mental illness add to society that is so worth burdening one to four people for a significant amount of their day?”

Depends on the person really, doesn’t it.

Hint:
Van Gogh
Stephen Fry
Graham Greene
Edvard Munch
Edgar Allen Poe
Hans Christian Anderson
Woody Allen
Ingmar Bergman
William Blake
Winston Churchill
Charles Dickens
Fyodor Dostoyevsky
T.S. Eliot
Samuel Johnson
Soren Kierkegaard
Nietzsche
Isaac Newton
Rachmaninoff
Tolstoy
Tchaikovsky
Brian Wilson

My personal belief is that we are overdiagnosing and pathologising appropriate negative emotions and exacerbating poor coping skills.
Florid psychosis apart, obviously.

I think we do need to keep emphasising that it is ok to feel low and sad at times and that this isn’t always inappropiate or an illness.

14

USA is of course best in for mental health care.

15

Is feeling low and sad at times considered an illness by anyone? It sounds like you’re confusing feeling blue (which certainly is not a diagnosis) with Depression which is a whole heck of a lot more serious issue than feeling low and sad at times. It’s pretty much apples to oranges.

16

Is that sarcasm? Because mental health care is actually pretty good in America, at least for children. There are problems with schools, but still…

17

I have mentel health issuses okay nobody loves me they want me to be kept in a corner thats why.

:frowning:

18

I don’t have a cite, but as I understand it the “care in the community” schemes that were such a disaster in the US and UK during the 1980s (where large mental institutions were closed, but no adequate non-institutional framework brought in to replace them), were based on the French system. However unlike the US/UK system the French system was adequately planned and funded, and hence did actually work. It ensured people who had mentally were actually cared for in the community.

19

No. Your examples are of people who can live, more-or-less without outside aid. Woody Allen doesn’t require one to four people watching out that he doesn’t stab himself with a fork, that he doesn’t get lost on the way to the store, etc.

People who require that sort of aid are probably not worth the effort of one or more personal caretakers. If they can do math or paint or whatever, there’s nothing to stop them from doing that at a mental clinic. Van Gogh in a mental hospital can still make beautiful paintings. But if he couldn’t properly get himself dressed, manage his finances, watch his diet, or whatever, society gains more by having him in an institution where one person is taking care of twenty Van Goghs rather than having one person taking care of one Van Gogh.

20

Aelita Daystar-I’m a doctor who has worked in psychiatry (past tense- it isn’t an area I want to specialise in).
I’m aware of depression and the DSM IV/ICD diagnostic criteria for it.

I do think that to some extent normal and appropriate sadness and grief about relationship breakdown, loss of role, financial difficulties and bereavement have been medicalised and pathologised.

To be diagnosed with a Major Depressive Episode all you need (as an example, using DSM IV guidelines) is to feel low, be unable to sleep, have decreased appetite and increased fatigue and a diminished inability to concentrate nearly every day over a two week period. DSM IV allows you 2 months after a bereavement to feel ok- you still feel low, tired, unable to eat or sleep- it is depression.

I would suggest that those symptoms, if preceded by job loss, relationship breakdown or other stressful life events are NORMAL, do not require medication or therapy and should be accepted as part of the spectrum of healthy human emotional reaction rather than labelled as a disease.

At least ICD-10 recognises mild, moderate and severe depression and only suggests medication for moderate to severe depression and hospitalisation for severe depression where suicide is a real risk.

Don’t even get me started on hypoactive sexual desire disorder- if 20-40% of women “suffer” from it, it suggests that it lies on the NORMAL part of the bell-curve of female sexuality and is not a disorder at all, but rather is secondary to a cultural belief that normal adults must want to have sex ALL THE TIME and that anything else must be abnormal.