How different societies regard the elderly

The older you get, the wiser you get. This is undoubtedly a continuum scale. My concern is, why do some societies treat the elderly so poorly? These humans carry a vast amount of information and knowledge. They have witnessed and experienced adversity throughout history, shaping the modern world. Some have information that we can only get through books. Wouldn’t it be more interesting to hear concrete facts and anecdotes from someone who has lived in that moment of history? What a wealth of knowledge the elderly have! They are deserving of every type of respect. The young will always be at their mercy in terms of acquiring their wisdom, knowledge, and information.

Different societies treat the elderly in different ways. For some, they are highly esteemed since they are seen as a source of wisdom. In other societies, the old or per se aging is viewed negatively and as a burden. Others consider them as storytellers with enormous knowledge to impart on the young.

The terminology of society typically reflects its respect for the elderly. In Hindi, honorific suffixes like -ji allow speakers to show further respect for notable figures, such as Mahatma Gandhi, who is frequently referred to as Gandhiji. According to Wikipedia, mzee is a phrase used by younger speakers of Kiswahili, a language spoken in various parts of Africa, to express a great level of respect for elders. The Hawaiian word kūpuna means “elders” with the additional sense of knowledge, experience, and skill. The suffix -san in Japanese, which is frequently used with elders, indicates the country’s strong respect for the elderly.

Many African societies are shaped by the ideal of the respected elder. The senior generation rules the extended family. The elderly wield power in the community because they are the closest in age to their forefathers. Older individuals have a high standing because they believe that family growth is beneficial and fortunate. People consider large families as a source of protection in times of difficulty, and they want to be remembered as ancestors by their offspring. Older people have always been seen as a positive light in Sub-Saharan Africa as reservoirs of knowledge and wisdom. After dinner, many African villages gather around a central fire to listen to the elder storytellers.

What a wealth of knowledge the elderly have…

The elderly are held in high regard in Eastern societies. A new “Elderly Rights Law” passed in China warns adult children not to “ignore or insult elderly people” and requires them to visit their elderly parents frequently, no matter how far away they live. The law also offers tools for enforcing it: Offspring who fail to make such visits to their parents risk penalties ranging from fines to jail time. As in Chinese culture, the common expectation in Korea is that once parents reach retirement age, roles reverse and it is the responsibility of an adult child to care for his or her parents.

A person’s 60th birthday is likewise a big deal in Japan. Kankrei, as the festival is known, is a rite of passage into old age. Respect is regarded as a religious obligation in Asian cultures. Respect is focused on the family and is formalized through language and gestures. The Asian idea of respect affects sentiments of duty within the family as well as how Asian patients make decisions.

When exploring western societies, we find that as people age, the younger generations tend to view them with greater contempt. In Western culture, old age is associated with forgetfulness and irrelevance. They are treated more like children who, due to superior technology, can not understand the modern world. Because the fast-changing world has left them behind, the younger generation regards them as unreliable. According to a National Center for Biotechnology Information research, this attitude may originate from westerners’ preference for personal ambitions over familial bonds.

The emphasis on qualities like autonomy and independence is typical of Western societies, which are often youth-oriented. According to anthropologist Jared Diamond, who has examined the treatment of the elderly throughout cultures, the elderly in countries such as the United Kingdom and the United States live “lonely lives apart from their children and longtime companions.” The elderly in these cultures frequently move to retirement villages, assisted living facilities, and nursing homes as their health deteriorates.

Similar to China, France also implemented an Elderly Rights Law in 2004 (Article 207 of the Civil Code) requiring persons to maintain contact with their geriatric parents. Perhaps some hope is on the way for Western societies…?

The elderly are considered the “wisdom-keepers” in tribal cultures and are held in high respect. They are regarded as the guardians of their tribes’ language and traditions. Most of these tribes, such as the Choctaw among Native Americans, have a long tradition of oral storytelling. Their stories were meant to preserve the tribe’s heritage and teach the next generation. Stories about westward migration, the birth of the world from a mound, other histories, and lessons about life or morality.

In her book, Experiencing Old Age in Ancient Rome, Dr. Karen Cokayne of the University of Reading argues that the Romans utilized their elderly and trusted their wisdom and experience, quoting Cicero as saying, “For there is definitely nothing dearer to a man than wisdom, and though age takes away all else, it undoubtedly brings us that.” However, Cokayne emphasizes that elderly people had to earn that high level of esteem by leading a virtuous life. “Wisdom had to be earned – through hard effort, study, and, most importantly, virtuous life. At all times, the elderly were expected to act with moderation and decency. It was assumed that the young learned by example, thus the old had to set a good example for them. This was deeply ingrained in Roman culture.

References

Sugirtharjah S. (1994). The notion of respect in Asian traditions. British journal of nursing (Mark Allen Publishing)3(14), 739–741. https://doi.org/10.12968/bjon.1994.3.14.739

Honorific – Wikipedia. (2009, December 1). Honorific – Wikipedia; en.wikipedia.org. https://en.wikipedia.org/wiki/Honorific

Diamond, J. (n.d.). Jared Diamond | Speaker | TED. Jared Diamond | Speaker | TED; http://www.ted.com. Retrieved August 13, 2022, from https://www.ted.com/speakers/jared_diamond

WAGSTAFF, K. (2015, January 8). In China, adults must visit their aging parents… or else | The Week. In China, Adults Must Visit Their Aging Parents… or Else; theweek.com. https://theweek.com/articles/462599/china-adults-must-visit-aging-parents-else

Storytelling and Cultural Traditions | National Geographic Society. (n.d.). Storytelling and Cultural Traditions | National Geographic Society; education.nationalgeographic.org. https://education.nationalgeographic.org/resource/storytelling-and-cultural-traditions

-. (n.d.). Elders | NCAI. Elders | NCAI; http://www.ncai.org.

Africa: Age and Aging. (n.d.). Africa: Age and Aging; geography.name. https://geography.name/age-and-aging/

Healthcare in underdeveloped nations

In certain impoverished nations, unless you pay at the reception, you cannot see a medical professional–even if you are bleeding, there is nothing they can do other than give you a cloth to wrap and stop the bleeding and that’s if someone is kind enough. This means that you must pay out of pocket for healthcare services each time you see the doctor. In these countries, unemployment is very high, sanitation is very poor, and people are highly susceptible to illness not once or twice, but constantly, with no access to healthcare.  As a result of having to pay for these services out of their own pockets, the lack of financial security increases families’ financial strain.

“Without health care, how can children reach their full potential? And without a healthy, productive population, how can societies realize their aspirations?” said UNICEF Executive Director Anthony Lake. “Universal health coverage can help level the playing field for children today, in turn helping them break intergenerational cycles of poverty and poor health tomorrow.”

The most primary and infectious causes of death in developing nations are malaria, AIDS, and tuberculosis. In fact, these diseases can be prevented in the same manner as in industrialized nations. Tuberculosis? implying that both adults and children lack access to immunization. Immunization, seriously? Everyone should be vaccinated against these deadly diseases, which have claimed countless lives before our great-grandparents were born. In the 1700s, tuberculosis was not only referred to as the white plague due to the sufferers’ pallor, but also as the “Captain of all these men of death.” Now that it is possible to contain the disease, why not do so in every region of the world and not only in wealthy nations? 

If an outbreak occurs, it can affect people in both underdeveloped and developed countries. For example, Ebola emerged in 1976 in the DRC and South Sudan. After a period of few to no occurrences, an outbreak resurfaced between March 2014 and June 2016. This was the largest Ebola outbreak ever reported, with over 28,000 cases. This occurred not just in West Africa, but also in East Africa, Italy, Spain, the United Kingdom, and the United States. If these regions of Africa had proper healthcare, the disease may have been efficiently contained. National and international authorities collaborated to help terminate this outbreak by building prevention programs and messages, as well as implementing policies with care. Personnel from the CDC were dispatched to West Africa to aid in response activities, including surveillance, contact tracing, data management, laboratory testing, and health education. In addition, the CDC team assisted with logistics, staffing, communication, analytics, and management.

During the height of the response, the CDC trained 24,655 West African healthcare professionals in infection prevention and control methods. In addition, by the end of 2015, 24 laboratories in Guinea, Liberia, and Sierra Leone were equipped to do Ebola virus testing. If all these strategies were done not only during pandemics, we would be able to avert a great number of outbreaks. These nations and others would be able to contain an outbreak before it spreads internationally. However, we wait until a pandemic threatens our minds before implementing laboratories and educating more healthcare staff in developing nations. Why not do this in the absence of a potentially deadly disease? Why not be prepared for anything that could affect us in both developed and poor countries?

We’re not ready for the next epidemic, Bill Gates remarked during the ebola outbreak. Obviously, Covid happened, and what appeared to be a simple sentence made so much sense. He went on to explain that we require a response system with the capacity to mobilize tens of thousands of healthcare staff. During his TED talk, he mentioned that in order to combat an epidemic, we need robust health systems in developing nations– where mothers can safely give birth there, and children can receive all of their vaccinations there. However, this is also where the outbreak will appear first.

“Past experiences taught us that designing a robust health financing mechanism that protects each individual vulnerable person from financial hardship, as well as developing health care facilities and a workforce including doctors to provide necessary health services wherever people live, are critically important in achieving ‘health for all,’” said Mr. Katsunobu Kato, Minister of Health, Labour and Welfare, Japan. 

What are we waiting for to improve healthcare in developing nations? In other words, what affects individuals in developing nations is likely to impact developed nations. Why not collaborate to create not only a better national healthcare system but also a universal healthcare system? Universal health means that everyone has access to and is covered by a well-organized and well-funded health system that provides quality and comprehensive health care and protects individuals from financial ruin if they utilize these services.

Guaranteeing the right to health means eliminating all kinds of barriers to accessing services…

Dr. Carrissa F. Etienne– Director of the Pan American Health Organization

Some Key actions for Universal Health are:

  1. Expanding equitable access,- Initiating and gradually extending primary care models and comprehensive service delivery that are centered on people’s needs. Assuring the prudent utilization of medications and health technology.
  2. Increasing stewardship and governance by teaching and empowering people and communities about their health-related rights and duties and encouraging them to participate in the development of health-related policies.
  3. Increasing and enhancing finance through eliminating payments at the point of service entry, identifying sustainable means of increasing health financing, and financially protecting individuals. These are only a few examples; the list is far longer.

The enhancement of health care in developing nations will have a substantial effect on the mental health of an infinite number of individuals. Healthcare is a human right!

References

World Bank and WHO: Half the world lacks access to essential health services, 100 million still pushed into extreme poverty because of health expenses. (n.d.). World Bank; http://www.worldbank.org. Retrieved June 7, 2022, from https://www.worldbank.org/en/news/press-release/2017/12/13/world-bank-who-half-world-lacks-access-to-essential-health-services-100-million-still-pushed-into-extreme-poverty-because-of-health-expenses

CDC. (2022, January 14). World TB Day History. Centers for Disease Control and Prevention; http://www.cdc.gov. https://www.cdc.gov/tb/worldtbday/history.htm

Fact sheet about malaria. (2022, April 6). Malaria; http://www.who.int. https://www.who.int/news-room/fact-sheets/detail/malaria

2014-2016 Ebola Outbreak in West Africa | History | Ebola (Ebola Virus Disease) | CDC. (2019, March 8). 2014-2016 Ebola Outbreak in West Africa | History | Ebola (Ebola Virus Disease) | CDC; http://www.cdc.gov. https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/index.html#:~:text=The%20patient%20recovered.,hospitals%20in%20the%20United%20States.

Universal health coverage (UHC). (2021, April 1). Universal Health Coverage (UHC); http://www.who.int. https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)

Gates, B. (n.d.). Bill Gates: The next outbreak? We’re not ready | TED Talk. Bill Gates: The next Outbreak? We’re Not Ready | TED Talk; http://www.ted.com. Retrieved June 7, 2022, from https://www.ted.com/talks/bill_gates_the_next_outbreak_we_re_not_ready

Quote of the day

Many cultures, particularly in developing countries, continue to believe brain disorders in the context of metaphysical affiliations, exorcisms, taboos, bad luck to the family, et cetera… To this day so many people suffering from mental illness are homeless and left on the streets, where they are mocked, beaten, harassed or jailed.

DMK

Quote of the day

You fall into one of two categories: normal or abnormal. Because MENTAL HEALTH is non-existent in developing countries, there is no in-between of rather mental disorders. That is, if there is nothing physically wrong with you, you must be fine; otherwise, you are insane, or perhaps your behavior is insane. 

DMK

Linkpost — Mental health in developing countries

Linkpost— Misconceptions and stigma of mental illness

Quote of the day

People in developing countries are left with wandering minds, more akin to a state of limbo when you know there’s something seriously wrong with you because you can feel it in every inch of your body, and it’s screaming at you excruciatingly—becoming louder and louder with time. 

–DMK

Linkpost— Mental Health in developing countries

Different cultures’ perceptions of body image

As a documentary fanatic, I came across one that explored how people in different cultures view body image in detail. I was taken back by the breadth and depths to which people will go in order to acquire the ideal body image that society has set for them.

The one that intrigued me the most and was completely beyond my grasp was Mauritania’s culture. When it comes to Mauritania culture, the size of a female signifies how much of her husband’s heart she occupies. Every year, girls as young as five were exposed to the ritual of leblouh. Older women or the children’s aunts or grandmothers provide pounded millet, camel milk, and water in quantities that make them ill at “fattening farms” for girls from rural families. A regular typical diet for a 6year old will consist of two kilograms of pounded millet mixed with two cups of butter and twenty liters of camel’s milk.

Unknown to her, the girl is taken away from her family. In spite of her pain, she is advised that becoming obese will bring about happiness in the long run. Matrons utilize rolling sticks on the girls’ thighs to break down tissue and expedite the procedure. Sticks are used to punish children who refuse to eat or drink, inflicting tremendous discomfort on them. A 12-year-old who has been successfully fattened will weigh 80 kilograms. If she vomits, she must ingest the liquid. She’ll look like she’s 30 by the time she’s 15. While viewing this documentary, I was amazed at the extremes that people will go to in order to conform to society’s expectations. Currently, my mind is in “wtf mode” as I write this.

Another interesting aspect of body image is the “cult of thinness,” which has been cited as a major factor in the rise in the incidence of eating disorders and in the prevalence of obesity. As Hesse-Biber succinctly states in her book, the majority of westernized women share one desire: they want to be thin–or thinner. And they are willing to go to extreme lengths, even to the point of starvation, to achieve that goal. Why are American women so obsessed with their weight? What has caused an unprecedented number of young women–even before they reach their adolescent years–to develop an obsession with weight, a negative body image, and disordered eating? Why are some young women able to resist cultural demands to lose weight while others are unable to do so? Are there societal elements at play in the current outbreaks of anorexia and bulimia in America? Hesse-Biber goes beyond conventional psychiatric explanations of eating disorders to critique the social, political, and economic pressures women confront in a weight-obsessed society–a culture that, strangely, is becoming increasingly obese while worshiping an increasingly thin ideal.

Americans place too much emphasis on being skinny, according to Glenn Gaesser, a professor at Arizona State University and the author of “Big Fat Lies.” “We have had a fixation with weight loss and how to get skinny for decades now,” he declared. A skinny body is a desirable body, and a thick body is undesirable. This is a false dichotomy, and it has permeated our culture, from fashion to fitness, to health and wellbeing.” For as long as I can remember, I’ve thought that a healthy body may come in a variety of forms. This suggests that being fit is more essential than being slim, according to Gaesser’s findings: persons who are thick and in shape have superior health outcomes. “I believe that America as a whole is still not ready to embrace the notion that fitness comes in a variety of forms and sizes,” he explained.

Traditional African beauty highlights a woman’s curved and voluptuous shape, which is considered curvaceous among African heritage cultures. Many young people from ethnic minorities don’t look like the white women depicted in popular media since they don’t share their phenotype or culture. To avoid comparing themselves to White media representations, some girls of color may instead strive for standards of beauty that are more appropriate to their own cultural contexts. African American women, in particular, have provided some evidence to back up this claim in research. African American females and girls perceive mainstream media images to be less appealing and personable than their Caucasian counterparts.

Nonetheless, some individuals are under pressure to adhere to popular beauty norms and may feel self-conscious about their own bodies when compared to media depictions. In summary, while girls and women of color who identify strongly with their ethnic/racial group may avoid comparisons to Caucasian media images, girls and women of color who identify less strongly with their ethnic/racial group may compare themselves to Caucasian women in media. As a result, it is reasonable to speculate that ethnic identification may similarly protect young people of color from body image challenges. Indeed, research with African American women suggests that ethnic identification may perform a protective role.

Unlike the prevailing slim body image, Latina women have defined a “feminine curves” body ideal. It is possible that Latino culture values a “buen cuerpo,” or a “thick” ideal, which includes a slim waist, huge breasts, and hips as well as around behind, as opposed to the thin ideal of a thin body. In contrast, increasing acculturation into mainstream American society may drive Latinas to consider the overly thin body ideal depicted in mainstream media.

Asian cultures continue to integrate into a globalized and Westernized world that promotes cultural ideals of slimness but also maintains a non-Western traditional society – particularly the younger generation – which receives ideals of beauty from both the Western and their own culture and traditions. Young people may face significant conflict as a result of these disparate cultural ideals. Japan by far has the highest rate of body dissatisfaction. Japanese female teenagers ages 6-13 and 16-18 have a poor impression of their bodies and a strong desire to be skinny, regardless of their actual weight. Due to the fact that both sets of standards encourage people to be thin in distinct ways and for distinct reasons, the detrimental impact on Japanese adolescents’ body image may be greater than in other nations.

References
Greene, S. B. (2011). Body Image: Perceptions, Interpretations and Attitudes. Nova Science Publishers, Inc.

Hesse-Biber, Sharlene Nagy, and Sharlene Nagy Hesse-Biber. The Cult of Thinness. Oxford Unviersity Press, 2007.

Fujioka, Y., Ryan, E., Agle, M., Legaspi, M., & Toohey, R. (2009). The role of racial identity in responses to thin media ideals: Differences between White and Black college women. Communication Research, 36, 451-474. doi: 10.1177/0093650209333031

Poran, M. A. (2006). The politics of protection: Body image, social pressures, and the
misrepresentation of young Black women. Sex Roles, 55, 739-755. doi: 10.1007/s11199-006-9129-5

de Casanova, E. M. (2004). ‘No ugly woman’: Concepts of race and beauty among adolescent women in Ecuador. Gender & Society, 18, 287-308. doi: 10.1177/0891243204263351

Schooler, Deborah, and Elizabeth A. Daniels. “‘I Am Not a Skinny Toothpick and Proud of It’: Latina Adolescents’ Ethnic Identity and Responses to Mainstream Media Images.” Body Image, vol. 11, no. 1, 2014, pp. 11–18., https://doi.org/10.1016/j.bodyim.2013.09.001.

History of mental health

Even in developed countries, mental health has not always been seen as such. It does have a journey, a transformation, and advocacy for its current state. Mental illnesses have a long nasty past and continue so today through stigmatization and prejudices.

Since the ancient period, there have been three main notions on the causes of mental illness: supernatural, somatic, and psychogenic. For the supernatural,  It was claimed that demonic or bad spirits are to blame for mental conditions, as well as gods’ displeasure and the gravitational pull of the Earth. An example of a supernatural explanation for mental illness is the trephination procedure.  Prehistoric people drilled holes in the skulls of people suffering from mental disorders to heal head injuries and epilepsy, as well as to let evil spirits trapped in the head be expelled from the skull. [1] As early as 2700 B.C.E., the Chinese idea of “yin and yang,” or the balance of opposing positive and negative physiological forces, was used to explain mental (and physical) sickness. Somatogenic theories classify physical dysfunctions as a result of sickness, hereditary inheritance, or brain injury or imbalance. Traumatic or stressful experiences, maladaptive learned associations, and cognitions, or distorted perceptions are the focus of psychogenic theories of mental illness.

When it came to mental health conditions, Greek doctors didn’t believe in supernatural explanations. Hippocrates (460–370 BC) endeavored to detach superstition and religion from medicine by establishing the concept that one of the four basic physiological fluids(humors) such as blood, black bile, yellow bile, and phlegm to be responsible for the causation of illness whether physical or mental.  He did not believe that mental illness was shameful or that people suffering from it should be penalized for their actions. Hippocrates divided mental illness into four categories: epilepsy, manic, melancholy, and brain fever.

According to Greek philosopher Plato (429-347 BCE), he believed that community and families should care for the mentally ill humanely using reasoned conversations because of the important role that early learning and social environment play a role in the development of mental problems. Also,  Galen (A.D. 129-199), a Greek physician, stated that mental diseases were caused by physical or mental factors such as fear, shock, intoxication, head traumas, puberty, and shifts in menstruation cycles.[2]

Instead of accepting Hippocrates’ theory of four humors, philosopher Cicero and physician Asclepiades (c. 124-40 BC) in Rome said that melancholy is not caused by excess black bile but rather by feelings of sadness, dread, and fury. Roman doctors used massages and warm baths to cure mental disorders.  When it comes to physical and mental health, they embraced the concept of “contrariis contrarius,” which means opposite by opposite, and used contrasting stimuli to achieve a state of equilibrium.

Economic and political turbulence endangered the Roman Catholic Church’s dominance in the late Middle Ages, which resulted in the rise of the Church and the demise of the Roman Empire. Between the 11th and 15th centuries, mental disorders were once again described as devil possession, and procedures like exorcisms, flogging, prayer, touching relics, chanting, attending religious sites, and holy water were employed to cleanse the individual of the Devil’s control. At this moment, supernatural conceptions of mental illness dominated Europe, bolstered by natural disasters such as plagues and famines. The afflicted were jailed, beaten, and even executed in extreme situations.

Women, particularly those with mental health issues, began to be viewed as witches in the 13th century. The Malleus Maleficarum (1486) was written by two Dominican monks during the peak of the witch trials during the 15th through 17th centuries when the Protestant Reformation had thrown Europe into religious conflict. However, both Reginald Scot’s and Johann Weyer’s writings were condemned by the church’s Inquisition— their writings claimed that mental sickness was not a result of demonic possession, but rather a result of a malfunctioning metabolism and disease. Only in the 1700s and 1800s did witch-hunting begin to wane, after more than one hundred thousand people were accused of being witches and burned to death. [3][4]

Protests against the living conditions of the mentally ill began in the 18th century and during the periods of 1800s and 1900s, a more humane perspective on mental disease emerged. While working at the St. Boniface Hospital in Florence, Vincenzo Chiarughi (1759–1820), an Italian physician and educator, dismantled the chains that bound people there in 1785. Patients were freed from their chains, moved to rooms that were well-ventilated and well-lit, and encouraged to engage in purposeful activity on the grounds of La Bicêtre and the Salpêtrière in 1793 and 1795, respectively, by French physician Philippe Pinel (1745–1826) and former patient Jean-Baptiste Pussin. [5]

Humanitarian changes began in England as a result of religious concerns. William Tuke (1732–1822) pushed the Yorkshire Society to build a retreat in 1796, where patients were treated as guests, not as captives. The standard of treatment was based on dignity and kindness in addition to the therapies and moral value of physical labor. [6]

While in America, Benjamin Rush (1745-1813), the pioneer of American psychiatry, pushed humane treatment for the mentally ill. His profession featured therapies like blood-letting and purgatives, the design of a “tranquilizing chair,” and a strong belief in astrology, which shows that he couldn’t escape the beliefs of his day. Dorothea Dix (1802-1887), a retired teacher worked tirelessly to change the public’s attitude toward persons with mental disorders and to establish institutions where they may get humane treatment. She was the driving force behind the mental hygiene movement, which aimed to improve patients’ physical health as well. She was a proponent of the creation of public hospitals. She aided in the establishment of around Thirty mental facilities in the United States and Canada between 1840 and 1880. [7] In Massachusetts and New York, the first asylums were erected in the 1830s. By 1860, twenty-eight of thirty-three states had established mental institutions (Braslow 1997). People with mental illnesses were able to heal from their illnesses because of moral therapy movements in both the United States and Europe.

However, a large number of academics strongly opposed mental health facilities. This “tale of noble intentions gone wrong” is what Shorter calls the rise of American asylums (Shorter 1997, 33). Asylums were built in the nineteenth century on the premise of “moral therapy,” a theory that maintained that meticulously structured institutions might provide a haven from the chaos of regular life. The mentally ill can gradually adjust to and eventually adopt a sense of normalcy in an orderly setting that encourages regular social interaction, work, and recreation. [8]

Due to a deterioration in morality in the late 19th-century moral treatment approaches led to two rival perspectives – biological or somatogenic and psychogenic or psychology by the 20th century. The biological approach is challenged by the psychological or psychogenic perspective, which asserts that emotional or psychological variables have a role in the development of mental diseases. Emil Kraepelin (1856-1926), a German psychiatrist, noticed that symptoms appeared in clusters, which he referred to as syndromes. These syndromes were distinct mental disorders, each with a distinct cause, course, and outcome. When he released Compendium der Psychiatrie in 1883, he laid the groundwork for the Diagnostic and Statistical Manual of Mental Disorders (DSM) currently in its 5th edition, which is based on his classification system for mental disorders (published in 2013). Clinicians and psychiatrists now use the “Diagnostic and Statistical Manual of Mental Disorders” (DSM) to diagnose psychiatric conditions.

Despite this, not all countries adhere to the latest standards. Many cultures, particularly developing countries, continue to believe brain disorders in the context of metaphysical affiliations, exorcisms, taboos, bad luck to the family, et cetera. Psychological illness is often misunderstood by the general public, which leads to stigmatization and dehumanization of those who are afflicted. To this day so many people are homeless and are left on the streets, where they are mocked, beaten, harassed, jailed, and so on. These countries have very few if any, facilities or resources for mental health care. Many people are stuck in limbo in a state of ignorance, unsure of what might be wrong. People suffering from mental illnesses are dying at an alarming rate, yet they can be saved. Developing countries have an urgent need for education and advocacy for mental health.

References

[1] Restak, R. (2000). Mysteries of the mind. Washington, DC: National Geographic Society.

[2] “1.3. The History Of Mental Illness – Essentials Of Abnormal Psychology.” 1.3. The History Of Mental Illness – Essentials Of Abnormal Psychology, Opentext.wsu.edu, 5 January. 2018, https://opentext.wsu.edu/abnormalpsychology/chapter/1-4-the-history-of-mental-illness/.

[3] Schoeneman, T. J. (1977). The role of mental illness in the European witch hunts of the sixteenth and seventeenth centuries: An assessment. Journal of the History of the Behavioral Sciences, 13(4), 337–351.

[4] Zilboorg, G., & Henry, G. W. (1941). A history of medical psychology. New York: W. W. Norton

[5] Micale, M. S. (1985). The Salpêtrière in the age of Charcot: An institutional perspective on medical history in the late nineteenth century. Journal of Contemporary History, 20, 703–731.

[6] Bell, L. V. (1980). Treating the mentally ill: From colonial times to the present. New York: Praeger.

[7] Viney, W., & Zorich, S. (1982). Contributions to the history of psychology: XXIX. Dorothea Dix and the history of psychology. Psychological Reports, 50, 211–218.

[8] Melissa Schrift, et al. “Mental Illness, Institutionalization and Oral History in Appalachia: Voices of Psychiatric Attendants.” Journal of Appalachian Studies, vol. 19, no. 1/2, Apr. 2013, pp. 82–107. 

Farreras, Ingrid G.. “History Of Mental Illness | Noba.” Noba, Nobaproject.com, https://nobaproject.com/modules/history-of-mental-illness.

Schizophrenia across different cultures

Kraepelin was the first to raise the topic of whether schizophrenia is a universal condition in 1960. Is it possible for it to happen to anyone or even different populations, cohorts, and cultures? According to the findings of the World Health Organization’s research conducted in 20 nations, Schizophrenia can affect anyone, regardless of their age, ethnicity, gender, or geographic location. [1] Even though the outcome of schizophrenia appears to be better in developing countries compared to developed countries, the reasons for this are not fully understood; however, it can be safely assumed that culturally determined processes, whether social or environmental in nature, are at least partially responsible. [2]

The pattern for most diseases is clear: the richer and more developed the country, the better the patient outcome. Schizophrenia appears to be different. This paradox first came to light 40 years ago. For further research, in the 1960s, the World Health Organization (WHO) launched the first of the following three landmark international studies: the International Pilot Study of Schizophrenia (IPSS); the Determinants of Outcomes of Severe Mental Disorders (DOSMeD); and the International Study of Schizophrenia (ISoS).

The IPSS included 1,202 patients from nine countries, three developing (Colombia, India, and Nigeria) and six developed (Denmark, Taiwan, the United Kingdom, the United States, the Soviet Union, and Czechoslovakia). The patients’ outcomes were rated from one (best) to seven (worst) based on three factors: time with psychotic symptoms, remission after each episode, and social impairment (worst). After five years, India had the most success, with 42% of cases reporting the “best” outcomes, followed by Nigeria with 33%. However, only 17% of cases in the US and less than 10% in other wealthy countries had the best outcomes.

In the early 1980s, DoSMeD began studying schizophrenia in 12 centers in 10 countries. From a single psychotic episode to a chronic illness, its 1379 patients fell into nine categories. The study found that 37% of underdeveloped countries had complete recovery compared to 15% of developed countries. Chronic illness rates were 11.1% in the developing world and 17.4% in the developed. Patients in developing countries had longer periods of normal social functioning despite taking fewer antipsychotics. The researchers discovered that a powerful element called ‘culture’ can influence gene-environment interactions that cause disease. The present study does not answer the question but simply states that it exists. To see if the prior studies’ better outcomes persisted, the ISoS trial added two more groups of IPSS and DOSMeD patients after 15 and 25 years. It found that half of the patients had positive outcomes.[3]

According to a 2009 assessment by psychiatrist Parmanand Kulhara of the Postgraduate Institute of Medical Education and Research in Chandigarh, India, 58 schizophrenia papers were examined in order to compare outcomes across industrialized and developing countries. The explanation doesn’t make any more sense. As Kulhara points out, “patients appear to be doing better in impoverished nations, even while resources such as health facilities and medical infrastructure are severely constrained,” including treatment facilities and treatment facilities. This could be attributed to the fact that developing countries have a different socio-cultural environment, with a larger reliance on family members for care and assistance, as well as stronger social support and social networking.[4]

If you ever found yourself on the verge of going insane, a supportive network like this would do everything possible to help you regain your composure. 

So does this imply that the greater the amount of support available, the more likely it is that someone suffering from schizophrenia will be able to improve? Perhaps. If you compare developing nations to developed nations, which are known for their individualistic cultures, developing countries are known for their collectivist cultures. To be clear, collectivist cultures place a higher value on the needs of a group or community than they do on the needs of an individual, whereas individual cultures are the polar opposite. As a result, a problem that affects one person affects everyone else.

Most developing countries have limited or no resources, as well as little or no awareness of mental health issues, but the good news is that they have each other. They are extremely supportive of one another, which is amusing because it is not necessarily because they want to, but rather because it is ingrained in cultural norms. And that is the most potent force they have; they either prosper or perish together. If you ever found yourself on the verge of going insane, a supportive network like this would do everything possible to help you regain your composure. Perhaps there is little time for one’s own thoughts because they are predominantly occupied by the group. A patient’s ability to maintain a satisfactory social support system is directly related to reduced hospitalization and re-admission to the hospital among those suffering from schizophrenia. Patients who have a larger network of people who care about them spend less time in the hospital and perform better on tests and assessments.

References

[1] Jablensky, A, and N Sartorius. “Is schizophrenia universal?.” Acta psychiatrica Scandinavica. Supplementum vol. 344 (1988): 65-70. doi:10.1111/j.1600-0447.1988.tb09003.x

[2] Kulhara, P, and S Chakrabarti. “Culture and schizophrenia and other psychotic disorders.” The Psychiatric clinics of North America vol. 24,3 (2001): 449-64. doi:10.1016/s0193-953x(05)70240-9

[3] Padma, T. V. “Developing Countries: The Outcomes Paradox.” Nature News, Nature Publishing Group, 2 Apr. 2014, http://www.nature.com/articles/508S14a.

[4] Parmanand Kulhara, Ruchita Shah, Sandeep Grover, Is the course and outcome of schizophrenia better in the ‘developing’ world?,Asian Journal of Psychiatry,Volume 2, Issue 2, 2009, Pages 55-62, ISSN 1876-2018, https://doi.org/10.1016/j.ajp.2009.04.003.
(https://www.sciencedirect.com/science/article/pii/S1876201809000306)