Culture, Medicine, and Psychiatry

By Yusuf Lenfest

Professor Robert Sapolsky, a professor of biology and neurology at Stanford University, rightly identifies depression as a particularly crippling disease insofar as it affects one’s very response mechanisms and modes of coping, namely, experiences of gratitude, joy, pleasure—at bottom, some of the key emotions of resistance and healing. In discussing depression, he provides an overview of the biological and chemical elements, touching on the role of neurotransmitters (epinephrine, dopamine, serotonin) in depression, and a summary of the psychological elements (and their relation to the biological); as such, his description focuses primarily on physical and biological explanations. However, to examine depression or any psychological illness in purely physical and biological terms misses a crucial element, namely: human culture, lived experience, and the different modes or methods of social thought. Culture plays a primary role in defining many mental disorders such as schizophrenia and psychosis, and even the symptoms, intensities, or typologies of depression, according to Arthur Kleinman in his seminal Writing at the Margin: Discourse Between Anthropology and Medicine.

Despite these findings, Western biomedicine by and large continues to analyze mental health in clinical and biological terms. This is not insignificant given the statistics:

  • Approximately 1 in 5 adults in the U.S.- 43.8 million or 18.5% – experiences mental illness in a given year.
  •  Approximately 1 in 5 youth aged 13–18 (21.4%) experiences a severe mental disorder at some point during their life. For children aged 8–15, the estimate is 13%.
  • Only 41% of adults in the U.S. with a mental health condition received mental health services in the past year. Among adults with a serious mental illness, 62.9% received mental health services in the past year.
  • Just over half (50.6%) of children aged 8-15 received mental health services in the previous year. (National Alliance on Mental Health)

Current trends in medicine suggest that the medical community broadly speaking is ill-equipped to adequately tackle this rising trend, especially with regard to the treatment of diverse patients from various cultures, religions, and social circumstances. To best address the problem, the medical community – both on the level of policy and practice -ought to take steps to understand and treat mental illness more holistically.

People are inscribed in the dimension of the social realities that they have created through their interactions, the observation of others, and the sharing of their observations and their subjective experiences. These processes allow them to share the descriptions of their experiences in the first person, to establish a consensus on the merits of these experiences by assigning them designations (of names or of symbols): thus do they ensure that these experiences are common to all human beings (Ricard and Singer, 2017). This process is arguably replicated as much in the institutional culture of biomedicine as it is in spheres of religious authority.

Bridging disciplines

One of the most salient questions, “Do we treat people’s brains or their minds?” led Professor Tanya Marie Luhrmann to conduct an “ethnography of psychiatry.” Psychiatric anthropology considers the experience of mental illness, ethnographic studies of mental illness and health, the experience of psychiatric treatment and clinical settings, as well as violence and trauma in culture and subjectivity (Luhrmann, 2000; Good et al., 2008). As such it allows for the possibility to examine marginalized individuals and communities—whether that marginalization stems from society or from the institution of biomedicine and psychiatry itself.

According to the biocultural anthropologists Daniel Lende and Greg Downey, bridging different areas of neuroscience and cognitive science with anthropology provides an interface between biology and culture. They recognize that in the realm of human experience there are experiential, cultural, social dimensions, but there are also physiological and neurological dimensions; and part of their work is focused on incorporating these ways of thinking into anthropology, and vice versa, in the same way that genetics and epigenetics, or nature versus nurture, are now understood in complex dialectical ways. Their approach explicitly departs from purely brain-based explanations that ignore both environmental influence and biochemical individuality. Instead, they propose that anthropologists ought to incorporate neuroimaging technology into their working tool kit, recognizing that anthropology has always been about the study of diverse and extended mind types of approaches, which brings these together with social sciences (Lende and Downey, 2015).

A tradition locates different sites of meaning for itself because its metaphysics or belief structure is different with regard to mind and consciousness. “Western” biomedicine is suffused with a particular “local” Western metaphysics which is not necessarily located within the empirics of medicine itself. Other medical epistemologies meanwhile, such as traditional Chinese medicine or Islamic medicine, have different approaches and concepts—and therefore different sites of meaning—which are able to cohere into a self-sufficient tradition of being, or even a paradigm of meaning. Perhaps giving some emphasis to culture, meaning, and/or religious belief alongside the analysis of the neurobiology of mental illness could allow for scientific accuracy and philosophical reflection whilst remaining respectful of personal experience.

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