Cultural aspects of mental disease

Abstract

This paper, read at the International Congress of Psychotherapy, Barcelona, September 1958, discusses a few among the many cultural aspects of mental disease: 1. Cultural relativism. Is the concept of mental illness universal, or is it (as Ruth Benedict and others contend) relative to the various cultures? In fact, certain mental conditions are recognized everywhere as abnormal (idiocy, senile dementia, agitated confusion with fury). Cultural relativism is restricted to the aspects of human behavior which present a normal and an abnormal facet. Cultural divergences in the appreciation of what is normal or abnormal are hardly more marked than are the conflicting diagnoses of psychiatric experts in a legal case. 2. Cultural specificity. Since Hippocrates’ “Scythian disease”, several mental conditions have been described which are supposed to be specific to certain countries or cultures; such as in present days, the running Amok in Malaya. Careful studies show that these allegedly specific conditions also occur in other parts of the world, although in less conspicuous forms. Thus they are in fact universal manifestations which, in certain settings, acquired a special coloring owing to a very high admixture of cultural elements (notably permissiveness and ceremonialization.). 3. Cultural coloring of mental disease. Clinical instances borrowed from a paper by Dr. Gustave Martin illustrate the differences in delusional ideas whether they occur in “bush negroes” or acculturated natives of Northwest Africa. Psychiatrists working in a different setting should pay the greatest attention to the patient's culture. Not infrequently it is only a precise anthropological knowledge which will enable a psychiatrist to recognize whether certain manifestations are normal or abnormal, and if abnormal, to evaluate their degree of severity. 4. Cultural stimulation or inhibition of mental disease. Much attention has been given to the cultural factors which produce or stimulate mental illness, but not enough to those factors which repress or inhibit its manifestations. Repression or inhibition of mental illness has been observed: in concentration camps, during wars, in certain religious sects, in individual clinical cases. A certain index of permissiveness or intolerance to mental illness is characteristic of every culture, and within each country of every cultural wave (as shown in the history of Western civilization). This index is internalized by every individual and acts as an unconscious permissive or repressive factor in the production of individual mental illness. 5. Biocultural interactions. The progress of civilization forwarded an un-precedented development of Science. Science produced inventions which transformed the structure of man, not only socially and psychologically, but also biologically, with far-reaching consequences upon the manifestation of mental illness. Three instances are given: (a) The prolongation of the average length of human life produced not only geriatric problems but also new problems of adolescence, of which the increase in juvenile delinquency is the most conspicuous. (b) The advent of surgical anaesthesia and pharmaceutical analgesia resulted in the almost complete disappearance of pain, but at the same time made man much more intolerant to pain, and therefore the idea of pain plays a greater role in the psychogenesis of certain neuroses. (c) The enormous increase of quantity of stimulation given to children and adolescents produced biological consequences, one of which is probably the increase of the frequency of schizophrenia. The author concludes by referring to other cultural aspects of mental illness and emphasizes the importance of careful statistical studies and exhaustive individual case histories.