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Jenni Sells Psychological Anthropology Professor Snodgrass September 21, 2009 Mental illness, for all intents and purposes, is a highly subjective category of disease that can change drastically depending upon who is viewing the illness, and through which lens they see the patient. It’s not a simple task to diagnose and treat any mood disorder or mental illness through a narrow frame with which to focus on a patient. Because ideas concerning illness or disease vary widely between biomedical and psychodynamic psychiatry, treating a particular mental illness in a holistic way requires expanding this framework to include a multifocal lens that combines psychiatry and anthropology to examine the patient. It is necessary, then, for psychiatrists to begin intensifying their diagnostic and treatment regimens to include all of the aforementioned strategies in order to best serve the needs of each individual patient and ensure that they receive the best possible care. Diagnosing and treating a patient from a strictly biomedical perspective, or from a strictly psychodynamic perspective, to the exclusion of each patient’s unique life history and cultural experiences is doing a great disservice to that patient. However, if psychiatry as a whole begins to embrace all aspects of a patients’ illness and treats them accordingly, patients will have a much better chance of living their best possible life, given their circumstances. It is absolutely the responsibility of the psychiatrist to become more familiar with both a biomedical and psychodynamic perspective of mental illness, and be able to combine treatment regimens in order to help their patient. But it’s more complicated than that. Not only should psychiatry embrace those perspectives, they must be willing to accept that an individual’s experience of mental illness depends on a multitude of other factors, including life experiences and cultural influences, as these contribute both directly and indirectly to a patient’s well being. We saw in “Dialogues with Madwomen” that mental illness is a result of a variety of contributing factors. It’s undeniable that these women were much more complicated beings, with much more complicated lives than a simple diagnosis would suggest. This paper will examine two of the impressive women interviewed for the film. Both women were minorities, very well educated, and diagnosed as mentally ill. We will use the biomedical, psychodynamic, and biopsychosocial models to investigate how and why the models fall short of a holistic approach for these women, and take a look at how including a more comprehensive approach could have been much more beneficial for these unique individuals. Anna, a beautiful, articulate, and well-educated Chinese-American, grew up feeling isolated and alone, with a strong hatred for white people. She didn’t fit in with the white, upper middle class Jewish children at her school, or with the African-American children that got bussed in from the city. She was ridiculed and called a “commy” because of her heritage. Anna went to college at Berkley, and as an adult she joined a Marxist organization. Her desire was to obliterate the cultural construction of the “victimized, passive Asian.” However, in 1980, after a nervous breakdown and a visit with a psychiatrist, she was convinced that she could not function properly in society. She was prescribed thorazine and anti-depressants, which drastically decreased her creativity and energy level. She experienced profound depression, and isolated herself from the world. After some time, she stopped taking the thorazine and spoke with a female therapist. For the first time, she felt as if someone understood her – that she was not completely alone in the world, and that her life could be better. She wanted, after years of Elizabeth, an eccentric, creative, intelligent African-American female in her fourties had a much different childhood. She describes herself as “a drummer’s child” who was always dancing and had to learn how to be still. She attended Stanford Law School, where she developed a fear of the “ruling” (white) class because of their un-evolved attitudes towards the opposite sex. During particularly stressful times, she would escape into a stairwell to sing at the top of her lungs in order to help relieve her anxiety. She was raped while on a leave of absence from school. When she returned, she sought comfort from other African-American women, and eventually received counseling for the trauma and rage she experienced as a rape victim. Before we examine how these women would be perceived from a psychological or anthropological perspective, lets first take a look at some of their similarities. Both Anna and Elizabeth were middle aged, minority females. Anna and Elizabeth both described a variety of “visions” seen at different times in their lives. They went to fantastic universities, and were diagnosed with mental illness as adults. Both women were subjected to particularly stressful periods of time in their lives, and both women, with the aid of a psychiatrist, found strategies to deal with their emotional turmoil – however effective or destructive they were. At the time of the interviews, they were intelligent, well-spoken, and seemingly strong, courageous women From a biomedical perspective, each woman suffered from a malfunctioning brain. They had real diseases that made it difficult to function “normally.” The malfunctioning might be caused by some hereditary factor, or by genetic abnormalities, or some other such thing that was beyond their control. Because their illness was the result of something beyond their control, they were not ultimately responsible for their disease. A biomedical psychiatrist might refer to the visions they had by asking a question like, “Hello Anna, how are your visions doing today?”-- as if the visions were somehow separate from the patient, yet something that she must deal with due to faulty hard-wiring. The psychiatrist would attempt to treat the women by experimenting with a variety of prescription drugs with the hopes of alleviating the symptoms of the disease. These women, for all practical purposes, were not responsible for their conditions, because they have no control over how well their brains were or were not functioning. Psychodynamic therapists tend to take a slightly more comprehensive view of mental illness. They see the illness as part of an elaborate system of malfunctioning equipment. Not only is the brain diseased, but the patient also lacks the coping mechanisms to handle their problems. The unconscious drives their self-destructive behavioral patterns, and it is the job of the psychodynamic psychiatrist to unlock the hidden motives of the patient and assist them in developing healthier, more productive strategies for dealing with their lives. If a psychodynamic psychiatrist were treating Anna, he/she would likely see her illness as a product of the isolation that she experienced during childhood that has manifested itself again and again in her life, until she could no longer function rationally. They might address her visions as a manifestation of unconscious desires left unfulfilled, or as her unconscious bubbling up to the surface to highlight the areas within her life that need to be addressed through talk therapy. Her treatment regimen might consist of prescription medications to help alleviate her symptoms, but the focus would be in relieving her depression and anxiety by coming to terms with her unconscious motivations and creating more productive coping mechanisms with which to respond to life’s hardships. While both of these perspectives can be beneficial to the patient, in order to get a more complete look at what is really going on, it is also necessary to consider Lhurman’s biopsychosocial model of mental illness. As an anthropologist that grew up with a psychiatrist for a father, Lhurman understands the importance of including many of the social constructions of mental illness in order to fully comprehend the patient’s physical and emotional status. There are many cultural factors that play a role in our development as people, and those factors can be just as important as genetics, personality, and individual life experiences. Some examples of the cultural influences that can affect mental illness include how a patient regards the illness based on culturally driven frames suggesting how having a mental illness should be perceived personally, and how it might be perceived by others. Furthermore, cultural constructions regarding race, social class, and gender roles can deeply affect a patient’s personal belief system, and contribute to their overall sense of self. These constructions deeply affected both Anna and Elizabeth. As women, they grew up in a society that behaved as if women were somehow weaker than their male counterparts. While it can be a challenge to understand that this isn’t really true on an intellectual level, our society sends messages in many ways every day that drive the idea of women as the weaker sex deeply into our unconscious minds. As members of a patriarchal society, women must fight to overcome the notion that they aren’t as physically strong, that they aren’t as intelligent, and that they don’t deserve to make as much money as men. Not only did Anna and Elizabeth grow up as the weaker sex in a patriarchal society, they were also both members of another minority group. Their status as minorities had profound impacts on their development. Anna grew up very isolated and alone because she was the only Asian in her white upper middle class school. Elizabeth struggled with her fear of the “ruling” class because they spoke so poorly of women as sexual objects. Because both women were highly intelligent, they understood that according to the standards of their society, their existence wasn’t particularly valued. It would be foolish to think that these kinds of culturally constructed ideals wouldn’t impact how a person feels about their position within that society, and deeply undermine their overall sense of self. Additionally, we must also consider the frame through which the psychiatrist believes the illness is rooted; that is to say whether they approach the patient’s illness from a biomedical or a psychodynamic perspective. Lhurman illustrates how drastically different these perspectives are, from the ways in which they are trained, to the ways in which they learn to diagnose and to treat mental illness. The psychiatrist is integral in the doctor-patient relationship, because their belief system impacts the patient directly. For example, when Anna had a nervous breakdown her psychiatrist, operating from a biomedical perspective, prescribed thorazine and anti-depressants. These medications didn’t help her. Instead, she had less energy and became even more isolated than she was before. She didn’t start feeling better until she stopped taking the medication and started talking to a therapist. It is clear that the biomedical model of psychiatry failed her. It wasn’t until she was able to speak, and to be heard, that she started to feel better. Her illness was less rooted in biology, and more a product of her life experiences, her social status as a minority female, and her ineffective coping mechanisms. I question whether Anna in fact, suffered from mental illness. It is clear that she was depressed, but given what she experienced, depression seems like a logical outcome. She described seeing visions, such as notes floating through the air when listening to music, or seeing faces in ocean waves. A biomedical or psychodynamic psychiatrist would be trained to see this as mental illness due to their education and training, but I would argue that perhaps she was just more creative than “normal” people. Perhaps her imagination was all she had to develop during those years of isolation, which allowed for an overactive imagination, rather than mental illness. But because seeing visions is something our culture describes as abnormal, Anna was put into the category of mental illness. The same is true for Elizabeth. The visions she described when working through her anger after being raped were just as likely visions produced by her mind in order to effectively work through the rage she felt at being violated. She expressed herself more creatively, through dance and song, than most of us are capable of doing. These visions, then, were seen as abnormal and labeled as illness when in fact, she is probably no more “crazy” than the rest of us. Mental illness is a complex issue with many contributing factors, and equally as many opinions or ideas associated with diagnosis and treatment. However, psychiatry alone is not comprehensive enough to do justice to the patient. Psychiatrists must also begin recognizing the role that they play in the lives of their patients as an outsider, with their own biases and their own brand of “craziness” that they bring to the table. Psychiatry must take much more than biology and the unconscious motivations of their patient into consideration when diagnosing and treating their patients. People do not exist in a vacuum – rather, they are a part of many larger cultural ideas and constructions, and those social frames cannot be ignored if we seek to truly help the


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