Brain and cognition: the significance of culture?

Neural and Behavioral Sciences Senior Seminar

Bryn Mawr College, Spring 2010
Brain and cognition: the significance of culture?

A presumption of many scientists, and of many people reading/using their research, is that neural and behavioral sciences are aimed at describing "universal" features of the human brain and its cognitive processes, features that exist across humans of all cultures.  There are though bodies of observations within the neural and behavioral sciences that call such a presumption into question, both in particular cases and, perhaps, in general.  We will explore some examples of such bodies of observations, using them to think more about whether a presumption of universality is either necessary or sufficient for research in the neural and behavioral sciences and, if not, what alternative presumptions might be more appropriate. 
Background readings:

Some relevant thoughts from last week:
Depression and biology: what's to understand?
I don’t mean to simplify a highly complicated neural problem like this but it seems that it can be seen easier if broken down to its core ... vpina
understanding the biological “core” would be extremely useful, but it will not explain the full story. It will not fully explain the variability that exists nor will it offer simple solution answers ... EB Ver Hoeve
Depression and "illness"
It is important to acknowledge that mental disorders such as depression and anxiety are illnesses so that people who are affected by them realize they don't have to live with the pain. There are treatments available and upon recognizing that they have an illness perhaps people will be more likely to seek those treatments to improve their quality of life ... Sasha
Depression is something that should be cured then, right? These people are not living healthy and normal lives, right? However, what if we're not right? ... mrobbins
Our society gives such deference to Western medicine and "hard sciences". As a result, these institutions have set the precedent for what is to be expected from a health care field and from health care professionals. Unfortunately, psychology, and especially neuroscience, is not as cut-and-dry ... meroberts
Illness and culture
if you're telling me that, despite my harmlessness, my vivid reality is incorrect, that my feelings of euphoria are wrong, that my habits are abnormal, and that I have to take pills that will leave me feeling numb and apathetic, then I might say screw you. I'm not saying I entirely disagree with Sasha or Vidya, but I wonder if we can explore this a bit further before drawing such close comparisons to other physical but unknown illnesses: these importantly differ in how we *as patients* desire ourselves. ... David F
why does it really matter if we call depression (or ADHD) an illness or not? ... LMcCormick
Issues arising
What do we mean by "illness"?  Are "illnesses" "objective" characteristics of individuals, universally recognizable?  What role does "subjectivity" and culture play in the definition of "illness"?  In the etiology of "illness"?  What are the implications of all of this for research on "mental health"?
Discussion summary (Megan)

We began our discussion with a recapitulation of last week’s topic, depression pharmacotherapy. Several interesting questions were raised regarding ethics and researcher responsibilities. Among these were: “Can we ethically model depression? In animals? In humans?”, and “Is it appropriate to devote 90% of research efforts to pharmacological treatments on a neurotransmitter level?”. This last question gave rise to the streetlamp example. Arguably, we should be looking for answers in the “light” from the streetlamp instead of groping blindly in the dark. In other words, we should continue developing an already established body of research instead of spreading our resources over a broader field. However, I believe it could also be argued (and feel free to disagree) that researchers should also be focusing efforts in the unknown/unexplored territory to further our understanding of depression and its possible treatments.
Perhaps if the universal understanding of depression (its etiology, symptoms/manifestations, and treatments) were further developed, we wouldn’t have to return to our question of whether or not depression should indeed be classified as an illness. Unfortunately, we must continually confront this issue because of the variability in the definition, diagnosis, and treatment of depression. This variability could be a result of the variability and uniqueness of the human mind. Certainly, if we acknowledge the fact that no two brains/minds are the same, then it should be realized that a mental health illness might not manifest itself the same way in different people. Yet there is still a core set of symptoms that are generally agreed upon and regarded by mental health care professionals to be indicative of depression. Will depression then become an umbrella term for variations in this set of symptoms? Or will depression eventually be narrowed down to one definitive illness? Is that even possible given the breadth of variations in the “wiring” of the human brain/mind?
If it is possible to narrow our definition of depression, why aren’t treatment protocols tailored to individual needs/symptoms? Why is there such pressure (especially in American societies) to “fix” depression, and to “fix” it quickly with pharmacological treatments? Perhaps society is to blame for the prevalence of depression. But which society? To find the answers to these questions, one must look at cross-cultural interpretations of depression, as well as other illnesses. Additionally, it is important to note the differences in societal views and individual perceptions of the same mental illness. These discrepancies can result in socially induced mental illnesses, stigma associated with these illnesses, or societal trends in diagnoses. Perhaps some disorders are culturally based. Perhaps cultural perceptions of “normalcy” create and aggrandize differences between people. Acknowledging and accepting differences (both cross-culturally and within one’s own culture) would greatly reduce the stigma associated with mental health disorders.
 
Continuing conversation in on-line forum below
 

Comments

mrobbins's picture

deep impressions

 

Maybe depression is not a human defect at all, but is rather a natural vulnerability. Mild depression can actually be a positive experience in life. In its moderate forms, depression serves as a healthy defense mechanism that encourages people to reevaluate their circumstances. This type of depression does not necessarily need “fixing” so to say, but rather it heralds introspection and resolution. For instance, negative circumstances, such as an abusive relationship, unfulfilling career, etc., may cause a person to feel depressed. Experiencing depression in such times encourages the affected to eventually make positive changes to their life in healthier directions. Perhaps these instances are adaptive examples of depression and that is why this enigmatic journey of conflict with oneself has been passed down through the ages. Granted, depression is more widespread today than it has ever been in the past. This epidemic malaise may be due to increased cultural awareness, increased pressure to succeed, and less emphasis on self-nurturing.

Moreover, a society that is over eager to medically treat a natural process may be exaggerating an extent of human nature. This is not to say that those with serious depression should not be treated or ignored. To the contrary, in fact those people are the ones that should first and foremost be treated. However, those with the most severe afflictions may now get lost in vogue. To a certain extent, our society stigmatizes depression, but it also embraces it once you separate mild from severe depression. Many famous artists and athletes only uncovered their strengths by forcing themselves to overcome their weaknesses. They conquered themselves. The way in which culture may contribute to severe depression is more complicated factoring in that depression has been shown to exist, in varying forms, in many different cultures. For example, the Banda tribe in Uganda calls depression, “the illness of thought.” Widespread culture did not necessarily create depression, but it feeds on the natural vulnerabilities of mankind that, in more isolated and less severe circumstances, are actually beneficial rather than detrimental in the long run.

 

dshanin's picture

Change the patient or change society?

 

The discussion of the role of culture in mental illness struck me as a fairly circular argument. Culture creates the normal, those who violate the normal are mentally ill, if we change culture we change the normal and thus change what we view as mental illness. What was more interesting to me were the so-called “nontraditional” approaches to mental healthcare such as the way an African tribe viewed schizophrenia as a demonic possession and not an illness of that particular person. This allowed the person’s symptoms to be treated without any sort of judgment about the actual patient. The author argued this was beneficial in that these person’s were able to easily re-enter community life in times of remission and thus suffered none of the socio-cultural isolation and stigmatization that is such an issue in westernized mental healthcare.   Interestingly, it seems that our own mental health establishment has possessed these notions many years ago when “a cruise around the world” was the preferred treatment for depression. 

                These two seemingly unrelated treatments are really the same idea, rather than focus all interventions on changing the disorder; these treatments instead change what is “normal”. Instead of bending patients to fit society these societies bend to fit their patients. This approach requires a very active “population” which has the motivation and flexibility to accommodate the differing needs of its members but that does not necessarily make it a dead end for modern treatment. I am not quite sure how this methodology could be integrated with modern care but perhaps some form of family training should accompany an individual’s recovery plan. Especially in disorders such as schizophrenia where the emotional affect style of a patient’s family has been shown to play such a role in relapse rates it is crucial that the treatment extend beyond just the patient.        

LMcCormick's picture

The Mental Illness Fad

I don’t find the idea of mental illness fads surprising.  Like Claire mentioned, it is easy to see how the occurrence of mental illnesses may be in part due to self-fulfilling prophecies.  One can be a hypochondriac and it probably won’t induce a physical disease.  One could argue for the influence of stress in physical maladies; however, in general it seems unlikely that one could will themselves into getting a sinus infection or rheumatoid arthritis.  On the other hand – as we have previously mentioned – when we talk or think we are physically influencing our brains.  With this in mind, it seems not only possible, but likely, that people may talk themselves into depression.  Thus, it is easy to see how one may be able to convince themselves that they have depression when surrounded by a culture consumed by the topic, leading to the manifestation of more serious symptoms.

            Mental illness trends probably also occur due to fads in diagnosis.  Part of this may be warranted: if the symptoms of a mental illness are on everyone’s radar, then both parents and doctors may be more likely to recognize the problem.  However, there is also the possibility of over-diagnosis.  I read an article discussing the problem of over-diagnosing children with bipolar disorder.  The article points to the prevalence of popular books about “the bipolar child” which may convince parents of normal children that their child is afflicted.  Because mental illness diagnosis depends on patient (and parent) description, it is easy to see how this may lead to over-diagnosis.  Additionally, doctors are not immune to the influence of trends in science.  If they have recently read an article on a new theory of depressive symptoms, for example, they may be more likely to diagnose depression simply from a recency effect.

            Also, I found the notion that a disability only exists in the context of an ability very interesting.  However, I agree with Bobby that there seems to be little practical application of this realization.  We function as a society because of our shared abilities (similar to our dependence on shared subjectivity).  To take an obvious example, there would be no cohesive structure or unified mechanism of communication without a shared language system.  And there is no practical reason to abolish a system simply because some people do not have the ability to assimilate.

 

rdanfort's picture

My notes

 As I could not make it to the last class discussion, I have instead taken notes on as much of the reading as I could and then compiled them into something more coherent here – hopefully it will be of interest and not an impenetrable block of text.

 

On “Neuroanthropology”:

I appreciate the references to cognitive enhancement, psychiatric treatment, and the issue of inequality – would have really liked to see some specifics! Which brain differences have we found for different cultures and occupations? What particular activities might they be related to? The general idea that brain structure and function reflects its “owner”’s activities makes a lot of sense and is well-established.

It is a fact that humans are homogenous to a degree that is rare among mammals. We are only just beginning to realize that the people who live in the next valley are not blood-sucking ghosts, and I would hate to see this cultural approach misapplied to exaggerate the differences between individuals, as might have been said of phrenology and earlier endeavors. I am tempted to say that this is a silly thing for me to worry about, given the many differences in frame and backing between neuroscience and phrenology, but also recall individuals such as Watson and countless less-known authors misusing valid data in supremacist arguments.

On “Americanization of mental health”:

I skimmed this article when it was published and really liked it. The author was careful to describe substantive issues without edging into Scientology territory, always important when addressing the numerous problems in modern psychology. The most important message that I took away was the discussion of cultures which approach mental illness (e.g. schizophrenia as possession) in a way that appears to reduce anxiety in the patient and family.

I find the "Dr. Lee" example re: anorexia convincing, but would not go as far as to point at a report on one death by anorexia as a hinge point. Rather, I would imagine that the influx of capitalism and consumerism in China has produced some of the pressures we think are responsible for anorexia in America. When Lee reports that in 2007, 90% of his anorexic patients reported fat phobia, it is also notable that at this time China has a massive emerging consumer class and a previously unknown visible incidence of obesity. It may also be that the underlying features that make an individual susceptible to anorexia are independent of what might trigger the condition, just as a psychotic break might occur from losing one’s job or because of graduating college.

With respect to the later discussion of "victorian psychologists" and "veiled pity" towards them, I am reminded somewhat of Zizek's commentary on the monetization of social relationships. That is, we tend to confide in therapists and not (or in addition to) close friends. (Zizek does not imply that therapy is bad or does not work, only an observation on how people have come to handle emotional distress.) In that context, it might be supposed that even an unscientific and misled Victorian practitioner might be effective in certain ways on a Victorian patient.

What Psychologists need, I think, is a way to contextualize illness without descending into complete relativism - it must be possible to evaluate whether a cultural context of prescribed treatment is best for the patient. For example, cultures that deal with trauma by not discussing it strike me as unlikely to promote good outcomes, if we are to believe any of the earlier premises about repression.

On “Culture as Disability”:

I really dislike some aspects of capital-D Deafness. There are those who insist that their child should not be given a chochlear implant because they've lived their entire lives without music and gotten along just fine, and there are those who seek to use IVF to deliver Deaf children. Many of the parents featured in Deafness articles and film have outright said that they want deaf children because they do not want to lose their children to the hearing world. No amount of good intentions and blissful, well-adjusted ignorance will make that right. If you are born deaf, you have perhaps five years to be fitted for a cochlear implant. If that happens, an individual has as much of a choice about their culture and community as any of us does - if not, they are forever shackled to the culture of their parents, however thriving it might be. We are not accepting of honor killings and arranged marriages, and I feel that this particular notion of Deafness should be viewed in the same light.  If we are to find a way to characterize deafness without BEING disabling, it must be done in a way that also allows us to prevent parents from deafening their children.  I'm not sure if I can think of a coherent way for that to work.

My notes on the learning disability discussion are pretty scattered, so what I think it comes down to is this: there are many ways in which our education structure might be changed to accommodate some of what we call disability without detriment to “normal” people. There are other ways in which the educational system does not reflect the skill set needed for much of everyday life. However - I am glad that we have a culture that requires literacy. I am glad that we have a culture that requires some associative and mathematical ability. If we did not, we would probably not be able to post at each other about the constraints of our culture! I will accept that people who cannot do these things are disabled because our culture requires them to do these things, and not necessarily because of some other factor, but have no idea what should be done with that understanding.  I am wary, for example, of simply laning students into forms of education that fit their capabilities, as I understand educational outcomes to be heavily influenced by expectations.

 

EB Ver Hoeve's picture

  I agree with Paul and the

 

I agree with Paul and the statement, cultures can be changed. But in the context of mental health and the treatment of mental health disorders, how are we supposed to initiate the cultural change? Would the change occur through the law? How drastic of a change are we talking about? I do not think that anyone was actually suggesting that we eliminate our language or do away with the entire educational system, but then what types of change are we actually suggesting?   I have been thinking about Paul’s suggestion that, within the classroom, children and teens should be told that, everyone here is different and that everybody here is good. Although, I agree with the sentiment and usefulness of this message, could this basic of a message actually translate into cultural change? Could anything that was said in this hypothetical classroom actually stand up against the high powered and competitive culture that exists directly outside the classroom?

 

If labels can’t disappear from our culture (at least within the near future) could we maybe use those labels to create new opportunities? For instance, could a change in culture begin through the creation of a new type of special education system… In this new type of education, a person is not taught how to simply get by in a society that will never understand them, but instead, that person is taught how to discover and embrace whatever they’re good at and whatever makes them special. But maybe this is just further isolation…

 

About the European Cruise…I just don’t know how accurate that type of treatment would be. It would be one thing if the cruise provided live in therapists. It seems like it would be quite another if the only thing the depressed person did was just sit on a boat, alone, and watch life go by. And about the desire for antidepressant medication, if you were depressed wouldn’t you just want a quick fix too? Can culture really take all the blame for the fact that people want drugs? It seems to me pretty understandable that a depressed person, with low motivation and low energy who knows that antidepressants exist, would desire an easy solution involving a physical way (drug) to improve their physical state (depression).      

 

 

Bo-Rin Kim's picture

culture and labels

I think our discussion about culture added an interesting new dimension to our larger discussion of mental illnesses as it brought into perspective factors of mental health that are beyond the individual. It was interesting to think of culture as the source of mental illness. I believe that mental illnesses do have a biological basis, however, I also believe that culture can act to exacerbate any underlying mental conditions. As shown in the example of Hong Kong and anorexia, media/culture plays a huge role in determining what people know and how they think about themselves—including how they think about their current state of health. Culture defines and makes people more sensitive to any deviations they may display from the societal norm, and this hypersensitivity can exacerbate the symptoms they display. This is why I wonder if depression levels are as high or depression symptoms are as severe in societies that have not placed an emphasis on or have never heard of this condition.


The labels that cultures give mental illness and how these labels strictly compartmentalize a set of behaviors as being indicative of an illness also increase the stigma against mental illness. Like Professor Grobstein mentioned, these labels emphasize how these people are different from the rest of society, and the fear of the different/unknown is what I believe fuels the stigma against mental illness. However, at the same time, I feel that labels are necessary to define illness in order to make them “legitimate” conditions that require treatment and research. Labels, while separating people as being different, at the same time give them the recognition that they have a medical condition that is not a sign of weakness or something that can be changed on their own. Thus, while I agree that it is entirely wrong to define a person by a mental health label, these labels are needed to treat and, in a sense, legitimize a condition.
 

Jeremy Posner's picture

Lamp Metaphors

We spend some of our discussion time in class on Monday debating the degree to which the study of depression and the treatment of depression should focus upon psychopharmacology and upon neurobiology, whether it is appropriate that the majority of time and resources devoted to researching the disorder are spent in those areas.  To me personally it’s a difficult question both because of my personal inclination, which is towards interest in those biological and pharmalogical areas, those are the areas that I myself am most interested in understanding and so my own curiosity is best satisfied by the current biological focus and because in the long term I do believe neurobiology holds the greatest potential of the areas of depression research while at the same time I recognize that non-pharmacological depression treatment has been proven to be very effective in many cases and merits further investigation. 

I think the streetlight metaphor might have been a little belabored by the end of our discussion but in those terms I tend to think that there is good and bad in the logic that the area best illuminated is the area that it makes the most sense to continue to investigate.  If we’re speculating as to where the keys that we’re looking for are my guess is that they’re eventually going to be in the direction of that light, ultimately everything involving the brain is a chemical process and if those processes could be perfectly understood than what exactly causes depression would be understood as well.  Practically it is certainly also true that neurobiological and neurobehavioral research is an easy sell for funding currently, allowing for research into the biological side of depression to be logistically easier than behavioral research.  On the other hand at present it’s not clear that in the short term that medical treatments of depression or of other mental disorders is more effective than behavioral treatments, and I am sure that there are many who would be far more comfortable receiving behavioral treatments than pharmacological treatments. 

And all of this is of course assuming that depression is something that needs to be treated, that the thinking of depressed individuals is problematic and needs to be corrected.  There’s no doubt that there are a great many people suffering from depression, or from other mental disorders, who would like to be treated, and to no longer experience their disorder.  There are others, however, and whole categorizations that are the product of a behavior that is non-culturally normative, but not necessarily unpleasant, or something for which many want to be treated.  There has been a great deal of discussion regarding the Gender Identity Disorder and its place in future versions of the DSM, and I imagine that it could very well go the way of some of the other disorders that once described behavior that was considered abnormal but have since been phased out as culture has changed and as those behaviors have been recognized as not “disordered”.  Whether some of the less obviously contentious disorders, like mood disorders, will eventually meet the same fate is hard to say, but imposed treatment is a very grey area in psychology both because it can be argued that the nature of disordered thinking may preclude a patient from acting in their own interests and because the nature of the idea of disordered thinking makes the idea of forced treatment a very uncomfortable one. 

Claire Ceriani's picture

Mental Effects on Health

I think it's worth considering how the brain may be responsible for influencing its own health.  We've already talked about just talking can cause changes in the brain.  Can thinking in a particular way influence the progress of mental illness?  Suppose a person had a few mild symptoms of depression.  He might not quite meet the time and severity specifications in the DSM-IV to get a diagnosis of depression, but he knows he doesn't feel right.  Could reading or hearing about depression through the media influence his symptoms?  Could he think that, because his symptoms are kind of like the ones described in the Wikipedia entry on depression, he must have it, and actually cause his symptoms to get worse just because he believes they should?  Our discussion last Monday brought up the idea of depression being "en vogue" right now.  Depression and anti-depressants are the subjects of numerous articles and news stories.  Most people probably know at least one person on anti-depressants.  It seems to me that mild depression that could be overcome without drug therapy might become more serious and long-term if the sufferer believes that his symptoms are going to continue to get worse until they match the descriptions of serious depression found in the media.  If he interprets his symptoms as only the beginning of true depression, then he could be creating a self-fulfilling prophecy.  In this way, a culture's media could actually shape the way a particular mental illness presents.

sberman's picture

commercials and googling symptoms

I definitely agree with Claire here- I read an article awhile back about patients coming to psychiatrists, not just asking to be put on antidepressants/SSRI's, but asking to be given a prescription for a particular drug they saw advertised on TV. And could this lead to another problem--patients consciously or unconsciously tailoring their symptoms to those discussed in the advertisement in order to get the drug, which they may view as quicker fix than talk therapy/CBT?

Furthermore, I think that googling illnesses or symptoms on the internet and then thinking you are afflicted with the disorder/disease that pops up is a problem for both mental and physical illnesses. Though with mental illnesses, maybe its more of an issue since the symptoms are more frequently based on the patient's report rather than on laboratory tests (which are used for some, but not all, physical illnesses). 

meroberts's picture

Societal Stigma Toward Unproductivity

Given the facts that 1. Culture/society shapes our reality and 2. Everything we perceive about our realities is constructed by our minds/brains, isn't it natural to assume that culture is to blame for the stigma associated with mental health disorders? As Professor Grobstein pointed out, cultures and cultural values can be changed. Nothing exists in a vacuum. There is a constant interplay between society and the individuals that comprise it. Society is evolving just like everything else- it is only what we make of it. As stated in class, accepting individual differences would be the first step in correcting the skewed perception of "normalcy" which our society tends to assume. But that would only happen in a perfect world. I agree with Allie that society definitely serves a purpose, although I'm not sure that the majority of individuals in our society are well-represented by our value systems. I believe a relatively small group of people hold the majority of the power in our culture and for this reason certain topics are considered taboo.  
I greatly enjoyed the discussion in class about why our culture/society values productivity above all other qualities. It made me realize how capitalistic our society truly is. In these reports: http://www.ncbi.nlm.nih.gov/pubmed/12813119 and http://depression.about.com/b/2010/01/25/depressed-workers-less-productive-even-with-antidepressant-treatment.htm productivity is the means in which a workers' worth is measured. The term 'lost productive time' (in the first report) refers specifically to time not spent furthering the company agenda. Ultimately, the company does not earn as much money as they could have and that is to be avoided when possible. Which means, companies can refuse to hire, fire, or deny requests for time off from work from people with a mental illness based on the information gleaned from the report by the media. So a common cultural assumption is that a person taking time off from work is a detriment to society. It could be argued that removing a person with depression from his/her job is more productive because the corporate machine can continue on with employees that are ready to "join society and make stuff". Clearly if the individual with depression lacked the drive to succeed, the company would be better off giving that individual some vacation time instead of forcing them to adhere to company policy. Our own culture engenders the negative attitude toward mental health illnesses because of its product-driven behavior.

Sasha's picture

research and the brain

This past weeks discussion brought up the argument that perhaps mental health research efforts should transfer some more focus onto diagnosing and treating "differences" with a more observational approach as opposed to the more conventional physical- "look at changes in neurons and brain activity" approach. I believe discussion and observation of individual's mental differences are valuable approaches to understanding how the brain works. However, I also believe that what goes on in our brain is a result of physical actions. People don't develop depression or anxiety or schizophrenia or experience anything without something physical happening in their brain. Since the technology exists (and is constantly getting better) to monitor and see these physical changes in the brain I think that as many resources as possible should be used to try and figure out what is going and why. By understanding the physical basis behind emotion and behavior we can ultimately come up with better treatments (which don't necessarily have to be pharmaceutical) for illnesses. It's very possible that I did not understand the argument in class and that I am off topic- but I believe we can philosophize and discuss and observe human behavior and differences all we want, but unless we have a solid understanding of the physical basis of whats going on in the brain we can never really be sure of whats going on in our head...

alesnick's picture

"The Myth of Mental Illness"

Greetings -- I write as a visitor to this thread to share appreciation of the need to question the medical model of mental  illness.  My own education in this questioning was advanced significantly when I read Thomas Szasz's  1960 book "The Myth of Mental Illness."  In it, Szasz writes, " When you call a rock a rock, nothing happens to it; but when you call a person a schizophrenic, something happens to him."  Anyone who has been or who has loved someone in the mental health care system has a feeling for this.  It definitely connects with the isolating, dominating, totalizing, and diminishing of people that Paul references above.  To Paul's highlighting its "tendency to dissociate people from the larger culture," I would add that the medical model obscures the ways in which people's suffering is itself a manifestation of that culture, makes cultural sense -- not always, but I think often. 
 
 

aliss's picture

Depression and Culture

Why do we feel like we need to treat depression?  Mostly I believe it is because the people with depression feel like they need to be treated.  Although depression may be described as “wanting to want” something, where does the line between wanting to want to be happy cross into wanting to be happy?  There is still a source of discomfort in the patient, so why shouldn’t that discomfort be addressed?  Antidepressants, including SSRI’s, may not be the only effective course of treatment – maybe a long European vacation will do just fine – but why shouldn’t we use them, if we know that they work at least some of the time, and might give a placebo effect if they are not actually working?  Why shouldn’t we be researching what they do, so that we can have a greater understanding of the mechanisms of depression?  This is not to say that we should stop all other avenues of research on depression, simply that we should not give up on one that we’ve found that seems to be leading somewhere.

We’ve described depression as something that diminishes what a person adds to their society, which is perhaps the reason a depressed person feels uncomfortable with their depression.  However, I do not believe that is necessarily the case.  Depression is an uncomfortable mental state, with or without the judgment of others.  It seems almost impossible to take life on a case-by-case basis, to change our culture to suit the needs of every individual person.  Our culture exists the way it does because we have found an equilibrium that suits most people, or at least fills the needs of more people than not.  We have a culture for a reason, and it would be impossible to have a functional society without any sort of culture.  We could get rid of written language to make life easier for those with learning disabilities, we could change the structure of education to make it more conducive to those with ADHD, and we could eliminate social interaction for those who are depressed and don’t want to interact with others, but without our standards, society would fall apart.  As human beings, we have evolved to live in groups and to interact with others.  Culture is the only way to ensure stability in these groups.

 

VGopinath's picture

Financing "Productive" Depression

     Although this is a cavalier perspective on depression, if I could enjoy a European cruise for a few years paid for by my health insurance, I just might pretend to have depression. David's question about how our society would feel about some individuals being "productive" and others healing themselves, either physically or mentally, for prolonged periods of time seems to bring us back to our original discussion concerning the differences between physical and mental illnesses. 

     If a member of my community was in a terrible accident and my tax money was used to reattach a limb or if it's used for a child who is trapped in bed with leukemia, I am okay with that.  And I believe most people would be as well.  I don't know how I feel about my money being used for a European cruise for someone who lost their spouse 5 years ago but still doesn't sleep and says he has thoughts of killing himself.  Perhaps because mental illnesses, due to our smaller body of knowledge and its less quantifiable symptoms, are easier to mimic and people can manipulate the system better. The symptoms listed in the DSM are not the chemical imbalances recent studies have shown to be linked to depression but symptoms such as changes in weight, changes in hours slept and other symptoms that a person can easily control or lie about. But I understand the hesitancy many feel about the recent change in the health care system to treat physical and mental illnesses the same. Yes, we want everyone healthy and reenergized but to what extent can mental illnesses open the system to abuse? No one wants to manipulate the system when the treatment is unpleasant like electric shock therapy but when it's therapy or just "time off," the incentive for lying is high.

sberman's picture

depression within micro-cultures

 I am quite intrigued by our discussion of whether low energy and motivation, which we commonly view as hallmark symptoms of depression, could in fact be the causative agents of depression (at least in our productivity driven culture). I'd like to know whether in careers or micro-cultures that are high powered and competitive, is the etiology of depression the same or different as it is in less stressful situations? Does low motivation and energy experienced in an environment where high energy and drive is the norm contribute more to depression than low motivation in other situations? Furthermore, if depression is in fact more common amongst people in these competitive micro-cultures, is it because these cultures are more likely to contribute to the onset of depression, or is it that these cultures simply attract people who are more prone to depression? Perhaps the reason why so many doctors and CEOs are depressed is that depressed individuals have intrinsically more motivation and drive for success, but then a higher proclivity towards depression when they experience minor set-backs or dips in motivation. 

In terms of labeling depression as an illness or a mood "difference," I am conflicted. Perhaps the categorization of people as depressed leads them to feel isolated and alone; but could it also influence them to seek treatment? Although depression may in fact be productive in some cases, I think its important to recognize that this productivity comes with a price of patient discomfort and unhappiness. Where do we draw the line? I wonder if labeling depression as a "mood difference" will make it harder for those patients who want help to receive it, especially as insurance companies are looking to cut costs in any way they can. 

David Feingold's picture

Disability by any other name

Greetings Professor Grobstein! I continue reading your site with interest and delight. Here is a site you might find very relevant for this topic. Best wishes, David Feingold http://igodap.ning.com/profiles/blog/show?id=3412976%3ABlogPost%3A4861&xgs=1&xg_source=msg_share_post (click on Facebook link)

Paul Grobstein's picture

A new word for "disability"?

Thanks David.  "A new name for disabled people" is indeed a relevant and intriguing conversation.  For others who haven't met David yet, see his gallery, Exploring Disability: Images and Thoughts

vpina's picture

Media power and Responsibilities

 

 Some points that I found most surprising is how strong the media is when it comes to the spread of diseases. It seemed very accurate that it was due to the media’s influence that anorexia, an internal mental issue in my belief, spread so quickly across Hong Kong because people just decided that their symptoms and problems had to be associated with that. My older sister works at Boston children’s hospital and her stories also give me the same idea of the media. When the H1N1 virus broke out every parent that heard a slight cough come from their child ran to the hospital proclaiming that their child had the virus when 80% of the kids did not. If there was no media coverage on the H1N1 scare than most parents would treat the cough, as a normal cold and only when the sickness got a lot worse would try run to a hospital.

Now with this power of media I ask whether the media should take more responsibility and say in this case advise parents to not take evasive actions unless the child had been sick for a certain period of time instead of over crowding the hospitals and taking away from the patients that really need the help.     

 

kenglander's picture

The media's influence on

The media's influence on medical diagnosis is particularly complicated and relates, in part, to the larger issues associated with medical diagnoses in our (American) culture. Where do we draw the line between spreading awareness and creating fear?

As Vadilson said, it can be a problem when people misdiagnose their family members and crowd emergency rooms. Not only does it create more chaos in the emergency room, but it also means that fewer resources can be allocated to patients that do require emergency medical care. Sarah pointed out that misdiagnoses may also affect interactions between patients and doctors during check-ups as well; patients may start asking for drugs by name and possibly exacerbating symptoms. This puts pressure on the doctor to sort out real symptoms from imagined symptoms and also to treat the patient with the appropriate therapy. In other words, practitioners must use their observations to decide how legitimate the concerns of their patients are in light of the potential influences of the media.

Conversely, I wonder if the benefits of alerting the public to certain diseases, illnesses, and treatments could outweigh the detrimental effects. If parents, for example, are aware of an epidemic, they may seek treatment for their children earlier than they would have if they were unaware of that epidemic. While there may be more false alarms in the emergency rooms, if doctors are able to save the life of a patient, isn't it worth it? Perhaps the problem is not with alerting the public but improving our hospital systems?

In class we've talked extensively about how scientists, researchers, and doctors have invested a lot of time, money, and resources in classifying depression and other mental illnesses. This desire to classify and treat illnesses and diseases is not unique to professionals in the medical field. Recently, society has become more obsessed with self-diagnosis (i.e. www.webmd.com). Drug companies have also capitalized on the public's desire to learn about treatment options and have spent millions of dollars advertising their pills. So, where do we go from here? How can we make information provided to the public more comprehensive and fair (i.e. with minimal influence from drug company commercials)?

David F's picture

Depression as a "productive" mechanism

Professor Grobstein's reflection on what has been hinted at in class - that depression may in part be productive - is a really interesting thought, particularly in the context of cultural variation. It is certainly a contentious suggestion; there seems to be a certain visceral repulsion to the idea that a condition that causes so much discomfort could in any way be framed so callously, but maybe that is precisely the problem: that our notion of "productivity" is a calloused one.

To assess something for its "productive" value implies a certain end to be fulfilled, where the subject at hand is described relative to his/her/its ability to contribute towards that end. That end, however, may, and in fact is likely to, differ drastically between cultures. The Western idea of productivity, as someone in class so eloquently put it, seems to be a lot about "making stuff," or improving the efficiency of the "machine" that is our goods-producing culture. The very English word "productivity" contains within it the notion of manufacturing or creating products. Thus, in this context, depression seems to be an inherently unproductive condition: to lose energy and motivation to work for this cultural machine is to slow its progress, hinder its ends, and therefore to be a "malfunctioning unit." As has been mentioned in other discussions, this notion appears to permeate the current psychiatric paradigm; patients with depression are often assessed in terms of and treated with the goal of improving their "functionality," or ability to rejoin society as a contributing member.

But might productivity be defined differently in alternative cultures? As the readings indicated, many Eastern cultures harbor much more collective mentalities. It is not clear from this, however, that those with depression in these societies wouldn't suffer from many of the same problems as those in Western cultures. Although perhaps less individualized, there remains a focus on becoming integrated into culture, and thus someone with "low motivation" may feel similarly excluded and alienated.

Is it feasible to imagine a culture in which the ends of "productivity" were defined on an individual basis? Where to be the most productive is to deal with problems and personal tragedies in one's own way, and to the fullest extent necessary? In this case, depression as a coping mechanism may in fact play a productive role: to recuperate energy in recovering from emotional trauma. What if the end of a culture was for its members to attain the most accurate, objective view of the world possible? Then the realism that accompanies depression may also play a productive role. But it seems like the question then becomes: are these worlds that we would want to live in? Would we feel comfortable assuming the responsibilities of sustenance (e.g., hunting and gathering food) while others cope with a death for years after? Would we want to live in a world where our perceptions and estimates were accurate but bleak? Or more generally, would we want to live in a world where depression is a productive construct?

Paul Grobstein's picture

depression, illness, culture, and cultural change

Interesting conversation last night.  Some thoughts that stuck in my mind, that I want to mull further, maybe return to in conversation at some point ....

I was struck by the extent to which the argument that disabilities/mental "illnesses" as a function of interactions between individuals and cultures was't useful because, while perhaps true, cultures are what has been collectively created/agreed to and can't in any case be changed.  My own sense is that acquiring the ability to be critical of cultures one is familiar with is an essential element of being a scientist, or for that matter of being a responsible citizen of any kind.  And it seems to me demonstrably not true that cultures can't be changed.  Both the civil rights movement and the gay rights movement are relatively recent examples of cultural change generated by people able/willing to not only look critically at culture but to act on the critique.  Disability rights has also begun to be an effective culture changing movement.   Perhaps we could contribute to some culture change re "mental illness"?

Along those lines, I was intrigued by the thinking we did together about reasons why calling mental health problems "brain illnesses" might not be the best way to go.  "Illness" labels tend to isolate people from the larger culture (create a "them" as distinct from an "us"), to diminish their identities (s/he is bipolar, as opposed to s/he is someone with bipolar characteristics), and to, relatedly, diminish their perceived agency (you need to cede power to an authority).

I think there are real possibilities in an alternative that emerged from our discussion: to speak not of "disability" or "illness" but rather of "difference."  That, along with a recognition that we are all different in various ways, might avoid the tendency to dissociate people from the larger culture and make it easier to treat characteristics as aspects of their identity rather than the totality of it.  Acknowleding that we all cede authority to other people at various times for various reasons (we all need "help") could as well help with the perception (by both others and ourselves) of diminished agency.  

On a somewhat more local scale, I think there were some intriguing possibilites opened for some alternative research into depression (and perhaps other mental "illnesses").  I'd very much like to know whether in fact "mood variation" (and personal discomfort) is secondary to low energy and low motivation, and is perhaps a less characteristic feature of depression in cultures that are less competitive/"rigorous"/demanding.  And I'd like to know to what extent various aspects of depression can be exacerbated/alleviated by various kinds of interpersonal interaction.  I'd also like to see some serious followup of suggestions that aspects of depression may in fact be "productive" rather than "detrimental" (with appropriate attention to variations in cultural definitions of these terms).  

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