4.3 culture and mental health

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En provenance du cours de University of Toronto

The Social Context of Mental Health and Illness

96 notes

University of Toronto

The Social Context of Mental Health and Illness

96 notes

Learn how social factors promote mental health, influence the onset and course of mental illness, and affect how mental illnesses are diagnosed and treated. This course explores how our understanding of mental health and illness has been influenced by social attitudes and social developments in North America and around the world. The course begins by situating our contemporary mental health practices in historical context, then looks at different aspects of mental health, mental illness and mental health services and their connections to what’s going on in our social environment.

À partir de la leçon

Culture, mental health and mental illness

4.0 introduction to lecture 4 4:08

4.1 culture mental health mental illness 7:30

4.2 culture & mental health in historical context 15:19

4.3 culture and mental health 14:03

4.4 culture and mental illness 11:41

4.5 an example of intersections between culture and mental health 8:09

4.6 cultural competence and multicultural mental health care 12:23

4.7 Conclusions 2:33

Rencontrer les enseignants

Charmaine Williams
Associate Professor
Faculty of Social Work

>> Okay. So now, we're going to move ahead 40, 50

years, and we're going to talk about the contemporary context for culture, mental

health, and mental illness. So I'm actually going to start us off with

talking about culture and mental health. Really looking at practices that are

outside of the mental health care system, for the most part.

I think this is good for us to cover for a few reasons, one is, I think, it's,

important for us to realize that, although there has been this dominance of western

methods, and medical methods for treating mental health problems.

There are other methods that have been in existence long before that, and that

continue to be in existence now, that people use, in various parts of the world.

But also, in even the west, and the other things is, more and more, we are finding

that when you actually talk to people about what they do to promote their mental

health, they are usually mixing, medical treatments with what we might call

complimentary or alternative treatments that are from some of these traditions.

So, while we tend to talk like there is this division between, medical and

non-medical treatments, the truth is, for most people, there's a mixture.

And a lot of us are, dabbling in both worlds when we're trying to think about

how to promote our mental health, or even to deal with the specifics of a mental

disorder. So with that introduction, I'm going to

take us into culture and mental health. Our discussion about culture and mental

health is going to focus on the ways that different cultural traditions have

addressed the promotion of mental health, and the treatment of mental illness.

So I want to start us off by positioning what I'm going to call traditional

knowledge. There can be a tendency to think of

traditional knowledge as knowledge that is old but with a negative connotation that

it is also then outdated, backward, primitive, unscientific and all kinds of

other negative things that mean it's not useful in contemporary times.

However, I believe that traditional knowledge should be understood as

knowledge that has been in place for a long time, and that has an ongoing

presence. Because it has proven itself useful for

meeting the challenges it's designed to address.

Tradition, like culture, has its roots in the past, but it continues to evolve in

response to changing circumstances and changing needs.

The idea of traditional knowledge is closely linked to an understanding of

indigenous knowledge. In the same way, indigenous knowledge is

knowledge that has been developed over the long-term, usually within a specific

locality, to meet the needs and challenges faced by a specific group or society

within that locality. Rather than dismissing it as something

that is outdated, archaic and unsophisticated, it needs to be understood

as something that has stood the test of time and stood the test of various

circumstances for a very long time. This type of traditional or indigenous

knowledge, is the basis for many of the culture-based approaches to mental health

that we encounter all over the, the world. I'm going to start by talking about the

approach to mental health that has been described for Aboriginal peoples in

Canada, because I'm doing this course in Canada, and mindful of the fact that this

land was first occupied by peoples that had knowledge and traditions that proved

useful to them in the past, and can continue to be useful to them in the

present. The report on aboriginal perspectives of

mental health that you see me citing here is available on the internet and the link

is provided in your resource list. From the perspective of Canada's

indigenous peoples, health is supported by balancing the four dimensions of life: the

physical, the mental, the spiritual and the emotional.

Some of you may be familiar with the representation of these dimensions in

something called the medicine view. Indigenous perspectives on health, also

focus on the interconnection between the well-being of all living things, which

includes individuals, families, communities, animal life, and the physical

environment. This represents to some extent, the

ecocentric persp-, perspective that was mentioned in the paper that we read

earlier about colonial determinants of mental health.

Ill health is believed to result from the disruption of this crucial balance between

the four dimensions of health. In addition, health is affected by the

connection to other living beings. So if there's damage or disruption in any

of these systems, then the others are affected as well.

Within that framework, healing is focused on the restoration of balance and

reconnections across the systems of individuals, families, communities, and

nature. This indigenous perspective actually gives

us a different way of thinking about the elevated levels of mental and physical

illness in aboriginal communities. Colonialism has not only created

circumstances that create negative determinants of health, but has also

created circumstances that break these connections that are so crucial to

well-being. The indigenous perspective is a good

demonstration of the approach that Suman Fernando describes as representing much of

the way that the non-western world approaches mental health.

Mental health is not focused on just the treatment of illness or disease, but

instead it focuses on ways to deal with the everyday stresses of life, addresses

potential illness, and promotes spiritual development.

In Suman Fernando's book, Race, Culture, and Mental Health, he introduces us to

five types of culture based treatments that address these purposes, and we will

address them briefly. They are herbal treatments, acupuncture,

yoga and meditation, trances and dreams, and spiritual healing, these are all

coming up. Before we talk about the specific

treatments, it's important to know that Fernando warns us that culture-based

treatments are not always transferable. Although a given approach to care may work

very well in its original context, when it is transferred, we have to be cautious.

It is possible that the interventions may not be transferred accurately, or that

they are not as effective when they are used outside of the original cultural

context. Another important consideration, is that

the introduction of one cultures method of healing into another may result in

disruption of the important healing elements that are present in the host

culture. Most of the treatments I am about to

address have been adopted or adapted for use outside of the original cultures and

with all of them I think it is interesting to consider.

Do they maintain their effectiveness when they are removed from the original

context? So we're going to start with herbal

treatments. Herbal treatments are focused on balancing

systems of the body. Many healing traditions include practices

of the administration of earth, plants, and roots to promote health and healing.

There's often a strong emphasis on the procedures that are surrounding the

growing, harvesting, preparation, and use of these substances.

In addition, the herbal, the herbal practitioner themselves must have specific

qualities in order to use these substances properly and effectively.

In the west we have adapted and adopted many of these treatments.

One way in which we've adapted some of these treatments is through the

manufacture of pharmaceuticals. Another way, is that we increasingly see

the marketing of herbal treatments to promote health and healing.

One example that comes to mind quickly, is the use of Saint John's Wart to treat

depression. Not surprisingly, medical specialists and

pharmaceutical companies are getting involved with the prescription of herbal

treatments as well. Acupuncture is a treatment that originated

in China and it is used to balance the forces of yin and yang in the body.

Now a full description of this is beyond the scope of this lecture, but traditional

Chinese medicine has its own system of diagnosis and treatment, and acupuncture

is a possible recommendation for healing, that would also include things like,

recommendations for the diet, exercise, and living according to specific

principles. Acupuncture has certainly made a

transition to western context, although its application is mostly for the

management of pain, so it's used in, in quite an isolated way.

Yoga and meditation are practices with very long histories in many cultural

traditions, and it's often associated with spiritual practice, but also has

applications to the overall maintenance of health.

Goals such as obtaining liberation or enlightenment, the relief of suffering,

cultivating attention and detachment speak to the mental and spiritual benefits of

such practices. This type of contemplative practice, is

part of many religions, but it is also applied within secular context.

You are probably noticing that I've mentioned mindfulness here.

Mindfulness is part of the spiritual and mental practices, but in its translation

to the West, it has been mostly associated with stress reduction.

Yoga, in particular, has become a type of exercise, far removed from its spiritual

roots, but of course, that doesn't mean it isn't still benefi-, beneficial for

promoting mental health. Trances, dreams, and altered states are

used in many culture traditions to facilitate communication with spirits, or

to gain insights that are not otherwise available, they are often considered part

of conventional practice for maintaining health, because communication with the

spiritual world, is considered part of maintaining your health.

But then it can be used to treat specific problems or disorders.

As assessed here these altered states can be induced by using substances under the

direction of a practitioner, and they are usually embedded in some kind of family or

community treatment process. So I'm not sure what exactly to say about

Western adaptations. There are definitely people using

substances to induce altered states but I'm not sure that I can comment on how

much of this is used as part of a heath practice and how of this is used for other

purposes. One of the most tangible examples I could

think of for the western adaptation of trances dream and altered state, was the

use of hypnosis or hypnotherapy, Which is sometimes used to treat issues like

addiction or sometimes used to help people who are dealing with trauma.

Finally, spiritual healing can cover a lot of practices within many traditions, some

of the things that are included are rituals, meditations, prayers, and there

are many who will point to spirituality or religion as something that aids in the

maintenance of mental health. Though I do know that in the forums there

was some discussion about whether religion helps or hurts your mental health, so I

realize we don't all agree about this. Part of what makes spiritual healing work,

is that in its traditional use it is not an isolated practice.

Although the person is helping themselves, they are usually doing it within a

community that provides additional social support and mutual support.

I want to make special mention of exorcism here, because its understanding has been

so distorted by, well basically by Hollywood, I think.

[laugh] Exorcism in its traditional form is based on an idea that illness is caused

by an undesirable presence that must be removed, but not through the kind of

dramatic, horrifying circumstances you may remember from films, like The Exorcist;

but through a process that is built on compassion for the person who is occupied

by this undesirable presence, and also for the presence itself.

This is beautifully demonstrated in the YouTube clip, that I'm going to recommend

you watch at the end of this section. I'm not aware of any mainstream western

adaptations of exorcism, but I will say it reminds me of an approach called narrative

therapy, in which problems like depression are treated as unwelcome intruders in a

person's life. People will actually talk about when

depression entered their life, the affect that depression has had on them.

The model of therapy focuses on trying to understand how this unwelcome presence

called depression, entered the life. What effect does it, what affect it has

had, and how its Influence can be reduced or eliminated.

I think that this method of therapy and this type of spiritual practice have in

common is the desire to have a person see the potential for being freed from

whatever is causing their distress. However in the spiritual context, there's

also the involvement of some kind of community of supporting people who are

attempting to help you free yourself from this presence.

So what can we take from these various traditions that might point us towards

some kind of transcountral, trans-cultural principles for mental health?

First, that there is a need to develop a shared meaning for what is causing

distress or illness. This may be a shared meaning between the

practitioner and the person suffering, or between a doctor and his or her patient,

or between an individual and the family or community that is trying to help him or

her. Second, there is an importance attached to

giving people roles and responsibilities in the healing process, so there is a

clarity about what is to be done and by whom, and people are not seen as passive

or helpless in the healing process. Third, a healer must communicate hope,

optimism and confidence in the methods that they are using.

When people are in distressing circumstances, it can be very difficult to

sustain hope for a better future. Traditional methods suggest that holding

this hope, and communicating this hope is an important role for the healer or

practitioner. Lastly, ritual has an important role to

play. An understanding that there are

standardized ways of approaching these highly unusual circumstances, is often a

reassurance to people who find themselves in those circumstances.

And participation in some kind of set of procedures is another way of helping

people to feel empowered And active in their healing process.

So I would suggest that there's actually quite a bit we can learn from traditional

healing practices. And it's really no surprise that so many

people combine that with mainstream medicine or even opt to just go for the

so-called healing, so, so called traditional or alternative treatments

rather than using the mainstream medical healthcare system.

As I've already said there's a beautiful demonstration of these principles in the

You Tube segment I'm going to refer you to now.

One of the students in this course sent this link to me before the course started

and I'm very glad to have the opportunity to share it with all of you now.

It is an amusing, but very educational look at an American mans experience of

being transferred into a healing context that was very different from what he had

experienced before.

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