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December 13, 2019 - February 27, 2020
One of his patients once told him that anorexia felt like getting on a train, only to discover too late that she was headed in the wrong direction. This patient felt she had little choice but to stay on that train to the final destination.
“As doctors’ own ideas about what constitutes ‘real’ disease change from time to time due to theory and practice, the symptoms that patients present will change as well,” he writes. “These medical changes give the story of psychosomatic illness its dynamic: the medical ‘shaping’ of symptoms.”
Shorter believes that psychosomatic illnesses (such as leg paralysis at the turn of the twentieth century or multiple personality disorder at the turn of the twenty-first) are examples of the unconscious mind attempting to speak in a language of emotional distress that will be understood in its time.
When someone unconsciously latches onto a behavior in the symptom pool, he or she is doing so for a very specific reason: the person is taking troubling emotions and internal conflicts that are often indistinct or frustratingly beyond expression and distilling them into a symptom or behavior that is a culturally recognized signal of suffering.
Because the patient is unconsciously striving for recognition and legitimization of internal distress, his or her subconscious will be drawn toward those symptoms that will achieve those ends.
Slowly but steadily, in the early 1990s he noticed mental health providers around him succumbing to a kind of color-blindness, an inability to see the cultural and individual differences in the patients they interviewed.
Not surprisingly, popular book writers, researchers, and mental health educators are loath to see themselves as a vector transmitting the disease they hope to eradicate.
The idea that people from different cultures might have fundamentally different psychological reactions to a traumatic event is hard for Americans to grasp.
“A victim processes a traumatic event as a function of what it means,” they wrote. “This meaning is drawn from their society and culture and this shapes how they seek help and their expectation of recovery.”
The mother offered no promise of protection or even survival, only togetherness in the face of violence and death.
“There is a method of talking,” she said, “talking with our eyes, our face, with our whole posture, we must tie them to us.… We take the information out of the clients.… We put them in a position in which they can’t keep any secrets.”
What we say about mental illness reveals what we value and what we fear. JULI MCGRUDER
Researchers believe that the experience of being criticized or constantly observed and judged parallels the experience of the disease itself.
“When humans do not assume they have rather complete control of their experience, they do not so deeply fear those who appear to have lost it.”
The problem, it appears, is that the biomedical or genetic narrative about an illness such as schizophrenia carries with it the subtle assumption that a brain made ill through biomedical or genetic abnormalities is more thoroughly broken and permanently abnormal
If the irony isn’t already obvious, let me make it clear: offering the latest Western mental health theories in an attempt to ameliorate the psychological stress caused by globalization is not a solution; it is a part of the problem. By undermining both local beliefs about healing and culturally created conceptions of the self, we are speeding along the disorienting changes that are at the very heart of much of the world’s mental distress. It is the psychiatric equivalent of handing out blankets to sick natives without considering the pathogens that hide deep in the fabric.
