IT’S NOT ALL IN YOUR HEAD: HOW MENTAL ILLNESS MANIFESTS ACROSS CULTURES

By Becca Chong
Staff Writer

Depression affects 350 million people worldwide, It is the leading cause of disability, a major contributor to the global disease burden, and one of the most underfunded areas of healthcare in the world. Even in developed countries like the United States, where there is abundant research and resources dedicated to mental health services, the proportion of people who can access them is comparatively small.

In the United States, the Diagnostic and Statistical Manual of Mental Disorders is used to diagnose depressive disorders. There exists an overarching family of disorders, including major depressive disorder, mood dysregulation and even substance-induced depression. The criteria for these disorders are based off of symptoms such as a depressive mood and feelings of hopelessness, reduced interest in daily activities, the inability to sleep, and suicidal ideation. These diagnostic factors are specific to a Western population that has been extensively studied.

However, not all cultures and populations in the world experience mental illness in the same way. Many cultures have different “idioms of distress”; that is, they experience somatization in which psychological distress is often presented as physical symptoms of anxiety. The increased understanding of variations for depressive symptoms has shifted popular belief that depression is “an American affliction” to one that affects people on a global scale.

Take, for example, how depression presents itself in the Chinese population: as a set of physical symptoms that resemble heart disease and other illnesses rather than a psychological manifestation. Neurasthenia is one such example of how psychological distress leads to physiological symptoms such as fatigue, headache, heart palpitations and even high blood pressure.

The reasons for this difference in presentation are thought to be related to the culture-specific values of the Chinese population; the emphasis on interpersonal relations over intrapsychic concerns, the privacy of personal matters, a prevalence of the externalizing coping method, and an emphasis on physical well-being. All this, in addition to the stigma of mental illness, makes admitting to having neurasthenia much easier that admitting to having depression.

Structural factors also sanction the somatization of depression through physical symptoms that resemble neurasthenia. The work-disability system and the ability to claim chronic illness allow for a reprieve from the tedium of work in such way that the somatization of mental illness is beneficial. The history of using illness to withdraw oneself from a dangerous situation, such as the political unrest of the Cultural Revolution, is yet another reason that the category of physical disease is much more socially beneficial than claiming a stigmatized mental illness.

All this is to say that mental illness diagnoses are culturally-mediated and subconsciously constructed to best suit the environment that the people live in; it is a form of evolutionary survival. Western frameworks of mental illness are not completely compatible with other cultures and have implications for designing mental health care services that will be effective and useful for the people they serve. More research is being done worldwide to learn about these cultural differences that will hopefully bring us to a world where mental illness is treated extensively and competently as a physical diseases.

Image by: Internet Archive Book Images

THE CUTTING, THE VIRUS, THE FISTULA


Joyce Sunday
Staff Writer

I can never forget the girl, how the women held her down with the sharp blade ready to cut off her female genitalia, and her innocence. As the blade started coming towards her direction, she began to struggle, cry, and scream. All those tears fell on the deaf ears of the women strongly holding her down, spreading her legs wide open. I couldn’t watch, so I left the room, though her shouting pain echoed in the silence. After a few minutes, she was taken out of the room by her mother, her legs tied. She had been abused, but now was rewarded with gifts because the experience had made her a woman. This was the first time I ever experienced the female genital cutting, or rather what my society will call the “womanhood initiation ritual” of a five-year old Nigerian girl.

Female genital cutting is the “partial or complete removal of the clitoris”, or inflicting of other injuries to the female genitalia. Girls are often subjected to cutting before they reach the age of puberty, though cutting still may occur anytime between puberty and marriage as well. There are three major types of female circumcision: type I is the clitoridectomy, type II is the excision, and type III is the infibulation. The clitoridectomy involves either the partial or whole removal of the clitoris organ. The excision type is the partial or whole removal the clitoris organ, as well as the inner labia, which may be accomplished with or without removing the labia majora. The infibulation, which narrows the vaginal opening by creating a seal, is the most severe type of female circumcision and is performed by cutting and repositioning the labia. After this procedure the two sides of the vulva are stitched together to cover the urethra and prevent continuous bleeding.

In most countries circumcision practices are performed by untrained operators who have limited understanding of the female anatomy, and also often lack surgical skills. The clitoris has about eight thousand sensory nerve endings, and it is located at a very sensitive neurovascular area of the female genitalia. Any attempt to remove or alter a tiny amount of tissue can cause serious medical and physical problems. Certain medical complications like severe pain, prolonged bleeding, and hemorrhage can cause death or immense shock for the victims of female circumcision. In some cases, while the victims are still alive, prolonged bleeding can cause severe anemia which can affect the development of the girls. Some infections such as tetanus, ulcers, septicemia and gangrene have been encountered after the circumcision procedures as well. In third world countries especially, unexperienced operators perform surgery with unsterilized instruments, leading to the spread of the human immunodeficiency virus, Hepatitis B and other blood transmitted infections. The infibulation is the most severe type of circumcision, and can cause long-term health complications because it affects urine drainage, as well the flow of the menstrual blood through the vagina. Pelvic inflammatory diseases that arise from infibulation can lead to infertility, pelvic pain and painful periods (dysmenorrhea). Yet another medical condition that can arise from circumcision is keloid formation, which may cause pain, itching and disfigurement of the female genitalia.

Intercourse, pregnancy, and childbirth can be more difficult for circumcised women. Female genital cutting reduces the size of the vagina, making it difficult for its victims to have sex, or give birth, without being in pain or having their genitalia skin ripped apart. During birth, the head of the fetus may be impeded by the stitched up area of the genitalia, resulting in intense contractions that can cause perineal tears. When the woman has a weak contraction and the delivery of the baby’s head is detained, the fetus may die. This may additionally result in necrosis of the genital septum, which is the separating of the bladder and the vagina, ultimately leading to vesicovaginal fistula (VVF). Vesicovaginal fistula, also known as a type of female urogenital fistula (UGF), is a condition which allows the continuous discharge of urine without any control.

Female genital mutilation affects millions of women worldwide, and thankfully, a known reversible surgery exits. One by one, female genital circumcision survivors are being cut for a second time, but now to reclaim what they lost. The “defibulation” procedure, also known as female circumcision reversal operation, is not performed by many surgeons. Luckily, a select few doctors, such as Dr. Marci Lee Bowers of the San Mateo Surgery Center in California, is an American gynecologic surgeon that has performed this rare surgery on over one hundred patients. Most of her patients are women born in Africa, but now living in the United States. She was the first surgeon in the United States to ever carry out this reverse surgery. According to Dr. Bowers, after the reverse surgery, the clitoris is still found even in the worst cases of female circumcision. When the scar tissue is opened and the mutilation is reversed, the female genitalia can be restored, which will bring back the sensuality of the clitoris. Despite these efforts, there is still a need for more research and investment to provide additional surgical techniques that would be accessible to the victims of female genital mutilation.

Image by Jackson