The Social Nature of Mental Illness

The summer issue of the Wilson Quarterly  contains a fascinating piece by Stanford anthropology professor Tanya Marie Luhrmann on our changing understanding of mental illness. (You may recognize her name from her recent book  When God Talks Back , which Peter Berger  reviewed in our April issue .)

Focusing on schizophrenia as a particular exemplar of this change, Luhrmann examines the evolution of psychiatry from psychoanalysis (mental illnesses are caused by emotional conflict) to a purely biomedical scheme (mental illnesses are caused by genes) to present theories, which incorporate both the biological and the social causes (and treatments) of mental illness.

Along the way she covers the problems with antipsychotic drugs, the complexities of genetic research on disease, and the surprising ways that culture shapes our experiences of and reactions to disease.

You should read the whole thing , but here’s one particularly interesting section:

Schizophrenia has a more benign course and outcome in the developing world [than in the wealthy, industrialized nations]. The best data come from India. In the study that established the difference, researchers looking at people two years after they first showed up at a hospital for care found that they scored significantly better on most outcome measures than a comparable group in the West . . . . No one really knows why Indian patients did so well, but increasingly, psychiatric scientists are willing to attribute the better outcomes to social factors. For one thing, families are far more involved in the ill person’s care in India. They come to all the appointments, manage the medications, and allow the patients to live with them indefinitely. Compared to Europeans and Americans, they yell at the patients less.

The pushback [against purely biological theories] is also a return to an older, wiser understanding of mind and body. In his  Second Discourse (1754), Jean Jacques Rousseau describes human beings as made up out of each other through their interactions, their shared language, their intense responsiveness. “The social man, always outside of himself, knows only how to live in the opinions of others; and it is, so to speak, from their judgment alone that he draws the sentiment of his own existence.” We are deeply social creatures. Our bodies constrain us, but our social interactions make us who we are. The new more socially complex approach to human suffering simply takes that fact seriously again.