This is why I have no life. All I do is work and drink. I don't even get paid for this and it means I have do do more work at the weekend. It's my choice though. No matter how bad this depression is or how painful the misery and isolation it means I can get a lot done. I read a lot and that's how I know a fair bit amount mental healthcare, enough to know that I'm a wreck. C'est la vie. The school of hard knocks taught me well. Misery just is. It's part of life and an important part. It's not for everyone though and I'd want no one else to live the life that I lead. It'll kill them.
Sadly this response is the last thing the project will want to hear. This is the problem with a lot of my consultation. I've asked my friend to soften the blow, which is basically me saying this lovely project to help people suffer less after a disaster runs the risk of just spreading a Western ideal which hasn't really proved successful in providing better outcomes and may cause the worse outcomes by calling it mental health and mental illness. Empowering local systems might be a better idea but this isn't the point of the project... It will be interesting to see the response to my response.
Anyway, here are some snips from the response.
Cultural awareness is important. Basically mental illness is a Western concept and a construct rather than a real illness. Post industrial age developed world society shifted significantly and created the forms of exclusion which meant that the mad would, for example, be put on ships and cast out to sea to drift to the next town or die. In a great act of compassion the old leper houses became the homes of the severely mentally ill where they could be kept and looked after. Then psychiatry was invented. The 'illness' is the prognosis of poor outcomes in life but those are a problem caused by a society and people who disadvantage people who are different.
Other countries didn't have this same process though the more Westernised countries (/developed world nations) in the East are getting into the dogma of psychiatric thinking. And perhaps the outcomes will be as poor there as they are in the West, because certainly for schizophrenia people do better in developing world nations without mental healthcare systems. The factors of exclusion and poorer social outcomes are less harmful in these nations and happen less in my opinion.
Religion was the dogma before and as it waned in the West so did the function it provided, for example community through the church, an explanation for suffering or unusual behaviour and confession as a form of psychological therapy.
I think religion still has a lot of power in Pakistan. There is the option to support the Islamic religious organisations to do what they do better as well as bring in the white man's new religion (sorry. This might be inappropriate language but I feel it makes the point rather well. You can edit it).
It may also be worth considering how the Muslim religion considers these events. I assume they've spoken to local Imams - think that's what the priests are called. Anyway, using the psychiatric dogma, even if it's one based on a psychosocial paradigm, may not be as effective as using the dogma which the culture already uses. If people start going around saying "depression....seee a doctor" rather than saying "really unhappy....how can I help them" then this causes poorer outcomes and is one of the root causes of the problems of mental illness in the West in my opinion, one which I'm happy to elaborate upon with a pint in my hand. I see that one of the goals is building community but this isn't achieve when the community start considering misery is an illness and individuals should see a doctor to resolve it. It's an ill society which thinks like that.
Just one more example o how religion does what mental health does. I studied Islam at GCSE and was amazed to find out that some Islamic cultures dictate that after death (perhaps this is only women but maybe men too) people must grieve properly for a month. They must shout and wail and cry - essentially act out - for a solid month to get it all out. Everyone supports them during this time. After a month that's it. Just get on with life after that. Psychiatry on the other hand makes an exclusion for grief in the diagnostic criteria for depression. It is 6 months of experiencing the symptoms of depression before it can be called depression if the trigger is a death - and really then it's sort of an adjustment disorder but I really don't know a lot about those or the differentiation. (In practice I'm sure doctors do offer grief counselling before 6 months but they'd be very unlikely to prescribe antidepressants during that period).
For example dance therapy might be more culturally appropriate. There is a sub-culture in Islam which dances...not sure if that's in Pakistan though.. They spin around and stuff. http://www.youtube.com/watch?v=GJIofU-0jC0
This is sort of inline with the cultural sensitivity point but this is about psychiatry itself. People in different countries present with different symptoms to those in the West. It's already observed that the Western symptoms underrocgnise male depression and the diagnostic criteria for depression is also fundamentally biased against male expression of subjective unwellness (studies show that men and women roughly equally say the feel bad but as the psychiatric diagnostic cluster of symptoms is added men get their misery underrecognised more than women do).
My fave example of this problem is how the diagnosis of anorexia in Hong Kong changed after a media story. A girl dropped dead in the street with anorexia so the journalists went online to get diagnosis information. They'd have got the information from the stuff in Wiki which is based on DSM or from other sources which might use ICD. In fact local psychiatrists didn't diagnose people using either criteria. They knew from their clinical experience that people present with totally different symptoms. None of the journalists contacted the girls psychiatrist to understand what were her specific symptoms. What's extraordinary is after the media story local psychiatrists found people presenting with Westernised symptoms.
http://www.nytimes.com/2010/01/10/magazine/10psyche-t.html
So this rather lengthy point is about training people to recognise local symptoms. This means involving local psychiatrists. There's little point in training people to recognise Western symptoms if they people there present with different externalisations of misery or have different cultural values. It may also be inappropriate to pathologise a woman wailing after her husband's death as depression when the culture understands that it's their way to express it.
Technology
There's a key problem with natural disasters and healthcare: the telecommunication network goes down. When a disaster happens the network which is being built may not be able to communicate.
There's this professor geezer. Crazy genius type. He's developing a shoe phone. That's not what we're interested in though. He's also developing telecoms solutions for disasters. One of them is mobile phone masts that can be parachuted in to create a temporary local mobile network. The smartphone is the other bit of clever tech. He's written this bit of code which means that smartphones with wireless can create a mesh communication network - essentially the network is created through the phones acting as masts for each other. The project is called Serval - http://www.servalproject.org/ and the shoe phone can be found here - http://realshoephone.com/
Regardless of this possibility the problems of telecoms going down during a natural disaster need to be considered. There may be a simpler solution, for example long wave radio, which already works. These would add to the cost of the project but imagine what happens in a natural disaster when the network of trained quasi-therapists have ways which people can still communicate. People will come to them to use the radio or walkie talkie or whatever communication tech they have and this creates the opportunity for people to come to get mental healthcare. In a disaster people go to get food and water and medicine. Those are the essentials. The next step is finding out about their loved ones. Their concern isn't usually to go see a therapist. You can finish off the logic for this one yourself. It will significantly increases costs of course but it delivers two positives: the network of quasi-therapist can still communicate after a disaster and the people affected will actively access the network which provides the mental healthcare. Otherwise I don't think they'll bother. It's just practical and stuff.
-- Don't let justice be the privilege of the elite. Support the Justice for All campaign http://www.justice-for-all.org.uk/
No comments:
Post a Comment