This is an area I might have covered already but I want to write about it again because it's so important to what mental health is. This is something I've spent some time considering but haven't yet come to grasp what I'm talking about.
The impact of society on mental health is large and multifaceted. Society at large influences psychiatry as it does people.
A fascinating case study detailed in Ethan Watters erroneously titled the Americanization of Mental illness shows what influences other than the individual can do to mental health as do other chapters of the book.
An anorexic drops dead in the street and the Hong Kong media report the story. The journalists reach for Google or whatever search engine they prefer. They inevitably read the Wikipedia entry as well as other sources.
The problem was the dead anorexic didn't present with those symptoms listed online. In Hong Kong psychiatrists used to see a different presentation to anorexia though, I assume, they expected the same prognosis and treatment. Online are the Westernised reference symptoms but psychiatrists see different presentations (symptoms) across the globe.
After the media story disseminated the Western symptoms to the Hong Kong public consciousness local psychiatrists found more people presenting with the reference symptoms rather than the usual local ones.
A media story changed the presentation of a mental illness. This is a strange result and not well known nor, I guess, understood.
One of the little tit bits I use to convey mental health information to people I meet in the pub.
It's not just geography which can affect mental illness. Around the time that modern psychiatry came into existence there was an epidemic of hysteria. Epidemic is not hyperbole. Hysteria was a mental illness which Kraeplin, Jung and Freud all tried to tackle because of its very high prevalence.
It was often women who had hysteria but I'm afraid I don't know the exact percentages. One common treat was to give a woman a paraoxial orgasm. Usually by hand a doctor would proceed to stimulate a woman until she climaxed.
What would now get a doctor struck off was then a common practice treatment. The only problem the doctors had with it was their arms would get tired. This was the Industrial Age and so someone invented a steam powered device to do the job which doctors were doing. And so the vibrator was born.
It is extraordinary to consider that in the space of two centuries the hysteria prevalence has dropped dramatically. Conversion disorders, as they're now know, have a prevalence of inidence of about 1% (the Wiki page is wrong. Conversion disorders are the modern diagnosis for hysteria. Diagnoses relating to sexual dysfunction might present and be detected as a conversion disorder but the majority of disorders of sexual function don't. Conversion disorders are about the display of psychosomatic symptoms which are the hallmark of hysteria.
So what happened apart from the name change? Was it the vibrator? I doubt it though it's amusing pub banter to consider it. (Too frequently the conversation drifts to "so there's a truth behind when people say she just needs a shag and she'll be alright." A funnier response was...a woman goes to see a therapist because she's not feeling herself...this was by a Norwiegan artist friend of mine.)
Sexual mores were very different then and women weren't so ready to find release sexually or enjoy carnal pleasures, at least openly. Whether the paroxial orgasm worked on not is unknown. It is my guess it was the sexual revolution which changed things as well as a greater acceptance of women's behaviour without the stigma and pathologisation, perhaps as a factor of the equality movement whereby men lost a lot of power over the social judgements of normal behaviour. After all, it was likely husbands complaining about their insufferable wives which brought women to the doctor in the first place all those years ago.
I'm just guessing though. There have been lots of changes in society since psychiatry was invented. Unmarried mothers and homosexuals are no longer mentally ill. There has been a small amount of progress in my opinion. Sadly the number of diagnoses and the percentage of the population who are pathologised has swelled.
Along with psychiatry the Industrial Revolution brought many changes. The demise of religious power was one of them and it is my view that psychiatry took over a lot of the function of religion. But everything changed.
Mass education is one example. Before then Industrial Revolution there was no public schooling. This was a privilege for those who could afford it. Pip in Oliver Twist was lucky to go to school. The Dickens story has more relevance to the modern public because of this but they forget that only the very rich went to school back then.
Mass education is one example of the cheap standardisation which came with the paradigm of progress of the Industrial Revolution. "They can have anything they want as long as it's black" epitomises the tenet of standardisation.
Children had to begin to live standard lives too. They had to wake at the same time, arrive at school, concentrate in lessons and learn to do what they're told. And, of course, they became smarter and more productive through their conditioning.
Schools became a way to prepare people for the jobs they would do for life. Military schools like Sandringham would make the cadets who became the generals of the future. The children in these schools were conditioned in the same way but more so targetted to their future life job, their application to the engine of society.
The military went through changes too. Hierachy and routine became more important. Uniforms and training for even the lowest ranks fostered professional soldiers as the standard core of the modern army, much like the Romans had before.
In all areas of life this new change improved things for most people. The average length and quality of life rose rapidly but at an equal pace so did inequality and the gap between those best and worse off.
It is a sort of strange concept but it's fairly obvious in a way. The good things of the Industrial Revolution brought some bad things.
At the end of the Agriculture Revolution most people were poor by Industrial Revolution standards and died much earlier. In the IR a lot of people did better. They had better quality of life and longer, healthier lives. It wasn't just the advances made possible by science applied to medicine. It was a more regular food supply. It was the cleanliness from sanitation which reduced illness and spread of illness. Other factors also meant a lot of people were advantaged by the the progress of the Industrial Revolution.
Some weren't. Some did not do better and perhaps worse than before the Industrial Revoltion. Some were left out not only by the technological changes but by the social changes too.
Towns and cities teemed with outcasts, homeless, poor and/or crazy people. These were those left behind by the significant evolution of humanity. The methods used to help or remove these people were not pleasant. One of the less tasteful ones was the herding of these people onto derelict ships which were pushed out to sea without care for their passengers. The lucky ones might drift to the next port whereupon supplies are more of their kind would be loaded onto the mad ship before it was once again cast out to sea.
This is mental health. This is why psychiatry came to exist.
The history lesson is worthwhile because I've spoken badly of psychiatry. It isn't fair. What I'm doing is making value judgements on the body of mental health. Ultimately the only truth I have is that is exists.
It means many things and serves many purposes. One purpose is as a corrective system. A few centuries changed the face of daily life in developed world nations. Some of the systems and changes meant some people were disadvantaged.
This is the prognosis manifest. This was also a reason for psychiatry to exist. The Poor Laws and Asylums Act were two legal instruments used to use buildings such as old leper houses and turn them into places to house those who were worst off.
This was the start of the instituion of psychiatry. Some or many of the caretakers of the asylums became the first psychiatrists. They were tasked with looking after their inmates who had been spared from a worse life outside the asylum....perhaps.
This is an act of compassion. It is how the medical profession usurped religion in formalising compassion for the worst off in a system of the modern age. No longer did the church look after these people. Atheist systems did this function of religion using the system which became psychiatry.
And yet there's a problem. The author Foucault is said to exsplain it much better. I tried to rerad Madness and civilisation but found the language impentrable. People have explained to me how he sees mental illness as a false construct. It's not just the power of psychiatry though.
In short, he calls the creation of the asylum system The Great Confinement. It was when they were housed that the mad disappeared from society.
I'm exolaining this very quickly. Imagine if any type of person was, for generations, summarrily taken out of society - from view - into a treatment facility where their behaviour - or just the expression of an internal force - would be changed.
The idea of medical illness came later. The notion to hide the symptoms of madness from societies view was never an aim. The aim was primarily compassionate, as it often is when things fuck up, to help those worst off. I don't know when the idea of treatment arose. It was something which existed throughout the medical professions history but a lot of the knowedlge of Hippoxrates and Galen was lost to religions which saw it as heretical.
Nonetheless, the symtpoms of madness z- the mad themselves - became prisoners without crime. They spent their lives in asylums and society forget they existed.
Society bowed to the power of psychiatry but the initial force which created psychiatry was the people themselves and what they did to the mentally ill.
The solution meant society developed differently. I personally would suggest that societ became maladapted. This is why the schizophrenia prognosis is worse in rich, developed world nations like the UK and US. Their society is different and treats the mentally ill much worse than in poor nations. The society - in a sense - is ill in that the misdevelopment allowed by the Great Confinement means people do worse off in affluent nations on the best quality research available.
The mentally ill are now found outside the asylum but they're still confined. What I mean is the current paradigm of treatment - treating the individual - serves to suppress behaviour, thought, action or whatever else. Mental health diagnosis relates to a treatment which heals the illness by changing the individual to be more normal.
It all serves to make the human race more homogenous. The effect of psychiatry is a system which sees people to be something to standardise. The reason is the prognosis - the worse life outcomes - for those who do not live standard lives or behave ina standard way or whatever other quantity determines a loweing of life outcomes.
....a lowering of life outcomes in the society - the time and place and culture - in which a person lives their life in.
This standardisation is made even more possible by the creation of the asylum system and the empowerment of psychiaty to suppress the unwanted difference which creates the worse outcomes. The more powerful and effective psychiatry is the more developed world nation culture can demand more standardised people. Anything less than this false grade or quality of standardisation means a human being will do less well in life.
The body of psychiatry, the institution, must understand this but it so rarely attemtps what is a new direction: change society to alter the prognosis and disability of disadvantaged people.
Has anyone seen trading places,....actually...hold on. I need to crack open another bottle of wine then i'l move on to the idea of a new dijrection for mental healthj. Well..it"s not new. Charities have been doing it in a small and unrecognised way.
Change society to change mental disability...and other disabilities.
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