Comparing Freud's Vulnerability To Emotion And Mental Disorders

"Emotional and mental disorder is widespread in human societies" (Ingham, 1996: 142). Vulnerability to emotional and mental disorder is inherent in the psychological characteristics of human beings because, like personality, disorder is a response to life events and particular social circumstances. Social experience and cultural settings are pertinent in the observation of the origins of disorder, as they affect both the inner experience of disorder and its outer manifestations. More important is an understanding that emotional expression - namely that of disorders such as depression, hysteria and schizophrenia - is both a natural and socially constructed part of social interaction (Ingham, 1996: 116). While a particular expressed emotion may
exist cross-culturally, its definition and conception varies according to the culture in which it exists. The importance of culture also rings true when it comes to mental illness.

"Emotion occurs within the mind and the body, but it is also a social phenomenon" (Ingham, 1996: 116). Human beings experience emotion when participating in social interaction, as well as upon remembering or imagining people or events. Positive emotions often accompany love, attachment and empowerment, while negative emotions are often a response to losses, including those of love, status or reputation. When people are unable to express their emotions, or when expression fails to bring relief, the result may be emotional disorder, such as depression or hysteria (Ingham, 1996: 118). The symptoms of depression include sadness, loss of appetite, disturbed sleep patterns, feelings of hopelessness and suicidal thoughts, as well as loss of pleasure in life. The common experiential core of depression in many cultures may be a feeling of meaninglessness and absurdity and a sense of emptiness and soul loss, while other symptoms vary (Ingham, 1996: 119). Verbalization of sadness, guilt and self-criticism is characteristic of westerners, whereas among people in many non-western cultures, depression may appear physically, in the form of fatigue, loss of appetite and energy, or bodily pain. While the outer symptoms of the condition may not be the same cross-culturally, the feelings associated with the actual depression are.

According to Freud 's reasoning, depression stems from identification with, and anger toward, a lost object.
In his view, the person in grief identifies with the missing object in the sense where it becomes part of the self. While his theory may be true when applied to western cultures where childhood losses and separations may be precursors of some adult depression, it is unlikely to be the case in societies such as Bali for example, where aggressiveness is inhibited. If one were to apply western ideas of depression to the Balinese, who are by nature passive and emotionless, the conclusion may be that they are all suffering from an emotional disorder. Therefore, it is almost impossible to define a mental illness unless by the standards and ideals of a particular culture. Dissociative reactions in the syndrome of hysteria include temporary psychosis and so-called mass hysterias (Ingham, 1996: 122). Hysteria itself illustrates the susceptibility to fragmentation in human personality, where the unconscious wishes and fears may take control of the body from the conscious ego, and the ego itself may develop separate selves. The severity of fragmentation can be witnessed in sufferers of schizophrenia (Ingham, 1996: 144). A person with schizophrenia may confuse the imaginary with the real, which can in turn radically undermine their capacity for productive activity and social relationships. Like depression and hysteria, schizophrenia occurs in social and cultural contexts, and the
ways in which these factors contribute to both the definition and understanding of the disorder have long been part of anthropological interest. This is due in part to the fact that while in western societies, a person showing schizophrenic symptoms who is acting out against the norm, may not be doing so when placed in a different cultural context. When comparing this western understanding of schizophrenia to a culture where sorcery and witchcraft are common in every day life, the 'crazy person ' is the one who does not care about the threat that these things pose. If a westerner were to talk of fear of witchcraft, his actions would be considered delusional and he will be labeled as having a mental illness, whereas in somewhere such as Bali, he will not. Ruth Benedict once remarked: "It does not matter what kind of 'abnormality ' we choose for illustration, those which indicate extreme instability, or those which are more in the nature of character traits like sadism or delusions of grandeur or of persecution, there are well described cultures in which these abnormals function with ease and with honor and apparently without danger or difficulty to the society" (Bendedict, as cited in, Bourguignon, 1979: 273). Thus mental illness is defined on the basis of what is 'normal ' in a particular cultural setting.

"Cross-national and cross-cultural studies suggest that the risk of becoming schizophrenic during a lifetime is about one percent" (Ingham, 1996: 147). Despite this, it is devastating for its victims and still a major concern for health-care professionals. Rather than a mere condition, schizophrenia is seen to alter entire personalities. "The subjective experience and overt symptoms may include lack of insight, forethought and self-control; gender identity confusion; poor self-esteem; diffuse and unstable boundaries; depersonalization and derealization; deficits in language and narrative memory, and paradoxically exaggerated intellectualism" (Ingham, 1996: 147). While some evidence may suggest that the broad outline of schizophrenia does not vary much, and that the defining characteristics are similar from one society to another, there is in fact a slight variation. "A comparison of schizophrenic persons in Japan and the United States found that the Japanese patients were more assaulting but better at reality-testing than the American counterparts" (Schooler and Caudill, cited in, Ingham, 1996: 147), while Irish-American males with schizophrenia in New York City have lower self-esteem and more guilt-feelings, apprehension about females, and paranoia. Italian-American patients, on the other hand, are more impulsive, given to mood swings, and are hostile towards male authority figures (Opler and Singer, cited in Ingham, 1996: 148). The variation here in the actual symptoms of schizophrenia, although involving societies that are all very much in the 'west ', occurred in cultures that are all quite different from each other, further underlining the theory of the social construction of mental illness.

A group of sociologists has developed what has come to be known as 'labeling theory ', which holds the claim that in western society, a person to whom the label of mental illness is attached is made to learn a special stigmatized role.
Because of the cultural relativist implications of labeling theory, Jane Murphy sought to test it on the basis of data on mental illness from her research among the Eskimo of Alaska and the Yoruba of Nigeria. Upon collecting data through interviews and participant observation, she found that in both of these cultures there was a label for the term 'insanity '. "Descriptions of insane persons included reference to hallucinations, delusions, disorientation, and bizarre types of behaviour, and resembled what would be called schizophrenia in western societies" (Bourguignon, 1975: 275). The processes that produce disturbances of thought, feeling, and behaviour in the illness not only exist in most cultures, but also are recognized and labeled. However, a clear distinction is made between insane persons, and those with special gifts who are able to hear and see things that others cannot, as well as look into the future. In western societies, a person who claims ability in the latter would be considered crazy, because it is not socially accepted, nonetheless normal, to have such beliefs in oneself. There is occasionally confusion among Westerners between pathological and visionary states, between madness and shamanism, however this confusion is not
seen among the local people. Murphy cited the example of the Eskimo shaman who is temporarily thought to be out of his mind, however his behaviour is in fact controlled and measured, and executed only at appropriate times and places, and not continuously and spontaneously; the kind of control that is lacking in an insane person. This reiterates the importance of interpreting cross-cultural behaviors based not on western models and ideals, but rather by a cultures own standards.

Of course, there is an increasingly accepted view according to which schizophrenia results from biological causes, which is why it is important for the psychiatrist to understand what kind of behavior is culturally patterned and what kinds of ideas are socially shared (Bourguignon, 1975: 275). It is easy for the psychiatrist to consider certain types of behavior bizarre when they are unknown to his own cultural background. Whether or not an idea is bizarre depends on whether it is a unique and deviant personal product or whether it is a socially shared belief. Beliefs influence actions, and in order to understand whether particular actions are bizarre, it is necessary to consider how they are related to local beliefs, as well as to the personal, even deviant, views that the individual may hold. This perspective must be taken when looking at trance and possession. The term 'trance ' is a psychiatric and psychological term defined as a dissociative state involving a disturbance or alteration in the normal integrative functions of identity, memory or consciousness. It is a universal psychobiological potential in all human beings, but varies greatly, and is altered in different ways across human societies. For the Balinese, trance has a highly therapeutic function. The Balinese are people who are expected to mask their negative emotions, which are then released through trance with positive recognition, thus acting as a release of psychological tension. When in states of trance, the Balinese behave very differently to the norm, becoming highly aggressive and emotional, and often seeing and hearing things that those in trance cannot. In Western terms, the Balinese in trance is in fact hallucinating; an underlying symptom of mental disturbance. Possession includes dissociative states that are interpreted, in the societies in which they occur, as due to the 'possession ' or takeover of the individual by a spirit or other alien entity. An individual can be said to be possessed only when the cultural group believes in possession and when, consequently, associates, seeing certain behavior, recognize the individual to be possessed (Bourguignon, 1975: 276). Where such beliefs do not exist as a social tradition, it can be said that the person has in fact developed a personal pathological delusion, resulting typically from emotional disturbance, rather than learning from the doctrines of a particular group.

The debate continues among psychiatrists on whether or not there are mental disorders that exist only in certain specific societies, which have been referred to as 'culture-bound ', 'exotic ', or 'culture-reactive ' syndromes or culture-specific disorders. Local terms such as amok, arctic hysteria, koro, latah, malgri, possession and windigo, which are employed in a specific group or region, pose the question of whether the patient 's behavior represents a specific syndrome or group of symptoms unknown elsewhere, or whether there are disorders familiar in other parts of the world, appearing exotic simply because of some of the cultural content and the local beliefs associated with them (Bourguignon, 1975: 280). Amok is a Malay term that has entered the English language with a broader range of meaning, referring to someone who is exhibiting wild, aggressive behavior. However, among the Malay, it refers to a more highly stylized behavior, and is believed to occur typically among middle-aged men, who, following a period of brooding over an insult, continue on a series of violent, murderous attacks. The attack represents a response to shame and insult, and is a vigorous expression of male self-assertion. In terms of traditional belief, this behaviour may be accounted for by magic or spirit possession, with the community reacting to it with both fear and respect. Attempted explanations of amok in medical literature range from epilepsy, liver disorders, and infections, to schizophrenia, hashish poisoning, and sunstroke (Bourguignon, 1975: 281). Tan and Carr (1977) conclude that "Amok is a culturally (Malay) prescribed form of violent behavior, sanctioned by tradition as an appropriate response to a given set of conditions. It is not, per se, a disease, but a behavioral sequence that may be precipitated by any number of etiological factors, among them physical, psychological, and socio-cultural determinants" (Tan and Carr, 1977: 65, as cited in, Bourguignon, 1975: 281).

The so-called culture-bound syndromes such as amok may indeed be only fragments of complex traditional medical systems, but through contact with Western medicine, have been turned into special diagnostic categories. "The judgments that have to be made by the psychiatrist in differentiating schizophrenia from other illnesses, and from normality, concern another person 's thinking, beliefs and emotional reactions. The psychiatrist has to decide whether the (prospective) patient 's beliefs are true or imaginary, whether the patient is thinking in an organized way, and whether emotions are blunted or in keeping with what is expected" (Fernando, 1988: 140). This is dependant on judging interactions between persons, but is greatly influenced by the society 's norms, and so-called commonsense. Though western views of illness are held to be correct and other views are generally thought of as 'primitive ', normality must be judged on "the average level of functioning of individuals within the context of a total group" (Fernando, 2002:38); one must therefore look at the picture through a perspective of cultural norms. Mental illness cannot be defined based on western ideas of psychiatry alone. There is indeed a need to recognize that each culture has its own norms for health, for ideal states of mind and for the functioning of individuals in society.

References:

Bourguignon, E., (1979), Psychological Anthropology: An Introduction to Human Nature and Cultural Differences, Holt, Rinehard and Winston, Sydney

Ingham, J., (1996), Psychological Anthropology Reconsidered, Cambridge University Press, New York

Fernando, S., (1988), Race and Culture in Psychiatry, Routledge, London

Fernando, S., (2002), Mental Health, Race and Culture, Palgrave, New York