In Search of Comfort

"Many traditional cultures regard the self in different terms — as inseparable from your role in your kinship group, intertwined with the story of your ancestry and permeable to the spirit world."

In my head, I know the cultural differences between my clients and me are a big deal, but most of the time I go around blissfully believing I can still be of help. But then I read the recent New York Times article: "The Americanization of Mental Illness."

Offering the latest Western mental-health theories, treatments and categories in an attempt to ameliorate the psychological stress sparked by modernization and globalization is not a solution; it may be part of the problem. When we undermine local conceptions of the self and modes of healing, we may be speeding along the disorienting changes that are at the very heart of much of the world’s mental distress.

Whew. I had just spent an hour with a the client my supervisor and I affectionally call "Eeyore," because of his persistent gloominess. He was telling me another infuriating story about his boss, and his inability to stand up for himself. I was encouraging him to respond to the ever-so-ethusiastic lessons about assertiveness we've been repeating for the last year. Both of us were frustrated, so I tried to dig deeper.

"I get the sense you feel too helpless to be assertive," I said. "You think you have no control over what happens to you, or what people demand from you. But you have more power than you think you do! You have the right to ask for things and to say no to things. Give it a try!"

Spoken like a true child of the Enlightenment. I stood squarely in my Anglo-American view of the self, dripping with the assumption that we are captains of our own destinies.

Of course he felt helpless! He's from Guatemala--a place where you damn sure choose your battles wisely, to say the least.

As often as I can, I try to own my contingent perspective. I'll say things like, "I know leaving home and building independence is more of an American ideal. Tell me what you think and what it means for you." Or, "I hear you saying that it's normal for you to hit your kids. But here, it's illegal. And to my ears, it's a big deal." And for God's sake, don't even get me started on the sticky conversations about feminism. Even the language is flagranty sexist. The word for "handcuffs" is "esposas," or "wives." The word for "helpless" is "impotente."

My clients are reticent, if not suspicious, of their providers' beliefs about mental health. Most fear medications might cause more harm than good. Many think it's just as likely that their problems are caused by spiritual forces, witchery, psychic ability or a thousand other things, and that the cure might be food, sex, herbs, rituals, ice-cold water baths, or none at all. I spend many a well-meaning session explaining mental illness as a medical condition. "It's like diabetes or hypertension," I often say. I am one of many who hope this "disease explanation" will reduce stigma.

This article says the opposite. In many non-Western countries, people with mental illnesses fare much better. The author mentions a few studies where people who accepted the disease explanation actually treated sufferers worse. "Our most remarkable scientific leaps in understanding the brain haven’t yet created the sorts of cultural stories from which humans take comfort and meaning."

Science is our dominant ideology. Our very country is born from the rational secularism that asserted itself in opposition to the Church throughout the 18th century. According to Judith Herman in Trauma and Recovery, scientific interest in "hysteria" began with Jean Martin Charcot, Freud's teacher, as part of the French republican political agenda.

To me the purist disease explanation is, well, depressing. It strips emotional experiences of their complexity and meaning. It infuses profound feelings with a sort of nihilistic emptiness. Many studies read like a slow, meticulous "boiling down" of people's inner worlds.

As the article says, viewing mental illness through others' eyes, we start to look pretty sad and fearful. "We are investing our great wealth in researching and treating mental illness — medicalizing ever larger swaths of human experience — because we have rather suddenly lost older belief systems that once gave meaning and context to mental suffering."

I'm reminded of just how wholeheartedly I need to live in the dissonance between me and my clients. It's a challenge to know when to maintain their narratives, or to consider altering mine. What's common between us is a fervent search to find what's helpful, and preserve all the meaning we can.