Ethan Watters wrote in the NY Times that the importation to other cultures of American models of mental illness actually creates new symptom patterns as people replicate what they are taught about themselves. This intervention of American mental health models sometimes obliterates local forms of understanding and healing. He writes, “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.” American mental health models may also be disorienting this country.
There is, however, another view of mental illness that derives from relational psychologists and psychoanalysts. This model can cross cultural boundaries without disrupting indigenous meanings. It suggests that the interaction between biological processes and sociocultural contexts produces personality, and that mental illness results when there is a poor fit between them. Let me explain.
Society and culture influence our bodies because other people, who enact sociocultural values and meanings, impact our development. The human being cannot survive without the care of others. Yet, events in the social world affect the choices caregivers make and how they both perceive and understand the child, and then the child also has his or her own formative experience with many people, who are also affected by cultural processes. Human biology always develops in conjunction with the human social process. Biological processes in sociocultural contexts create our minds, personalities and soul.
Ordinarily when there is a good fit between self and other a person will develop in a manner that is balanced, and therefore, “healthy enough”. Sometimes, however, there is a bad fit between self and other. For instance, a person can have a hard time managing external stimulation. Or a person can suffer from an intensity of internal stimulation that is inaccessible to socializing influences. In the first instance, if the person who is very sensitive grows up in a context of well managed boundaries, strong structure and opportunities to regulate their contact with the “too-much” environment, he or she might gain enough mastery over their environments to turn their heightened sensitivity into gifted creative thinking. A person without the needed regulatory control over their environment could develop erratic mood or attentional problems. Likewise, the person with the “too-much” internal world who can’t be penetrated by others can compromise their ability to understand and participate in a shared reality. If exposed to active engagement and affective enlivenment and attunment the pr0pensity toward withdrawal can become an intellectual talent.
Our difficulties arise because no two bodies are alike, and therefore everyone has a uniquely functioning neurological system. For this reason there is no way to determine the correct balance between self and other. It is different for every person.
The goal of mental health treatment is to help each person find his or her correct balance. This can be done through talking, therapy, coaching, even prayer, and physical interventions like exercise, yoga and dietary change. In some cases, when a person possesses extreme neurological sensitivity or overly dense barriers against the social world, they may also benefit from pharmacological support.
The American mental health system’s science, research and voluminous clinical literature has a good deal to offer home and abroad. Our system’s strength is our understanding of the dynamic movement between self and other. When mental illness, however, continues to be broadly described by strict and static categories that define behaviors and prescribe specific treatments, clinical symptoms will multiply while the actual process of mental illness, otherwise known as suffering, will go untouched. That doesn’t help Americans any more than it does people of other cultures.