Medicalization of Mental Health

Overview

Mental health as defined by World Health Organisation is "a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community", also one of the most important aspects of life in the modern society. Mental illness can be experienced across all populations, regardless of their race and ethnicity.There are various factors that cause mental illness such as one's thoughts to social and cultural to community support. Hence one's age doesn't determine the risk from mental disorders but rather one's mental state and environment factors. Even though, mental illness can be classified into more than 200 forms. It can be categorised into two major factors internalising and exeternalising. Internalising factors includes anxiety, depression and somatic. As for externalising factors, it includes impulsive, disruptive conduct and use of substances.

With ever growing list of diagnosis and potentially new health disorders, American Psychiatric Association has and continue to publish Diagnostic and Statistical Manual of Mental Disorders(DSM), the latest edition being DSM-5. DSM is regarded as the standard guide that provides common language for clinicians and researchers to diagnose and classify mental health. Having the common language enable those involve to share the same conceptual framework, organisational structure, diagnostic criteria and language.

Socio-Cultural Contexts

There are many factors that influence the impact of mental health, mental illness, and the approach of mental health services. As for culture and society, it influence the responsiveness of mental health services to those that are racial and ethic minorities. Culture of patient determine "how people communicate their symptoms and which ones they report." Specifically, culture determine how people react to their illness, motivation to seek treatment, whom or types of help they seek, their social support, and level of stigma they attach to mental illness. On the other hand, culture of clinician determine how the institution respond to the illness, for example, will they rooted for Western medicine? If the patient and clinician are from different cultural background, this impact the level of understanding and the way they communicate.

Culture of Patient

Patients tend to describe illness in a more subjective way and selectively about how they view the symptom, this determine by attitudes and beliefs of which their culture holds. From culture to culture, there are some distinctively different symptom recognition. Asian patients are more likely to report somatic symptom initially before acknowledge of their emotional symptoms if they has been questioned further. Cultural impact doesn't limited to those suffer from the illness, but rather their families and communities as well. Family environment can contribute greatly to the risk of developing mental illness. It could be level of acceptance when they realised that their close one suffers from mental illness (example such as negative emotion and criticism) or family conditions such as child, and sexual abuse (children may be at risk of mental disorders). Living in a society that view mental illness as socially unacceptable reflect one's stigma which leads to attitude such as reluctance to disclose. Such attitude also reflect self-esteem and further preventing them from seeking much needed mental treatment. Even though, family support might be positive, some cultural beliefs could influence whom they seek the treatment from. It is likely that they will approach less formal source such as traditional healers, and even their friends and family.

Culture of Clinician

It is common that health institutions are rooted in Western medicine. "Most clinicians share a worldview about the interrelationship among body, mind, and environment, informed by knowledge acquired through the scientific method", therefore to a certain degree, distance between patients and clinicians does exist no matter what ethnicity they are . "It also means that clinicians view symptoms, diagnoses, and treatments in a manner that sometimes diverges from their patients". Different cultural background leads to miscommunication and misunderstanding, these will impact on incorrect mental health diagnosis, and argument over treatment approach. Furthermore, incorrect diagnosis can arise from clinician being bias and stereotyping of patient's ethnic or purely on their cultural background. The result is inappropriate treatment. Some researches does provide evidence of racial bias in not specifically with mental health but health institutions setting overall, while some said their biases reflect on patient's socioeconomic status or their professional culture.

Diagnostic and Statistical Manual of Mental Disorders, 5th-edtion (DSM-5)

American Psychological Association is determine to improve diagnosis and care to people of all backgrounds by incorporating a greater awareness of patient's culture, social customs, race, ethnicity, religion and geographical origin (higher socio-cultural sensitivity). Cultural considerations become one of the key factors to diagnose and treat mental health effectively.

Cultural Concepts

DSM-5 updates mental illness criteria that reflect cross-cultural variations, which provide more "detailed and structured information about cultural concepts of distress." The result of this updated cross-cultural variations criteria is the illness would be more diagnose more equivalently across difference cultures. Example given by APA is "the criteria for social anxiety disorder now include the fear of "offending others" to reflect the Japanese concept in which avoiding harm to others is emphasised rather than harm to oneself." The changes will help clinicians objectively assess cultural factors related that may influence patients' perspectives of their mental illness and acceptance for treatment options.

Statistics

World Health Organisation report states

Globally,

• 300 million people suffer from depression
• 260 million are living with anxiety disorders
• 60 million suffer from bipolar affective disorder
• 23 million suffer from schizophrenia
• 50 million suffer from dementia

Treatment and support,

• around 76% to 85% of people with mental disorders in low- and middle-income economies, and between 35% and 50% of people with mental disorders in high-income economies doesn't receive any kind of treatment or support