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…In a neuroscientist?

James Fallon, a neuroscientist for the University of California – Irvine, ran a PET scan on his brain after finding out that his family had a history of serial killers (including Lizzie Borden).  He found that his brain demonstrated the exact same patterns as those of many serial killers.  Check out the article below for an interesting perspective on nature vs nurture:

NPR: A Neuroscientist Discovers a Dark Secret

In Reclaiming Children and Youth a recent article took a look at Conduct Disorder’s etiology for youth.  The writer of the article, Robert Foltz maintains that although brain imaging techniques can see some of the signs and signals of conduct disorder in adolescents already diagnosed with the disorder, the fact that children are already diagnosed suggest that the brain changess through neuroplasticity as a result of life experiences.  He notes that in 1999 the Surgeon General noted that “no drugs have been found to consistently decrease aggression in youth.”  However, Multisystemic Therapy and Positive Peer Culture have been found to be effective.  Ecological interventions would appear to be the most effective for youth dealing with conduct disorder.

Flotz, R. (2008).  Behind the veil of conduct disorder: challenging current assumptions in search of strengths. Reclaiming Children and Youth. 16(4). 5-9

A study in the Journal of Counseling Psychology looked at differences in help-seeking behavior and etiological beliefs for mental illness and found that when looking that Mainland Chinese, Hong Kong Chinese, Chinese Americans and European Americans, generally, the more Westernized a person was, the more likely they were to seek help for mental illness.  They hypothesized that this was due to a difference in the etiological beliefs about mental illness; namely, that collectivist cultures believe that mental illness results from personal factors, like history or life quality and individualistic cultures believe that mental illness results from environmental or hereditary factors.  One interesting outcome of this study was that although Mainland Chinese and Hong Kong Chinese were less likely to seek help for mental illness than Chinese Americans or European Americans, Mainland Chinese were more likely that Hong Kong Chinese to seek help.  (This is surprising because Hong Kong is considered more Westernized due to colonial history.)  An idea that may explain this difference is that in Chinese Universities, school clinics are run by doctors and psychiatrists in tandem; visiting a counselor or therapist is not all that different than visiting a medical doctor.

Some of the questions I have about this study include:

  • Does the etiological belief that mental illness results from personal factors lend itself toward more rapid solution focused therapy? (In my own work, I have found that when a client is willing to take ownership for their part in interpersonal conflict, they are able to resolve conflict much quicker.  Does it work similarly for larger, more global issues?)
  • Would physically integrating mental health and medical care increase utilization for mental health services in general?
  • How does one go about determining the etiological beliefs for mental illness in languages that don’t have words comparable to “mental illness”?

Chen, S.X. and Mak, W. W. S. (2008)  Seeking Professional Help: Etiology Beliefs About Mental Health Across Cultures.  Journal of Counseling Psychology, 55(4), 442-449

War, cultural beliefs and a lack of infrastructure all have combined in Afghanistan to create a virtual maelstrom for families dealing with mental illness. There is only one hospital in the country with a psychiatric ward, and it has a mere 60 beds, 20 of which are dedicated to treating drug abuse.  (A variety of other hospitals in the country have beds for treating people dealing with mental illness, but the focus in those is rarely on treatment.)  With the lack of governmental or privatized supports, families who have a member dealing with mental illness often opt instead to bring their mentally ill to shrines around the country where the clients are chained outside when it is hot, inside when it is cold.  They are left at these shrines for 40 days and 40 nights and the belief is that God will cure them.  In spite of the few improvements that outsiders see, such as lowered blood pressure because of the minimal diet, the people who run the shrines and the families that utilize them report miracles.  Individuals are cured regularly the legends report; statistics and observation seem to speak otherwise.  In the context of this paradox, 68% of the country is probably dealing with some sort of Axis I disorder.

Wali Sutani in a shrine for the mentally ill. (Photo from Chicago Tribune)

Wali Sutani in a shrine for the mentally ill. (Photo from Chicago Tribune)

This article makes me think a lot about the challenges implementing effective medical care of any kind can have within cross-cultural contexts.  A year ago or so, I read the book The Spirit Catches You and You Fall Down by Anne Fadiman, a book about a Hmong family in central California whose daughter had epilepsy.  It covers the work the doctors, social services, and family went through to cope with their three year old daughter’s illness.  According to the Hmong worldview, epilepsy was a blessing, a sign that she was gifted and was going to eventually become a shaman.  According to most of the doctors’ view, epilepsy was an illness that needed treating.  According to the social services system view, it was the families right to practice their cultural beliefs however they wanted, as long as they were compliant with her medications.  Each system wanted what the best for the child; each system believed that best was something dramatically different.  Due to a variety of factors, the child eventually passed away.  Throughout the course of the book, the author speaks about individuals in the various systems and one doctor’s appraisal in particular appealed to me.  He was the one doctor in the area that the Hmong families most often went to out of choice.  When asked why he was so successful with their families, his reply was simple.  “Their lives are not my own.”

The lives of the people dealing with mental illness in Afghanistan are not my own.  Their plight is not my own.  Their problem is not mine, and their solution in all likelihood, cannot come from me.  When I first read this article, solutions started to pop into my mind, but am I really even correctly identifying the problem?  If the culture in which the people live does not identify a problem, is there one?  By the same token, I believe that there are some rights that all people should have access to, regardless of cultural orientation, ethnicity, religious beliefs, or even actual physical availability.  In my heart of hearts, I believe myself to be somewhat of an idealist.  Medical care is one of the rights that I believe all people should have access to; I believe that mental health coverage is one aspect of that basic right.  With that set of biases on the table, I would like to purpose some ideas.

For the situation in Afghanistan, I wonder how effective starting at the ground level would be.  Sunni Muslims don’t agree with the use of the shrines talked about in the article, but the article doesn’t cover what the Sunni majority thinks about mental illness in general.  I wonder if using Afghani community leaders to educate their own people about mental illness and the effectiveness of treating many of the Axis I disorders the population seems to be dealing with would be effective in curbing the use of the shrines.  Perhaps working with the people who run the shrines to develop more humane conditions for the inhabitants would be effective.  I would also like to see a systemic study of the effectiveness of the shrines in treating what the families perceive to be the major treatment issues.  (If the family’s main issue is violent behavior, how well does 40 days and nights at the shrine effect violent behavior upon return?)  Ideally, I would like to see Afghani people doing most of this work as well because I think it would have more credence for the population.  What do you think?

American Psychological Association (2008, December 26).  Mentally ill suffer in Afghanistan: Afghanistan lacks system to treat them. PsychPort. Retrieved December 29, 2008, from http://www.psycport.com/showArticle.cfm?xmlFile=knightridder_2008_12_26__0000-0231-TB-Mentally-ill-suffer-in-Afghanistan-1226.xml&provider=

A study published by the Netherlands Organization for Scientific Research suggests that there may be a link between schizophrenia and autism.  By examining a variety published research, Annemie Ploeger, found that a disruption within the first 20-40 days of pregnancy seems to be related to the development either autism or schizophrenia.  Her hypothesis is backed up by some of the similar specifics in the bodies of people dealing with autism or schizophrenia.  For instance, both people with autism and people with schizophrenia typically have larger than average heads and ears.  Further research is needed to confirm this hypothesis, but changes in womens’ behavioral health is one of the natural outgrowths of such hypotheses.  The link between smoking and an increased risk for autism or schizophrenia was already well established.  However, it is the hypothesis that the risk for abnormalities can occur so early in pregnancy highlights the importance of healthy behaviors even before a woman knows that she is pregnant.

NWO (Netherlands Organization for Scientific Research) (2008, December 18). Autism And Schizophrenia Share Common Origin, Review Suggests. ScienceDaily. Retrieved December 29, 2008, from http://www.sciencedaily.com­ /releases/2008/12/081216114746.htm

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