New Visions to Solve for Mental Health Problems in the Future
By Faruk Arslan
The medical community has been trying to understand, examine, classify and treat mental illnesses in the current mental health system based on human experiences under the review of the history of madness. A number of disciplines and theories have been used for understanding how and why societal structures lead to oppression and how we can escape from that oppression. This paper will argue about what a reformed health system might look like in the future; instead of scientific approach, crisis resolution and early intervention in psychosis are used in order to be brought towards more recognition of the social, spiritual, and psychological aspects of these problems in the treatments that provide a cross-cultural community support based approach. The psychiatric instruments need to develop, and future cross-cultural psychiatric research should be both comparable and culturally valid because there are some similarities with biomedical concepts of mental illness and medications, as well as dispute spiritual causes and solving methods that give the direction towards the mental health policy, in which could lead the development of assertive out of reach.
First of all, there are a growing number of literatures that explore “the impact of socio-cultural factors, race and ethnicity on clinical care” (Berger, 1998; Hill 1990). Increasing racial and ethnic minorities are not trusting service providers because of the fear and need for equality of treatment. An existing system of racism and discrimination plays a major role here as well as differences in language and communication. Lack of understanding socio-cultural differences, patient’s perspectives, values, beliefs and behaviors breaks trust relationships between patients and clinicians where the diagnosis and treatment of mental disorders greatly depend on verbal communication and trust. Mental health clients are living lower economic conditions, and social, and political status. These barriers affect on “patient satisfaction, adherence and health outcomes” (Smedley, Sitithand, Nelson, 2003). There are many barriers exist to minorities for reaching treatment such as cost, fragmentation of services, lack of availability of services, and societal stigma toward mental illness. Cross-cultural model of treatment and special attentions needed in that focus on vulnerable, high-need populations in which minorities are overrepresented. Mental health care of racial and ethnic minorities compared with privileged white population are unequal, for example, minorities have less access and availability of mental health services, less likely to receive needed treatment, often receive a poorer quality of mental health care. The mental health professionals must be trained according to improve current consumer/survivor model to adapt new cross-cultural ecological model. Of course, they need a large-scale expansion, funding, support and availability of several services, such as ethnic support, education, outreach, role models, mentors, and advocates. Limitations are funding, geographical availability, participation, and leadership development opportunities, as well as lack of transportation, and controlling and mistrustful professionals hinder peer support efforts. Furthermore, the cross-cultural medicine and methods need to be rediscovered, not only for “cultural sensitivity”, it is also for “cultural competence” a more skill-focused paradigm (Lavizzo-Mourey, 1996). Cross-cultural diversity education must be given both undergraduate and higher levels to all the future and current health sector providers. The attitudes, knowledge and skill are playing critical role when apply to cross- cultural model, understanding multicultural approach also known “categorical approach”, providing knowledge on attitude, values, beliefs, and behaviors of certain cultural group ( Paniagua, 1994). For example, the Middle Eastern, the Asian, the Hispanic or the African clients would have different kinds of believe and health priority, cultural norms and communication skills. An effective knowledge based approach increase decision making process and choosing treatment method for health providers because mental health incident among these certain group historically and culturally different. Institutional racism in health and treatment for ethnic and linguistic minorities still has many problems attitudinal, structural, institutional, and ideological that produces inequality, especially disparities between the mental health care and health status. On the other hand, after knowing the cause of the major mental illnesses, in which are schizophrenia, the bipolar affective disorder (manic depression), and clinical depression, providers should have knowledge an alternative treatment methods available in the cross-cultural community that approach had been looked over because the side effects of current medication are sometimes too much to handle that patients or their family members, and mistrust is going on. Their families must be trained to call their doctor immediately, and the “patient shouldn’t stop the meds on with own decision” (Double, 2000). Probably the hardest part is to believe in yourself, especially when your self esteem may be brought down while a family member, friend, or community support is absent. Trust is the key factor for helping others in the mental health sector both patients and clinicians.
Secondly, the psychotic illness is often recognized as ‘madness’ though emphasis is on behavioral symptoms rather than delusions; neurotic presentations are much more varied, sometimes not be considered to be mental illnesses at all. Both psychological (mind) and biological (body) explanations of the causation or conceptualization of the mental illness are different from one another. Many wonder how eastern concepts and theories have been applied throughout the history as “a social psychological perspective in terms of its similarities and differences” such as the aspects of Tibetan or Islamic psychiatry and the Buddhist or Muslim views of mental illnesses (Roberts, 2001). A common thread of all practices is the importance of body, mind, spirit, and harmony with nature in the healing process, all therapies recognize the holistic nature of healing as being of prime importance. Tibetan medicine is a unique and holistic system of healing. It has been continuously practiced for over a thousand years, but has still to take its place in the history of medicine as we know it in the West. The holistic Buddhist concept of mind-body based on, “Tibetan medicine is a system of psycho-cosmo-physical healing whose philosophy and healing techniques have much to offer towards the world-wide campaign against disease” (Clifford, 2003). In Islamic view, religious and mental health forces are intimately intertwined. These observations have led a number of Muslim psychiatrists around the world to develop innovative methods for the promotion of mental health and the prevention of mental illness. One of the most important of a holistic world view is into the body of Islamic thought. The origins of this view of humans and their world were in Indian philosophy and Muslim mystic thinkers developed it further. In this system of thought, the human mind is regarded as a complex, multifaceted entity that is the product of continuous interaction of many inter-related spheres. These spheres are body, soul, society, the past (history), and even the collective memories in mythology (Foroozanfar, 1980). This is what in modern psychiatry has found a simpler but ironically less comprehensive synonym in the term “bio-psycho-social” (Ammar, 1997). In seventh and eight centuries, many Muslim physicians had discovered treatments and medicines on mental health such as Avicenna, Al-Kindi, Jorjani, Maimonides, Rhazes and Tabari, the great philosopher Ghazali, who can be regarded as one of the founders of psychology, the great scholar Farabi, an early sociologist, and psychological studies were started with the names of Ibn Zahu, Ibn Rushd, Ibn Hazm and Ibn Khaldoun, and philosophical thinking and views on the human mind were also influenced by scholars like Ibn Arabi, Rumi, Hallaj and other so-called mystic thinkers in this part of the world ( Ammar, 1997). Around the ninth and the tenth century, the first humane psychiatric hospitals and even psychiatric wards in general hospitals were built in the Middle East, the methods of mental health treatment in this period were a mixture of psychotherapy, reassurance and support. The common belief was based on the close relationship between psychological set-up, mood and the body. Avicenna used a combined method of persuasion, psychotherapy and pharmacotherapy in the form of different remedies. The Greek concept of attributing different diseases to different temperaments was also important, both in understanding the diseases and in devising treatments. Music was a very important part of treatment of mental illnesses and was used in many places (Mohit, 2001). After the seeds of Islamic enlightenment had declined in seventeenth century, mental illness people seen as insane people and locked in cruelly all over the world until recent years.
Thirdly, locking away the “insane people” to these mental institutions were common in near past centuries that were really madness rather than mentally sick person named insane. Psychological medicine of the Renaissance did not produce an influx of new ideas on mental health area compare the other disciplines, such as surgery and anatomy. What is madness and how does one become insane questions had unanswered. Attempting to answer questions of this type in late nineteenth century Europe resulted in, in practical terms, the establishment of a more humane and understanding way of dealing with mental illness and the mentally ill. Many psychiatric hospitals were punishing attitude to mental illness in first two quarters of the twenty century, finally began to appear in Europe and North America after 40’s. The supremacy of superstition was slowly over after 50’s; mental illness was now a legitimate subject for science and medicine. Conditions in these institutions were really horrible, so health professional have obviously dealt with perceived deviance differently now than they had in the past. Constant changes depend on the development of assertive outreaches instead of getting the treatment, where persons who are viewed as deviant or dangerous go to jail rather than mental hospitals. Long ago, no differentiation had seen the differences between the mentally ill and criminally insane. These accused people were whipped and beaten for misbehavior, much like the behaviour of acting as if they were wild animals in the Middle age. Today, the healths providers used to have supposed a perfect social model as a control agent. On the other hand, providers couldn’t seek to end or to reduce poverty with all its associated stresses, as well as discrimination, exploitation, and prejudices as other major sources of stress leading to emotional problems because the head of the health profession here is elite of people who wish the profession to function as an agent of social control. A mental illness person still can be sent to jail for nothing instead of hospitalized mental health clinic for treatment. The profession of social work has been facing similar problem that it had become characterized by control and supervision as opposed to care. Clinical psychology as well as social work field has joined the forces that perpetuate social injustice. The profession of psychology is currently failing in our responsibility to society.
In Conclusion, the cross-cultural education, medicine, and related approach could “improve providers-patient communication and help eliminate the pervasive racial/ethnic disparities in medical care today “ (Brach and Fraser, 2000). If health professionals understand the patience socio-cultural belief system, they could assist medical care successfully and satisfy customers/survivor. The mental illnesses have the need for special medical assistance, sensitively trained and educated health providers could reduce poverty with all its associated stresses, as well as discrimination, exploitation, and prejudices as other major sources of stress leading to emotional problems. Providers must aware of internal psychological factors and external social-environmental factors are involved in the development of mental health problems. Alternative medical health and mental health treatments have become increasingly more popular over the last few decades such as European herbals, Chinese medicine, Buddhist meditation, Native American sweat lodges, Asian acupuncture etc. The eastern civilization, including the Ottomans, Arabs and Central Asian civilizations, knew many mental illnesses and their needed treatments with music and herbs centuries ago; soon they’d taught the western civilization. There are many “ways of dealing with these diverse mental illnesses and diverse ways of approaching” in terms of our argument of the mind-body issue (Kinderman, Cooke, 2000). There is the future possibility of new discovery, which might lead to the end of this sufficient cycle, such as “the most outstanding recent examples that are family therapy, psychology and Ericksonian hypnosis” (Farber, 1987). There is also the infrastructure problem because there were still persons with “mental illness that are being housed in jails rather than treatment facilities” across the country, while mental institutions aren’t working close to their prisons (Cooper, Foster, 2002). Jails and mental health services may develop new strategies to work together in the practice of outreach in mental health laws and in the policies of the government. The future leads us the development of assertive outreach, become culturally, religiously, socially sensitive in order to provide better health service and satisfy customer/survivor.
Ammar S. 1997. Arab psychiatry between yesterday and today. Medical Journal of the Federation of Arab Physicians, third year, Issue No.1.
Berger JT. 1998. Culture and ethnicity in clinical care. Archives of Internal Medicine, 158: 2085-2090
Brach C, Fraser. 2000. Can cultural competency reduce racial and ethnic disparities? A review and conceptual model. Medical Care Research and Review. 1:181-217.
Brian D. Smedley, Adrienne Y. Stithand. Unequal Treatment: Confronting racial and Ethnic Disparities in Health Care, pp 199-204. national Academies Press.
Cooper, Duggan M, Foster, A J. 2002. Modernizing the social model in mental health: a discussion paper. London: Social Perspectives Network for Modern Mental Health/TOPSS England, 2002.
Clifford, Terry. 2003. Tibetian Buddhist Medicine and Psychiatry: The Diamond Healing.
Double, Duncan B. 2000. Redressing the biochemical imbalance. Norfolk Mental Health Care NHS Trust /University of East Anglia.
Farber, Seth. 1987. Transcending Medicalism; An Evolutionary Alternative. The Journal of Mind and Behaviour, Winter 1987, Volume 8, Number 1. p 128. York University Pub.
Foroozanfar B. 1980. Rumi (Maulana Jalaleddin) Mathnavi. Teheran, Amir Kabir Publishers, 1980
Hill RF, Fortenberry, JD Stein HF. 1990. Culture in clinical medicine. Southern Medical Journal. 83: 1071-1080.
Lavizzo-Mourey. 1996. Cultural Competence-An essential hybrid for delivering high quality care in the 1990’s and beyond. Transactions of the American Clinical Climatological Association, VII, 226-238
Mohit, A. 2001. Mental health and psychiatry in the Middle East: Historical development. Eastern Mediterranean Health Journal, Volume 7, No. 3, May 2001, 336-347
Kinderman P, Cooke A. 2000. Recent advances in understanding mental illness and psychotic experiences. London: British Psychological Society, 2000
Roberts, Maureen B. 2001. Divine Madness: Schizophrenia, Cultural Healing & Psychiatry’s Loss of Soul c. 2001 Darknight Publications.
Paniagua FA. 1994. Assessing and Treating Culturally Diverse Clients: A Practical Guide: Thousand Oaks, CA: Sage Publications.