As its title suggests, reference 1 is a book which takes a look at mental disorders around the world. I have yet to finish this small book, but part of the story seems to be that while the main lines of the western classification of mental disorders do map onto the rest of the world, there are plenty of differences of detail in the presentation and management of those disorders.
In the chapter on the communication of distress, there is a suggestion that we in the west are very focussed on the self, on the subjective experience and are open to what I might call psychological discussions about same. Whereas in other parts of the world, distress tends to be expressed in more physical terms.
In his explanation, Leff suggests a story for me which involves two salient differences. First, other parts of the world – he was writing near forty years ago – tend to have peasant economies, with lots of subsistence farming: lots of threats, uncertainty and rural poverty. These last can cause plenty of distress. Second, other parts of the world tend to have extended families in which the roles, responsibilities and duties of the various family members are both defined and important; roles, responsibilities and duties which may be rather old fashioned and restrictive, particularly in so far as they affect the women of the family. This last also can cause plenty of distress.
But a positive feature of subsistence farming is that there are plenty of things to do which do not require too much skill or application. Compared with life in the fast lane in the west, it is relatively easy to find useful and helpful slots for people with problems. To which thought I add two more. First, in the civil service of old there was both the duty and the possibility of finding occupation for a reasonable share of the people with problems; with both duty and possibility having eroded over the last fifty years. Second, I remember stories of village idiots. People with serious problems who were just left on the fringes of villages, possibly restrained in some way, while the rest of the village got on with its business. So things were not that great in the olden days.
And a feature of the extended family is that there has to be restraint if it is to work. People have to do their duty without making a lot of fuss about it. Social conformance is important, much more important than self-expression, than wallowing in self. The expression of personal feelings might well be regarded as distasteful, as rather shameful, certainly not something you would go to the doctor or anyone else about. So on the credit side, people do not learn to make a fuss about mental disorders – and to that extent those disorders do not exist. From where I associate to the various epidemics – not to say fads and fashions – of psychiatric disorder which afflict the west from time to time. Furthermore, there are established roles for people to slot into; they can just slot in, rather than trying to go it alone – and failing. But on the debit side, they do not learn how to make a fuss, how to talk to a psychiatrist, instead tending to couch their distress in misleading physical symptoms and complaints. With traditional healers, perhaps because they have more relevant background and experience, sometimes being good at dealing with this sort of thing.
There was also the observation that older languages tend to be rich in words for all the minutiae of family relationships – distinguishing, for example, maternal aunts from paternal aunts. Leff also points to the intriguing suggestion in reference 2 that ‘I’ emerged relatively late in the evolution of language.
Perhaps there are anthropologists and sociologists out there who have picked up on all this, have run with these particular batons.
Afterthoughts
Talk of rural poverty reminds me that my father, brought up in rural Huntingdonshire, used to talk of rural slums. Not so many years that we had that sort of thing here in the west.
I had thought that word ‘distress’ might be related to the word ‘stress’, but this seems not to be the case, at least not according to OED. Rather to old French meanings of the word ‘district’. With old English meanings of ‘distress’ being more physical than psychological: so distress might have been used transitively to mean to crush or overwhelm in battle. Another plus point for the story above.
References
Reference 1: Psychiatry around the Globe: a transcultural view – Leff J. – 1981. I arrived at Leff – a civilised and interesting writer – via a complicated route which started with O. Sacks, moving onto A. R. Luria and then with my wondering what exactly the symptoms of hysteria were, a diagnosis which has more or less vanished from the western scene. No discipline!
Reference 2: The Gift of Tongues – Schlauch M. – 1943.
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