Doctoral Dissertation Research: Cultural Contexts of Mental Health Care

Washington University, Saint Louis MO

Investigators

Abstract

Does the experience of mental illness vary across cultures? While the simple answer to this question is yes, how this happens turns out to be quite complex. On the one hand, there is evidence that mental health problems and patterns often emerge in similar ways across the world. Therefore, the psychiatric sciences argue for the use of diagnostic categories that are broadly applicable. On the other hand, anthropological research has found that mental illness manifests differently in different places, reflecting the social and cultural environment in which it is embedded. As researchers, policy-makers, and service users debate how social systems should best provide care for those who experience mental health crises, it is important to understand how such experiences are connected to social and cultural surroundings in order to assure that care is appropriate and effective. This is particularly important to contain costs. The market-based health care policies, medication-centered treatment plans, and dependence on hospital emergency rooms that are characteristic of mental health care in much of the Western world are costly and not always effective. As these approaches spread to other parts of the globe, it is urgent to know what works, what does not, and why. These questions will be addressed in the research supported by this award. Washington University St. Louis anthropology doctoral candidate, Lauren Cubellis, with the guidance of Dr. Rebecca Lester, will investigate the idea that the experience of mental illness, specifically schizophrenia, is a complex interplay of multiple factors: heritable risk, traumatic history, social and economic context, and individual social relationships and resources. The researcher began her invesigation in New York City and with this award will extend it Berlin, Germany, which will allow her to understand the effects of cultural context on mental health and treatment outcomes. Berlin is a particularly apt site because German reunification has created a cultural context that markedly increases stress for some residents but not for others, offering a scientifically useful lens for comparison. The research will be conducted in a clinic that offers an option for care designed to reduce the numbers of people admitted to the psychiatric emergency room each year, and to improve the quality of life for people living with the symptoms of severe mental illness. Data will be collected with a mixed-methods approach, including participant observation, personal and professional history narratives, interviews, and archival research. These data will allow her to determine why this treatment model has been adopted in Berlin, how it relates to the history of Berlin as a fundamental center of psychiatric thought and knowledge production, and its potential spread as a plausible treatment option throughout Germany, Northern Europe, and the United States. Findings from the research will illuminate the role of history and socio-cultural context in the development and treatment of an apparently universal mental health syndrome. At the same time, it will provide information on a particular treatment model that may reduce costs and improve quality of life. This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.