Mental Health
June 20, 2004 7:50 AM   Subscribe

Question about mental health and the developing world. More inside.

Recently I had an interesting online conversation with a friend in Nepal. My friend comes from an ordinary background by Nepalese standards, has never left the country, and is certainly not one of the elite. We had a discussion about 'stress' - he had a hard time grasping the whole concept of how people in rich countries suffer so much because of stress.

One of a few things may be true, and I'm not sure which. So some input with people of experience of this may be helpful...

Either people in the Third World (or particular cultures) are much much less prone to mental health issues we have in the West, such as stress and depression, because their culture is so utterly different and because so many people
are focused on just day to day survival. (In much the same way as we don't get malaria or bilharzia - the cultural environment is as different as the physical environment).

Or health care in countries such as Nepal is at a much lower level, so people suffer the same mental health issues but they go largely untreated.

Or possibly, what I suspect, being human they have many mental health problems of their own, but the cultural difference means they are manifested in a different way. I believe, for instance, that in rural Nepal, because of the civil war, many people suffer from post-traumatic stress disorder. The way this is manifested may be different due to cultural differences, and also may well go untreated as physical survival takes priority over mental health care.

Anyone have any experience of this?
How do mental health issues differ across different countries in the developing world?
posted by plep to Society & Culture (7 answers total)
two comments:

1 - not developing world, but here in chile the middle class (and presumably upper class too) seem much more likely to go see psychiatrists than in the uk. my impression is it's much closer to the us style.

2 - in the book i'm currently reading - the tangled wing - konner describes one culture (bali, iirc) where showing "negative" emotion is pretty much taboo. a woman is criticised for being upset on hearing of the death of her partner, and later praised for changing behaviour and smiling and joking. the point being that the praise reflects the communal recognition that what she did was difficult. in other words, emotions tend to be universal (a central theme of the book), but how they are expressed within a culture will, of course, vary widely. further, i would have thought that stress is a very basic human response, associated with physical changes in the primitive part of the brain (related to fight/flight, etc). with that kind of definition, it would not just be universal to humans, but also to mammals and probably other aimals too (depending on just how "low level" in the brain such changes occur).

so i go with your third "Or".
posted by andrew cooke at 8:25 AM on June 20, 2004

This article makes the suggestion that, often, ailments treated as physical problems in a developing country may be treated as psychological cases in first world countries. Since it appears that most depression is accompanied by physical symptoms (or vice versa), it brings up interesting chicken-and-egg questions about the nature of somatic versus psychic pain, and where the two overlap.

It may be that the discrepancy is largely a question of labeling, wherein a patient in one culture is treated for headache and stomach pain (with resultant stress/depression), while in another culture a patient with similar symptoms is treated for depression (accompanied by resultant headache and stomach pain).
posted by taz at 9:56 AM on June 20, 2004

I've no real knowledge of this area, so you'll have to excuse my ill-informed ramblings.

I'm of the opinion that a lot of the stress & pressure & mental ilnesses prevalant in our modern society is caused by the following
- an overabundance of choice.
- Unattainable lifestyles, popularity & beauty as popularised by our media.

The latter of these is a well known subject, so I won't go into too much detail, but it's possible that poor nepalese are going to experience less of this media driven consumer orientated pressure than the rest of us.

An overabundance of choice is harder for me to comment on, but (I think) more interesting. I've only read a couple of pieces on this subject, but there seems to be a growing concensus that the more choice people are given (blue, or green, or yellow, or white, or pink or I DON'T KNOW. SHUT UP.) , the more it affects them mentally. Again, poverty would preclude choice, and possibly increase happiness levels.

On a more useful note, there was a new scientist article on happiness (happy people are less likely to go mad) that may answer your questions. It's subscription based (free seven day trial) though (boo).

There's also the possibility that our modern western society finds crazy people harder to deal with than other places. Certainly, when I was younger, the village I lived near contained & dealt with many characters who (now) would be committed.
posted by seanyboy at 9:57 AM on June 20, 2004

Some aspects of physical lifestyle have a big impact on brain chemistry. Overstress/anxiety/depression have all been linked to decreased dopamine & serotonin levels. Some aspects of Western life that effect these levels are lack of sunlight, lack of exercise or activity (as well as sleep), and dietary issues such as fatty acid imbalances and excessive sugar. Also, the chemicals we eat and breathe are quite different in the West, and there is more and more research pointing toward artificial colorings and other man-made chemicals having a negative impact on brain chemistry, especially in children.

The fact that Nepalese may have a lifestyle that necessitates a much greater level of daily physical activity, includes far less time spent indoors, and has a diet largely devoid of petroleum-based colorings & weird fake fatty acids (the brain is mostly made from fatty acids, so a lack of them makes it harder for the brain to repair itself) may have an effect on their succeptibility to brain chemical imbalances.

I also imagine that meditation is a more effective "mental health excercise" than watching TV, which seems to be the Western equivalent (assuming Nepalese Buddhism here).
posted by obloquy at 12:28 PM on June 20, 2004

taz makes a good argument.

From what I've seen, in US people try to address the stress, the symptoms, not the cause. Example: a foreign student, first time in US, she was looking for a reasonable place to stay. After several days, she could not find anything she liked (mostly because a week before the school starts there is a housing crisis) and she manifested all the symptoms of "stress". An university official advised her to see a psychiatrist, when help finding a place to stay would have been much more appreciated.
posted by MzB at 12:32 PM on June 20, 2004

Another quick note about stress- for most of human history, the adrenal hormones created in a "fight-or-flight" response are dissipated by the process of actually fighting or fleeing. When we become stressed emotionally with no corresponding physical action, the adrenal hormones linger. So the stress caused by a Yeti coming after you is useful in providing the energy to run away, and the physical act of running helps re-regulate the hormones. Stress over taxes or traffic, on the other hand, don't provide for this kind of self-levelling of hormones, so we get all stressy & stay that way, often leading to a chronic imbalance (and road rage).
posted by obloquy at 12:54 PM on June 20, 2004

I also imagine that meditation is a more effective "mental health excercise" than watching TV, which seems to be the Western equivalent (assuming Nepalese Buddhism here).

The Nepalese are predominately Hindu, but there is indeed evidence that mediatation is good for your mental health.
posted by homunculus at 2:49 PM on June 20, 2004

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