Course Title: The Somatization of Mental Illnesses in Bengali American Women
Course Description:
Medicine and culture are two perspectives that are often at odds when it comes to disease and illness. Medicine takes the perspective of every health-related anomaly having natural and purely scientific causes. This is essentially the basis for definitions, etiology, treatments and cures for any given disease. Culture, on the other hand, has its own set of solid beliefs that may not always align with these same principles. This discrepancy in beliefs often creates conflicts in the medical environment as it becomes very challenging for medicine and culture to understand each other and find a middle ground as to ensure quality care for both practices.
This course will focus on the immigrant women who come from the country of Bangladesh. We will unfold the manifestation of cultural beliefs in regards to mental health and how it is viewed both by the culture and by medical professionals. In the first half of the semester, we will learn about the causes of mental illness in Bengali women and the social stigmas that come along with these disorders as well as the cause of these stigmas through the cultural lens. We will then dissect why these ailments appear to affect women a lot more than they affect men. The second half of the semester will dive into effect of these social constructs on the women and how it eventually leads to somatization. We will then explore the role of the medical field propose potential solutions to the issues that arise in our discussions.
Week 1: Cause of Mental Illness in Bengali Women
Selim, Nasima. “Cultural Dimensions of Depression in Bangladesh: A Qualitative Study in Two Villages of Matlab.” Journal of Health, Population, and Nutrition 28.1 (2010): 95–106. Print.
A study was done to explore the cultural dimensions of depression where participants were asked about the local terms for depression, perceived causes, impact, and treatments. Participants did not recognize the literal translation for depression but rather thought about it as a worry illness that they attributed to somatic symptoms. Men felt that it affected them more while women felt it affected them the most. The causes of this perceived illness were to be poverty and social issues that affected marriage, work, and education.
Week 2: Stigma of Mental Illness in Bengali Society
Davey, Gareth, and Mahbuba Keya. “Stigmatisation Of People With Mental Illness In Bangladesh.” Mental Health Practice 13.3 (2009): 30-33. Academic Search Premier. Web. 23 Sept. 2016.
Stigma in this article is defined as the rejection encountered in every day life as a result of a person’s mental health status. This type of stigma surrounding mental illnesses causes negative attitudes towards patients that lead to discrimination and a subpar quality of life. Patients in this study that had various illnesses such as depression and schizophrenia suffered rejection from their family members, humiliation and seclusion from society, as well as unfair treatment in the workplace. Further research found that there were beliefs among family and the community that a mentally ill patient causes defamation to the family prestige. Both the patient and their family members have a difficult time maintaining relationships and settling down for marriage.
Week 3: Cause of Stigma against Mental Illnesses through a Cultural Dimension
Lauber, Christoph, and Wulf Rössler. “Stigma Towards People With Mental Illness In Developing Countries In Asia.”International Review Of Psychiatry 19.2 (2007): 157-178. Academic Search Premier. Web. 23 Sept. 2016.
This study reveals the role of supernatural, religious and magical approaches to mental illness as a result of mistrust towards mental health services. Similar to the previous article, there is an entrenching stigma that surrounds a mentally ill patient and their family. The social disapproval that patients face is particularly serious as it leads to marital separation and divorce. Often, this stigma prevents someone who may have an illness from reaching out and receiving the medical care that they need for fear of being labeled as a crazy person. This in effect leads to the somatization of mental disorders; patients turn their mental symptoms into physical body symptoms as a way of coping with their illness yet keeping it under wraps.
Week 4: Why this Stigma Affects Women more than Men
Fikree, Fariyal F, and Omrana Pasha. “Role of Gender in Health Disparity: The South Asian Context.” BMJ : British Medical Journal 328.7443 (2004): 823–826. Print.
Men take greater risks, causing more injury and death. Women are born with the advantage of outliving men. Women are socially, culturally, and economically dependent on men are in an inferior position to them. Women are usually excluded from decision-making and do not have access or control over resources. Sons are seen as having economic, social, or religious utility while daughters are perceived as an economic liability (due to the dowry system). This discrepancy in roles has created a disadvantage in the healthcare system and neglect of women’s health. Compared to industrialized countries, life expectancy is equal to or shorter than that of men. Neglect takes the form of poor nutrition, lack of preventive care (immunization) and delays in seeking health care.
Week 5: Effect of Stigma on Bengali Women and the Process of Somatization
Rogers, Anne and David Pilgrim. A Sociology Of Mental Health And Illness. Maidenhead, Mcgraw-Hill Education, 2010, https://books.google.com/books?id=CVKLBgAAQBAJ&pg=PA64&lpg=PA64&dq=somatization+in+south+asian+women&source=bl&ots=vbC1EI1paT&sig=nHSo-lfYnJMxCAIJDeUKA16K5oM&hl=en&sa=X&ved=0ahUKEwiSu_j2xfzPAhXBWD4KHfPODI8Q6AEIPjAE#v=onepage&q=somatization%20in%20south%20asian%20women&f=false
This article talks about the processes that come into play that eventually lead to the somatization of mental illnesses in South Asian women. It proposes that there may be several reasons for this somatization. One is that there is no recognition of mental illnesses so ailments are always portrayed as somatic. The second is that there is no recognition of the link between physical ailments and emotional states. The third possibility is that patients wish to present their symptoms as somatic even though they are aware of their health. The fourth possibility is that patients just do not want to mention any mental issues to their doctors. Critiques of this article are saying that there are too many generalizations going on, some of which include Islam being a protective mental health factor and Asian culture not having a notion about psychological causation.
Week 6: What is Somatic Symptom Disorder
http://www.mayoclinic.org/diseases-conditions/somatic-symptom-disorder/basics/definition/con-20124065
SSD means having a centralized focus on physical symptoms (pains and fatigues) to the point that it causes emotional distress and prevents normal functioning. There are no medical conditions that can be pinpointed as the cause of these symptoms. Often patients feel as if medical evaluation and treatment is not sufficient and often does not help or makes symptoms worse. Patients can also have no effect on medications or show extreme sensitivity to them. Causes of the disorder are usually attributed to biological factors such as an increased sensitivity to pain, family influence, a personality trait of negativity, problems processing emotions, and learned behaviors towards illnesses. Having a strong emotional experience such as a traumatic event or suffering from depression can increase the chances of developing SSD.
Week 7: The Role of the Medical Field
Hanley, Jane. “The Emotional Wellbeing of Bangladeshi Mothers during the Postnatal Period.” Community Practitioner 80.5 (2007): 34.Academic OneFile. Web. 30 Sept. 2016.
The interpretation of postnatal depression among the women of Bangladeshi communities in western countries stands as one that is still infused with ethnological and religious beliefs. The participants of the study demonstrated a high regard for the role of family and community support. However, when asked about visiting health professionals for their depression, they expressed confusion as to the actual role of the visits even though they still attend appointments. The women saw these services as a part of the pregnancy package and simply as a mandatory thing to do rather than a service that they can use to actually help them with their postnatal depression. Furthermore, because of the view that having emotional issues makes one very weak and inferior, the women in this study are hesitant to share their troubles with health professionals, whom they see as strangers. Moreover, by their beliefs, it is taboo and indecent to discuss a woman’s bodily functions.
Karasz, Alison et al. “‘Tension’ in South Asian Women: Developing a Measure of Common Mental Disorder Using Participatory Methods.” Progress in community health partnerships : research, education, and action 7.4 (2013): 429–441. PMC. Web. 28 Oct. 2016.
This article mentions the tendency for South American immigrant women to rarely seek out mental treatment, which is related to a lack of understanding of the medical model of mental disorder and more adherences towards the social model. When they do seek out medical care, it is with their primary care physicians to whom they present their illness as unexplained somatic symptoms than emotional distress.
Week 8: Resolution of Stigma and Mistrust of Doctors
Parveen, Shahana et al. “It’s Not Only What You Say, It’s Also How You Say It: Communicating Nipah Virus Prevention Messages during an Outbreak in Bangladesh.” BMC Public Health 16 (2016): 726. PMC. Web. 30 Sept. 2016.
There is a great miscommunication between the patients in Bangladesh and medical professionals. It is found that a lot of natives of the country, especially in rural areas have unconventional beliefs about their illnesses, most of which have supernatural bases. This combined with a general mistrust of the medical system causes patients to disregard the advice and medical instructions of professionals, which often causes deterioration in health and becomes a danger to the community. Therefore another approach has been attempted to battle these communication challenges. Rather than using the top down approach, where disease is explained through a scientific and pathological lens, a bottom down approach is being considered; where more of the cultural beliefs of the patients are incorporated into the way diseases are presented to them.
Karasz, Alison et al. “‘Tension’ in South Asian Women: Developing a Measure of Common Mental Disorder Using Participatory Methods.” Progress in community health partnerships : research, education, and action 7.4 (2013): 429–441. PMC. Web. 28 Oct. 2016.
There are public health campaigns in Australia and the UK that strives to close the gap created within low mental health literacy. These programs educate the public regarding the biological causes and treatments of mental illnesses all to try and change the popular conceptions of mental illnesses within the south Asian community. However, these programs have little success and the rates of seeking mental treatment still remain low.
