Course Title: The Clash Between Medicine and the Bengali Culture: A Look at the Perception and Treatment of Mental Illness in Bengalis.
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 under-researched third-world country of Bangladesh with its rich history and culture. 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 specific beliefs that constitute Bengali ethnology in two components: spiritual/traditional healing and interpersonal/societal systems. We will then explore how mental illness is viewed by Bengali society and the stigmas that come along with it. Last but not least, we will be discussing the communication barriers that these beliefs and views impose in the medical setting and how it can impact the diagnosis and treatment that Bengali people receive.
Week 1: Bengali cultural beliefs: Spiritual and traditional healing
Tarafder, Tasmiha, and Parves Sultan. “Reproductive Health Beliefs and Their Consequences: A Case Study on Rural Indigenous Women in Bangladesh.” Australasian Journal of Regional Studies 20.2 (2014): 351. Academic OneFile. Web. 30 Sept. 2016.
The first article of the semester will provide a great leeway to learning about the traditional and spiritual healers of Bangladesh. This will be explored through the reproductive health beliefs that exist among women in a rural village named Kakon Haat. The study finds that the locals in this village have very unconventional beliefs towards issues regarding reproductive health such as miscarriages or not being able to conceive. Their religion and culture causes them to put heavy faith into traditional and spiritual healers, who have no medical experience but rather turn to spells and herbs to cure them of a even a life-threatening disease. This has been exacerbated by the fact that a good majority of the locals do not have accessibility to a doctor for both financial and availability reasons.
Ayshi, Sharmi Sultana, Prince Suvro Biswas, Tawshif Rahman, Mazharul Islam Shuvo, Tonema Azad, Khondoker Nurain Haque, and Mohammed Rahmatullah. “Healing with Arabic Scriptures and Symbols: A Less Documented Aspect of Traditional Healing Methods in Bangladesh.” Advances in Natural and Applied Sciences 9.5 (2015): 1. Academic OneFile. Web. 30 Sept. 2016.
Ayshi et. al’s study opens up the religious aspect of traditional and spiritual healing, which plays a very large role in Bangladeshi culture. With a population made up of 90% of Muslims, many of the locals turn to spiritual leaders called Imams to cure them of their diseases, big and small. These imams use amulets that have Quranic verses or recite prayers from the Quran in order to heal those who come to them for help. In addition to treating diseases, these healing powers also have the purposes of eliminating evil eye or supernatural forces.
Week 2: Stigmatization of mental illness: The role of family and community
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.
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 3: Stigmatization of mental illness in medicine
Giasuddin, Noor Ahmed, Itzhak Levav, and Gilad Gal. “Mental Health Stigma And Attitudes To Psychiatry Among Bangladeshi Medical Students.” International Journal Of Social Psychiatry 61.2 (2015): 137-147. Academic Search Premier. Web. 23 Sept. 2016.
This article offers a particularly interesting perspective into the stigma of mental disorders. Rather than looking at it from the patient’s point of view, we have the chance to see it from a Bangladeshi medical student’s point of view. The lack of professionals in mental health makes it an important field to recruit residents in. However, it was found that even residents internalize a stigma toward mental illness that is rather detrimental for their area of specialty. The study suggests to terminate sending most students to high-income countries as well as expose them to patients who have recovered from a mental illness to improve their attitudes towards psychiatry.
Week 4: Communication and language barriers in the medical environment
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 advise and medical instructions of professionals, which often causes a 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.
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.
