Written by Lara Kitney
Nature vs Nurture debate
Renowned psychologist John Broadus Watson famously said,
“Give me a dozen healthy infants, well-formed, and my own specified world to bring them up in and I’ll guarantee to take anyone at random and train him to become any type of specialist I might select—doctor, lawyer, artist, merchant-chief and, yes, even beggar-man and thief”.
Being a Behaviourist, Watson, needless to say, was on the nurture side of the nature vs nurture debate. Although today we know that both nature and nurture exert their influences concurrently to contribute towards what ultimately makes us who we are, we cannot deny that the environment in which we grow up and live in has a lot to say as to who we become and how we behave.
What we can deduct from this quote, if nothing else, is that man is influenced by the context in which he exists and grows up in: and what more prominent context is there than our socio-economic and cultural one?
The socio-economic and cultural context
Our socio-economic and cultural context does not only influence our physical development but also our psychological one. Hence, it should come as no surprise that the trigger of many mental health issues may very well find its roots within one’s own society and the conditions, ideals, expectations and general mentalities that that particular society harbours and imposes upon its members.
Watson speaks of ‘[his] own specified world to bring [individuals] up in’, but aren’t we all, for all intents and purposes, living in our own different realities, and hence our own different worlds, framed by the political, economic and cultural dimensions of the societies we live in?
The point here is that mental health issues and psychological distress may be brought on the individual depending on the conditions of the country he lives in such as the country’s lifestyle and its society. Mental health is not an element in the human condition that can be overlooked and affects the whole nation.
Ultimately it affects the lives of people suffering such conditions holistically and impedes their performance in their careers, and the productivity of society as a whole. In fact, the mental health programme at WHO/Europe works with European countries and other partners to develop and implement national mental health policies and plans that reflect the WHO vision of “no health without mental health”.
Why have I said all this? Well if one looks at the statistics it all falls into place: In many Western countries, mental disorders are the leading cause of disability, responsible for 30-40% of chronic sick leave and costing some 3% of GDP.
The major depressive disorder
Let’s take major depressive disorder, or as it is most commonly known as; depression, as our first example. Depressive disorders cover single depressive episodes and recurrent depressive disorders. In typical depressive episodes, the patient suffers from a lowering of mood, reduction of energy, and decrease in activity. The patient’s capacity for enjoyment, interest, and concentration is reduced, and marked tiredness after even minimum effort is common; sleep is usually disturbed, and appetite diminished. Self-esteem and self-confidence are almost always diminished, and feelings of guilt or worthlessness are often present.
People suffer quietly at work, unable to perform, or go on sick leave, sometimes for long periods. One in seven people suffers from depression or any other form of mood disorder throughout their entire lifetime. It should then come as no surprise that in the EU, an average of about 7% of the population suffer from major depressive disorder every year. This figure rises to over 25% if anxiety and lighter forms of depression are included.
And this is just looking at depression, which is one of the most common conditions present in the EU and hence one of the more well-known forms of mental illnesses. Studies have shown that people living in European cities were amongst those reporting the highest rates of major depressive disorder. This is due to the unsurprising fact that the prevalence of chronic depression is affected by the degree of urbanisation, resulting in people who live in cities to have an elevated risk of suffering from chronic depression. In 2014, 7.8 % of the persons living in cities in the EU-28 reported depression.
How are disorders classified?
Other forms of mental illness or psychological disorders that may affect individuals include chronic anxiety, bipolar disorder, body dysmorphic disorder, borderline personality disorder, narcissistic disorder, schizophrenia and other psychotic disorders. These contribute to 4 % of all deaths in the EU, as recorded in 2015.
The key factor in all of this, from which many dissonances and incongruencies arise is the fact that here in Europe, we mainly use one of two classification publications: the International Classification of Diseases (ICD) which is published by the WHO or The Diagnostic and Statistical Manual of Mental Disorders (DSM) which is published by the American Psychiatric Association and covers all categories of mental health disorders for both adults and children.
Although recent editions of the DSM and ICD have become more similar due to collaborative agreements, each one contains information absent from the other, so how is it that both can be used separately and independently? Just stop and think about this situation and the possible issues that it may cause.
This system can be highly criticised on the bases of reliability and validity of many diagnoses, not only because of the social construct that man himself has created as to what is normality and what is mental illness, but also majorly because it excludes and ignores all possible cultural biases and influences. Being published by the American Psychiatric Association, the DSM is based on the research agendas that take place across the pond.
Therefore the DSM is based on the statistics, white papers, monographs and journal articles generated from information gathered from the American population, whose lifestyle and cultural baggage may differ quite substantially from that of us Europeans. Therefore, how can these guidelines and findings be applied to the diagnosis of a different population?
Improving mental health in Europe
Why not move towards a more united Europe in the sphere of mental health by formulating our own method of classification? One based on research that has been done here within the EU?
If every member state were to put forward a panel of mental health professionals, to create a board of European researchers who would work towards gathering data through longitudinal studies within their states and from this information formulate our own standard diagnostic book, wouldn’t it be more suitable? Wouldn’t we be promoting a more Social Europe to fight, diagnose and treat mental health more adequately and effectively?
This must be done through consultations with stakeholders such as Mental Health Europe (MHE), a non-governmental network organisation committed to the promotion of positive mental health amongst other objectives.
This would greatly facilitate the coherent treatment of mental health problems in different EU countries thus promoting the mobility of citizens suffering from such conditions. Not only would patients be given a more consistent line of treatment wherever they may be residing in the EU, but it will also make it much easier for psychologists and psychiatrists across the 27 member states to consult one another and share research findings.
Europe would finally have the autonomy to identify its own method of diagnosis and line of treatment based on shared European cultural tendencies and hence enhancing the well-being of its people.
cover image: source
