Nobody’s Normal: How Culture Created the Stigma of Mental Illness is written by Roy Richard Grinker, an anthropology professor at The George Washington University. Autism and cross-cultural psychiatry are listed as areas of expertise on his faculty page. He’s the father of an autistic daughter, who he refers to a number of times throughout the book.
Culture
The book revolves around the idea that mental illness is a product of culture and capitalism.
The first section of the book looks back through history, painting an oddly rosy picture of life for crazy folk back in the day. I spent much of this section being annoyed with what I was reading.
There’s mention of a 15th century “asylum for the ‘insane'” in present-day Morocco, with the odd juxtaposition of them being frequently bound and whipped but also them being surrounded by fragrant plants and having reassuring conversations with doctors, as if the latter made the former just fine and dandy. Any takers on the whipping?
The author says that in the early 1800s in western Europe, many ill people were kept in chains by their family members, but not because they had something their family members called “mental illness.” To me, that seems like saying people are having legs amputated because of gangrene, but they didn’t have something people recognized as being a thing called gangrene. Whether it’s crazy or rotting foot, not having a medical term to frame it in doesn’t make it less undesirable.
The book opens with a story of someone from the Jun/oansi, a hunger-gatherer people in the Kalahari Desert in Namibia. Someone has schizophrenia-like symptoms, but it’s not seen as “mental illness”; it’s spirits sent by other people, and not the ill person’s fault, so it’s all just wonderful. That’s a nice thought, but the possession by spirits belief doesn’t necessarily translate into positive treatment. It can translate into people being chained to trees for years out of desperation because their family can’t manage them any other way.
Speaking of which, Grinker criticizes a paper published in Nature with a photo showing a Somali girl chained to a tree. He argues that this “conceals the content of her life”, including family, politics, and religion. Yes, there’s content and context that’s not shown, but to suggest that the context is sufficiently enriching to make up for the poor kid being chained to a tree seems unnecessarily Kumbaya.
The author later points out the problem of taking a Western approach to illness in non-Western countries, but, in my mind, he missed the mark with it. Psychosocial interventions like prayer can only do so much, and it doesn’t help the people with mental illness if we encourage more praying and then wash our hands of it all. Culturally appropriate and effective should be able to co-exist.
Family ties
The author’s grandfather and great-grandfather both make repeated appearances in the book. His great-grandfather, who migrated from Prussia to the U.S., became a neurologist. He attributed insanity to an inability to control impulses, especially the desire to shop.
His grandfather did psychoanalysis with Freud as part of his psychiatric training, and in World War II used sodium pentothal (“truth serum”) to help soldiers access their trauma. The book also covers how mental conditions were viewed in WWI, the Korean War, Vietnam, Afghanistan, and Iraq, and how little seemed to be learned from one war to the next about how trauma affects people.
Medicalization
The author described medicalization as an integral component of capitalism, and called the “broken-brain model” an attempt to “give mental illnesses an objective reality apart from culture.” He gave electroconvulsive therapy (ECT) as an example of the problem with the broken-brain model; despite its high level of efficacy, it’s highly stigmatized because it’s rooted in that broken-brain model.
He also discussed how medicalization relates to autism and the anti-vax arguments, as well as chronic fatigue syndrome. He argues that the biological model of CFS/ME is problematic because it gets in the way of psychological interventions that could potentially be helpful. There’s a valid point in there somewhere, but you may find yourself annoyed before he gets to it.
Among the assorted points that I disagree with was Grinker’s argument that it’s actually a good thing that people are saying things like “a little OCD” or “a little bipolar,” as it validates that mental illnesses exist on a spectrum rather than being all or none, and decreases the stigma of those labels. I’m imagining some of my readers being rather unimpressed as they read this.
The author isn’t so keen on the whole brain business, as “neuroscientific approaches to understanding and treating mental illnesses perpetuate stigma by reducing the complexity of illness experience, or our personalities, to the brain.” He then adds that he’s not suggesting that neuroscience can’t come up with new treatments, but it can’t reduce stigma.
Sigh. This was one of many points in the book where there was a valid idea packaged up in a less than palatable way. For the first third of the book, I thought I disagreed with the author entirely, and it was only in the final third that I started to realize what he was actually getting at, and discovered I didn’t disagree with him as much as I thought.
Presenting mental illness to the public as a brain disease is associated with increased stigma; that’s what the research on the matter clearly shows. However, Grinker seems to be implying that biology needs to be tossed out the window. I don’t think that’s actually where he’s trying to go, but he’s pointing a sign in that direction, perhaps inadvertently.
My own theoretical perspective regarding culture tends to be along the more moderate lines of social constructionism; basically, the way we experience reality is socially constructed, and can never be fully separated from the social context. That’s not to say that mental illness doesn’t exist on an objective level, but the meanings attached to it and the way it’s interpreted are inextricably culture-bound. What Grinker was saying probably wasn’t too far off from where I stand, but with less of a space for mental illness on a realist level. Still, I found he was setting off my “this jerk doesn’t think mental illness is real” BS detector fairly regularly. I do think that’s more how he framed things than the essence of his ideas, but it was still there.
The book concluded with Grinker saying he wants readers to take away that stigma can be a conversation starter, not ender. Now that, at least, is a message I can whole-heartedly agree with.
Nobody’s Normal is available on Amazon (affiliate link).
You can watch a Youtube video here of a TEDx talk by the author based on the book.
I received a reviewer copy from the publisher through Netgalley.
You can find my other reviews on the MH@H book review index or on Goodreads.
My latest book, A Brief History of Stigma, looks at the nature of stigma, the contexts in which it occurs, and how to challenge it most effectively.
You can find it on Amazon and Google Play.