Doctoral Dissertation Research: Cultural Contexts of Mental Health Care

精神疾病的经历是否因文化而异？虽然这个问题的简单答案是肯定的，但这是如何发生的却相当复杂。一方面，有证据表明，心理健康问题和模式往往以类似的方式出现在世界各地。因此，精神病学主张使用广泛适用的诊断类别。另一方面，人类学研究发现，精神疾病在不同的地方表现不同，反映了它所处的社会和文化环境。当研究人员、政策制定者和服务使用者讨论社会系统应该如何为那些经历心理健康危机的人提供最好的护理时，重要的是要了解这些经历如何与社会和文化环境联系起来，以确保护理是适当和有效的。 这对控制成本尤其重要。以市场为基础的医疗保健政策，以药物为中心的治疗计划，以及对医院急诊室的依赖，这些都是西方世界大部分精神卫生保健的特点，成本高昂，而且并不总是有效的。随着这些方法传播到地球仪的其他地方，迫切需要知道哪些方法有效，哪些方法无效，以及为什么无效。这些问题将在该奖项支持的研究中得到解决。 华盛顿大学圣路易斯人类学博士候选人Lauren Cubellis在Rebecca Lester博士的指导下，将研究精神疾病的经历，特别是精神分裂症，是多种因素的复杂相互作用：遗传风险，创伤史，社会和经济背景，以及个人社会关系和资源。这位研究人员在纽约市开始了她的研究，并将这个奖项扩展到德国的柏林，这将使她了解文化背景对心理健康和治疗结果的影响。柏林是一个特别合适的地点，因为德国的统一创造了一个文化背景，明显增加了一些居民的压力，但对其他人没有，提供了一个科学上有用的透镜进行比较。这项研究将在一家诊所进行，该诊所提供一种护理选择，旨在减少每年进入精神病急诊室的人数，并改善患有严重精神疾病症状的人的生活质量。将采用混合方法收集数据，包括参与者观察、个人和职业历史叙述、访谈和档案研究。这些数据将使她能够确定为什么这种治疗模式在柏林被采用，它与柏林作为精神病学思想和知识生产的基本中心的历史有何关系，以及它作为一种合理的治疗选择在整个德国、北方和美国的潜在传播。研究结果将阐明历史和社会文化背景在发展和治疗一种明显普遍的精神健康综合征中的作用。该奖项反映了NSF的法定使命，并通过使用基金会的知识价值和更广泛的影响审查标准进行评估，被认为值得支持。

Does the experience of mental illness vary across cultures? While the simple answer to this question is yes, how this happens turns out to be quite complex. On the one hand, there is evidence that mental health problems and patterns often emerge in similar ways across the world. Therefore, the psychiatric sciences argue for the use of diagnostic categories that are broadly applicable. On the other hand, anthropological research has found that mental illness manifests differently in different places, reflecting the social and cultural environment in which it is embedded. As researchers, policy-makers, and service users debate how social systems should best provide care for those who experience mental health crises, it is important to understand how such experiences are connected to social and cultural surroundings in order to assure that care is appropriate and effective. This is particularly important to contain costs. The market-based health care policies, medication-centered treatment plans, and dependence on hospital emergency rooms that are characteristic of mental health care in much of the Western world are costly and not always effective. As these approaches spread to other parts of the globe, it is urgent to know what works, what does not, and why. These questions will be addressed in the research supported by this award. Washington University St. Louis anthropology doctoral candidate, Lauren Cubellis, with the guidance of Dr. Rebecca Lester, will investigate the idea that the experience of mental illness, specifically schizophrenia, is a complex interplay of multiple factors: heritable risk, traumatic history, social and economic context, and individual social relationships and resources. The researcher began her invesigation in New York City and with this award will extend it Berlin, Germany, which will allow her to understand the effects of cultural context on mental health and treatment outcomes. Berlin is a particularly apt site because German reunification has created a cultural context that markedly increases stress for some residents but not for others, offering a scientifically useful lens for comparison. The research will be conducted in a clinic that offers an option for care designed to reduce the numbers of people admitted to the psychiatric emergency room each year, and to improve the quality of life for people living with the symptoms of severe mental illness. Data will be collected with a mixed-methods approach, including participant observation, personal and professional history narratives, interviews, and archival research. These data will allow her to determine why this treatment model has been adopted in Berlin, how it relates to the history of Berlin as a fundamental center of psychiatric thought and knowledge production, and its potential spread as a plausible treatment option throughout Germany, Northern Europe, and the United States. Findings from the research will illuminate the role of history and socio-cultural context in the development and treatment of an apparently universal mental health syndrome. At the same time, it will provide information on a particular treatment model that may reduce costs and improve quality of life.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.