Doctoral Dissertation Research: Cultural Contexts of Mental Health Care

精神疾病的经历在不同的文化中是否有所不同？虽然这个问题的简单答案是肯定的，但事实证明，这是如何发生的相当复杂。一方面，有证据表明，精神健康问题和模式经常以类似的方式在世界各地出现。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。在研究人员、政策制定者和服务使用者讨论社会制度应该如何最好地为经历精神健康危机的人提供护理时，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，这一点很重要。这对于控制成本尤为重要。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地区精神卫生保健的特点，成本高昂，而且并不总是有效。随着这些方法扩展到全球其他地区，迫切需要知道哪些方法有效，哪些方法无效，以及为什么。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生劳伦·库贝利斯将在丽贝卡·莱斯特博士的指导下，研究精神疾病，特别是精神分裂症的经历是多种因素的复杂相互作用的观点：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开始了她的调查，随着这个奖项的颁发，她将扩展到德国柏林，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，因为德国统一创造了一种文化背景，显著增加了一些居民的压力，但对另一些人来说却没有，这为比较提供了一个科学上有用的视角。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科急诊室的人数，并提高患有严重精神疾病症状的人的生活质量。数据收集将采用混合方法，包括参与者观察、个人和专业历史叙述、访谈和档案研究。这些数据将使她能够确定柏林为什么采用这种治疗模式，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联，以及它作为一种看似合理的治疗选择在德国、北欧和美国传播的可能性。这项研究的发现将阐明历史和社会文化背景在一种明显普遍的精神健康综合症的发展和治疗中的作用。同时，它将提供关于可能降低成本和提高生活质量的特定治疗模式的信息。该奖项反映了NSF的法定使命，并通过使用基金会的智力优势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.