Abstract
Studies show that there are distinct differences between the Western brain and those of people from the East; the individualist culture of the West is characterized by peoples’ sense of independence whereas those in the collectivist culture of the East see themselves as interdependent members of society. Despite these fundamental differences, both cultures have one thing in common: these societies’ populations have significant problems with mental health. This paper examines these differences and looks at the prevalence of mental health issues and subsequent treatment in the respective societies of the UK and Thailand.
Keywords: depression, anxiety, psychosis, neurosis
Introduction
According to Nisbett (2003), the East Asian brain is more suited to being a part of a supportive community whereas Westerners are more individualistic thus possibly being more susceptible to mental illness due to a tendency towards isolation. Furthermore, remedies for mental health issues in the East have historically leaned towards the practice of traditional medicine such as acupuncture and meditation whereas in the West, operating or stimulating parts of the brain to get to the ‘root’ of its function, has now largely been replaced by talking therapies such as cognitive behavioral therapy (CBT). Studies in this paper show that the reliance on traditional remedies and allocation of resources are likely factors in Asia’s slow advancement in the field of psychiatry.With these points in mind, this paper examines the efficacy of care for people with mental health problems in both the UK and in Thailand.
Literature Review
Nisbett’s (2003) book The Geography of Thought puts forward the general idea that cultural differences have more bearing on the way people think than was previously understood. For example, Westerners tend to be more analytical about individual objects, whereas their Eastern counterparts are more likely to look at the object in terms of its relationship to other parts. Consequesntly, Westerners’ individualist mindset could have an impact on a person’s ability to deal with the stigma of mental health and similarly, in the East, shame and ‘loss of face’ can also impact how mental health issues are viewed and dealt with.
Meshvara’s (2002) journal article ‘Mental Health and Mental Healthcare in Asia’ puts the number of people in Asia suffering from mental or neurological conditions at 450 million and attributes that to many factors including the slow historical development of psychiatric care and prejudice, ignorance and fear towards mental health issues.
Conversely in the UK, Fundamental Facts (mentalhealth.org.uk, 2007) is a set of facts and figures compiled by leading UK physicians and researchers which concluded that mental health problems were on the rise and its consequent economic and social burden presents a growing challenge for which this and future generations will need to find solutions.
The Bangkok Post newspaper article Mental Health: Neglected in Thailand (bangkokpost.com, 2012) states that ‘3 million Thais are mentally ill’, highlighting statistics provided by studies conducted by the Thai Ministry of Mental Health which proposes expansion of access to mental health services for all Thai people by 2016.
In an earlier study, the Thai Ministry of Public Health (2001) reported that mental health problems had steadily been on the increase, which is a culmination of surveys carried out in communities and reports from psychiatric facilities in Thailand. However, comprehensive later studies on the state-of-play of mental health in Thailand conducted by The World Health Organization (2006) also recommended that the way mental health data is collected in Thailand needs revising.
The Cultures
As Nisbett (2003) shows, Eastern and Western brains are biologically different and studies in the field of neuroscience are now starting to discover that culture can also effect brain development. Interestingly, despite high numbers of sufferers, it was found that East Asian cultures are less likely to be genetically predisposed to depression than their Western counterparts which is possibly a result of the brain’s adaptation to its familiarity with a more interdependent environment (apa.org, 2015). In the West, however, a person’s individualistic brain may make them more susceptible to mental illness as result of an inability to initially ‘reach out’ to a prospective supportive network.
Mental Health in the UK
A 2001 survey revealed that 15% of British adults reported experiencing depressive or anxious symptoms during the previous week with 9% of the total population meeting the criteria for diagnosis, which is a significant number of people. Although the health system is more developed to provide a higher standard of mental healthcare, there still remains a stigma which prevents people from being able to openly share their struggles and subsequently seek help. This has resulted in campaigns to raise awareness, aiming to encourage issues to be brought out into the open rather than be suppressed.
Nevertheless, the healthcare system is still struggling to cope with a rapid increase in neurosis diagnoses such as anxiety and depression, for which treatment is less likely to be given as an inpatient as psychiatric beds are increasingly required by patients suffering from more enduring, acute or psychotic illnesses (mentalhealth.org.uk, 2015).This increasing need was further compounded by UK government plans to cut funding to mental health services when its allocation already only accounted for 13% of the overall National Health Service budget. These proposed cuts would put an already under-resourced mental health service under further pressure resulting in more emergency hospital admissions, requiring further, more costly care (Duggan, 2014).
Mental Health in Thailand
In Thailand, mental health service provision continues to be a challenge. According to the Deputy Health Minister Dr. Surawith Konsomboon, 3 million people in Thailand suffer from some kind of mental illness (which equates to one-in-five) the most common conditions being depression, anxiety and psychosis (Konsomboon, 2011).This trend has continued on from the Thai government’s initial report on mental health in 2001 which stated that social and economic factors over recent decades had contributed to a measurable decline in the nation’s mental health.
Furthermore, Thailand allocates only 3.5% of its total healthcare expenditure for the treatment of mental health which leaves gaps in service such as refresher training for psychiatrists, a lack of community out-patient interventions and access to treatment in rural areas; as things stand, psychiatric treatment facilities are primarily available in cities, leaving outlying communities isolated (World Health Organization, 2006).
Conclusions and Future Study
To sum up, this paper proposed that although there are distinct cultural differences between people in the UK and those in Thailand, mental health issues are still prevalent on both sides and studies show that although these are recognized, healthcare systems in both countries need to address this growing problem with ever-decreasing resources. A criticism of psychiatric education in Asia is that it merely provides a general overview of psychiatry as opposed to giving training in providing more specific primary care to service users; it is also shown to lack in ongoing post-qualification training for psychiatrists. Nevertheless, one of the strengths of Asian culture is their reliance on the family unit and short-term residencies at temples which provide a safe environment which can aid recovery.
Although the UK benefits from continued training for its clinicians, funding cuts threaten greater access to care for the community at large. For aftercare, when patients are allowed recovery in a supportive environment whereby engagement is long term, they are more likely to make a fuller recovery. However, in the UK, this support is more likely to come in the form of a support network rather than from the patient’s family, which may prove to be increasingly necessary as a result of government funding cutbacks.
References
Nisbett, R. (2003). Geography of Thought - How Asians and Westerners Think Differently.
Meshvara, D. (2002) Mental Health and Mental Health Care in Asia.Official Journal Of The World Psychiatric Association, June 2002.
Mentalhealth.org.uk, (2015). Retrieved from: http://www.mentalhealth.org.uk/content/assets/PDF/publications/fundamental_facts_2007.pdf?view=Standard
Apa.org.(2015).Your Brain on Culture. Retrieved from: http://www.apa.org/monitor/2010/11/neuroscience.aspx
Konsomboon, S (2011) Mental Health: Neglected in Thailand. The Bangkok Post.Retrieved from http://www.bangkokpost.com/learning/learning-from-news/314017/mental-health-neglected-in-thailand
Duggan, S. (2014). Risks of Deep Cuts in Mental Health Funds. The Guardian. Retrieved from http://www.theguardian.com/society/2014/mar/12/risks-deep-cuts-mental-health
Thailand Ministry of Public Health (2001).Situation and Trends of Mental Disorders of the Thai People. Retrieved 15 October 2015, from http://eng.moph.go.th/index.php/health-situation-trend/92-mental-health-2001/110-situation-and-trends-of-mental-disorders-of-the-thai-people
World Health Organization. (2006). Retrieved from: http://www.who.int/mental_health/thailand_who_aims_report.pdf