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Annals of Global Health, VOL. 82, NO. 3, 2016
M a y eJ u n e 2 0 1 6 : 5 3 2 – 5 7 4
New and Emerging Priorities for Global Health
Funding: Indian Council for Medical Research.
Abstract #: 2.071_NEP
One community at a time
R.J. Bischoff 1, P.R. Springer1, N.C. Taylor1; 1University of NebraskaLincoln, Lincoln, NE, USA
Program/Project Purpose: Mental health conditions continue to
be one of the leading causes of disability worldwide. This is largely
because adequate mental health care is not readily accessible in many
parts of the world, including in many parts of the U.S. These disparities in access to care are the result of a complex interplay between
availability of mental health care providers, affordability of care,
and additional factors that influence the perception and acceptability
of mental health care (e.g., stigma, culture, policy). Solutions that
work must address this complexity. The purpose of this program
was to develop a community partnership model to reduce mental
healthcare disparities that address the complexity of challenges faced
by underserved communities, locally and globally.
Structure/Method/Design: Funded through a grant from the
USDA, we have developed a model for reducing mental health
care disparities around the world one community at a time. We
used rural towns (
18 years old treated for HCV with ribavirin and interferon combination therapy at King Faisal Hospital in Kigali, Rwanda from January 1,
2007 to December 31, 2014. Patient’s paper and electronic charts were
reviewed for data collection. Approval for the study was obtained from
the University of Maryland Institutional Review Board and King
Faisal Hospital K-Ethics and Research Committee.
Findings: The study included 69 patients; 52% were male, and
the median age at the start of treatment was 48 years (range 2569). The majority of patients had HCV Genotype 4 (61%) and
d practitioner often intuitively knows that the fit is good only insofar as it is therapeutically useful
and that what is left out of the slotting of experience may be more useful
(and valid) than what is hammered in.
In many societies a psychiatric diagnosis has significance in political and
l~gal arenas. In the former, it may be a reason why someone is judged
disabled and found worthy of disability-based welfare support. In the latter, 1t may alter a citizen's rights and responsibilities. The power of an
official psychiatric diagnosis in the modern state derives from its formal
status as the bureaucratic standard for determining everything from competence to revise a will to access to welfare benefits. Increasingly, contemporary society medkalizes social problems (De Vries et al., eds., 1983).
Alcohobsm, once a sm or moral weakness, is now a disorder. This is not
purely arbitrary. Genetic factors and physiological processes are involved.
But those factors and processes need to be regarded in a certain wa v _
~ay, differently from the way we usually regard blue eyes, baldness: an
mtolerance of strawberries, or an addiction to pasta-before we call them
a disease. The same is true of drug abuse, certain kinds of truancy and
~elinquency for which children and parents were once held legally responSible to school authorities but which are now relabeled as conduct disorder
and a wide range of the experienced problems of daily living, now called
stress syndromes, which to a greater or lesser degree have biological ante.cederrts, correlates, and consequents.
Medicalization-whether seemingly scientifically jw;tified or not-is an
alternative form of social control, inasmuch as medical institutions come
to replace legal, religious, and other community institutions as the arbiters
behavior. This is not always undesirable. In certain societies medicalizamay authorize useful social change that is otherwise politically unacOOJ>tal>le. For example, Stone (1984) has shown that the American disabilsystem has come to rnedicalize problems of poverty, under- and
· .1:me, and that of the patient, which includes the patient's
interpretation. Validity is the negotiated outcome of this transforming interaction between concept and experience in a particular context. Thus,
validity can be regarded as a type of ethnographic understanding of the
meaning of an observation in a local cultural field.
Let us return to the diagnosis of Mrs. Lin's disorder. For her Chinese
internists and psychiatrists, the disorder is neurasthenia-a putative
"chronic malfunction" of the cerebral t.'Ortex associated with nervousness,
weakness, headaches, and dizziness, thought to be common among ..brain
workers" and to have psychosocial as well as biological causes. But it is
held to he a physical illness and therefore neither conveys the marked
stign1a Chinese attribute to mental illness nor implies personal accountability for the associated physical impairment or emotional distress. The
way in which Mrs. Lin presents her symptoms i• also influenced by the
What Is a Psychiatric Diagnosis?
13
cat~go~y n~u.rasthenia, which is not only a technical psychiatric taxonomic
e~tt.ty m Chma but one widely understood in the popular culture. Mrs.
Lm s perception of her symptoms selects out and lumps together those
symptoms that are familiar and salient to her, namely the ones that fit
the popular. blueprint of neurasthenia. This prac'\ice is reinforced by the
relatives,. fnends, and practitioners to whom she tells the story of her ill~
nes..
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