A Social Approach to Mental Health
Starting in the late 1960s, the World Health Organisation compared the outcomes of people diagnosed with schizophrenia in ‘developed’ and ‘developing’ countries.
After both two-years and five-years, the researchers found that patients in the poorer countries “had a considerably better course and outcome than [patients] in developed countries. This remained true whether clinical outcomes, social outcomes, or a combination of the two was considered.” People in India and Nigeria did especially well.
Many people have commented on the potential differences in the two types of country in terms of social support for those in distress. It is hypothesised that in countries where such mental distress is less pathologised, and mental health infrastructure less apparent, people in distress receive the support of family and friends to a greater extent than in the ‘West’. Such has been the way, one might imagine, for millennia. Unfortunately, in industrialised countries, there has been a shift toward individualism.
Someone who warned of the dangers of individualism was Martin Buber, an Israeli philosopher. Buber foresaw risks of isolation and dehumanisation in the modern solely analytic, material views of existence. He related this thinking to human communication, distinguishing between two different forms. Ich-Du (I-you) is an unstructured, mutual, holistic communication in which no information is transferred, but the authentic existence of two individuals, such as lovers, or a mother and child is realised.
The opposite is Ich-Es (I-it), in which, despite the superficial appearance of a dialogue, individuals are really taking part in a monologue. The other person is an object; there is no authentic bond between the individuals. Buber thought that there was a normal oscillation between the two states, with Ich-Du being rare but virtuous, and an increasing common Ich-Es diminishing humanity.
‘It Takes a Village to Raise a Child’
Buber described a decline in authentic human-human meetings in a post Scientific Revolution world. In her book Mothers and Others: The Evolutionary Origins of Mutual Understanding, anthropologist Sarah Hrdy looks back to the origin of the human-human connection. Hrdy suggests that, historically, children required the care not only of a primary caregiver, but also from an extended family and others. She argues that this requirement led to the the human capacity for understanding others – that children learn who is caring, and who is not.
In the 1960s and 1970s, the psychoanalyst John Bowlby examined the emotional attachment between humans. In Attachment and Loss, Bowlby rejected previous ideas, such as Freudian thoughts on infant sexuality, to suggest that the attachment of an infant to its primary caregiver, was important in and of itself. Psychoanalyst Peter Fonagy describes the attachment theory further: “[It] postulates a universal human need to form close affectional bonds. At its core is the reciprocity of early relationships which is a precondition of normal development. The experience of security is the goal of the attachment system, which is thus first and foremost a regulator of emotional experience. In this sense it lies at the heart of many forms of mental disorder and the entire psychotherapeutic enterprise.”
“Emotions, unlike sensuous stimuli, are not visible or tangible and, consequently, must be apprehended by reverie, a waking dream state.”
– Grotstein, 2009
Psychoanalyst Wilfred Bion was interested in how the caregiver sensed, and made sense of, the workings of the mind of their child – or indeed, how they communicated at a fundamental level. He described this mysterious process as ‘reverie’.
Bion’s reverie allows the caregiver to receives raw stimuli from the infant, processes them, and returns them in a more digested and digestible form. In other words, it is the caregiver’s ability to make bearable, or contain, the child’s anxiety. Reverie is very similar to Donald Winnicott’s ‘maternal preoccupation’, and Daniel Stern’s ‘attunement’. In the psychoanalytic literature, reverie is considered to be an advanced state, the endpoint reached via a progression through both consciousness and attentiveness.
Reverie, from the Latin radix refers to a root, but from the French revere refers to a dream. The French philosopher Bachelard described a poetic reverie – an uprooting of the normal order of things, a profound experiential understanding. Both concepts, the rooting to what is basic, and the deep understanding of something beyond the material, are helpful in describing the archetypal communication between caregiver and child.
It is through this communication, the caregiver and child form a relationship – the prototype of all future relationships.
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