Abstract
At one time, psychologists had a tendency to treat human nature as something entirely separate from its physical, social and historical context. There is however an increasing acceptance of the ‘emerging evidence linking mental health to social context’ (Bhavsar, Zhang, & Bhugra, 2019). Mental disorders may spread the world over but the way they express themselves is dependent on their social and cultural context, shaped by historical and religious forces. We are all hostages to history.
Ireland exemplifies this. Joyce (1922/1936) pointed out, ‘I am the servant of two masters . . . The imperial British state and the holy Roman catholic and apostolic church’. Even by the 1950s, Ireland was ‘a grim, inward-looking and deeply repressive society’ (Cooney, 1999), still recovering from civil war and dominated by the church. Resisting the Power of Mea Culpa is a deeply moving personal account of a child growing up in a family with a violent, abusive alcoholic father and a submissively devout mother (there was no divorce in Ireland then), sexual abuse by a priest (The Irish Catholic church has still not faced up to the realities now and was certainly not prepared to face up to them then), homosexuality (then totally illegal in Ireland), the death of his lover from AIDS (untreatable at the time), alcoholism (there is a well-recognised high rate of addiction among survivors of childhood sexual abuse – see, for example, Widom, Weller, & Cottler, 1999) and attempted suicide.
The 1990s were the critical period when the Catholic ethos started to lose its normative grip on Irish society. Somewhere along the line, the author managed to acquire a degree in psychology and a doctorate in psychotherapy, though he gives very little space to any account of how he pulled himself together to achieve these. The last, and longest, section of the book describes his legal and political struggles to achieve transparency, acceptance and institutional accountability for silenced or hushed-up moral harm in historic Ireland. His book is, perhaps, open to the criticism that it concentrates on the miseries of life. Some mention of its joys – graduating, finding contentment with a new (now legal) partner, success as an academic and therapist and so on might have given a more balanced impression.
Ireland has been through major cultural changes in recent years, with the end of the troubles (though there are Brexiteers who seem willing to restart them), an economic boom and the weakening of the church’s grip. As the author points out, it is ‘a very different country to the time when John Paul II visited in 1979’ – more open and more at ease with itself. Other countries have, similarly, faced major social, cultural and economic upheavals. China, for example, made a complete U-turn from the Cultural Revolution of 1966–1976, with its emphasis on state control of everything and the merciless suppression of anyone showing any signs of individual initiative, round to Deng Xiaoping’s economic reforms which encouraged entrepreneurialism while attempting to retain full state control of social behaviour.
This change appears to have coincided with an increase in mental illness. Huang et al. (2019) noted a much higher prevalence of a range of disorders in 2013 than in 1982. Comparative figures are difficult to ascertain because admitting the existence of mental disorder was frowned on during the Cultural Revolution and there was officially no unemployment, whereas now, as Jie Yang points out in Mental Health in China, ‘Unemployment Complex Syndrome’ is classified as a mental illness, rather than unemployment being regarded as a potential trigger for mental disorders.
Resisting the Power of Mea Culpa focussed on the power of organised religion. In contrast, religion has played less of a part in Chinese culture than in any other known human society (Guha, 2018). Civil conflicts in Chinese history, which have been many and bloody, have usually been about power rather than about belief (Guha, 2017). In her broad-ranging anthropological review of mental health problems in China, Yang hardly mentions religion at all. This brings up the main criticism I would make of an otherwise excellent book. Mental Health in China seems entirely concerned with the Han majority. Religion is of major importance to the Uighur Muslims of the western territories and to the Tibetans. In both these areas, the local cultures are being suppressed, partly to enforce uniformity and partly through sheer incomprehension. Tang (2019) pointed out that being mentally ill and being part of an ethnic minority imposes a double hazard. A study of the mental health of Muslims confined in a Xianjiang ‘re-education camp’ would make for interesting reading.
Chinese society is undoubtedly stressful. The ways in which people respond to stress are social constructs (Cloward & Piven, 1979). The social factors in this case are Confucianism, with its strong emphasis on the family rather than the individual (Gao, Corrigan, Qin, & Niewegloski, 2019) and a long history of totalitarian control. It is always tempting for any of us to assume that anyone who disagrees with us must be mentally disordered. A totalitarian state can completely give way to this temptation. A Chinese folk saying ‘Mental illness afflicts all those who petition’ is well exemplified in this book. Yang clearly describes the scale of the problem – over 100 million people suffer from some form of mental disorder, an estimated 25% of the overall health burden catered for by an estimated 1% of health expenditure. She briefly summarises both the specifically Chinese ways in which disorders are expressed and classified and the ways in which they are treated.
One of the new disorders which Yang describes is ‘Internet addiction’. China has the greatest number of Internet users in the world and the biggest online gaming community in the world, with millions of young people playing to the extent that it hampers their educational, social and working life. The state, however, manages to keep such a tight control of content that the use of the Internet as a tool for dissent hardly rates a mention. In the rest of the world, the situation is very different. Governments in societies based on the ideal of ‘freedom of speech’ have barely started to get a grip on the problems that this can entail, and poorer countries in the Middle East and elsewhere have neither the resources nor the will to try. It is very hard for those of us who have grown up with access to books, journals, newspapers, films, radio and television to get into the mind-set of young people, particularly in poorer countries, whose main or only contact other than word of mouth is online. Neil Aggarwal, associate professor of clinical psychiatry at Columbia, has attempted to do so in Media Persuasion in the Islamic State. Muslim culture is by no means monolithic – Zolezzi, Alamri, Shaar, and Rainkie (2018) found a very wide range of attitudes within Arab states. Nevertheless, a broad pattern emerges of frustrated young men with limited access to other media getting hooked on videos that invite them in to participate as though they were joining an online video game. It is this interspersal of fantasy and reality that appears to make these videos so seductive. Going down in a blaze of glory can be enjoyable in a game, so the more game-like the programme is, the more effective it will be as a recruiting tool, whether the Islamic State or any similar body retains control of any physical territory or not.
The final chapter in Aggarwal’s book is entitled ‘Toward a Science, Policy, and Practice of Militant Counter-Messaging’. There have been increasing calls for psychiatrists to contribute to a public mental health approach in the development of counter-messages to violent extremism. The author obviously has reservations about this approach, but suggests a form of public health screening, not for law enforcement but for treating individuals. Aggarwal suggests that there is sufficient evidence of a link between exposure to violent media and psychological distress to justify a cautious therapeutic approach.
All these books can be recommended to the attention of readers of this journal. Resisting the Power of Mea Culpa is a gripping personal account of the traumas of growing up in a highly repressed society dominated by a single powerful religion. Mental Health in China gives a snapshot of mental disorder among the Han majority under an economically tolerant but politically and socially oppressive government, inclined, like all totalitarian governments, to use ‘mental disorder’ as a label for dissidents. Media Persuasion in the Islamic State illustrates the ways in which new media can be used to induce barbarianism, even to the level of suicidal behaviour, using a single powerful religion rather than physical territory as a base.
Religion can be a source of solace or can be a source of trouble: ‘a significant role in mental health care and in psychopathology, especially when patients adopt extreme and negative interpretations’ (Hannabuss, 2019). Most founders of religions – Jesus, Buddha and even Mohammed appear to have set out to be inclusive, but their followers get their chief pleasure from being exclusive. The step from St Francis preaching to all living beings down to friars presiding at the burning of heretics is all too narrow.
Similarly, the founders of modern information technology, such as Tim Berners-Lee, started off with the best of intentions: trying to create tools which would liberate and ennoble mankind. Information technology (IT) can play an important and useful part in therapy, but whether we are ‘racing towards a digital paradise or a digital hell’ (Wykes, 2019) is a moot point. The somewhat depressing conclusion that can be drawn from these three books is that humans can occasionally create relatively open and tolerant societies like modern Ireland, but by and large, in any circumstances, there will be humans whose aim is to make life hell for other people.
