Autism, Depression and The Body

Blogging on Peer-Reviewed ResearchMental disorders such as depression and autism are generally viewed in one of two lights, either as something neurological or something psychological.  Cultural anthropology obviously has greater affiliation with the psychological side, and biological anthropology with the neurological.  The same split is true in psychiatry, ably demonstrated by Tanya Luhrmann’s Of Two Minds, which, to radically simplify, describes the fight between talk-therapists and pharmaceutical-dispensers.  (Still, at least this anthropologist wishes Luhrmann had gone beyond ethnographic description of fields to tackle the same problem that both anthropology and psychiatry embody—bridging the nature/nurture or biology/culture split.)

 But is this way of dividing things, an enculturated mind versus an epigenetic brain, an accurate description?  Recent research suggests no. 

The January-February 2008 Harvard Magazine’s cover story is on autism, with one section entitled “Beyond the Genome,” which opens: “During the past few decades, most scientific research into the causes of autism has been focused on the structural wiring of the brain and on the genes that control it (28).” However, as this sidebar indicates, clinicians and researchers have “begun to ask whether disturbances in children’s broader bodily systems may be influencing, or even causing the disruption in their brain (28).”

 Margaret Bauman, associate professor and pediatric clinician at Massachusetts General Hospital, says: “Many kids with autism have gastrointestinal problems that may affect their behavior.  But because these kids are often nonverbal or hypoverbal, they have trouble conveying their discomfort or localizing their pain.”  The article notes that Bauman “believes that researchers need to pay attention to close attention to the pattern of physiological problems that attend the autistic syndromes of a significant portion of children.”  When these physical problems are treated, often children stop banging their heads or moving their bodies in reaction to the physical distress.  “It turns out that when you treat the medical problem, in many cases the aggressive and self-injurious behaviors abate,” Bauman says.

 Brandon Kohrt, in a 2005 Ethos article on co-morbidity, somatization, and depression in Nepal, presents a similar argument, but focused more on the mental/cultural side.  A prominent group of anthropologists has long argued that somatization, the physical expression of mental problems such as depression, is more prevalent in non-Western cultures, whereas as in the West, we present the psychological symptoms associated with depression (e.g., low affect).  Kohrt et al. note, however, that “few of these studies have rigorously considered possible physical explanations before diagnosing cases as somatization.  For example, bodily complaints may result from comorbid nonpsychiatric physical illness as opposed to psychological distress exclusively (125).”  After presenting some convincing evidence on co-morbid physical illness, such as arthritis, diabetes, and vitamin deficiency, they write that the “ethnographic cases suggest an intimate link between physical and mental health (142),” a conclusion I have seen reached in other research as well.  Kohrt et al. conclude by arguing “Only through biologically and culturally grounded investigation of somatic presentation of mental illness across cultures will we be able to uncover a more accurate picture of the mechanisms by which individuals come to experience and express distress (143-144).”

 Sounds like a good plan to me.  Alongside that enculturated mind and epigenetic brain, there is a body.  George Berkeley and Samuel Johnson?  I refute it thus!

6 thoughts on “Autism, Depression and The Body

  1. I agree with this. Far too often we develop tunnel vision when approaching some of these issues. Many times we need to “zoom out” and look at the multiple, intertwined dimensions of disease.

  2. I completely agree that only through a biological and cultural study of mental illnesses will we be able to understand their underlying mechanisms. However, we must be very careful when studying conditions such as autism or depression from a socio-cultural perspective. For example, as a result of Leo Kanner’s studies in the ‘50s, the term refrigerator mother was coined as a label for mothers of children with autism. Autism was thought to be caused by emotionally frigid mothers, and therefore very often parents were blamed for their children’s behaviors.
    Perhaps our current focus on the biological origins of autism is a kind of reaction to the stigma created by socio-cultural terms like refrigerator mother. In my study of the roles that family and social networks play in the treatment of autism in Peru, all of the parents interviewed mentioned that they initially felt responsible for their child’s diagnosis. However, after attending a center for autism and being told that the origins of autism were entirely biological, parents felt generally relieved.
    A socio-cultural approach to studying autism need not assign any responsibility for the individual’s condition. Nevertheless, the line between studying the socio-cultural context and pointing fingers has been hazy in the past.
    We must highlight that the objective of studying a mental illness from a socio-cultural perspective is to improve our understanding of how the individual could better integrate into or feel more comfortable in his/her society or environment. In fact, by studying different cultures and their relationships with mental illnesses, our knowledge and tools to help these individuals will be both broadened and more fine-tuned.
    Finally, I may be criticized of being too cautious while steering interest away from the biological approach. However, the reasons for avoiding a socio-cultural approach to understanding autism and depression are certainly understandable. For example, the present biological focus may be attributed in part to an attempt at reducing stigma and subjectivity. Interestingly enough, this biological focus has not taken hold in many developing countries like Peru due mainly to a lack of resources. Therefore, Peru’s focus on understanding mental illnesses is still rooted in cultural approaches. Considering the wide range of explanations and treatments that mental illnesses have across the world it would perhaps be wise to study them all to tease out the successes. For example, although Peruvian biological science is not capable of determining the genetic mechanism of autism, we (developed countries) could still learn very useful information from Peru by examining the relationship among social networks, parents, and individuals with autism. In a mental illness center I studied in Peru, the family was considered the primary (often the only) point of contact between individuals with autism and society. Therefore family members were educated thoroughly and parents and close family members participated continuously with the center’s programs. They are the ones that then teach their community and extended family about autism. If this center and these families have demonstrated effective mechanisms to achieve this public education even in Peru, a country were societal stigma is still ubiquitous, learning from them and modifying their model for other cultures could be extremely helpful.

  3. Andrea, your fieldwork sounds fascinating–do you have any publications or information online so we can learn more about it?

  4. You might be interested in reading “A Dose of Sanity: Mind, Medicine, and Misdiagnosis” written by a doctor giving lots of examples of patients with DSM diagnoses that actually had serious medical conditions. Apparently once someone fits a psychiatric diagnosis, many doctors shut off the possibility of a medical ailment–a dangerous bias!

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