17.4.2 Culture and the Brain

The human brain is a fascinating research topic, both medically and culturally. Different cultures conceptualize the brain, its functions, and its health differently. Biomedicine and ethnomedicine systems view human physiology in distinct ways, and these two systems typically have very different explanatory models for understanding the brain and its role in psychology and neurology. Anthropologists are interested in both of these explanatory models and the ways they influence treatment. Some topics of particular interest to medical anthropologists include how psychology affects biology and health, the stigma of mental health across cultures, addiction, culture-bound syndromes, and experiences and illnesses related to stress. Daniel Lende and Greg Downey brought together these topics under the heading of neuroanthropology, an emerging specialty that examines the relationship between culture and the brain.

As highlighted during the discussion of the cultural systems model, the acceptance of psychology is highly variable by culture. Societies that rely upon biomedicine are more apt to embrace psychological approaches to mental health problems. Encouraging other cultures to apply psychology and psychiatry sometimes requires an anthropologist’s touch. One challenge for a medical anthropologist is convincing people who do not believe in mental health challenges that acknowledging and treating mental health issues is a better approach than ignoring them. India’s slow but eventual acceptance of psychology is described by Rebecca Clay in a 2002 article. In this case, psychology was gradually normalized and accepted through a combination of Indian medical theory and psychological treatments and diagnoses. This culturally based path toward normalization indicates the need for cultural understanding and a nuanced approach by medical anthropologists.

Culturally specific nuance is especially important in understanding what anthropologists call culture-bound syndromes. Culture-bound syndromes refer to unique ways in which a particular culture conceptualizes the manifestations of mental illness, whether as physical and/or social symptoms. The condition is a “cultural syndrome” in that it is not a biologically based disease identified among other populations.

A prominent example is susto, a syndrome in Latino societies of the Americas. First documented by Rubel, O’Nell, and Collado-Ardon (1991), susto is stress, panic, or fear caused by bearing witness to traumatic experiences happening to other people around you. Originating with Indigenous groups in the Americas, this panic attack–like illness was seen as a spiritual attack on people and has a number of symptoms ranging from nervousness and depression to anorexia and fever. Cultural syndromes are not limited to non-Western societies, however. According to anthropologist Caroline Giles Banks (1992), anorexia nervosa, an eating disorder where the person does not eat in order to stay thin in accordance with the beauty standards in the United States and Europe, is a prime example of a culture-bound syndrome. Only in these cultures, with specific pressures on weight and beauty applied to women and men, does anorexia nervosa appear. But as these beauty standards spread with globalization and the spread of media from these cultures, so does the disease. Cultural syndromes are not restricted to cultures that prefer biomedicine or ethnomedicine: they are as diverse as human culture itself.

A related concept gaining ground in psychology is known as cultural concepts of distress, or CCD. These concepts, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5, “refer to ways that cultural groups experience, understand, and communicate suffering, behavioral problems, or troubling thoughts and emotions” (American Psychiatric Association 2013). In sum, CCD is used to describe how a culture explains and conceptualizes the unique manifestation of mental illness as physical and/or social symptoms.

The psychobiological dynamic of health—the measurable effect of human psychology on physical health—is a primary tool used by medical anthropologists to study health. The psychobiological dynamic of health helps anthropologists evaluate the efficacy of health-related treatments that may not accord with those used in their home culture. For example, ritual healing has real measurable effects on people, both the patient and those in attendance during the ritual, as long as they believe that the ritual has healing power. Similarly, for those who share a cultural belief in the power of such practices, being prayed over by a priest or blessed with holy water can offer effective healing power. Psychological belief grants healing efficacy. The same principle applies to biomedicine, as illustrated by the placebo/nocebo effect. Of course, belief alone cannot entirely negate the harmful or helpful effects of medicine or any other substance.

Another area in which psychology and health intersect is the experience and effects of stress, a human universal. Indeed, it is well established that mental stress can make someone physically sick. The work of anthropologist Robert Sapolsky (2004) analyzes the evolution of the human body to adapt to, use, and heal from stress. His analysis suggests that stress pushes humans to both physical and mental limits, that these limits differ in different humans, and that being pushed up against limits due to stress can result in growth. The human ability to adapt to stress is a difference from other primate species, and it likely developed over millions of years of evolution. While human bodies have evolved with stress and have sometimes grown as a result of stress, we were not evolved to withstand chronic stress over extended periods of time. Chronic stress induces a high rate of stress-related diseases, such as heart disease, indicating the limits of even evolution to adapt to long-term stressors.

Addiction is another area in which medical anthropologists have done significant work, analyzing how culture and biology contribute to addiction. Addiction comes in many forms and affects multiple measures of health. Medical anthropologist Angela Garcia tackles addiction in her book The Pastoral Clinic: Addiction and Dispossession along the Rio Grande (2010), which explores the intersection of race, class, immigration status, and dispossession with drug addiction and the ability to treat it. Focusing on a small town on the Rio Grande and specifically a clinic within that town meant to treat addiction, she tracks the trajectory of a number of patients and the factors that contributed to their addiction. Her analysis highlights the status of these patient as immigrants, minorities, and outsiders, which prevent reentry into society for many. Similarly, João Biehl’s work Vita: Life in a Zone of Social Abandonment (2103) analyzes the effects of dispossession and homelessness on social health, looking specifically at the role of drugs in the highlighted zone. His exploration of vita, a place where people are “left to die” when their addiction or mental illness becomes too much of a burden, shows the cultural effects of mental health and addiction on Brazilian society and the struggles of the individuals abandoned there. In both works, the role of drugs is highlighted, exploring how cultures symbolically characterize problematic drug use and addiction and attach a stigma to admitting a problem and seeking treatment. The works also explore how drugs are justified and understood, illustrating both how drugs change the biochemistry of the brain and how the human mind characterizes the drugs, each shaping one another.