Saturday, January 2, 2010

Pastoral Society and the Nigerian Paradox - Or, If I Were to Act Out Where No One Noticed, Would People Think I Was Mental?

The other day, in a conversation with a mental health advocate, I contended that had I been born into a pastoral society in a different century, my bipolar symptoms most likely would have passed under the radar.

Okay, there is a good chance my fellow villagers would have regarded me as weird or eccentric, but they would hardly consider me unfit for my standard pastoral duties of hewing wood and drawing water and the like, not to mention my reproductive obligations.

It’s not just me or my particular illness. I’m including practically all of us, across the full mental illness spectrum. Think about it: No literacy, no books, no classrooms - where was the ADHD going to come from? No doubt people had it. But if a tree falls in the forest and no one hears it ...

What about anxiety? My advocate friend tactfully reminded me that Mongol Hordes and famines and the like would have given our ancestors plenty to be anxious about. She also pointed out that mental illness has been around forever, and that there is ample documentation of this in the ancient world.

True, I acknowledged ...

The conversation came up in the context of what I call the “Nigerian Paradox." Back in 2004, I published an article on mcmanweb that noted that the average Nigerian earns $300 a year and has a life expectancy of 45.3 years. Yet, In 2003, a World Values Survey of more then 65 countries ranked Nigeria number one in terms of happiness.

Then, in 2004, a World Health Organization survey of 14 countries and two Chinese cities found Nigeria way lower in mood disorders (at less than one percent over 12 months) than the US (at nearly ten percent) and the others. In terms of serious mental illness, Nigeria was second-lowest at nearly five percent (Shanghai was four percent). Significantly, US residents with serious mental illness spent 70 days unable to carry out their duties compared to Nigerians at 15.

We have no definitive answers here, but the contrast between two entirely different worlds gives rise to all manner of legitimate speculation. The two which come most readily to mind include community ties and social stresses. Indeed, you can make a very good case that mental illness is an industrial and post-industrial disease, but I’ll save that for another day.

This is all about my big mouth and my under-the-radar hypothesis. Let’s start with the proposition that at a very tender age we are jammed into crowded classrooms, then, at a less tender but far more malleable age, into crowded workplaces. Add to this the fact that society attaches to both very high (and typically unrealistic) expectations. We must produce or else. We must toe the line or else.

Hello? Not only are we going to be a lot more stressed than our ancestors - we are going to be noticed. Case in point: Back in the late eighties, in a work-induced sleep-deprived state of anxious mania, I stormed into my boss’ office in a crowded newsroom and quit my job. Just like that, I became a pariah, an outcast, with no hope of redemption.

Forgive me for speculating, but let’s find a different venue for my mad scene, say a remote pasture 300 years ago. “I hate you cows!” I can see myself raging. “Cows suck!”

Boy, that would have got me fired fast. But suppose two or even three people noticed. What would they be thinking? Can’t trust this guy around the cows? Maybe, but we’re in a pre-industrial age, here, or, to be more precise, pre-post-industrial. So what my fellow pastoralists are definitely NOT thinking is: Good cow management requires highly advanced people skills. Not to mention razor-sharp cognition. Let’s get rid of the guy.

As long as I remember to close the gate before I go back to my hovel, my job is secure. And if I really do need time off? Fifteen days tops, is my guess. Same as the Nigerians. Imagine that, 15 days and I’m rehabilitated, back in my community. How does that feel?

Now compare this to how I felt back in my own time when I came to the realization that I would never be employable in my chosen profession again. On the other hand, forget it - even more than two decades later the memories are still too painful.

Moving on, we have the small matter of the Mongol Horde factor to consider, the one that my friend brought up in our conversation. I have to admit she had me stumped, but the next day an answer jarred loose. This is why I love conversations with smart people, which makes living in a post-industrial society well worth it, but I digress. Anyway, consider:

Suppose Genghis Khan and his clansmen were on the horizon. Would not EVERYONE be going crazy? Not just you? Even if you were to go a bit more crazy than the others, all things considered, who would notice?

I don’t want to create any false impressions. Life back then was nasty, brutish, and short. Heaven help if my symptoms were to attract serious attention. Heaven help if my village were to turn on me. Chained to a wall the rest of my miserable life would be my likely fate.

All I am saying is that back in the old days, it would have taken me much longer to cross this attention threshold. My internal hell back then would have been no different, only the types of behavior it triggered, such as taking it out on the cows. And, if no one noticed - if there were no external hell to pay for my internal hell - then what would that have done for my internal hell?

Just asking ...


Willa Goodfellow said...

I think the story is mixed. I'll confine my comments to Medieval Europe.

People with schizophrenia were thought to be possessed. Exorcism was not a pleasant process, and if unsuccessful, the next step was the stake. The one brilliant shining exception was the city of Geel, Belgium, which has had community-based mental health care from the 14th century to the present. I'll be writing about it soon.

People with depression were considered to have an excess of the humour melancholia. Not good to be seriously out of balance, but there was a place for all types. Melancholics made good gardeners, night watchment, writers.

Visionaries and people with stigmata -- were they the bipolars, alternately praying and acting out? The Church was uncomfortable with these, but tolerated them as long as they didn't disrupt the status quo. I think the DSM takes pretty much the same approach.

Personally, "here and now" is my worst subject. So I would have been lousy at closing the gate. Better herbs than herds.

Today, schizophrenia is pretty evenly distributed across the planet with a couple notable exceptions in isolated populations. But you are on to something with mood disorders and the stress thing. There are two kinds of stress, the short-term resolvable kind that our bodies can handle, "We need adrenaline up here!" and the chronic, unresolvable sort, "Release the Kracken/cortisol!" Western culture (and locations of genocide...) have more of the second sort. I have gotten to the point that I can actually feel the cortisol attacking my poor pitiful hippocampus each month when I have to deal with my disability benefit carrier.

But you put all the brain science better at

:-) Happy New Year, John!

John McManamy said...

Happy New Year, Willa! Love your analysis. A confession - I, too, have no grasp of the here and now. I think I could get closing the gate right. After that, I'm hopeless a screw-up, which is why I became a writer. Also fits with my melancholia. :)

John McManamy said...

Margaret asked me to post this:

One of the things I learned early on, is that people with mood disorders don't handle stress as well as others. We freak, others probably just say, 'oh shit' and go on with their day.

Michelle said...

Okay, so my grandparents didn't live quite that long ago but they did live through the depression as sharecroppers. The poorest of the grandfather's alcoholism and gambling compounded the problem and my grandmother's bipolar "I'm laying here dying again" likely didn't help. They had a large family - 7 kids, most if not all are bipolar including my father, so this behavior was their "norm" - isn't that a scary thought. My dad's behavior was our norm growing up - he was sensitive, brilliant, eccentric, demanding at times and a fun alcoholic (yes I know that's not politically correct but guess what I'm not). So my eccentric behavior and "temperament" were accepted by my mom's family cause "she gets it from her dad". And when my son started falling off the edge, well, it was hard to tell, we were all used to what the world calls being crazy, at least until he tried to kill himself. So yes, I'm bipolar and I live most of the time and I work most of the time and yes I am eccentric most of the time. My son, well, he has a very hard to manage disorder - bipolar nos - will he find his place in this "did you close the gate?" society? I hope so, at some point. He is brilliant, sensitive, eccentric, and extremely tempermental - an outcast in many ways. There are so many of us, outcasts that is, I think he is in good company, at least the brilliant and interesting company.