How do cultural aspects influence the perception of drug use?
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How do cultural aspects influence the perception of drug use?
Virginia Berridge Victorian Studies Vol. 21, No. 4 (Summer, 1978), pp. 437-461
When I was younger, I read a book set in Victorian England. Everything from the literature of the time to the culture intrigued me. An interesting fact that my younger self overlooked, however, is the mention of opium dens. Though it is true that the India-China opium trade was an important aspect of the British economy during this time, that does not mean that the consumption of the drug (particularly by the Chinese community that had settled in the slum in London’s docklands by the 1800s) was overlooked by the public. This article discusses the responses to the opiate use and the way this conversation was impacted by the class tensions and racial hostility of the time.
Week 6 - Drugs
Perhaps my favourite reading this week was from the introduction of the book, Let Them Eat Prozac by David Healy. This book, which discusses the connection between the development of Selective Serotonin Reuptake Inhibitors (SSRIs), such as the drug that the book is named after, and social perception of depression brought to my attention the relationship between drugs used to treat anxiety and depression disorders and Japan.
The book mentioned benzodiazepines and their continued growth in Japan beyond the collapse of the market for them in the West, the diminution in the development of antidepressants in the country, and the social construct and perception of anxiety disorders such as social phobia. Growing up in a country where mental health is hugely stigmatized, I felt compelled to learn more about the way a culture can change the way a disease is perceived and how the drugs that are used to treat it are developed and used. I fell into a bit of a rabbit hole and was able to learn more about the way the Japanese feel about antidepressants.
According to the World Population Review, suicide is the leading cause of death for people under 30 in Japan. A significant factor of this is depression in the country. Despite these facts, SSRIs seem not to have yet been introduced to Japan at the same rate that they have in Western psychopharmacology. The study “Psychopharmacology in a Globalizing World: The Use of Antidepressants in Japan” cites that in addition to government regulation of the introduction of new drugs, a significant reason for this may be social issues surrounding sadness.
In his book, Healy states that “the Japanese antidepressant market [is] a small one, with no Prozac available as late as 2003.” In contrast, SSRIs were first instituted in the U.S. in the early 1970s. However, antidepressants have been shown to decrease the national rate of suicides. In a study done from 1999 to 2003, the prescription of SSRIs was associated with decreases in suicide rates. Moreover, the study “Cultural Aspects in Social Anxiety and Social Anxiety Disorder” cites that taijin kyofusho (TKS), a Japanese culture-specific syndrome relating to fear of interpersonal relations (think: social phobia), responds well to serotonin reuptake inhibitors and selective serotonin and noradrenaline reuptake inhibitors. So what is hindering the growth of the antidepressant industry in Japan?
The answer is complicated. On the one hand, conversations about mental health in Japan are still not widespread. All types of mental illnesses continue to be heavily stigmatized. An article from the Lancet adequately explains why: “Japanese are socially programmed to feel a sense of shame if they lack ... will power.” Admitting to mental health problems is perceived to be a renunciation to the ability to control and take care of oneself. This leads to not only lack of use of antidepressants, but an increase in depression issues in of themselves. Another possible reason comes up in the “Psychopharmacology in a Globalizing World” study. Since being in a tranquillized state of mind is perceived to be more socially desirable, the Japanese may note sadness and depression as a sign of “enhanced awareness of the transient nature of the world.”
Whatever the case may be, both the cultural and value systems of Japan and the personal perceptions of sadness prove to have a thought-provoking effect on the use of antidepressant drugs in a country in which depression seems to be a profound issue.
Who actually benefits from quarantine?
When a Public Health Service medical officer diagnosed an immigrant with a “loathsome or a dangerous contagious disease,” that individual was considered “medically certified.”
This article’s overview of the medical procedures that were used to examine immigrants upon arriving at the US is similar to the process itself: brief. This paper truly gives insight into the immigrant experience in the 19th and 20th century and gets you thinking about how different (or not so different) quarantine processes in the US work now.
Week 5 - Quarantine
This week, we learned about quarantine and how the US healthcare system treats immigrants. Perhaps the most interesting thing I saw this week is the “Quarantine and Border Health Services” website.
There is a very large sense of sensationalism on this website. It is almost as if the US is trying to make themselves be seen as do-gooders that work to help the poor immigrants that come to the US to seek refuge.
In our discussion section, I got to look further into the refugee services. Though they claim to want to help people everywhere, they seem to only place importance in US-bound refugees. They claim to have locations that cover the Middle East, Africa, and Asia, when in reality they only have three locations.
Overall, I feel like learning about the history of quarantine and the way the US welcomes immigrants is a true insight into the values of the country and demonstrates that they still have a lot of space to grow when it comes to providing healthcare and a caring environment for refugees across the world.
What are the responsibilities of someone who makes a new medical discovery? What good is a discovery if the world does not get to know of it?
Crawford W. Long first used ether as an anesthetic on March 30, 1842. This article examines factors in his education and practice that prompted his di…
There is a lot of controversy behind who actually discovered the pain-killing properties of ether. Crawford W. Long, an American surgeon and physician, had long been using ether before Wells or any of the men that came after him. Who is he and how did he contribute to the change of the medical world as we know it? And does he deserve credit if he did not try to spread his discovery?
Week 4 - Pain
On October 16, 1846, history was made as the first surgical procedure alleviated by the use of anesthesia was completed. John Collins Warren famously uttered the words “Gentlemen, this is no humbug,” as the discovery of the pain-killing properties of ether went on to revolutionize the medical field forever. It’s interesting to see how disease and medicine are basically measured by the history of pain. But what do you do when you have finally conquered pain?
Three key players took part in the experiment that allowed patients to not feel the excruciating pain that was, by then, very commonly associated with any type of medical procedure. The first, Horace Wells, was an American dentist. His partner in practice, William T.G. Morton, also played an important role. Finally, Charles T. Jackson, a professor of chemistry at Harvard University, can also be accredited to this great discovery. What were their contributions to Ether Day and what did they go on to do afterward?
Wells first noticed the pain-killing properties of N2O at a laughing gas roadshow. He was convinced that these properties could help numb the pain that his patients felt during dental surgical procedures and so, after months of trying to convince someone to let him try it out, Massachusetts General Hospital granted him the chance to test laughing gas out during a tooth extraction procedure on January 1845. The results did not come out as expected. Some speculate that Wells probably used the wrong dosage but alas, the damage was done. Having been a strong believer that N2O would work, he was subject to ridicule from his peers at the workplace. He did not give up, however, and continued to experiment with various chemicals. Many believe that exposure to these influenced him negatively, as a drastic change in his personality ensued during his last years. At the end of his life, he was imprisoned for throwing acid at prostitutes in New York and went on to commit suicide in his cell on January 24, 1848.
When speaking of Ether, the name that people most commonly associate it to is Morton’s. He is the man that took Wells’ experiments further and finally succeeded in using it as a pain-killer. He learned from Wells’ technique, experimented on his own, and managed to convince Massachusetts General Hospital to try out his research. With the help of a surgeon, this experiment took place in Ether Dome. The patient, Gilbert Abbott, was to be treated for a vascular neck tumor. With the help of an inhaler, Morton administered the ether to Abbott, who fell unconscious within minutes and did not react when the first incision was made. Onlookers were fascinated by this and the fact that the patient’s blood appeared darker than usual. When Abbott woke up, he remarked that though he had felt a scratching sensation, he had felt no pain. News of the successful experiment traveled and the rest is history. Morton passed away in July 1868 due to a stroke.
Perhaps the most controversial man out of these three is Charles Thomas Jackson. Well-known for being involved in priority conflicts of new discoveries, he fought with Morton for years over credit for the discovery of ether as an anesthetic. Jackson claims that over a meeting, he had suggested using ether to alleviate pain in surgical procedures. Though Morton had previously experimented with ether, he had never tried it out on a patient and so, a legal dispute came to be. This lasted for twenty years. Jackson passed away at an asylum, where he was due to insanity, in 1868, not long after Morton’s death.
These three men with remarkable life stories spread the knowledge and use of ether to the world and went on to change the medical field as was known.
What factors affect the chance of a doctor misdiagnosing a patient and how does this affect the doctor and the hospital’s credibility?
This article eloquently talks about the dilemma of specificity in diagnosis and how it can come to compromise the role of the practitioner.
Week 3 - Diagnosis
Diagnosis, you could say, is the core of medical care. It is essentially the process by which a medical expert can distinguish or recognize a disease. Because of this ability, doctors have grown to be idolized by communities as beings with awestriking knowledge. But what happens when a doctor makes a mistake?
In the past, diseases and diagnoses were a wide topic. Compared to today, diseases and their descriptions used to be very very vague. For example, most diseases in the 16th and 17th century were simply deemed to be Consumption. Diagnoses have been narrowed down through time. Due to our growing medical knowledge, doctors nowadays are able to use more tools, technologies, and practices that help pinpoint what exactly is wrong with the patient and bestow upon them a specific diagnosis. Though there is no arguing how helpful it is to narrow down the disease the patient has, there are a number of issues that doctors still must deal with when diagnosing someone.
By tying down a patient to a specific diagnosis, doctors eliminate the possibility of other diseases. If you monopolize the data with just one set of diagnosis, it increases the chance for misdiagnosis which becomes a problem because doctors cannot easily “undo” a diagnosis without incriminating their reliability.
Another issue that doctors face is their limited knowledge. Though there are many talented doctors out there, there is no way a single person can become an expert all around. Because of this, doctors are restricted to only commenting on their area of expertise and are unable to assess the situation completely, which can lead to misdiagnosis, as well.
Lastly, doctors cannot administer treatment if they cannot pinpoint what exactly is the issue. This can lead to problems as conditions usually deteriorate over time. They are faced with a choice: should they treat the patient even though they are not completely sure what disease they have, or should they wait and risk their patient’s health? The inability of doctors to diagnose someone immediately and effectively is mostly due to the limited time doctors have with patients, especially if the hospital is busy or understaffed. In addition, limited resources where they work could also influence their ability to provide accurate diagnoses. This can also create complications. (*cough* Dr. Harris *cough*)
In the end, the responsibility doctors take on when treating patients every day is undeniably big.
What do patients seek in a hospital and how do doctors work to provide it?
Elizabeth Broadbent, I Han Kuo, Yong In Lee, Joel Rabindran, Ngaire Kerse, Rebecca Stafford, and Bruce A. MacDonald
This study shows the reaction of patients being treated with a real-life consultant as opposed to a robot. Though I personally feel that the quality and accuracy of the robot is undeniable, including robots and having them treat patients takes away from the empathy and humaneness commonly associated with going to a doctor.
Overall, I worry about the ethics of it all. As medicine and technology progress together, I worry that these robot doctors will take over the field. Even though it does not seem to be a big deal now, I would not want a robot to tell me that a loved one has passed away.
Week 2 - Beyond the Clinic
Nowadays, there are many different ways in which doctors can reach patients beyond an appointment and consultation. In fact, the ever-growing market for health apps has made tracking your lifestyle easier than ever. But are these apps profitable in the long run? In my experience, the answer is no.
Months ago, I started tracking my calories and what I eat with an app. I had recently stopped doing high-intensity exercise and felt that it was necessary for me to track how much I ate now that I was not burning as many calories. Though the app is easy to use and tracks everything from how much water I drink to what kind of macros I consume, at the end of the day, my limited knowledge of health allows me to only do so much to improve my lifestyle.
I am a firm believer that these type of health apps are only helpful to people that know how to interpret the data that these give them. Did I maintain my weight? Yes, but I do not feel like I am eating healthily. The grams of protein and carbohydrates I consume in a day fly over my head, and frankly, I am not able to interpret this data on my own to fix my diet.
I saw an example similar to this one in our reading this week. Kristina Grifantini’s article, “How’s my Sleep? Personal sleep trackers are gaining in popularity but their accuracy is still open to debate”, depicts the flaws behind sleep tracking apps. Jordan Gaines, an expert in the sleep analysis field, states, “Sleep trackers need to have a practical message for its users.” I agree. Though technology could continue to improve and eventually reach the same level as a consultation with your doctor, it is equally (if not more) important to discuss your health problems and concerns with a specialist that can help you and give you professional advice.
Week 2 - Hospitals
Hospitals were originally built for efficiency, looking to serve the diseased public (who were predominantly poor people) in strategized locations. Since the establishment of the first public hospital post-American revolution, Massachusetts General Hospital, it is safe to say that a lot has changed, not only in the way hospitals are run and the type of equipment and practices used, but also in the way hospitals look.
Modern-day hospitals seem to have shifted from prioritizing function to now prioritizing the comfort of their patients, as well. Some seem to follow the model of hotels, by designing lobbies and rooms in a way to make the patient almost forget that they are in a hospital. Everything from lighting, architecture, and furniture seem to add to the feeling of a peaceful ambiance.
To build on our topics from last week, I think this approach could be very beneficial to patients. Similar to the way not being called “patients” affects how people looking for care feel, being in an atmosphere that treats them like guests instead of sick people could make them feel better. It is important to build an environment that people can feel safe and comfortable visiting and healing in.
Why do many people feel a divide between their mental health and their physical health and how does it affect the way we perceive psychiatry?