A re-examination of the theoretical basis of our practice of psychiatry (that is, its epistemology) reveals the insufficiency of the empirical, inductive approach which we have come to regard, too myopically, as the sine qua non of our science. Traditionally in psychiatry, the discipline of philosophy, of which epistemology is one of its major fields of endeavour, has generally come to be regarded as irrelevant or unreliable as a source of true knowledge. But an objective look at our variegated practice of psychiatry–roughly divided into two groups–the biological on the one side and the psychosocial on the other–reveals a glaring lack of integration, cohesion, or synthesis in basic theory. While analysis is the prime modus operandi of science, synthesis is the main objective of philosophy. While we subscribe to various operational theories to explain how our various procedures work, we lack an overarching, unified, general theory to subsume them. Hence we lack a truly holistic concept of the person who is our patient. In this we are much in need of the discipline of philosophy, which promotes clarity of thought, breadth of comprehension, and systematic (logical) reasoning. Psychiatrists acquire more of this philosophic expertise through collaboration with professional philosophers (epistemologists in particular) and through the introduction into our graduate psychiatric training programs of some specific course content from the literature of philosophy. As a preliminary suggestion for this, an “Annotated Reading List” is appended.
PMID: 3203268 [PubMed – indexed for MEDLINE]
Adapting to American society causes mental illness to double among Mexican immigrants, finds UC Berkeley study
By Patricia McBroom, Public Affairs
As Mexican nationals adapt to American society, their rates of mental disorder begin to soar, a professor of public health at the University of California, Berkeley, has discovered.
In the largest study of its type, involving approximately 3,000 people, Professor William Vega has found that acculturation to American patterns has a detrimental impact on the mental health of Mexican immigrants. And the longer they’ve been in the United States, the worse it gets.
Vega found twice the rate of mental disturbance among Mexican-Americans born in this country, compared to recent immigrants or Mexicans who remained in their homeland.
His report was published today in the Archives of General Psychiatry, the American Medical Association’s primary journal in the field of mental illness. Co-authors were Ethel Alderete and Ralph Catalano of UC Berkeley; Bohdan Kolody of San Diego State University; Sergio Aguilar-Gaxiola of California State University, Fresno; and Jorge Caraveo-Anduaga of the Mexican Institute of Psychiatry in Mexico City.
The team found that for U.S.-born Mexican-Americans, the lifetime risk of being diagnosed with any mental disorder was similar to that for non-Hispanic whites – 48.1 percent, or almost one in two people. But for new immigrants and Mexican nationals, the rate was only 24.9 percent.
Moreover, they discovered that the rate of mental illness climbed consistently after immigration, so that Mexicans who had been in this country for more than 13 years had nearly the same high rate as native-born Americans.
“This is clearly a social effect,” said Vega, “not a biological one.”
“Mexicans come to this country with some kind of natural protection against mental disorder, and that breaks down very quickly in American society,” he said. “In fact, it goes in one generation.”
He believes this protection lies in the strength of Mexican families and the emotional support and security individuals receive from being imbedded in a family group. Such benefits countered even the effects of poverty among Mexican immigrants, Vega discovered.
“These people are under enormous financial stress,” said Vega. “Yet, the primary issue for the development of mental disturbance was not financial. I believe it has to do with the emotional support and nurturance people received from living in committed family relationships.”
Vega and his team interviewed some 3,000 residents of Fresno County in California, choosing a sample of households from urban, rural and small town environments. The sample was representative of U.S.-born Mexican-Americans and Mexican-born immigrant populations, with roughly 1,500 from each group.
Originally Vega intended to focus on the urban-rural differences in mental disorder. It is known that rates for mental disorder are lower among rural residents. In fact, Vega did find such a difference, but it washed away when he factored in the immigrant status.
“Wherever the immigrants lived, the rates were lower,” said Vega. “Whether in urban or rural areas, the increased mental disturbance came with acculturation into the American mainstream.”
The worst problem was drug abuse and/or drug dependence, which was four times higher among Mexican-Americans than Mexican immigrants. Anxiety and depression showed the second highest rates of increase.
Schizophrenia, however, was not included in the test of mental disorders that Vega adapted from a 1994 instrument called the World Health Organization Composite International Diagnostic Interview.
To find out whether the protective factor was due to national differences in rates of psychiatric disorder, the team compared the Fresno sample with a sample of about 1,700 people in Mexico City.
Interviews were conducted, using the same survey as in Fresno, by the Mexican Institute of Psychiatry. Again, the rate for mental disorder was half that of the Mexican-Americans (and other non-Hispanic whites).
Divorce rates exemplified the rapid breakdown of family ties, Vega said. Among Mexican immigrants, 80 percent of the people interviewed were currently married, compared to only 50 percent of Mexican-Americans in Fresno County.
But “divorce alone is not the cause of the decline in mental health,” said Vega. “It is one example of a change in values away from collective family life.”
“American people report that they need less contact with their families of origin, compared to reports from Mexican immigrants,” he said. Vega said previous studies have shown that Americans believe they are satisfied with telephone contact and feel freer when they move away from continuous family contact.
“But there is a cost for this greater personal and economic freedom.” said Vega. “The cost is loss of reciprocal support. Friends don’t replace that in the main.”
“Mexicans are coming from a much more integrated family system,” he said. “There are tremendous benefits of that in terms of everyday psychological resilience. They are much more likely to be in a situation where people help each other out. As a result, they are likely to be more satisfied with their lives.”
The investigation by the U.S. delegation provided
unequivocal proof that the tools of coercive psychiatry
had been used, even in the late 1980s, to hospitalize
persons who were not mentally ill and whose
only transgression had been the expression of political
or religious dissent.1 Most of the patients interviewed
by the delegation had been charged with political
crimes such as “anti-Soviet agitation and
propaganda” or “defaming the Soviet state.” Their
offenses involved behavior such as writing and distributing
anti-Soviet literature, political organizing,
defending the rights of disabled groups, and furthering
Under applicable laws of Russia and the other
former Soviet Republics, a person charged with a
crime could be subjected to “custodial measures of a
medical nature” if the criminal act was proved and
the person was found “nonimputable” due to mental
illness.7 Nonimputable offenders could be placed in
maximum security hospitals (the notorious “special
hospitals”) or in ordinary hospitals, depending on
their social dangerousness. All the persons interviewed
by the delegation had been found nonimputable
and socially dangerous and confined in special
hospitals after criminal proceedings that deviated
substantially from the general requirements specified
in Soviet law. Typically, the patients reported that
they had been arrested, taken to jail, taken to a hospital
for forensic examination, and then taken to another
hospital under a compulsory treatment order,
without ever seeing an attorney or appearing in
The delegation found that there was no clinical
basis for the judicial finding of nonimputability in 17
of these cases. In fact, the delegation found no evidence
of mental disorder of any kind in 14 cases. It is
likely that these individuals are representative of
Volume 30, Number 1, 2002 137
many hundreds of others who were found nonimputable
for crimes of political or religious dissent in
the Soviet Union, mainly between 1970 and 1990.
The delegation also found conditions in the special
hospitals to be appallingly primitive and restrictive.
Patients were denied basic rights, even to keep a
diary or possess writing materials or books, and they
were fearful of retaliation if they complained about
their treatment, about abusive conduct by the staff,
or about restrictive hospital rules or practices. No
system existed for resolving patients’ grievances.