Narratives of Health and Illness
Since the 1970’s there has been a constant challenge of the traditional Biomedical Model of Health, (Wade, D.2015) writes “The biomedical model of health and illness is no longer ‘fit for purpose’, and is one major cause of current difficulties within the health service” (p1145-1154). The discord within this model is that it looks at illness as a problem that disrupts the smooth function of society and focuses heavily around physical factors dismissing any social factors contributing to the patient’s illness, although this model is very efficient at treating illness (as it is still the leading modern way to diagnose and treat in western countries) it places the blame solely on the individual. The challenge of this model is that the patients concerns, values and beliefs are never taken into consideration with the treatment, this is where the narrative of the illness needs to be heard as it contains the root cause for the illness, (Robinson, J.A., & Hawpe,L. 1986) define a narrative of health and illness as “accounts, attempts to explain and understand experience”. As individual as we all are so too are our interpretations of our surrounding environment/ society which vastly impact how we see our own illnesses.
Let’s observe the topic of mental illness, in 2007 the Australian Bureau of Statistics assessed the countries state of mental health and wellbeing, shockingly reported by (ABS 2008) “Around 7.3 million (43%) of Australians aged 16-85 will experience a high prevalence mental disorder, such as depression, anxiety or a substance use disorder in their lifetime”. Almost half the population is a truly unimaginable number, however our suicide rates in the very same year as written by (ABS 2008) “death by suicide is a relatively uncommon event (occurring at a rate of about 1 per 10,000 population per year)”. In Australia and even more so since the last study by the ABS the education around mental health has vastly expanded, even into schools and the general public (such as the RUOK? Initiative) and in turn has dramatically diminished the stigma surrounding mental health and validating it as a real illness and validating people’s narratives of what it is like to live with mental illness, historically speaking since 1998 Australia has witnessed a steady decline in number of deaths by suicide all due to the stigma our culture has attached to mental health/illness evolving. However, in 2008 the World Health Organisation assessed Japan’s mental health and the rates were astonishingly high, (WHO 2008) “In Japan, neuropsychiatric disorders are estimated to contribute to 24.6% of the global burden of disease”. Japan is a Capitalist society which is heavily Patriarchal, this has allowed their entire history to be incredibly meticulous and efficient in producing results, such as having one of the world’s lowest unemployment rates currently at 2.8% (comparatively Australia is 5.6%) and the world’s third largest economies (comparatively Australia is 12th). However stigmatic difference we can observe between the two countries is in a study where participants in Japan and Australia were asked a serious of questions on how they viewed people in different vignettes of mental illness such as depression or schizophrenia as written by (Griffiths, K. 2006). Japanese participants were more inclined to view mental illness as personal weakness over unpredictability as attributes of someone suffering whereas it was the opposite for the Australian participants. The Japanese culture impacts the narrative mental illness as it views it as a sign of personal weakness and we see throughout the study that the Japanese are less likely to live next door to someone suffering mental illness, socialise with someone suffering mental illness, marry into the family or make friends with someone suffering mental illness. History plays another part on the narrative of mental illness in Japan as it adopted the Act on Welfare of Physically Disabled Persons (1949) post WWII and the Act for Welfare of Persons with Intellectual Disabilities (1960) which allows “involuntary hospitalisation of people with mental illness . . . permitted by administrative order or proxy consent of a legally responsible person”. Professor Tomoko Kanata (2016) writes “Mental health care has been shifting from psychiatric institutions towards community-based settings for the last 40 years in most countries. However, Japan still has a very high ratio of psychiatric care beds per capita, and the average length of stay in psychiatric institutions is nearly 300 days” another sociological difference is Japan has no psychiatric care beds for adolescents, only adults. Thus, we have a culture that views mental illness as a sign of personal weakness and shame, a society that views mental illness as a deviation from structure and function, a history of involuntary hospitalisation for up to almost a year and the feeling of isolation the individual would experience. All of these factors would collectively impact on an individual’s narrative of suffering from mental illness and with nowhere for individuals to seek adequate help it leaves them open to higher suicide rates which is why Japan sadly has the world’s 5th highest. If healthcare practitioners in Japan could shift their opinions of mental illness and reduce the stigma then potentially the suicide rates would drop, which is why narratives are so imperative in dictating healthcare.
Narratives are a day to day basis of nursing practice within the modern day as the importance of them has been validated inarguably over the last 20 years. A person’s particular view or belief can completely dictate how you should care for the individual, for instance Alison Buckley wrote the article Using patient stories to reflect on care in which we observe a particular narrative of one, Jaymes Hyatt*(name has been changed), whilst in the hospital being treated for secondary lung cancer. (Buckley, 2015) “They did tell me I had cancer but said nothing about the future” Jaymes was diagnosed and immediately was transferred to the oncology ward which gave him the impression he was being treated for his lung cancer. After several ward changes Jaymes is met by the name tag of one of his nurses that states “End-of-life care team” which then hits him, he was never told he was terminal. Unfortunately, EBP (evidence based practice) is still predominantly used within the Australian Healthcare System and doesn’t take into account the opinions, views or emotions of the patient, which for Jaymes meant no one would tell him he was terminal until possibly close to the end if at all. Although in Jaymes’ case this lack of information is traumatic to him, sometimes doctors do not disclose potentially disturbing information in the hopes of saving the patient a traumatic experience should there be a misdiagnosis or perhaps the illness resolves. However, for Jaymes he felt lost “My experiences were isolated pieces of the jigsaw but I was left to put the pieces together. It seemed like I accidentally found the piece that told me I was incurable and nearing the end of my life” if the healthcare professionals working with Jaymes had discussed his prognosis of being terminal initially it would have given him more understanding or a potential choice to fulfil any last wishes he had.
So, we have observed through mental illness stigma and social isolation in Japan that many sociological and cultural beliefs and practices impact on an individual’s narrative of health and illness, this being only one example in a plethora of different cultural views when it comes to health and illness. Although the illness’ themselves remain the same worldwide, the social construct of what that illness means and what it is to be ‘healthy’ varies from one society to another and in turn transcribing and shaping the individual’s narrative. This solidifies the importance of using a person’s narrative in the healthcare profession on all levels, in the case of Jaymes Hyatt* we see how the lack of nurse’s understanding of the narrative left Jaymes feeling lost and completely unaware of his terminal condition. Although narratives are a product of a social, historical, cultural and individual constructs they have to be equally paired with evidence based practice to ensure that not only the physical aspects of the individual are cared for but also the mental and spiritual aspects too. With the ongoing work to treat health and illness issues it is becoming more apparent that the use of narratives should be used adjacent to primary care protocols, making primary care personally catered for each and every patient.
References
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Robinson, J.A., & Hawpe, L. (1986). Narrative thinking as a heuristic process. In T.R. Sarbin (Ed.), (p.111) cited in Murray, M. (2008). Narratives, health and illness. Retrieved August 10, 2017, from https://www.keele.ac.uk/media/keeleuniversity/facnatsci/schpsych/staffdocs/michaelmurray/Narratives,%20health%20and%20illness%20-%20Murray%20(2008).pdf
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Buckley, A. (2016). Using patient stories to reflect on care. Nursing Times: NT; London, 112(10), 6-7.
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World Health Organization (2011), Mental Health Atlas 2011 – Department of mental health and substance abuse. Retrieved August 11, 2017, from http://www.who.int/mental_health/evidence/atlas/profiles/jpn_mh_profile.pdf?ua=1&ua=1
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ISHIKAWA, N. (1990). People who suffer from mental illness. Tokyo: Iwanami Shinsho. (in Japanese) cited in Kanata, Tomoko. (2016). Japanese mental health care in historical context: why did Japan become a country with so many psychiatric care beds?. Social Work , 52(4), 471-489. https://dx.doi.org/10.15270/52-2-526
OECD (2017), Suicide rates (indicator). doi: 10.1787/a82f3459-en . Retrieved August 11, 2017, from https://data.oecd.org/healthstat/suicide-rates.htm
Griffiths, K. M., Nakane, Y., Christensen, H., Yoshioka, K., Jorm, A. F., & Nakane, H. (2006). Stigma in response to mental disorders: a comparison of Australia and Japan. BMC Psychiatry, 6(1). doi:10.1186/1471-244x-6-21