1. The King of Hearts presents an interesting look into what it would look like if the patients ran the asylum, so to speak. It becomes clear when watching the film that many of the patients can function at quite a high level, despite acting extremely oddly. This demonstrates how social psychological disorder conceptions and diagnoses actually are. The perplexing behaviors of many of the characters are perplexing specifically because they violate social norms and expectations. Such perplexing behavior likely contributed to the diagnoses of the patients in the asylum. When considering how diagnostic criteria and mental health disorder classifications are constructed, it is important to keep in mind that social deviance plays a major role in the construction process. The problem with a reliance on social norms for the construction of psychological disorder concepts and diagnostic criteria is that social norms change. In addition, social norms often reflect a problem with society.
For example, homosexuality was once considered socially deviant. Homosexuals were relegated to the shadows because of the strong opprobrium associated with homosexual behavior. This was reflected in the DSM. Early DSMs included diagnostic criteria for homosexuality as a paraphilia. It has also been classified as a sexual orientation disturbance. Eventually, homosexuality as a mental health disorder was dropped by the DSM. Nonetheless, this reflects the issues with relying on social norms to construct mental health disorders.
It is also important to recognize when progress is made on the development and revision of mental disorder concepts and classifications. For example, more recently the DSM has criteria for mental health disorders that more strongly reflect functional deficits, rather than social deviance. Even if behavior is bizarre, for example, it may not contribute to the classification of someone as having a mental health disorder. But when function is compromised by the symptoms of mental health disorders, then a diagnosis is much more likely. The bend towards function deficits as important diagnostic criteria is a step in the right direction. The patients in The King of Hearts were functional in some ways. Nonetheless, many had serious functional deficiencies. Their conceptions of reality, for example, were highly misshapen, which could be dangerous in certain circumstances.
Therefore, even though many of the problems with these patients could be viewed as socially deviant but not compromising functionality, other problems demonstrated by the patients likely impaired functioning.
Perhaps one of the more striking aspects of the film is the juxtaposition between the political and military leaders in the film and the mental health patients in the film. This juxtaposition reveals certain striking similarities, such as the decision-making processes of the two groups. While the leaders may have been less ostensibly odd, the leaders also demonstrated a level of irrationality comparable to that of the patients. This is most obviously expressed when Plumpick is selected to defuse the bomb. Such a mistake demonstrates the errors of the leaders in the film. When compared to the behaviors of the patients, the leaders do not seem that much more competent.
The major differences between the patients and the leaders is the adherence to social norms by the latter. But what harm comes of such social deviance? Perhaps some, but certainly not more than could have occurred with Plumpick being chosen to defuse the bomb. The film does a great job of demonstrating how unimportant and even arbitrary some diagnostic criteria for mental health disorders are. As mentioned above, great strides have been made in improving such criteria, including the move away from relying on social norms strongly and towards functional deficits. Even so, there remain certain diagnostic criteria that include social deviance. Moreover, it should be kept in mind that people ultimately diagnosis patients. There is a risk that the history of social deviance as part of the criteria for mental health disorder diagnoses continues to influence the diagnostic procedure. The result may be that mental health professionals continue to rely on social deviance as a marker of mental health disorders, even if such diagnostic criteria for these disorders no longer contain social components.
2. The variance and disparities in mental health across the globe demonstrate the pressing need for programs like the WHO’s Global Mental Health Initiative. It is not enough any more for individual countries to work out their own mental health issues. Certain parts of the world struggle with maintaining strong mental health for a variety of reasons. The resulting disparities in mental health outcomes is troubling because it suggests uneven patterns of mental health care and differing conditions for the promotion of mental health. Global initiatives aimed at improving mental health worldwide and specifically in those areas with a high rate of mental illness are extremely important for minimizing the rates of mental health disorders in those parts of the world current facing mental health crises.
With growing evidence of stress and anxiety as major sources of health issues, both physical and mental, it is becoming increasingly important for international organizations to identify the differences in stress and anxiety levels across countries. Stress and anxiety levels are dependent on environmental conditions and the social expectations of individual areas. For example, in the urban U.S., there are expectations for adults to work at least 40-hour weeks. Certain industries demand even greater hours, even up to 60 hours weekly. War, disease, and refugee crises can exacerbate stress and anxiety in certain parts of the world, thus exacerbating mental health issues. The WHO’s initiative, then, is crucial for addressing the issues of stress and anxiety in certain parts of the world currently. Such an initiative may not only spread awareness and education, but may also one day play a direct role in mental health interventions that prevent spikes in mental illness. The scope of the WHO’s initiative is quite important as well. After all, if the initiative becomes too exclusive, it may be not helping the most vulnerable populations with their complex mental health issues.
A major challenge faced by the WHO’s initiative is cultural relativism. In other words, it can be very difficult to create a set of objective criteria to make mental health assessments when there is so much cultural variance in the world. The relative nature of cultures makes it such that attempts to establish objective criteria risks singling out specific cultural groups. For example, certain cultures believe that their dead ancestors play a spiritual role in their lives. Yet, in other cultures this may be considered delusional. If objective criteria on mental disorders were created in the latter cultures, it could be the case that virtually everyone in the former culture would be classifiable as having poor mental health given their apparent delusional behavior. But, of course, this is problematic. What is delusional in one culture may be perfectly acceptable in another. Thus, a major challenge faced by the WHO’s initiative is determining how to establish objective criteria that applies evenly across all cultures. What may end up happening is that such criteria becomes so attenuated that it actually captures only a small amount of mental health-related issues within an area. Solving the issue of cultural relativity and cultural variance may require taking firm stands on certain harmful behaviors and thoughts, even if this risks singling out certain cultures.
- White, R. G., Jain, S., Orr, D. M., & Read, U. M. (Eds.). (2017). The Palgrave handbook of sociocultural perspectives on global mental health. Palgrave Macmillan.