Hey there ! I hope you guys are staying safe during these trying times. I’m back with a new post ! This was a paper I wrote for one of my anthropology courses at UofT – Medical Anthropology: Illness and Healing in Cultural Perspective. This paper looks at my medical diagnosis of generalized anxiety disorder through an anthropological lens. So, grab a cup of tea and read 🙂
Written By: Archana Baleswaran
Mental illness continues to raise issues of stigma whether it be in a public sphere or even a private one. Particularly in the South Asian community, the topic of mental illness remains a taboo. My family growing up never spoke about mental illness or even mental health for that matter. In my culture, above all, reputation and how you present yourself to the world is of utmost importance. However, my parents would soon have to come to terms with the state of my mental health and my diagnosis. This paper will be detailing my experience with mental health, the aftermath of diagnosis and will discuss a few themes in medical anthropology – illness, cultural salience, metaphors and agency.
Vacations are meant to be a joyful and relaxing time – but this was not the case for me back in the Summer of 2014. My mom and I were set to stay in Sri Lanka for six weeks. At first, I was quite excited – but eventually, it dawned on me that I would be away from the majority of my support system. During my time in Sri Lanka, though I made many memories, I experienced extreme culture shock. I faced the issue of language barriers, not being able to communicate with my relatives, separation from my support system and a change in scenery. All these factors ended up worsening my mental health and ultimately led to my anxiety.
After returning home, I was still not my true ‘self’, I found myself remaining in bed and isolated myself for the majority of my summer. Eventually, these feelings passed but they reoccurred frequently. During these periods of relapses, I found myself not wanting to do anything – I would miss school. Eventually, with the support and push from my family, I went to see a psychiatrist. She had me fill out a couple of questionnaires and within thirty minutes I was diagnosed with generalized anxiety disorder. Due to the severity of my anxiety, my psychiatrist recommended medication as treatment. By seeking help, I was to manage my anxiety and become aware of my common triggers. But after my diagnosis, I still had to come to terms with the stigma around mental illness. I remember my parents telling me not to tell anyone because they thought people would look at me differently. They believed that others will view me as crazy, weak and sensitive. By preventing me from telling others they thought they were protecting me from people’s judgments. Eventually, I came to terms with my diagnosis and now I wear it on my sleeve.
My experience with mental illness can be related back to a few medical anthropology concepts. Firstly, Arthur Kleinman defines illness as the experience of “symptoms and sufferings” from an individual’s perspective (Kleinman,1988, 3). This involves the interpretation and understanding of symptoms by not only the patients but also their family (Kleiman, 1988). In terms of my anxiety – my parents recognized the frequency of my symptoms and decided that action needed to be taken. Some of the symptoms I faced was excessive worrying, trouble falling asleep, and the need to avoid social situations. After getting fed up with suffering in silence, with the help of my family I was able to seek out the proper treatment I needed. Moreover, Kleinman differentiates between the meanings of illness in a few ways – one of which is cultural salience. Cultural salience refers to the ways in which certain conditions are and symptoms are given different meanings and significance. These conditions are either given a positive or negative meaning. An example of cultural salience is stigma (Kleinman,1988). Mental illness is often associated with negative connotations. Through my diagnosis of anxiety, I gained first-hand experience of stigma and the misinterpretations of mental illness. I remember back when I stayed home from school due to my overwhelming anxiety, classmates thought I was faking being ill. I also required a doctor’s note to explain my absence from school. This helps to further explain how issues surrounding mental health are not given the same attention as physical illnesses. Individuals often do not take mental illnesses seriously and think that people are lying to get out of doing something. But this is not true.
In addition, Sontag’s reading discusses, how metaphors influence our understanding of illness. The language used to describe illness reinforce stigmas about certain conditions and illnesses (Sontag, 2001). Complex conditions are referred to in simple terms – this is turn gets used by individuals to depict how they are feeling. Often, anxiety is understood as nervousness and depression as sadness. For instance, many peers of mine use the term anxious on a daily basis to refer to their feelings of nervousness and stress. These metaphorical understandings reinforce ideas that mental illness is simple – thus it leads to poor and ineffective responses from others. Lastly, Briggs concept of agency can be applied to how I dealt with my diagnosis. His concept of agency refers to the ability to act in meaningful ways. This can be further understood as a type of freedom or choice (Briggs, 2004). My diagnosis with generalized anxiety disorder has led me to have to face stigma and brought to light the various ways in which people like me are judged. But my choice to be positive in the face of adversity, has allowed me to wear my diagnosis on my sleeve. In order to help combat the stigma around mental health and spread awareness, I did a Tedx Talk at my high school about my experience with generalized anxiety disorder. By, coming to terms with my diagnosis I was able to not only share my story with my close friends but also my entire high school. Instead of dwelling on my diagnosis, I took matters into my own hands to spread awareness about the importance of mental health.
In conclusion, my diagnosis of generalized anxiety disorder can be observed through a medical anthropological lens – through my understanding of illness, cultural salience, metaphors and agency.
References
A, Kleinman. 1988. Preface; and The Meanings of Symptoms and Disorders. In The IllnessNarratives: Suffering, Healing & the Human Condition. USA: Basic Books, pp. xi-xvi; 3-30.
S, Sontag. 2001. Illness as Metaphor. New York: Picador. [Excerpt on Quercus]
C, Briggs. 2004. Theorizing Modernity Conspiratorially: Science, Scale, and the Political Economy of Public Discourse in Explanations of a Cholera Epidemic. AmericanEthnologist 31(2):164-187.
May 18th, marks the end of the civil war in Sri Lanka but for Tamils world wide it holds a deeper meaning. Below is one of my papers I wrote for my medical anthropology courses at University of Toronto.
I hope this post informs you guys (my readers) of an issue that is near and dear to my heart.
Written by: Archana Baleswaran
Basic rights and freedoms are a few of the things we often take for granted while living in a first world country such as Canada. Many individuals and cultural groups still struggle to access what we call basic rights – whether it be education or equal opportunity. Tamils in Sri Lanka, to this day, still face inequalities. This paper will be detailing the effects the Sri Lankan Civil War has had on Tamils both in Sri Lanka and worldwide. I will be discussing 3 main themes: immigration, trauma (physical and psychological) and death. Though the civil war has ended, 10 years later, Tamils are still impacted by traces of discrimination, inequality and trauma.
Observation:
For Canadians, November 11th marks Remembrance Day. On the eleventh month, of the eleventh day, we recognize all the fallen soldiers and individuals who continue to serve during the conflict and maintain peace worldwide. Similarly, for Tamils on the 27th of November, we celebrate all the lives lost during the Sri Lankan Civil war – known as Maaveerar Naal for Tamils. This roughly translates to hero’s day. This day commemorates the lives of all the fallen soldiers.
My parents were born in Point Pedro, a town in Northern Sri Lanka. My father was raised in both Mallavi and Viyapairimulai. Meanwhile, my mom was raised in Kangasemthurai and Kumbasutti Point Pedro. Notably, both my parents were raised single handily by their mothers due to the deaths of their husbands. However, their lives were deeply affected by the on-going civil war in the 1980s. Prior to the civil war, Tamils were routinely discriminated against and faced many inequalities – racist colleagues, poor treatment, no opportunities for promotions as well as disparities in education. The Civil war brought fear, hardship, and displacement.
My father, at the age of twenty, fell in love and decided to flee Sri Lanka in hopes of a better life for his family. With the approval of his immediate family and mother in law, he prepared to seek refuge in Canada. He set out for Canada leaving behind his family, home and friends. By September of 1988, he had arrived in Toronto, Canada. He had to work extremely hard to not only provide to his family back home but to also sponsor his fiancée. This required him to work multiple jobs – fast-food chain, factory parts assembler, and security guard. By May of 1993, my mother had arrived in Canada – two months later, my parents were married. Soon after that, they had children which brought my siblings and I into this world.
To this day, my father works endlessly to support us by working multiple jobs. He continues to sacrifice his time and sleep to provide for us. My father is one of the most selfless and hardworking individuals I know, my only hope is that I can provide for my parents in the future as they did for me.
Though my parents had been settled down in Canada – the events back home were constantly on their mind as our extended family lived there. Thus, my father took matters into his own hands and sponsored his brother. The civil war progressively had gotten worse from 2005-2009 (last few years of the civil war). When my father asked his brother in law if they would like to come to Canada – he responded with “Tamil Eelam vaarum”. This translates to ‘we will get independence’. My uncle had hope that soon Tamils would gain independence.
The civil war affected the lives of my extended family, but it had a deeper impact on my paternal aunt (father’s sister). In the spring of 2009, Tamils worldwide lost connection with family and friends back home in Sri Lanka. During this time, my aunt, uncle, cousins, grandma, and aunts’ mother in law were forced to evacuate their homes and had to make their way to internment camps. This required them to walk through water that was approximately above the waist level. My uncle realized that his mother and mother in law would not be able to do so he set out with them to a ship that would help them cross over. My uncle put them on the ship and was standing near a church when the army bombed it. He passed away on the spot. As for my grandma and my aunts’ mother in law – to this day we don’t know where they are. We assume that they have passed away due to their old age and lack of mobility.
Meanwhile, in Toronto, my father was attending protests in order to gain attention from the government of Canada. Growing up my parents made sure that my siblings and I understood the history of the civil war, why they immigrated and how lucky we are to be living in Canada. In elementary school, my family and I attended many protests in order to gain attention towards the genocide of Tamils – from Downtown Toronto to Ottawa.
May 18th marks the end of the Sri Lankan civil war but for Tamils, it means so much more. Tamils worldwide commemorate this day to all the lives lost during the final stages of the civil war – Mullivaikkal Remembrance Day. Notably, the Sri Lankan armed forces supposedly marked the end of the civil war with the killing of Velupillai Prabakaran – LTTE leader. However, there is no evidence that the militant leader was killed. In the final stages of the war, the United Nations reports at least 40,000 Tamils killed (Doucet, 2012). The war may be over but my extended family and Tamils residing in Sri Lanka are still affected by the aftermath. Post-traumatic stress disorder, loss of a loved one, disappearance, sexual violence, torture and rape is a few of the results of war. The experiences of a 26-year long war have detrimental effects on the psychological and emotional wellbeing of Tamils.
Anthropological Analysis
My understanding of the Sri Lankan civil war can be related back to a few medical anthropology concepts. Firstly, Michel Foucault’s idea of biopower can be used to explain the effects of the civil war. Biopower refers to “the ways that populations or groups are managed, regulated and encouraged to adhere to norms” (Dahl, 2019, 19). Foucault originally used this term to explain the management of institutions such as health care. He believed that biopower is seen in the field of health care through the view of dominant medical ideas and practices (Dahl, 2019). Furthermore, this idea of biopower also relates to panopticon. Panopticon was a building designed to be a jail in which the centre held a tower for the guard. Prisoners were not able to see the guard but because the guard was stationed in the middle – prisoners were on their best behaviour (Dahl, 2019). In terms of the civil war, in Sri Lanka, the dominant perception was that the civil war due to the rebelling of Tamils. The Sri Lankan government and the majority population (Singhalese) believed that the war was due to the Tamils and their inability to follow the norm. This stance takes a culture of poverty stance – as individuals blame the victim and the oppressed for the issue. It fails to take into account the social and historical reasons for the war.
Instead, a structural violence stance should be taken regarding the conflict in Sri Lanka. Structural violence refers to underlying political, economic, social, medical and legal reasons for issues. This perspective looks at how the issue is patterned and does not blame the individuals. Ugwu (2019) originally used this concept to explain how the malaria epidemic in Nigeria was not due to a cultural problem. Instead, it was the poor prevention efforts and inability to listen to the individuals’ concerns. Thus, looking at the history of interventions allows one to see what has worked in the past and what has not (Ugwu, 2019). In regard to the civil war, the structural violence point of view enables individuals to see how history and colonialism played a large role. Prior laws in Sri Lanka discriminated Tamils while favouring the Singhalese. For instance, they changed the official language from English to Singhalese. This prevented Tamils from seeking jobs in the public service industry as they would not be fluent (Britannica, 1988). Moreover, Tamils were routinely discriminated in public spheres – whether it be in the education or working sector.
In addition, Brigg’s concept of agency can be applied to how Tamils worldwide reacted to the last stages of the civil war. Agency refers to one’s ability to act in meaningful ways – in lay man’s terms, it is simply a freedom or a choice (Briggs, 2004). Tamils across the world engaged in several resistance movements during the final legs of the war when armed forces engaged in mass killings. In hopes of media and government attention, Tamils participated in protests. For instance, Tamils in Toronto protested and blocked the Gardiner expressway in hopes of bringing awareness to the genocide. It is important to note that Tamils living outside of Sri Lanka had the privilege to voice their concerns – something that Tamils residing in Sri Lanka still do not have. Another concept of Briggs that is applicable to this case, is political economy. Political economy in this sense is how inequalities are patterned in society in a political and economic sense. An example is structural inequalities like lack of resources (Briggs, 2004). For Tamils, this is seen through systemic oppression in both education, employment and even daily lives.
Furthermore, Wailoo’s concept of discourse relates back to the civil war. Discourse refers to the ways in which someone communicates and talks about an issue. It is the accepted way of talking about an issue (Wailoo, et.al, 2006). During the last legs of the war when communication was lost internationally, Tamils in internment camps were allowed to write letters to their families. My aunt had told us that she had sent many letters to us – but we had never received them. The Sri Lankan armed forces had been monitoring the letters and only sent out the ones they deemed appropriate to be read by the recipient. She had mentioned that in letters, she talked about what life was like in the camp and her experiences. This shows how during the conflict with the loss of communication – the Sri Lankan armed forces wanted to control what was being said or communicated to those outside the country.
Lastly, Kleinman’s concept of illness can be applied to the trauma that Tamils have faced due to the war. He refers to illness as the experience of “symptoms and sufferings” from an individual’s perspective (Kleinman,1988, 3). One’s understanding of their illness is influenced by their perceptions as well as their agents of socialization – whether it be friends or family. Kleinman’s use of this term refers to how the experience of illness is often a social one (Kleinman,1988). It involves communicating with others especially your loved ones to discuss how they are feeling. It also requires support from others – whether it be medical professionals, family or friends. For Tamils who have experienced the civil war firsthand, they are often left with post-traumatic stress disorder. This affects their lives in profound ways and often requires treatment from professionals in order to cope. Furthermore, Kleinman also refers to cultural salience which refers to the ways in which illnesses can have either a positive or negative meaning (Kleinman,1988). An example of cultural salience is stigma. It is important to note that mental health in the Tamil community is something that is not spoken about in the public realm and even a private one. Many Tamils suffer in silence because of the stigma of mental illness in the community.
In conclusion, the Sri Lankan civil war deeply affected the lives of those living in Sri Lanka, – especially Tamils. The civil war came to a close back in May of 2009, but it continues to have profound effects on the lives of Tamils both in Sri Lanka and globally. The Sri Lankan civil war can be analyzed through a medical anthropology lens through my understanding of biopower, structural violence, agency, political economy, discourse, illness and cultural salience. Many individuals view Sri Lanka as a paradise island but fail to recognize the history of violence, war and discrimination. Though there is still a long way to go and quite a bit of healing needed for Tamils – slowly things are changing for the good in Sri Lanka.
References:
Briggs, C. 2004. Theorizing Modernity Conspiratorially: Science, Scale, and the Political Economy of Public Discourse in Explanations of a Cholera Epidemic. AmericanEthnologist 31(2):164-187.
Kleinman, A. 1988. Preface; and The Meanings of Symptoms and Disorders. In The IllnessNarratives: Suffering, Healing & the Human Condition. USA: Basic Books, pp. xi-xvi; 3-30.
Ugwu, C. 2019. Framing Local Attitudes to a Modern Health Intervention in the Neoliberal Order: Culturalism and Malaria Control in Southeastern Nigeria. Journal of Asian and African Studies.1-18
Wailoo, K., Livingston, J., Guarnaccia, G. (Eds). 2006. A Death Retold: Jesica Santillan, the Bungled Transplant, and Paradoxes of Medical Citizenship. Chapel Hill, NC: University of North Carolina Press. [Excerpt, pp 1-45]
