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 Table of Contents  
DEBATE ON SOCIAL CHANGES & MENTAL HEALTH - FOR
Year : 2016  |  Volume : 32  |  Issue : 3  |  Page : 238-242

Social changes in the 21st century have differentially affected the mental health scenario in the developing world


National Institute of Mental Health, Angoda, Sri Lanka

Date of Web Publication3-Nov-2016

Correspondence Address:
Prof. Harischandra Gambheera
National Institute of Mental Health, Angoda
Sri Lanka
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9962.193198

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  Abstract 

The effects of social development in the 21st century have affected different countries and different social groups differently. Although social development upgraded life standards of a sector of population, it has affected adversely on poor socioeconomic groups in different parts of the world. Even though the economic status of urban cities in developing countries has gone up, standards of living have not risen parallely. The social structure has changed and risk factors for common mental illness have increased whereas poorly developed mental health services remain unchanged. Resource allocation for the development of mental health services in developing countries still appears to be minimal.

Keywords: Developing countries, mental health, social change, 21st century


How to cite this article:
Gambheera H. Social changes in the 21st century have differentially affected the mental health scenario in the developing world. Indian J Soc Psychiatry 2016;32:238-42

How to cite this URL:
Gambheera H. Social changes in the 21st century have differentially affected the mental health scenario in the developing world. Indian J Soc Psychiatry [serial online] 2016 [cited 2019 Jul 16];32:238-42. Available from: http://www.indjsp.org/text.asp?2016/32/3/238/193198


  Introduction Top


In the evolution of society, several distinct stages have been recognized depending on the physical structure, sociocultural, and economic characteristics. Preindustrial (before 1700), industrial (modern: 1700–1950), and postmodern period are distinct stages of the society visible in history. Manuel Castells argues that postmodern society has evolved and become the current “network society” since 1980.[1] Social characteristics of the various stages have affected different societies differentially depending on the different sociocultural, political and economic structures, and largely determined by geographical demarcation. The effects have been visible on many aspects of the lives of people in those societies such as life standards, education, and health. This paper attempts to analyze ways in which recent social changes affects the mental health of developing countries. It analyses effects of several characteristics such as revolution in communication, evolution of family, upsurge of global terrorism, rapid urbanization, and migration.


  Evolution of Communication Top


The radical changes in the realm of communication derived from the revolution in communication technologies has become one of the major developments in the twenty-first century. Other social changes in the fields of technology, economy, and cultural transformation have come together to give rise to a new form of society, the network society. According to Manuel Castells, the drastic changes in information and communication technologies have a powerful effect on transformation of labor markets and of the work process. Accordingly, two distinguishable work forces, self-programmable (educated knowledge) labor and generic labor appeared in the labor market. The “educated knowledge” workers, who are also referred to as talents, became more valuable assets for their companies and their decision making power increased gradually over time. At the same time, generic workers as executors of instructions have continued to proliferate as many menial tasks can hardly be automated and many workers particularly youth, women, and immigrants are ready to accept whatever conditions are necessary to get a job. This dual structure of the labor market is related to the structural conditions of a knowledge economy growing within the context of a large economy of low-skilled services and it is at the source of the growing inequality observed in most societies.[1]

Even though the key feature of the network society is the network connection between the local and global, the global architecture of the global network connects places selectively according to their relative value. Thus, networking has concentrated on populated metropolitan regions globally, increasing disparity in socioeconomic changes of developed and developing world as well as rural and urban regions. Together with these changes, the economy of the 21st century has taken a new trend which focuses mainly on processes rather than new products.[2] The new industries dominating would be microelectronics, biotechnology, the materials industries, civilian aviation, telecommunications, robots plus machine tools, and computers plus software. The knowledge power–based industries will take precedence over generic labor–based industries producing products. The invention of new products, therefore, no longer leads to sustainable profits because these products can always be copied and reproduced less expensively elsewhere. This shift will invariably lead to increase the disparity between poor and rich as well as rural and urban.

Although there are many great advantages in advanced communication, many disadvantages that affect mental health adversely also have been recognized. One major adverse impact of changes in communication age is the disruption of social capital and social cohesion. Social cohesion refers to the extent of connectedness and solidarity among groups in society. According to Durkheim, “a cohesive society is one that is marked by the abundance of mutual moral support, which instead of throwing the individual on his own resources leads him to share in the collective energy and supports his own when exhausted.” Social capital is defined as those features of social structures such as interpersonal trust and norms of reciprocity and mutual aid which act as resources for individuals and facilitate collective action.[3] The shift from industrial urban era to the communication age causes great disruption of social values, characterized by increasing levels of crime and social disorder, the decline of kinship as a source of social cohesion, and decreasing levels of trust.[4] These changes will have a great impact on mental health in different degrees depending on the advancement of communication.


  Migration and Urbanization Top


Migration and urbanization are worldwide phenomena and migration from developing countries to developed countries as well as from rural areas to urban cities has increased dramatically over the past few decades. The effects of migration have a more negative impact in developing countries compared to developed countries. The poorly developed infrastructures in cities in low-income countries face enormous difficulties due to socioeconomic and cultural problems in finding homes for a large population.

Migration to cities has increased dramatically over the past few decades. Most migrants come from rural areas, bringing values, beliefs, and expectations about mental health that are often very different from the ones they encounter in their new location. In many instances, people coming from rural areas have endured years of isolation, lack of technologic connection, poor health, poverty, unemployment, and inadequate housing. They need to acculturate and adapt not only to a new challenging urban environment, but also to alternative systems of symbols, meanings, and traditions.

Increased population in an unstructured city will indeed lead to overcrowding and insufficient infrastructure. The life of the migrants will be substandard with unemployment and poverty. The increase in shanty dwellings lead to environments with overcrowding, poor upkeep, and garbage, destroying the esthetic appearance of the city. The cultural changes will disintegrate families that might lead to child employment and exploitation of women labor. Increases in conflicts, estrangement, and isolation are also seen. In addition to the increase in crime, there will be an increase in traffic problems, overcrowding, and industrialization leading to environmental pollution. The future of city dwellers will be uncertain.

Poverty, drastic cultural changes, and poor sanitation will obviously carry mental health ramifications. The range of disorders and deviancies associated with urbanization are many and include psychoses, depression, sociopathy, drug and alcohol use, crime, delinquency, vandalism, family disintegration, and alienation.[5] The negative effects on mental health will be more in developing countries with poorly developed unstructured cities and the inability to deal with a large number of new immigrants.

Despite recent rapid urbanization, more than 70% of people in developing countries are still living in rural areas and there are advantages in living in traditional communities. The international pilot study on schizophrenia compared 1200 patients in nine countries. The investigators found that patients with schizophrenia in developing countries tended to have a less severe course and better outcomes than those in developed countries and those outcomes may be more favorable in rural settings. Favorable outcome was associated with vertical mobility, extended families, psychiatric services that included active family participation, and absence of specific community stereotypes of mentally ill persons. These findings point to the importance of cultural expectations, support systems, and stigma. High tolerance for mental illness appears to have a significantly positive impact on patients with schizophrenia in developing countries.[6]


  Evolution of Family Structure Top


The physical, psychological, and economic structure of the family has undergone various changes over many thousands of years in its journey of evolution. In early hunter-gatherer societies it was small hierarchically organized communities rather than composites of organized families. Hunter-gatherer societies evolved toward agrarian societies and accumulation of agricultural surplus with the transition of land ownership from communal to private from 4,000 to 5,000 years ago changed the form and the structure of the family significantly.[7] The family organized around agricultural productions, traditional crafts, or other family business ventures. These families were employers, producers, and also were consumers. They were called institutional families and the highest value was responsibility.[8]

Family and social structures evolved, adapting to the physical and social conditions of production, heavily influencing family dynamics and child rearing practices.[9] The structure of the modern family has been observed in the west with the beginning of the modern industrial era. There are three basic sentiments that can be seen in modern nuclear families; romantic love between spouses, maternal love and firmer relationships within the family.[10] The principal value of the modern family which is also termed as the psychological family is satisfaction.[8] Although the relationship within the family became so stronger and neighbors were strangers; the modern family became a “haven in a heartless world.”[11]

Modernization has commercialized many aspects of life leading to erosion of family values leading to independent individualism. The development of consumer market erodes even the values of the nuclear family, eventually leading to autonomous and irresponsible individualism.[12] Thus, advanced commercialization has influenced child rearing practices so much that preparing children for autonomy tends to make them precocious, unruly, and independent individuals eroding the traditional familism.

Although children from most traditional societies were more altruistic, children from modern complex societies were more egoistic. Depending on the degree of modernization children became more and more egoistic. This phenomenon has been observed only in a part of society, especially in the middle class. The postmodern family is also called pluralistic and it consists of many small free-flowing groupings that include modern nuclear families; a few traditional families; single parents; blended, co-parent, adopted, test-tube, surrogate mother, and gay and lesbian families, with or without formal marriage contracts.[8],[10] There is always a disparity and cultural difference between generations. Superimposition of new technology, new media, and value related to these has widened the cultural distance between generations and such disparity is more visible in developing countries than in developed countries. Wide cultural differences affect negatively on traditional family structures in developing countries.

The effects of the family on mental health are diverse and they differentially influence the etiology and management of long-term mental illness. However, a cohesive family structure is a good social support system that could protect from common mental illness and facilitate the management of mental illness. This is especially true for long-term major mental illness where a persistent social support system is necessary. The strength of cohesiveness depends on the degree of modernization and the traditional family structure still remains intact to a greater extent in developing countries. Having an extended family structure has also been found to have positive effects on prognosis.[6]


  Effects of Terrorism Top


Terrorism is the premeditated use or threat of use of violence by individuals or subnational groups to obtain a political or social objective through the intimidation of a large audience, beyond that of the immediate victim. Terrorists’ attacks are intended to apply pressure on governments to achieve their objectives and usually use extraordinary methods of violence. Terrorism has increased not only from its intensity but also from its breadth. Since 2000 there has been over a five-fold increase in the number of deaths from terrorism rising from 3,361 in 2000 to 17,958 in 2013. Over the same period, the number of countries that experienced more than 50 deaths rose from 15 to 24. Although it is highly concentrated in some countries, it is distributed throughout the world. It is recorded that more than 80% of deaths due to terrorist activity in 2013 occurred in five countries, namely Iraq, Afghanistan, Pakistan, Nigeria, and Syria. Terrorism is driven by many reasons such as religious, political, nationalistic, and separatist movements.[13]

Terrorist incidents have major impact on politics, economics, health, and finally society at large. Among economic consequences, diverting foreign direct investment, destroying infrastructure, redirecting public investment to security, and limitation of trade are important aspects. The economic downturn can create grievances that can lead to terrorism and then the poor economic conditions can be both the root cause and consequence of terrorism.[14] There is a vast difference in the socioeconomic impact of terrorism in developing countries when compared with developed countries. Developed countries possess more capable government institutions that can apply monetary, fiscal, and other policies to recover from either a large scale attack or a prolonged campaign. In addition, developed countries can take decisive and effective security measures to restore the confidence of the people. The impact of terrorism on health services is significant and these effects affect developing and developed countries differently. Apart from immediate physical damage, the long-term psychiatric sequelae following terrorist attacks have a great impact on mental health services.

Compared to developed countries, mental health services are poorly developed in developing countries. Poorly developed mental health services in developing countries in turn affects mental health literacy.[15] Therefore, any economic downturn due to terrorism will affect already compromised mental health services, and low mental health literacy indirectly increases the suffering of the afflicted people who by not realizing the nature of the illness do not seek appropriate help.

Psychiatric sequelae following a terrorist attack is diverse and affects even geographically distant location from the attacks. Studies indicate that posttraumatic stress disorder (PTSD) is the most common disorder experienced by the direct victims of the attack and depression, traumatic grief, panic, phobias, generalized anxiety disorders, somatization disorders, and substance misuse disorders are other disorders found among the victims.[16]

Although 30–40% of those directly affected by terrorist attacks develop PTSD, a minority of those not directly involved experience clinical or subclinical levels of symptoms often accompanied by functional impairment. However, the epidemiology of different diagnostic categories following trauma may be different in various cultures. The directly affected victims experience symptoms much longer term and the indirect victims usually suffer for short periods.[17] Psychological effects of trauma on children depend on the child’s developmental stage and the extent of the trauma. Although the studies are fewer, it has been observed that the children are more likely to experience PTSD.[18]

In developing countries, the poorly developed mental health services have no disaster preparedness, infrastructure, or adequate human resources to deal with any disaster including terrorist attacks. Therefore, psychiatric services in developing countries are not adequately prepared to intervene early to minimize the post psychiatric sequelae or continue to treat the affected people who need the help of psychiatric services. Affected people themselves are ignorant about their needs due to their poor mental health literacy and do not seek appropriate help.


  Effects of Stigma Top


Mental illness suffers immensely from the stigma attached to it. Stigma is defined as a mark of shame, disgrace, or disapproval, which results in an individual being rejected, discriminated against, and excluded from his/her society.[19] Stigma prevents persons with mental illness seeking treatment early, worsening their disability, and thereby increasing stigma further. Stigma affects negatively not only at the level of the individual but also at family and administrative levels. Mental health services also suffer from stigma and discrimination due to attitudes and the behaviors of health administrators and political authorities.[20] They do not believe that mental illness can be treated and mentally ill persons can be reintegrated in the community.

Stigma attached to mental illness prevails widely in developing countries than in developed countries.[21] Their concept of mental illness is also vastly different and the causation of mental illness is attributed mainly to supernatural powers and seeks remedies accordingly. The pathways to care are predominantly determined by the belief system toward causation of mental illnesses and their remedial measures. The community mental health services in developing countries are also not developed adequately.[22] Because of a multitude of factors, the duration of untreated psychoses is most often longer in developing countries than in developed countries.[23] Social changes in 21st century have made little change in attitudes and behaviors toward mental illness in low-income countries. Mental health services remain scanty and localized around cities and mental health literacy remains poor.


  Variations in Global Disease Burden Top


New sociocultural and economic developments in the network age have widened the disparity between developed and developing countries as well as rural and urban areas. Poverty levels have increased, cultural differences even among generations have been widened, and risk for common mental illness among lower socioeconomic groups has increased.

New changes in sociocultural development have affected epidemiology of common mental disorder worldwide. Mental and substance use disorders have been the leading cause of years lived with disability (YLDs) throughout the world and major depressive disorders have been predicted to become the leading cause of global burden of disease in the future.[24] The prevalence of unipolar depression varies not only across cultures but also across time.[25] Depression, which was the fourth leading cause of the global disease burden in 2000, will be the second leading cause in 2020. Sociocultural factors rather than hereditary factors may be responsible for such an increase in the prevalence of unipolar depression. Sociocultural and economic changes secondary to rapid urbanization such as overcrowding, unemployment, and poverty; increased crime and pollution; cultural changes leading to conflicts, estrangement, and isolation; child employment; and disintegration of families may be a playing a significant role in the changing epidemiology of common mental disorders.

Adverse sociocultural factors experienced in the urbanized network society may be influencing epigenetic mechanisms to make such changes in epidemiology of mental and behavioral disorders. Epigenetic mechanisms are molecular events that govern the way the environment regulates the genomes of organisms. Epigenetic processes lead to individual differences in appearance, physiology, cognition, and behavior—the group of traits known as the phenotype.[26]

It has been observed that there is a close association between poverty and common mental illness. Even though it has not been possible to establish a causal relationship, many studies have shown an association between indicators of poverty and risk of developing mental disorders. Factors commonly and closely linked with poverty such as poor education, unemployment, homelessness, and low-income levels have been recognized as risk factors for common mental illness.[27] The direct and indirect costs of mental ill-health worsen the economic condition, setting up a vicious cycle of poverty and mental disorder. Illnesses that have been recognized as common mental disorders are depressive and anxiety, somatoform, and stress-related disorders.


  Conclusion Top


The effects of social development in the 21st century have affected different countries and different social groups differently. Although social development upgraded life standards of a sector of population, it has affected adversely on poor socioeconomic groups in different parts of the world. Even though the economic status of urban cities in developing countries has gone up, standards of living have not risen parallely. The social structure has changed and risk factors for common mental illness have increased whereas poorly developed mental health services remain unchanged. Resource allocation for the development of mental health services in developing countries still appears to be minimal.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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  In this article
Abstract
Introduction
Evolution of Com...
Migration and Ur...
Evolution of Fam...
Effects of Terrorism
Effects of Stigma
Variations in Gl...
Conclusion
References

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