Our thinking is evolving according to our culture and our society.
What we consider to be psychological diagnosis, maybe we are wrong.
Maybe many of the things we today consider to be mentally ill, or mentally sick, or mentally unhealthy, maybe in a hundred years will be considered totally normal.
We have something called culture-bound syndromes.
Culture-bound syndromes mean syndromes, mental health programs, that are unique to specific locations in the world.
When such a patient emigrates to the United States and goes to a psychiatrist or a therapist, this kind of patient will not be understood.
Because his disorder, the pattern of abnormal behavior, is unique to his culture, society and geography.
No one knows exactly where the zar comes from. Some believe it originated either in Ethiopia, Sudan, Iran, or even Pharaonic Egypt.
We do know that today thousands of women in Africa and the Middle East use this music to cure all kinds of illnesses.
Are the spirits real? Are the women possessed?
The women believe that they are.
Remember, these patients turn to the zar after modern medicine has failed them.
Zar, Z-A-R, is the name given in Africa, big parts of Africa, for example, Ethiopia. Zar is the name given to what we in the West would call psychotic disorder.
People with zar in Africa, they see demons, they hear voices, they have hallucinations, many of them become violent. So zar is what we would have called in Western civilisation, demon possession.
But what is demon possession?
Demon possession is the name we used to give to psychotic disorder. It is simply a language element.
In religion, we call it demon possession. In psychology, we call it psychotic disorder.
Religion would tell you that demon possession or psychotic disorder is a result of an invasion by a demon. Your body, your mind is invaded by a demon.
So psychology will tell you different stories that are equally implausible, by the way.
And psychiatry will tell you that psychotic disorder is a result of a biochemical imbalance in the brain.
But to this very day, there are no conclusive studies. And to this very day, there is a massive philosophical confusion in the ranks of psychiatry.
Because it is true that when you have a psychotic disorder, you have a biochemical disorder as well.
It's true that when you are psychotic, when you hear voices, when you see visions, when you are instructed to kill your children, when you lose control, it's true that when all this happens, something goes on in your brain, different neurotransmitters, different biochemicals, different electrical activity, different flow of blood, it's all true.
We see it in functional magnetic resonance imaging.
So it's all true.
The only problem is, what causes what?
Does the psychosis cause these changes in the brain? Or do the changes in the brain cause the psychosis?
In other words, are we talking about a correlation between two events, one psychic and one physiological? Or are we talking about causation?
The events in the brain cause the psychosis, or the psychosis cause the events in the brain.
No one has answers to these questions.
The psychiatric medicalized explanation of psychosis is as dubious and problematic as the religious explanation and as the psychological explanation, or to cut a long story short, we have no explanation.
But what I'm trying to tell you is that zar, for example, possession in Somalia, in Ethiopia and in other African countries, in Egypt, in Iran, demon possession is not considered a pathology at all.
People are possessed by demons on a regular basis. It's part of life.
Everyone is possessed by a demon at one stage or another, especially women, by the way, but also men.
On the very contrary, men with demon possession have access to privileged knowledge. Some of them are considered prophets.
So here is a mental health pathology that is considered a part of normality, considered normal, even healthy, even privileged in many, many societies with billions of people.
So even the definition of pathology depends crucially on how we view normality and how we view normality depends crucially on our current phase in our culture and civilization.
Because if you go back to Europe, 400 years, 300 years, demon possession would still be considered a part of normal life.
Zar is when a patient comes and claims to have been possessed by a demon.
It's possession, in effect, but not possession like in Western society.
In Western society, the demon is an external hostile entity.
It is an entity that is evil, malicious, takes over someone's body in order to use the body for its own purposes.
Zar is something different.
Zar is a disorder which we find in Iran, Ethiopia, other parts of the Middle East and so on.
Zar is an intimate relationship between the patient and his or her demon. It's a little like a couple, like a couple.
The patient has intimate knowledge of the demon, develops a relationship with the demon, accommodates herself or himself to the demon and they live together happily ever after with the same body.
They are sharing the same body.
When such a person comes to you, the best treatment technique would be couples therapy. I'm not kidding. Couples therapy.
In cultures where the group is seen as more important than its individual parts, social anxiety disorders manifest differently as people often become increasingly distressed about how they may affect others.
The crucial difference between Taijin Kyofusho and social phobia is subtle.
Social phobia focuses on the fear of embarrassment in front of others, while the Japanese phobia focuses on being afraid of embarrassing others by being in their presence.
Taijin Kyofusho in Japan is the fear, the phobia, of being repulsive to others.
People who have Taijin Kyofusho believe that their body, the smell, their odor, body odor, parts of their body, their hands, their face, are repulsive to other people.
They are convinced that they disgust other people. That other people are disgusted when they smell them or look at them.
In the West, we would classify this as a mental disturbance, as a mental problem. We would subject the person with such a phobia to talk therapy. We would give such a person medication, usually antidepressants. We would consider this Taijin Kyofusho, a body image disorder.
There's a whole class of mental health disorders and they are called body image disorders.
If I think I'm too fat, if I think I'm too thin, if I think I'm repulsive, if I think my smell is horrible, if I think that my emotions are exaggerated, if I think that I displease or embarrass or that I'm offensive just by existing, that would be a form of body image disorder.
And all of you heard of eating disorders.
Why do we have eating disorders? Why do we have anorexia? Why do we have bulimia?
We have these disorders because we have a wrong image of our body.
For example, if I think I'm too fat, then I will develop anorexia. I will try not to eat.
I will try to control my eating and thereby reduce my weight, even if I'm thin to the point of medical danger.
But in Japan, Taijin Kyofusho, this body image disorder is considered commendable. A person with this disorder is considered sensitive to the needs of others, empathic, considerate, and compassionate.
The Japanese encourage this. They teach their children and they teach each other that you should be very concerned about the way you look, about your body smell, body odor, about how you move your motions and what you say and so on.
So they adopted a body image disorder as a tool to regulate social interactions to make life more pleasant for everyone involved.
Here is a situation where a culture, a society, a civilization, the Japanese culture, adopts what in the West is considered a mental health disorder, adopts it as a virtue, as something recommended, as something you should have if you are a good person.
It's good in Japan, it's bad in the West.
In the West, you get treatment. In Japan, you get praise.
Taijin Kyofusho is a mental health disorder found only in one country, in the whole world, Japan.
Japanese are, as we just said, collectivists, consensualist. They are very, they are shame driven. It's a society that is shame driven, embarrassment driven.
The main thing in Japanese society, as in Arab society, by the way, and some other societies, is shame. To avoid shame, to avoid embarrassment, to avoid disgrace. People want to talk about you, etc.
Japanese are like that.
This disorder, Taijin Kyofusho, means my body is an embarrassment. It is the belief that the patient develops that his body causes other people embarrassment.
Not him, but the body causes other people embarrassment.
So for instance, he believes that he has a bad smell. His body exudes a bad smell. Or his body is ugly, very ugly.
And he is not concerned about himself. He is concerned that other people are inconvenienced, that other people feel bad because they are exposed to bad smell. Or to ugly person.
That is strictly Japanese. I think it would be very difficult to find in other societies.
Mal de Ojo is the Spanish for evil eye.
Evil eye is the belief that other people can affect your child, your unborn child and your baby, just by looking at that baby, by giving praise to the baby, saying, oh how beautiful it is, wonderful baby, etc.
The evil eye is a curse, a malediction. It can make the baby sick. It can even kill the baby.
So women in many societies, some parts of Russia, in Spain, Latin America, some parts of Asia, in big parts of Africa, women do not tell other people that they are pregnant.
They hide their babies. Once the baby is born, they hide the baby for a few months. For other people not to give the baby the evil eye.
In Turkey, people sell their babies. They try to cheat the evil eye by selling the baby to another family. And such babies receive the name Mercado or Mercada, bought and sold, in Spanish.
So there are many ways of coping with the evil eye.
But why am I mentioning the evil eye?
If you went to a western psychiatrist and you told the western psychiatrist, listen, I believe that my neighbor is putting an evil eye on my baby, the western psychiatrist will prescribe medication. Because in western psychiatry, to believe that someone has the power to kill your baby just by looking at it is a delusion.
It's a delusional disorder. It's a recognizable mental health diagnosis, mental health problem.
If you believe that someone can kill your baby by looking at it, something is wrong with you. You're mentally sick. You need treatment in the west.
But for well over a billion people all over the world, this is absolute reality. No one will consider you insane if you talk about the evil eye in, for example, Brazil, or in parts of Africa, sub-Saharan Africa, or in Spain. No one would think that you're crazy.
Actually people would think that you are crazy if you deny the existence of the evil eye.
So here's an example of a mental health disorder, delusional disorder, that is highly culture-bound. Depends where you are and when you are.
Mal de Ojo. Mal de Ojo means evil eye. Evil eye.
Evil eye means if you have a baby or a child, and someone looks at the baby or the child and is jealous. Jealous that you have a baby or jealous that the baby is beautiful or jealous the baby is healthy and so on.
That person who is looking at the baby gives the baby the evil eye.
It's called Mal de Ojo and it's common in Spain, Portugal and Latin America and so on.
It is a mental health disorder because the person who believes in Mal de Ojo develops total paranoid ideation. Total paranoia. It's a paranoid spectrum disorder.
But unique to Spanish speaking provinces.
In Spain, and by the way in Spanish, there is Spanish Jews that emigrated to Turkey. My mother is a Turkish Jew. Spanish, Turkish Jew. Her family emigrated from Spain to Turkey.
So they brought with them the Mal de Ojo to Turkey. So the Spanish Jews in Turkey, the Latino Jews, have this Mal de Ojo.
And these societies developed huge rituals, treatment modalities in psychotherapy, rituals outside psychotherapy, and all codes of conduct to avoid Mal de Ojo. It's a whole science of how to avoid Mal de Ojo.
I will give you one example.
If a baby becomes sick after a neighbor saw him and gave him the Mal de Ojo, she gave him Mal de Ojo, maybe became sick.
Why is she? Only she. Do you know men with evil eye?.
This is culture. It's a cultural artifact.
Absolutely. That's why I asked.
Absolutely. It's a cultural artifact.
It's a gender discriminatory approach, gender prejudice.
But I'm mentioning she all the time because Mal de Ojo, the people who cast Mal de Ojo are exclusively women.
That's not connected to me. I was sure about that. Exclusively women.
So if this neighbor, woman, cast Mal de Ojo on the baby, the baby becomes sick, there is a whole procedure.
The baby has to be sold to another family. Sold for one coin.
So they take the baby to another family. They give the baby. They take the coin. And the baby changes his name.
Why?
To deceive the devil.
So when the devil looks for him, for Jorge, he will not find him because Jorge changed his name. The baby changed his name.
And these babies are called Melcada or Melcado. If you come across someone in Spain, Portugal, Latin America, Brazil and so on, called Melcado or Melcada, means that he is a sold baby. He was sold because of Mal de Ojo.
He or she.
For real?
Sold for a coin.
For real?
Not for a ritual.
For real.
It's a ritual, but that family becomes also his family.
And finally, let's consider something we all come across in our daily lives. Homosexuality.
Until 1973. And actually until 1980. Homosexuality was defined as a mental health problem. In the Diagnostic and Statistical Manual, Edition 3. 1980.
Homosexuality was still listed as a mental health disorder. Homosexuals were considered sick people in need of treatment. In need, sometimes, of medication.
And in many cases, in need of commitment to a mental asylum, where they went through conversion therapy. A therapy which tried to convince homosexuals not to be attracted to the same sex, but to be attracted to the opposite sex.
So, we are not talking about the Middle Ages. We are not talking about 300 years ago. We are not talking about Japan. We are talking about the West. We are talking about the United States of America. We are talking about the leading document of mental health. Diagnostic and Statistical Manual.
And until 1980, a year after the AIDS epidemic started, homosexuality was considered a mental health problem. I don't know if you know, that until 1980. 1980. Not 1880. 1980.
Homosexuality was considered a mental illness.
It was defined as a mental health diagnosis in the Diagnostic and Statistical Manual Edition 3.
So, if you get a copy of Diagnostic and Statistical Manual Edition 3, you will find, among the other mental health problems, paranoia, schizophrenia, I don't know what, you will find homosexuality.
Homosexuality was a mental illness in the West.
Actually, it was also a criminal offense in Britain until the 1940s, in Switzerland until the 1950s, in the United States until the 1920s, and so on and so forth. But that's beside the point.
More importantly, it was a mental health problem. People were treated for homosexuality. They were taken to psychiatrists and therapists, and the psychiatrists and therapists tried to teach them to love women if they were men, or to love men if they were women.
This is a nice case. There were bad cases for treatment.
No, that's a criminal. People were put in jail. Oscar Wilde, of course.
No, no. Alan Turing.
From the suicide effort, yes.
Turing, by the way, we mentioned later.
Homosexuality is an example of culture-bound syndrome. In Western society, homosexuality was considered to be a mental illness. In others, no. Not at all.
Witches were persecuted and executed only 300 years ago, in Europe and in North America.
Culture and society, then, accepted certain mental health disorders as an inevitable part of human life.
Today, we are living in the age of enlightenment. Most of us, at least.
Today, we don't believe in demons. We don't believe in devils. We don't believe in witches, except if we are married to one.
So, today, we would not use this language to describe this phenomena. We would use the language of psychology, because psychology is enlightened.
Psychology is scientific. You see, psychology is being taught in your university. Witchcraft is not.
To learn witchcraft, you have to find Harry Potter. To learn psychology, you just have to watch this video.
I am teaching psychology in a university, and I'm teaching it as a science, because culture and civilization is telling us that it's okay. It's telling us this is the correct language.
But is it? We don't know.
Mental health is not a science with strict quantifiable elements. It's not like physics.
Mental health depends where, who, when, when also, as you will see later. It's very fluid. It's a little like art, closer to art than to science.
Although, if you go to the Western universities, the psychologists there will be very angry. They will say, no, no, it's a science. We have now machines that measure blood flow in the brain, so it's a science.
That's, of course, a joke. We'll come to it later.
Psychology has never been a science, and never will be a science.
Until the year 2013, sadomasochism, sadomasochistic sex until 2013, was considered a mental health problem. It was removed from the fifth edition of the Diagnostic and Statistical Manual only in 2013.
Sadomasochistic sex is unusual sex. It is a rare form of sexual preference, only about probably 1% practice sadomasochistic sex on a regular basis, and fewer than 15% of the population experienced it at any stage.
Yet until 2013, that's only five years ago, it was considered a mental illness, a mental sickness, which necessitated treatment.
Today, five years later, society changed. Because, listen, what changed?
The sadomasochistic practice did not change. The people who practice sadomasochism did not change.
The knowledge of the psychiatric profession, psychological profession, did not change in five years.
What changed was the attitude of society, the attitude of culture towards sadomasochistic sex.
As our mores, as our values evolve, as our morality changes, as we become more tolerant, more accepting of unusual practices, as we realize that there is no such thing as normality, that there is a spectrum of disorders, we begin to understand that there is no such thing, for example, as sexual perversion.
We begin to understand that two consenting adults, if they don't harm each other, can do anything they want, and it would be utterly healthy.
We are transforming the concept of mental health.
We understand that human sexuality, human behavior, human sexual orientation, human interpersonal relations, human thinking, human emotions, they are not isolated points or isolated events, which we call normal.
They are on a spectrum. And in this spectrum, there is a place for everyone.
We used to think that there are only two sexes, male and female. Today, we identify seven sexes.
And in census questionnaires in the United States, all seven are going to be listed two years from now.
So our thinking is evolving according to our culture and our society.
In other words, what I'm saying is very worrying. What I'm saying is very frightening and very problematic, because what we consider to be clinical entities, what we consider to be psychological diagnosis, maybe we are wrong.
Maybe many of the things we today consider to be mentally ill or mentally sick or mentally unhealthy, maybe in a hundred years would be considered totally normal, totally healthy.
What about borderline personality disorder? What about narcissistic personality disorder? What about psychopathy?
Are they mental illnesses or are they society's judgment of certain people?
We don't know.
Experience shows that many things that used to be defined as mental illnesses are no longer defined as such.