Mental Illness, Culture & "Stress Poo"

25 March 2023:

A little over 10 years ago while I was attending Sacramento State University and studying Psychology for my Bachelors degree, I took a mandatory Cross-Cultural Cultural Psychology class. The professor was Dr. Akutsu and the course focused on sharing variations in the roles culture had on one's psyche and mental health. The "culture" being examined was not that of America (while Dr. Akutsu also taught a class for that too), but it was of cross-culture; meaning that we looked at cultures from countries all across globe. It was FASCINATING. The biggest take away for me, was how large of a role culture had in ones state of being or what's considered "normal," as well as the expression and symptoms of mental illness or what is considered "abnormal." An example of this is how in Western cultures mental illnesses that lead to the expression of eating disorders such as anorexia nervosa or bulimia were predominantly found in, and restricted to, industrialized, Western cultures (largely those with European influence). But Eastern cultures, specifically those impacted by famine and food insecurity, this form of expression of a mental illness, was not found.

One of the cases that stuck with me the most was a mental illness considered "culturally-bound" to Japan, known as "hikikomori." Hikikomori translates to "pull away" or social withdrawal and its basically where an individual develops a social anxiety that is so severe that they lock themselves into one room in the house and stay in there for a minimum of six months to years-they DON'T come out. The illness is found the most frequently among Japanese middle-school to high-school aged boys who have experienced bullying or decided they are DONE with school. Researchers have attributed the disease to be strongly influenced by the very strict roles and expectations within Japanese culture; if one is unable to meet the expectations, they may succumb to the pressure of desiring to fit in. The specific case we studied in class was of a 14 year old boy named Keisuke who on the outside appeared to be a mentally healthy Japanese teenager, but one day locked himself into the family kitchen and refused to leave. His family would slide him meals three times a day under the door but after they realized he wasn't leaving, they built another kitchen in the house to sustain themselves, while still support Keisuke during his illness.

When I first learned of this case and this disease, I had so many questions as to how something like this persisted. Wouldn't the parents just break down the door? How can one lock themselves in a room in the house for not just days, but YEARS? Apparently, by 2012 (in the timing the book was published) the disease had become so common that researchers estimated upwards of 1 million Japanese people suffer from it. Dr. Akutsu made it clear that when Japanese families learn of others who have family members with hikikomori, the response is one of empathy and great despair for them, "I am so sorry for the member and your family" is an appropriate response. My next question was what are the causes of this? As I read further into my "Cultural Psychology" book written by Steven J. Heine, it listed many common causes (see graphic below), which in summary, were unique to the culture of Japan and most commonly found in the eldest sons' of households as they experienced the most family pressure to carry on the family name. What also was interesting was how many of the symptoms of hikikomori did not align with any other symptoms published within the Diagnostic Manual of American Psychiatric Association (DSM) which is predominantly used in the Western part of the world. And while some countries showed some cases of this, Japan seemed to by far be the most prevalent.

Reflecting on what I learned in college, my observations of the world and my own personal experiences I started wondering if and what, role culture had on my own experiences with mental illness. I looked within the military culture and how living with heightened stress (even in peacetime), anxiety, insomnia, PTSD, and other symptoms seem to be pretty normalized. How every year we do pushups to remember the average 22 suicides a day of veterans and despite the awareness and emphasis on unit led resilience trainings, it doesn't look like the problem is getting better. Here at Osan AB the mental health office is a 200% capacity. They do not have enough staff to support the demand for care and as a result are unable to treat military dependents for any mental health needs.... could the problem be increasing it be increasing?

I then thought of mental health within my own family. A Black, African-America, descendent of chattel Slavery, family. While I wasn't aware of this as a kid, and even as a younger adult, but in more recent years I have learned that mental illness within my family is not uncommon. Some of my family members have diagnosis of bi-polar disorder, schizophrenia, anxiety, PTSD, and here I am rolling in with major depressive disorder (MDD). On the surface this might appear as something biological. But my education has taught me something different. Heine states the following:

"What does it mean to say that a psychological disorder is far more prevalent in one culture than in another? At the very least, cultural differences in such disorders demonstrate that we cannot simply conceive of those disorders as automatically and uniformly unfolding from a set of innate biological causes. Human biology is highly similar every-where, yet psychological disorders present themselves in a variety of strikingly different ways around the world. These cultural differences tell us that, in some ways, culture is implicated in the expression and experience of psychopathology [psychopathology means the study of mental illness]." (Heine 2012)

Reading this, to me, it makes a lot of sense. If cultures and the values and treatment of people within it vary, why wouldn't variations in symptoms vary? When I learned about just how much mental illness impacted my own family I thought about where we came from. A large portion of my family resides in or is from, Racist-ass Mississippi. Another half is from Racist-ass Los Angeles, CA. Some are in Racist-ass Texas. And honestly, you could really take your pick in cities across America that have some level of Racism-sexism-misogyny-homophobia-trans phobia-religious extremism or phobia- ass _____exert city/state name here____. The environments create a hostile space for anyone who is not in the majority's "in group." Entering hostile spaces, spaces where you don't feel safe and must enter daily for your own survival or the survival of your family, this can evolve into chronic stress. Stress and other emotions in excess can literally change your body. That expression, "stress can kill you," I am learning daily that, yes, that's a real thing!

I thought about my experience with MDD this past year. How I've had experiences with severe stressors before. I've experienced deep sadness possibly even felt depressed. But NOTHING like this. The isolation I felt by not feeling understood, not feeling emotionally safe, not knowing who to trust, carrying guilt, shame, betrayal and ultimately being beat down mentally, emotionally and physically for an extended amount of time without relief led me into a severely depressed and dangerous state. The biggest difference between my ability to be resilient in the past from my ability to be resilient here in Korea, had everything to do with my environment. I was unsuccessful in my ability to create or find a safe and supportive environment for myself. And despite my MANY MANY efforts, it took me getting hospitalized, getting new leadership, and opening up about my therapy journey to FINALLY start getting the quality of support and safety that I needed. I needed support in order to learn how to accept the rapid change and stressors in my evolving environment.

A few months ago, I was exchanging hospitalization stories with a good friend of mine. She was hospitalized years ago at the onset of her diagnosis of bi-polar disorder after experiencing an episode of mania. She shared how the experience left her with so much shame. And how she DREADED her time in the hospital, questioning why and all of the things that led her to be there. How she feared how this diagnosis would change the trajectory of her life and create an everlasting stigma within her. I on the other hand really enjoyed my time in the hospital. For me, it was the first time while in Korea that I finally felt a sense of emotional and psychological safely. I felt like I could finally feel some reminisce of positive feelings again and the daily quality care I received from the Psychiatrist, nurses, nutritionists, and mental health technician staff helped open a door that helped me begin to gather some sense of direction in learning what happened to me, so that I could learn how to care for myself in spite of all of the rapid changes happening both externally, around, and within, me. As my friend and I shared experiences of the external craziness that influenced internal disorder leading to our depression, I couldn't help but wonder, why is there so much pressure for what I believe are very human (severe and ill, but still human), responses to trauma? As I've mentioned in previous posts that not everyone responds to trauma and their environment the same even when circumstances "appear" to be similar. Not everyone perceives or interprets their environment the same way either. What some may consider traumatic, others don't bat an eye over it. With repeated evidence of all of this, why is there still a stigma with mental health? Why do we have to hide what is happening in our minds?

In the fall of 2011 when I broke my leg, had surgery, and was unable to participate in any physical activity in ROTC for months, I didn't have to hide it. When I get the flu and other physical illnesses, I may feel some guilt or disappointment with missing pre-planned engagements but I can acknowledge and don't feel pressure to deny what physically is happening to my body. Why is mental illness something that carries so much shame and secrecy when the truth is, SO MANY of us have experienced it either directly in our selves or in others we know and or love?

While I was a 1st Lieutenant, one of the Master Sergeants (MSgts) in my Squadron, deployed for six months to the middle east and shared stories of his experiences with myself and a few others. One of the stories he shared with me was about something called a "stress poo."

MSgt: "Have you ever had a stress poo?"

Me: "I don't think I know what that is. What's a stress poo?"

MSgt: "It's when you're body has been carrying chronic stress for SO LONG that when you finally are able to release the stress it comes out in your poop. And every worry and concern you ever had goes away with it and you are lighter in every way. Literally."

Me: "I don't know if I've had one of those. How do you know if you've had one?"

MSgt: "My friend said that when he had his stress poo coming back from deployment that it was coming out in all kinds of ways and colors and he lost almost 10 pounds. I'm looking forward to havin' mine. When you have one, YOU KNOW."

Another member from my Flight (office) chimes in: "What is this? A stress poo?! I NEED a stress poo!"

Another person: "I need one too! I want to lose 10 pounds!"

As dialogue continued in the office, I laughed and imagined what a "stress poo" for me would look like. I imagined it being wholesome, purple, with stars and all kinds of colors from the rainbow. All kinds of liberation from stress.

I think my MSgt was on to something. I believe that the day we as a society can make and embrace the connection between cultural differences and mental health; the day we work together to create a space to where the two can coexist-- not be erased, hidden or limited to a single path, then maybe our human race would gain an enlightenment allowing each of us and the generations after to evolve into something healthier.

Until then, I'll be working on releasing my stress poo.

Reference: Heine, S. J. (2012) "Cultural Psychology" pg. 458-461