After the fall of the Soviet Union in the early 1990s, Mongolia was left on shaky ground. When the Russians left, the country’s economic infrastructure quickly deteriorated and countless Mongolians were left jobless. One commodity that did survive the collapse, though, was liquor. Cheap vodka and other alcoholic beverages were available at every corner, and the masses of people left in poverty turned to it in an effort to cope with their plight.

Sadly, not much has changed in Mongolia since it became an independent country. There is a shop selling cheap liquor on almost every corner, and the number of people addicted to alcohol is astronomical. The U.N.’s World Health Organization (WHO) reported in 2006 that 22 percent of men and 5 percent of women in Mongolia are alcoholics. The rate of alcohol dependency is three times higher than that of Europe. Furthermore, about one in five Mongolian men binge drink every week.

In Ulan Bator, the capital of Mongolia, intoxicated individuals roam public spaces at all hours of the day. In a 2003 BBC story, journalist Rupert Wingfield-Hayes reported seeing a considerable number people stagger around the city’s train station at 10 in the morning—Mongolia’s streets are littered with addicts.

A typical Mongolian police station contains several sobering-up cells, where drunks are collected and deposited on a nightly basis so they do not freeze to death or commit crimes in the streets. The intoxicated cell mates who are not passed out shiver under blankets—their clothes are removed so that they can’t commit suicide.

Not all of Mongolia’s many alcoholics are to be found on the streets, however. As a matter of fact, in most cases, the people locked up overnight in the sobering-up cells are men who have been accused of domestic violence. Officers at the police stations regularly see the same people brought in for belligerence after binge drinking.

One reason for the ubiquity of alcohol in Mongolia is that the government is invested in it. A 2009 NPR article reports that alcohol-related taxes generate more government money than anything else, accounting for 20 to 23 percent of the government’s income. To maintain such high profits, alcohol is marketed as a symbol of national pride and cultural heritage. Heroic figures like Genghis Khan are associated with drunken celebration, and many consider heavy drinking to be an admirable sign of masculinity.

At the present time, there are insufficient recovery options for alcoholics in Mongolia. People seeking help are lucky if they can get into the country’s one government-run rehab facility, which has a mere 50 beds. Even the patients who make it into the center stay for only ten days, where they receive some medicine and counseling, and are then released back into the same harsh socioeconomic climate.

Clearly, more help is needed for Mongolia’s disproportionate alcoholic population, but unless the country can manage to improve its economic status and cultural priorities, a solution to the problem could still be far off.

LOCATION

If lithium is implicated in manic depression, or bipolar dysfunction, and lithium is found naturally in higher doses in some places than others, does it matter where you live?

Lithium is a naturally occurring element that shows up in soil, water, and certain plants. Doctors have used it successfully to treat bipolar mania for the last fifty years. Hirochika Ohgami and colleagues at Oita University analyzed the suicide rates in Japan’s Oita Prefecture, and found that cities with higher levels of lithium in their drinking water experienced lower rates of suicide, as reported recently in the British Journal of Psychiatry. The amounts of lithium were still much lower than those in conventional medication, but there is a statistically significant difference that may be important for those with bipolar disorders.
In a 1990 study of 27 Texas counties, researchers found an “inverse association of tap water lithium content in areas of Texas with the rates of mental hospital admissions, suicides, homicides, and certain other crimes.” It was also discovered that young men incarcerated for violent crimes in some parts of Texas had disproportionately low lithium levels. Schrauzer and Shrestha discovered that the negative correlation was confirmed, “ especially in the south-central region of the state where high suicide mortality rates correspond to low lithium concentrations.”

FOOD

Could some cultures eat combinations of just the right lithium-rich foods and foods with omega three fatty acids to keep bipolar illness at bay?

Foods rich in lithium include all kinds of dairy products, seaweed, potatoes, lemons, eggs, fish, grains, and vegetables. Natural mineral water and seawater also contain higher levels of lithium. While the amounts of lithium in these foods are far lower than clinical doses of lithium, a regular low dose of naturally occurring lithium may help to reduce bipolar illness. The Mediterranean diet, such as the traditional food eaten on the island of Crete, may provide an excellent combination of these foods. Likewise, the Japanese diets rich in fish and seaweed may also help prevent lithium deficiency.

In a study titled, “Cross-National Comparisons of Seafood Consumption and Rates of Bipolar Disorders”, scientists reported on the seafood consumption levels and rates of bipolar illness among nine countries. Their study showed the lowest lifetime prevalence rates of bipolar illness occurred in the countries with the highest levels of fish consumption, including Puerto Rico, Taiwan, Korea, and Iceland. Iceland had the highest rates of fish consumption – well above 200 pounds average per person per year—and the lowest rates of diagnosed bipolar disorders. In Germany, where the consumption of fish is much lower, the lifetime prevalence rate was much higher – 6.5 percent in Germany, versus 0.2 percent in Iceland.

The authors concluded, “There is some evidence that eating a lot of fish, or at least those rich in the omega-three fatty acids, may be able to combat the depression of bipolar disorder.” They note that it also may play “a preventive and therapeutic role” for depression.

SOCIAL STRUCTURE

Do some cultures have social structures that promote better mental health?

A series of well-known studies in the 1960s in the town of Roseto in Pennsylvania uncovered astonishing health statistics: no one was dying from heart attacks under age sixty-five, there were no suicides, no alcoholism, no drug addiction, and very little crime. Author Malcolm Gladwell notes, “The death rate from all causes in Roseto, in fact, was 30 to 35 percent lower than expected.” Roseto was named after a town in Italy, and most people were immigrants from that town. They had brought their culture with them. Physician Stewart Wolf and sociologist John Bruhn found that the family structure in the homes, and culture of work and egalitarian ethics, as well as close connections with each other, was the answer. The family homes often had three generations living under one roof, and showed great respect for the elders. In the tight knit community, which stressed an egalitarian social structure, extended family clans, people spending time together, chatting in the streets, respect for elders and the calming effect of the Church, these factors combined to provide better health insurance than anything money could buy.

With this study in mind, as well as many anthropological studies demonstrating the social strength of small face-to-face communities, it is possible to see another correlation in the nations showing lower rates of bipolar spectrum disorders. They are all island nations, or peninsular, and have numerous small tight-knit fishing communities. Because it takes years to learn to fish well on the ocean and even longer to gain the experience necessary to know where the fish will be, fishing is often a family business, with older generations teaching younger, and the younger family members showing respect, but also receiving support and direction. The community provides necessary support to the fishers and their families. Those who fish may be away from home for weeks at a time, plying a dangerous trade. Family members left behind build support networks in the community. Like Roseto, fishing communities with strong connections and generational family cohesion may provide an essential safety net that helps lessen the rates of bipolar spectrum disorders. It may be worth another study to find out.

Culture apparently does matter. People with bipolar spectrum disorders and those supporting them might want to consider living in one of those places with a blue horizon –on an island or in a coastal community with access to lots of seafood, or in a desert community in Arizona or Chile or Bolivia where levels of lithium in the soil are high. They might want to choose a community where the pace of life is a little slower, relationships and work are constant over time, and people have time for talking – a face-to-face community where people really get to know each other. That supportive network may be the best – and cheapest—investment people facing bipolar disorders can make.

REFERENCES:
Blade, Joseph C. and Gabrielle A. Carleson. 2007. “Increased Rates of Bipolar Disorder Diagnoses among U.S. Child, Adolescent, and Adult Inpatients, 1996-2004.” Department of Psychiatry and Behavioral Science, Stony Brook State University of New York, published online 16 February, 2007.
Gladwell, Malcolm. 2008. Outliers: The Story of Success. New York: Little, Brown and Company.
Hirochika Ohgami, Takeshi Terao, Ippei Shiotsuki, Nobuyoshi Ishi, Noboru Iwata. 2009. “Lithium Levels in Drinking Water and Risk of Suicide.” The British Journal of Psychiatry, 194: 464-465.
Kessing, L.V. ,Sondergard, L., Kvist, K., & Anderson, P.K. 2005. “Suicide Risk in Patients Treated with Lithium.” Archives of General Psychiatry, Vol.162 (8), 860-866.
Noaghiul, Simona, M.D., M.P.H. and Joseph R. Hibbely, M.D. 2003. “Cross-National Comparisons of Seafood Consumption and Rates of Bipolar Disorders.” American Journal of Psychiatry 160 (12): 2222-7.
Schrauzer, Gerhard N., PhD, CNS, FACN. 2002. “Lithium: Occurrence, Dietary Intakes, Nutrition Essentiality.” Journal of the American College of Nutrition Vol 21, No.1, 14-21.
Schrauzer, G.N. & Shrestha, K.P. 1990. “Lithium in Drinking Water and the Incidence of Crimes, Suicides, and Arrests Related to Drug Addictions.” Biological Trace Elements Research 25, 105-113.

For many people, Burning Man is an amazing counterculture experience. A group of tens of thousands of people (thirty to forty thousand are expected in 2009) set up a tent city that is clean, organized, and functional, in a matter of days. People bring amazing art installations, vehicles that are themselves mobile art, and colorful costumes. Then, after the festival, a dedicated volunteer crew cleans up, and leaves the area “without a trace”. Not surprisingly, FEMA has sent representatives to learn from their organizational expertise.

Art, fantastical, extreme, participatory, and extraordinary, takes place as vehicle decoration, mobile sculptures, body art, parades, costumes, and more, beginning with entry into the festival. A kind of artists’ paradise combined with Mardi Gras follows, with events both planned and spontaneous. Many people go just for the art, the music, the shared cultural experience, and the chance to make new friends and networks. But a core group of regulars go each year for a quasi-religious experience based on the original philosophy of the creator of Burning Man. They go to purge themselves of the past year, of experiences both bad and good, so that they can purify their lives and move on to a new year of fresh possibilities. “Burning the Man” late in the week is both vivid and symbolic – a religious ritual that allows participants to feel cleansed, and reborn for the next year, in a way that is strikingly parallel to religious confession and communion.

Unfortunately for many people, the association of this purging and purifying with excessive use of drugs and alcohol is not uncommon. Drugs ranging from marijuana to LSD to MDMA or ecstasy are available, and some people use large amounts in cathartic events. A number of mistaken assumptions circulating among the drug and alcohol users fuel dangerously high levels of consumption for some people. These are just a few of the assumptions:

• “It’s okay to use drugs like LSD, MDMA, or mushrooms because I only do it once a year at Burning Man. It won’t affect me the rest of the year.” Unfortunately, this is far from true. Hallucinogen Persisting Perception Disorder (HPPD) can occur months after even a single use of any of these. HPPD can cause anxiety and depression, an inability to control moods, and frightening flashbacks, even when the original “trip” was pleasurable.

• “The setting is really protective and safe – I’m around good friends who won’t let anything bad happen to me and we all trust each other, so the effects of the drugs will just be positive.” In fact, the “safe” setting lures some users into taking higher and/or more frequent doses than they otherwise might take, putting them at even greater risk for schizophrenia, depression, and other mental health disorders later on, as well as the higher risk of HPPD. And just because they trust others does not mean that everyone is trustworthy. A number of sexual encounters with new partners take place at Burning Man, and not all of it is “safe sex” or protected by any means.

• “ I have to settle down and work hard the rest of the year, so this is my one chance to have fun and party with friends – it won’t affect the more serious part of my life.” Actually, many new networks of friends are formed at Burning Man, some healthy, some not. Young adults in particular may be vulnerable to new friendships with people who are regular drug users or who are heavy drinkers the rest of the year as well, and who model and encourage these inappropriate behaviors. Some adults, young and older, discover that the urge to party hard does not just go away, and longer term addictions form. Others may successfully avoid regular use of drugs and alcohol, but find themselves drawn into other large festival settings, such as Mardi Gras celebrations, where drugs and alcohol are freely available and the social constraints temporarily removed.

While large art festivals and art installations, concerts, partying, and bingeing on substances from food to drugs to alcohol, have been a part of the human experience for thousands of years (think: Stonehenge), there is an unfettered limitlessness to the experiences that many are having at Burning Man that mimics moments in history when extreme excess was a part of the demise of a civilization. The festival has extraordinary and positive aspects — its support for art, culture independent of corporate spending, and positive social networking bring hope for the future to many creative and thoughtful individuals. Yet if it cannot rein in the excesses of risk taking and health-threatening behavior, the dark side of Burning Man may overwhelm both individuals and the positive spiritual event and alternative culture it seeks to create.

Author Catherine Knott, Ph.D., teaches Anthropology and Sociology for the University of Alaska on the Kenai Peninsula. She has a Ph.D. in Anthropology, Natural Resources, and Education from Cornell University and a B.A. from Yale University.

“Compared to other hallucinogens, peyote is a very focused and concentrated fire, an inner fire that causes an increase of energy, giving spiritual insights.”
–Anonymous source

Peyote (Lophophora williamsii) a small cactus without spines, found from Mexico to Texas and Southern California, has inspired generations of poets and musicians, as well as members of the Native American Church through the ingestion of its button-like growths. Peyote’s psychoactive alkaloids affect the mind through hallucinogenic experience, and may help some to transcend the material world, enhancing transformation of the spirit. Indigenous people of the Southwest and Northern Mexico have used peyote in ritual religious ceremonies for over five thousand years to heal their communities. Yet contemporary non-native people using peyote at parties or other events may be missing its potential to assist in positive life changes, because of the importance of the “set” and “setting” in which people use this powerful plant. Both the mental states people bring and the environment in which they find themselves when they ingest the plant, or drink tea made from it, provide critical context for the type of experience they will have.

The re-discovery of writings from the sixties and seventies about using peyote, from Hunter S. Thompson’s Fear and Loathing in Las Vegas, to the writings of Carlos Castaneda, has encouraged experimentation by a new generation of party drug users and others seeking more serious introspection through the use of hallucinogens. But as ethno-botanists have discovered through research on plant use around the world, the use of plant medicines often requires hundreds of indigenous experiments to figure out safe methods of preparation, as well as appropriate dosages and contexts for use. The Native American Church, with the legal permission of the U.S. government, uses peyote to induce deep meditative states that enable participants to transcend their surroundings and present situation, leading to psychological and physiological healing. Sometimes it is used for healing relationships between people. A couple or family describes the pain and problems they face, and the others listen and provide empathy in this ritual based on near hallucinatory experience and a sense of unity with other living beings.

In the Native American Church, a healer, sometimes called the road man, directs the proceedings. All participants are required to sit in a circle, sometimes for ten hours or more, without getting up or moving even their upper body. For some people, this requirement is the hardest part of the whole experience. The road man then directs the individuals to take the peyote, which may be in the form of buttons, or a powder, or a tea. It is extremely bitter, and this alone may account for the vomiting that often follows. Sometimes, as in the case of researcher Dr. John Halpern, the healer may insist that the participant take more peyote after vomiting. During the experience, the participant may feel purified, or frightened, but many feel they have gained greater spiritual insight, tapping into an awareness that they do not have in their daily lives. While the Native American Church limits who may partake of peyote to those whom the healers feel are ready, people from other cultures self-select. A healer may feel uncomfortable with some who want to join the experience, but readiness may be more difficult to ascertain in a cross-cultural encounter.

Some indigenous groups, such as the Huichol of the Sierra Madre in North central Mexico, appear to have little fear of peyote, and ingest it regularly after participating in a religious ritual that allows them to experience blissful communion, as Barbara Myers describes in her classic study, Peyote Hunt: the Sacred Journey of the Huichol Indians. She took peyote herself and describes her experience as a sequence of vivid events like beads on a string.

Experiences with mescaline, another name for peyote, among the Yaqui Indians may be so powerful that they overwhelm the participant for more than twenty-four hours. During a discussion about death with Mexican sorcerer or “man of knowledge” Don Juan, in anthropologist Carlos’ Castaneda’s book, A Separate Reality (considered to be at least partly fictional), Don Carlos says,

“Death has two stages. The first is a blackout. It is a meaningless stage, very similar to the first effect of Mescalito, in which one experiences a lightness that makes one feel happy, complete, and that everything in the world is at ease. But that is only a shallow state; it soon vanishes and one enters a new realm, a realm of harshness and power. That second stage is the real encounter with Mescalito. Death is very much like this. The first stage is a shallow blackout. The second, however, is the real stage where one meets with death; it is a brief moment, after the first blackout, when we find that we are, somehow, ourselves again. It is then that death smashes against us with quiet fury and power until it dissolves our lives into nothing.”

Because of the depth and sometimes the severity of the effects of peyote, members of the Native American Church may not allow young people to try it, until elders feel they are ready. Peyote, as other hallucinogens, can cause users involuntarily to experience hallucinations even months after the initial use, and after ingesting the actual plant just one time. Clearly, such a powerful drug has the potential to disturb deeply someone who does not live in a compassionate community that understands its use and potential after-effects. Living in the extended families and close connection of some Native American communities, whether that of the Yaqui or other southern tribes who have used the drug for thousands of years, or in the Navajo communities who have begun to use it in their Native American Churches only since the early 1900′s, provides a very different setting for the use of peyote than living in the current mobile and disconnected society of most Americans. Non-indigenous users take grave risks when they try peyote without the constant cultural context that provides long-term understanding, and interpretation for its effects.

Nevertheless, as Dr. John Halpern reported in his study of the effects of peyote on the brain in a study following Navajo members of the Native American Church, who had used peyote at least one hundred times, “church members show no deficits compared to sober nonmembers, and score significantly better than former alcoholics”. He and others believe that peyote may be useful in treating alcoholism. What is clearest from the anthropological research on peyote and indigenous cultures that use the plant hallucinogen, including the Huichol, is that set and setting matter enormously, which should be ample warning for those individuals who regard peyote as a recreational drug rather than as an aid to spiritual healing in a supportive and compassionate community.

Author Catherine Knott, Ph.D., teaches Anthropology and Sociology for the University of Alaska on the Kenai Peninsula. She has a Ph.D. in Anthropology, Natural Resources, and Education from Cornell University and a B.A. from Yale University.

REFERENCES:
Horgan, John. 2003. “Peyote on the Brain”. DiscoverMagazine, February 3.
Horgan, John. 2005. “Psychedelic Medicine: Mind-bending, Health-giving.” New Scientist, February.
Momaday, N. Scott. 1966. House Made of Dawn. New York: Harper and Row, Publishers.
Myerhoff, Barbara. 1976. Peyote Hunt: The Sacred Journey of the Huichol Indians. Ithaca: Cornell University Press.
Thompson, Hunter S. 1971. Fear and Loathing in Las Vegas. New York: Random House