EASA2014: Collaboration, Intimacy & Revolution
Collaboration between psychiatry and anthropology: nosological and etiological challenges
Date and Start Time 03 August, 2014 at 09:00
This panel probes the relationship between local categories of mental illness and behavioral disorders, and the "universal" categories of mainstream psychiatry/psychology.
Supported by the WHO and other organizations, the "global mental health" movement is growing rapidly. But what sort of mental health services will be introduced into those countries said to "lack" them? Before such questions can be answered, there needs to be a basic discussion on the relationship between the purportedly universal diagnostic categories of mainstream psychiatry and the local categories of mental illness/ behavioral disturbance that are more typically the focus of anthropologists. What should be the balance, if any, between them? How can such local nosologies be investigated and described? How "systematic" are they, and is this important? Can the nosologies of mainstream psychiatry (as found for example in the DSM and the ICD) be regarded as "vernacular"? Can the anthropological interest in "embodiment" be combined with standard measures in psychiatric epidemiology, based as they are on linguistic articulations of inner states? What about the question of etiology? What is the relation between physiological, sociological, and supernatural etiologies of mental illness? Where do they overlap, and when are they incommensurable? In this panel, we welcome discussions of such questions from those interested in cultural psychiatry, psychological anthropology, and global mental health.
This panel is closed to new paper proposals.
Anthropology meets psychiatry: the cultural epidemiology of ritual healing
This paper discusses the rewards and challenges of combining ethnographic with epidemiological approaches to ritual healing. I
Anthropologists have provided a great deal of evidence that ritual healing can be effective in the treatment of mental disorders. Epidemiological studies of the topic are much more rare, but they, too, suggest that ritual healing can be effective. Anthropological evidence for the effectiveness of ritual healing tends to be anecdotal and contextual, to emphasize immeasurable factors like "practice" and "embodiment," and to focus on supra-individual units like family or village. Epidemiology, by contrast, thinks of itself as purely quantitative, and constructs its evidence almost exclusively from individual sufferers' linguistic reports. Can these two approaches to the study of ritual healing be combined, and if so, how? More importantly, why would one want to combine them?
Categorizing "madness" in classical and contemporary Āyurveda - a traditional category of mental disease in historical perspective
In the classical literature of Āyurveda, a traditional scholarly medical system of South Asia, unmāda (“madness”) is a distinct disease-category with its own etiology and symptomatology. How this disease is described in classical and contemporary Āyurveda forms the theme of this paper.
Āyurveda, a classical learned medical system of South Asia, looks back at a vast specialized literature spanning two millennia. Starting from the oldest layer of extant āyurvedic literature unmāda (literally "madness") forms a distinct disease-category. In this paper symptomatology, etiology and classification of unmāda in four seminal texts of classical Āyurveda from the first centuries CE (Caraka-Saṃhitā, Suśruta-Saṃhitā, Aṣṭāṅgahṛdayasaṃhitā. Mādhavanidāna) will first be described in their context. Generally speaking one finds etiological classifications on the basis of a humoral pathology side by side with the idea of possession (graha) by supernatural beings (bhūta). The short historical survey of these concepts in the classical texts will be completed by a passing glance at the role and interpretation of unmāda in contemporary Āyurveda where this classical disease-category is most often equated with the modern category of "psychosis". The idea of "possession" is often disputed by modern āyurvedic authors or the term for "supernatural beings" is interpreted to mean pathogenic microorganisms.
Stealing artefacts, offending spirits and psychosis: navigating a pluralistic medical system in the Tibetan context
This paper will use a Tibetan case study of 'madness' from fieldwork conducted in North India to examine the relationship between local and biomedical categories of mental illness, and investigate how these divergent approaches play out in terms of treatment, prognosis and community understanding.
To what extent are Tibetan medicine and biomedical systems analogous in terms of the classification, diagnosis and treatment of mental illnesses, and where do they diverge? Research has suggested a certain amount of 'overlap' between these two systems in terms of symptoms; but with widely divergent perceptions of causation, contemporary Tibetans' explanatory models of mental illness and health-seeking behaviour frequently encompass a patchwork of Tibetan Buddhist, 'folk-religious' and Tibetan cultural concepts, as well as biomedical ones. Furthermore, as each system reflects a particular view of personhood and the individual's place in, and relationship with, the world, divergent aetiologies highlight the significantly different - and sometimes contradictory - perspectives on mental illness which inform illness management and health-seeking behaviour. This paper will illustrate the frequently complex interplay between multiple nosological and aetiological systems in the Tibetan context through the description of a case of 'madness' (Tib.: smyo nad) from ethnographic fieldwork conducted within a Tibetan exile community in North India. It will examine the multiple explanations for his condition commonly held by the community, including 'karma' resulting from the theft of religious artefacts, spirit possession and 'psychosis'; and what these perspectives mean in terms of treatment (or lack of), prognosis and understanding within the community. It will explore how patients and their families navigate a pluralistic medical system in the Tibetan context in their search for meaning and treatment in the event of severe mental illness.
The reformulation of DSM IV in a Turkish context
This paper analyses how the interplay between Islamic thinking, the self-perception of the individuals and the global understanding of depression forms Turkish conceptualisation of depression.
This paper intends to analyse the conceptualisation of depression in the cultural context of Turkey. The global understanding of depression, based on the DSM IV, has a major influence on the formulation of the concept of depression in Turkey, although it remains unclear whether the interpretation of DSM IV has been smooth and unproblematic or not. Here, it is proposed that there are two possible factors which might have interfered with this interpretation: individuals' self-perception in Turkish society, which is considerably different from self-perception in the Western world; and the Islamic understanding of suicide and depression. The former is important firstly because depression is often defined in relation to the concept of self, and secondly, human understanding of their selves often influences their experience of depression. Islamic understanding is also significant, as DSM IV is the product of a Western medical tradition. However, Turkish medical history is based on a different tradition, which was influenced by Islamic thinking. The understanding of Turkish interpretation of depression thus requires a broader analysis going beyond the DSM IV. For this reason, the concept of self will be defined in the cultural context of Turkey. Additionally, the Islamic understanding of suicide and depression will be described. Finally, the work of two Turkish investigators will be used to exemplify how the DSM IV treatment of depression has been adapted for a specifically Turkish social/cultural/religious context.
Listening to disembodied voices
This paper examines the role of hearing voices in ritual healing (therapeutic method) and in psychiatry (psychotic symptom).
What is the role of the voice in Indian explanatory models of madness and psychiatric nosology? Anthropological and psychiatric challenges, it is argued, are crystallized in the voice, a medium that signifies the intersection of models of occult madness and schizophrenia. The psychiatry and religious healing practiced at a Sufi shrine in Gujarat differed in terms of the status accorded to the voice: psychiatry interpreted the voice as a symptom of mental disorder, whereas religious healing used the medium in ambiguous practices of possession trance, combining performances of madness and healing. Although 'doing trance' is considered an essential part in the process of healing, patients diagnosed with schizophrenia do not experience trance. Their patiency is displaced onto a caretaker. Psychiatric theories resting on the somatised mind partly converge with theories of madness based on sorcery and possession in so far as both posit a direct link between the brain and behaviour. Against the background of the contested religious healing sites that are currently debated in Indian public mental health, attention to multiple dimensions of the voice reveals its significance as an alternative to the psychiatric institutionalisation of people coping with mental disorder. The voice reconciles the dichotomy between scientific psychiatry and traditional ritual healing, partly by making sense of madness by engaging with the sense of hearing.
The local in the universal and the universal as local: the Hanuman Chalisa in German psychosomatic medicine
This paper intends to interrogate the categories of the local and the universal, both with respect to nosology and aetiology, through an ethnography of psychosomatic medicine in a German Reha Klinik.
This paper intends to call into question the presumptive
conceits of Euro-American anthropology, particularly as it pertains to
what it calls "mental illness". Anthropology often functions as the
handmaiden and distant double of psychiatry at "home", collecting
curious tales of possession, exorcism and healing as it traverses the
world away from home, with the home always imagined as a Euro-American
navel, and the addressee implicitly presumed to be one's peers and the
public in this narcissistic navel. One example of this narcissism,
without any sense of irony or embarrassment, is called "medical
anthropology at home". One of the many side-effects of this narcissism
is to be blind to two possibilities: that there are enough tales of the
curious kind at home and, either this has always been the case, or
close to two centuries of curio collecting has so infected and
inflected the categories at home that the other has come home to
roost. This paper will wrestle with both these possibilities by
ethnographically examining German psychosomatic medicine and its
penchant for past-life aetiologies brought about by inducing trance
through breathing and breath work, and through the playing of exotic
Hindu music like the Hanuman Chalisa. It will then proceed to ask
whether "universal psychiatric categories" have been inflected if not
infected by the "local", or whether all universals are nothing other
than the local, and doubly so as in the German case these exotic
aetiologies and their attendant therapies are paid for by socialised
health insurance, especially the Beihilfe.
Madness in East Africa: narratives of spiritual healers in Kenya
Spiritual healers in Kenya were asked how they deal with psychoses. They named physical, psychological and social causes. Most important were spiritual causes and witchcraft. The question is if such diverse cultural etiologies can be summarized in one worldwide classification system.
According to the World Health Organization (WHO) more than the majority of the population in Africa use traditional medicine. And it is mostly the spiritual healer, who is able to deal with psychoses from the point of view of many Africans, because psychoses are very often related to spirit possessions. To advocate intercultural exchange, spiritual healers in Kenya, East Africa, from different ethnic groups were asked how they deal with psychoses. Because the term psychosis was not common to all interviewed healers, the more colloquial term madness was used throughout the field research, which was understood by every healer. The descriptions of the symptoms showed many similarities to western medicine and comparative cultural studies and most closely resembled psychoses from the schizophrenic group. And as in Western medicine the spiritual healers described a multifactorial etiology. Almost all spiritual healers named physical, psychological and social causes. Still most important and in contrast to Western medicine were spiritual causes, like spirit possession, and witchcraft. Depending on the etiology were the different treatment options. The narratives of the spiritual healers were quiet heterogeneous and will be presented in the panel. Furthermore a transfer to classification systems like ICD-10 or the DSM -V, based on an Euro-American culture, has significant limitations. One's own cultural limitations should always be considered before attempting to classify disease phenomena from other cultures. And it is to be questioned if such diverse cultural etiologies and treatment options can be summarized in one worldwide classification system.
Doshas, sorcery, spirits and the ICD: the pragmatics of nosologies and etiologies in an Ayurvedic mental hospital in Kerala, south India
I will analyze the pragmatics and politics of how doctors and patients of Ayurvedic psychiatry engage different nosologies and etiologies. Ayurvedic psychiatrists' diagnostic and therapeutic practices and their politics of recognition are characterized by etiological and nosological pragmatism.
The globally circulating nosologies of biopsychiatry are worldwide used for diagnosing mental illness and behavioral disorders. Moreover, practitioners of local medical traditions and vernacular healing engage the ICD and integrate the diagnostic entitities into their own frameworks. Beyond constating an antagonism of biopsychiatric and vernacular nosologies, anthropologists should therefore, I argue, ask how and why these categories are being made appropriate and how they are appropriated and transformed by various stakeholders.
The discipline and practice of Ayurvedic psychiatry is an interesting case in point. Using the case of a governmental Ayurveda mental hospital in Kerala and drawing from interviews with doctors and narratives of patients and their family members there, I will analyze the pragmatics and politics of engaging different nosologies and etiologies. On the one hand, Ayurvedic "manasika doctors" (psychiatrists) strategically accentuate Ayurvedic physiology to respond to biomedicine and discard all supernatural influences that have long been part of "externally caused" mental affliction. On the other hand, doctors pragmatically utilize vernacular etiologies of sorcery and spirit affliction in order to gain patients' compliance for the purifying treatments while at the same time demarcating from these etiologies. The biopsychiatric, Ayurvedic and vernacular nosologies and etiologies as well as the treatments are in many ways linked and strategically accentuated and interpreted according to context. Thus, I argue, it is nosological and etiological pragmatism rather than doctrinal or theoretical purity that characterizes Ayurvedic psychiatrists' diagnostic and therapeutic practices as well as their politics of recognition.
Categorizing the spirits at Balaji temple: a study comparing the vernacular and psychiatric nosology of spirit-possession in north India
This paper describes the perceptions on spirit possession and healing among the afflicted in Balaji temple, Rajasthan (India) through case studies. Analyzing these, vernacular nosology is discussed and evaluated vis-à-vis standard psychiatric diagnosis for divergences/convergences between the two.
Spirit-possession has variously been explained in psychiatry as a specific mental disorder or one including different such disorders. However, the experienced realm of this phenomenon is difficult to lend to neat demarcations into psychiatric categories of disorders. As such, the psychiatric nosology of mental ailments is often incommensurable with the general native perceptions on spirit affliction and exorcism. These native beliefs usually involve multi-vocality of intruding spirits and their manifestations onto sufferers and their social groups as well as beliefs on etiology, effect and course of healing.
This paper is drawn from the data gathered during fieldwork (including case studies) in Balaji temple in the state of Rajasthan, India, which is renowned for ritual healing of those possessed by spirits. The vernacular beliefs on different aspects of spirit-possession like causes, types of spirits and pattern of affliction, symptoms and manifestations as well as exorcism as found among the visitors that comprise of sufferers and their care-groups are described through the means of case-studies. These beliefs are then analyzed in order to attempt to arrive at vernacular nosology of spirit-affliction, which is then compared with the standard psychiatric nosology in order to evaluate possible convergences or divergences as well as strengths and short-comings of both.
This panel is closed to new paper proposals.