Culture and Mental Health

In this seminar we will explore research and ideas about the cultural contexts of both mental illness and health, at the interface of psychology, medical anthropology, and cultural psychiatry. The course will examine psychiatric approaches, anthropological studies of psychopathology, epidemiology, clinical work, and recent theorizing, and then how all this may contribute to our understanding of the categories and idioms of mental illness. We will look more closely at three psychiatric disorders and suicide. We will also review current work on culture and well-being in order to better understand meanings of mental health.

American Ethnologist, 1984

INTRODUCTION Michel Foucault (1971) amongst other social and medical historians (e.g., see Ellenberger 1970; Szasz 1973), has located the development of psychiatry and institutions of medical custody in the historical epoch associated with the secularization of scientific inquiry and with the emergence of new ideologies of self and society which accompanied the onslaught of the Industrial Revolution in Europe. 1 This paper poses a question of anthropological relevance: If the concepts and practice of psychiatry are so culturally and historically embedded, how far can they take us in the exploration of self and other, madness 2 and "sanity" in societies which until recently were peripheral to these developments? These concerns form the background to this paper, which focuses on Balinese indigenous therapies and healers called balilln. 3 Balians thrive in Bali in response to popular demand for their services. In the district where I worked, one of eight on the island (which forms a province of Indonesia), there were 250-300 balillns practicing publicly4 in a population of approximately 151,000. I will discuss several case studies to illustrate therapeutic responses of balians, clients and families, and to show how the ideas which balillns and their clients invoke about madness and other disturbances integrate with broader notions about health, human personality and the influence of the supernatural in worldly affairs. To this end I present in the latter part of the paper a cultural phenomenology of 'person' in Bali. s I contend that a crucial component of therapeutic processes is communication about the key symbols which operate in the conceptualization of 'person'. BALINESE VIEWS OF MADNESS Medieval Europeans viewed madness quite differently from their descendants of today. Foucault, in Madness and Qvilization, writes: In the Middle Ages and until the Renaissance, man's dispute with madness was a dramatic debate in which he confronted the secret powers of the world; the experience of madness was clouded by images of the fall and the Will of God, of the Beast and the Metamorphosis, and of all the marvelous secrets of Knowledge (Foucault 1971 :xii). In Bali, too, madness is potentially at least an inspired and not a degraded state. The phenomenon almost invariably leads out of the mundane world, and in many instances is perceived to give humans intimations of the divine. Such madness is basically beyond human comprehension as the causes are 251

Clinical Psychology Review, 1999

The predominant Western approach to understanding mental disorder, as indicated in the Diagnostic and Statistical Manual of Mental Disorders (DSM) , is based on a biomedical perspective which sees mental disorders as "natural kinds" or discrete entities which manifest as dysfunction within individuals. Following from this is the view that the DSM 's primary syndromes are universal, based on the assumption that this dysfunction is similar across diverse human populations. The cross-cultural literature, however, reveals significant differences in the manifestation of these syndromes across ethnic groups, thereby challenging the universalist position. In response to this shortcoming of the predominant contemporary conceptualization of mental disorder, a constructivist approach is offered which, it is argued, has a number of important advantages over the traditional view. Finally, the implications of a constructivist definition are discussed, demonstrating the important connection between theory and practice. © 1999 Elsevier Science Ltd THE NATURE OF mental disorder has been the focus of fierce debate over the last 100 years and has generated a number of different theoretical perspectives and research programs. However, researchers remain unclear about the mechanisms generating the majority of psychological disorders and problems, and dispute the degree to which mental disorders represent illnesses, adaptational difficulties, or social disruption. At the heart of this debate is a lack of clarity concerning the relationship between mental disorder and sociocultural factors. Are mental disorders primarily diseases requiring diagnosis and treatment just as purely physical conditions are? Or alternatively, do they represent a lack of attunement between individuals and their social environment? Both these viewpoints have quite different implications for research and treatment, and for the understanding of the relationship between psychological distress and culture.

2008

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Kirmayer, L. J. (2007). Cultural psychiatry in historical perspective. In D. Bhugra & K. Bhui (Eds.), Textbook of Cultural Psychiatry (pp. 3-19). Cambridge: Cambridge University Press.

Cultural psychiatry stands at the crossroads of disciplines concerned with the impact of culture on behavior and experience. It emerges from a history of encounters between people of different backgrounds struggling to understand and respond to human suffering in contexts that confound the alien qualities of psychopathology with the strangeness of the cultural 'other'. The construct of culture offers one way to conceptualize such difference, allowing us to bring together race, ethnicity and ways of life under one broad rubric to examine the impact of social knowledge, institutions, and practices on health, illness and healing. Cultural psychiatry differs from the social sciences of medicine, however, in being driven primarily not by theoretical problems but by clinical imperatives. The choice of research questions and methods, no less than the interpretation of findings and the framing of professional practice, is shaped by this clinical agenda, which emphasizes the quest for therapeutic efficacy.

While mental illness has recently been framed in largely neurobiological terms as “brain disease,” there has also been an increasing awareness of the contingency of psychiatric diagnoses. In this course, we will draw upon readings from medical and psychological anthropology, cultural psychiatry, and science studies to examine this paradox and to examine mental health and illness as a set of subjective experiences, social processes and objects of knowledge and intervention. On a conceptual level, the course invites students to think through the complex relationships between categories of knowledge and clinical technologies (in this case, mainly psychiatric ones) and the subjectivities of persons living with mental illness. Put in slightly different terms, we will look at the multiple links between psychiatrists’ professional accounts of mental illness and patients' experiences of it. Questions explored include: Does mental illness vary across social and cultural settings? How are experiences of people suffering from mental illness shaped by psychiatry’s knowledge of their afflictions?

Medical Anthropology Quarterly, 2017

The International Encyclopedia of Anthropology, 2018

Cultural psychiatry (transcultural psychiatry, cross-cultural psychiatry, or ethnopsychiatry) is an interdisciplinary field of research and clinical practice concerned with the impact of culture on mental health and illness. Culture, in this context, refers to the shared knowledge, practices, values, and institutions that constitute particular ways of life of communities or groups. The different terms for the field reflect particular intellectual and research traditions as well as changing configurations of the social world, but all address questions of enduring importance concerning variations in the causes, experience, expression, and course of mental health problems and the efficacy of specific modes of individual or collective coping, social response, and healing practices. In addition to these scientific questions, cultural psychiatry is an applied health discipline that aims to develop methods of clinical assessment, treatment, and prevention of mental health problems appropriate for culturally diverse populations. Finally, cultural psychiatry is concerned with psychiatry itself as a cultural institution, critically examining its social history, cultural assumptions, and impact on society. This self-reflexive aspect of the field provides a basis for intercultural dialogue and knowledge exchange.