An uncritical encounter between anthropology and psychiatry

Indian Journal of Psychiatry, 2018

The issue of culture in Indian psychiatry has endured increasing neglect with the burgeoning biological paradigm. This viewpoint debates and demystifies the connotation of “culture” in mainstream psychiatry. As a template to infer dominant thinking in mainstream psychiatry about culture, DLN Murty Rao Oration in 2011, “Indianizing Psychiatry – Is there a case enough?” by Avasthi (2011) (published in the Indian Journal of Psychiatry) has been used. Engaging a broad interdisciplinary view helps unravel the inherent biases in psychiatry and opens up space for analysis of the Indian psyche from a different philosophic tradition and ways of researching it. Effort here is to open up dialog with cultural psychiatry, make efforts to involve traditional and folk therapies, and use available theoretical and empirical resources within cultural psychiatry for a refined practice of psychiatry in India.

The current emphasis on Global Mental Health risks losing the focus on the local and the particular and rendering anthropological insight pertinent. A more critical examination of pedagogical methods and curricula, and of the challenges of establishing collaborative, balanced partnerships is required.

Anthropology and psychiatry have long shared common intellectual and scientific ground. Both are interested in human beings, the societies within which they live and their behaviours. A key starting difference between the two is anthropology’s interest in relativism, whereas psychiatry has been interested in universalism. Also, both anthropology and psychiatry have a long history of common interest in phenomenology and the qualitative dimensions of human experience, as well as a broader comparative and epidemiological approach. Jenkins illustrates the common ground by emphasizing that both disciplines contribute to the philosophical questions of and experience raised by cultural diversity in mental illness and healing. Both disciplines also contribute to the practical problems of identifying and treating distress of patients from diverse ethnic, gender, class and religious backgrounds. Psychiatry focuses on individual biography and pathology, thereby giving it a unique relevance and transformation.Patient narratives thus become of great interest to clinicians and anthropologists. Development of specializations such as medical or clinical anthropology puts medicine in general and psychiatry in particular under a magnifying glass. The nexus between anthropology of emotion and the study of psychopathology looks at normality and abnormality, feeling and emotion, variability of course and outcome, among others. The article concludes by highlighting the convergence between these two disciplines as a very fertile ground for the burgeoning field of Global Mental Health.

The appropriation of biopsychiatric concepts such as depression, and their reframing in clinical and academic discussions, are important parts of the revitalization of bhūt vidyā as Ayurvedic psychiatry. Drawing on ethnographic fieldwork conducted in Kerala from 2009 to 2011, in this article we explore the process and the controversies of translating and correlating the biopsychiatric notion of depression, as a discrete and biologic pathological entity, with Ayurvedic notions of body, mind, and mental distress. Depression, conceptualized as a neurochemical imbalance, is, we argue, relatively compatible with Ayurvedic notions of a fluent body and mind, and so is easier to correlate with Ayurvedic concepts of dos _ ic imbalances and blockages of channels than the former psychoanalytically dominated model of depression. The appropriation of depression within Ayurvedic discourse challenges the dichotomy of universal and culture-specific disorders, and this has a significant impact on mental health programs in Kerala.

Analysing ‘modernity’ in India is a complex exercise, as the movement of the ‘modern’ is locally determined and may be non-linear at different sites and contexts. General medicine and psychiatry are illustrative of the difference in how ‘patienthood’ has been historically constructed, with each wave of ‘modernisation’ changing the subjecthood of the ‘mentally ill’. Unlike the public health sector in India, the mental health sector is driven by the ‘mental asylum’ archetype, continuing through late colonial times into contemporary science in refurbished designs. A related set of changes also concomitantly happened in the domain of indigenous healing, with each epistemic shift pushing this domain to the margins of knowledge and healing practice. The paper is set against the time period covering 1850s until recently (2014).

Article, 2002

Medical Anthropology Quarterly, 2017

Culture Medicine and Psychiatry, 2004

Studies in Medical Anthropology: Cambridge, UK. 357pp.

Philosophy, Psychiatry, & Psychology, 2024

Philosophical speculation about how psychiatric externalism might work in practice has yet to consider the multitude of actual externalist psychiatric systems that exist outside of modern psychiatry. On the conviction that anthropological insights can inform philosophical debate on the matter, the paper illustrates one such case. The discussion is based on 19 months of first-hand ethnographic fieldwork among Akha, a group of swidden farmers living in highland Laos and neighbouring borderlands. Firstly, the paper describes the Akha set of medicinal, ritual, and shamanic practices, analysing issues of stigma and medical pluralism within it. Secondly, it makes the case that the Akha realise a functioning biopsychosocial system which comes with a well-developed set of resources for treating the social dimension of illness. Externalism among the Akha reframes psychiatric illness as a ‘problem in living’, which becomes manageable as such. The paper claims that, in so doing, the Akha system succeeds in many of the areas where modern internalist psychiatry falls short, and that it does so because Akha society is structured in such a way so that its practitioners can shift the social environment around the patient. As a take-away for philosophers, it suggests that the development of an externalist psychiatry must begin from questioning the accepted ontology of the social causes of psychiatric illness.