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Anthropology and Psychiatry: the Contemporary Convergence

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Anthropology and Psychiatry: the Contemporary Convergence II Anthropology and psychiatry: the contemporary convergence janis H. jenkins EDITORS' INTRODUCTION Introduction ! Anthropology and psychiatry as disciplines appear to The convergence of anthropology and psychiatry is' have a considerable amount of common ground. Both one of the most productive zones of intellectual' are interested in human beings, the societies within activity in the history of ideas, bringing two disci-. which they live and their behaviours. A key starting plines to bear on a set of questions fundamental' difference between the two is anthropology's interest in to the definition of human being. The notion of ai., relativism, whereas psychiatry has been interested in uni­ comparative psychiatry dates back at least as far., versalism. Also, both anthropology and psychiatry have as Kraepelin. Psychiatrists since Freud have become 1 a long history of common interest in phenomenology fascinated with the experiential diversity of ethno·l and the qualitative dimensions of human experience, graphic data, and anthropologists such as Benedict j as well as a broader comparative and epidemiological 1 approach. and Devereux, struggling with the slippery boundary: jenkins illustrates the common ground by emphasizing between normal and abnormal, have had repeated '. that both disciplines contribute to the philosophical quest­ recourse to the data of psychiatry. Anthropologists~ ions of meaning and experience raised by cultural diversity such as Levi-Strauss and psychiatrists such as Frank1 in mental illness and healing. Both disciplines also contri­ have invoked an analogy between indigenous; bute to the practical problems of identifying and treating ritual healing and psychotherapy in their attempts~,, distress of patients from diverse ethnic and religious groups. to understand the efficacy of both genres of treat· J Psychiatry focuses on individual biography and pathology, ment. Both anthropologists and psychiatrists have : thereby giving it a unique relevance and transformation. struggled with the question of relativity in defining · Patient narratives thus become ofgreat interest to clinicians forms of psychopathology, in a debate ranging from ; and anthropologists. Development of specializations such as medical or clinical anthropology puts medicine in gen­ the demonstration that there are universal core · eral and psychiatry in particular under a magnifying glass. symptoms of some disorders to the identification Using Jungian psychology as an exemplar could lead to a of culture-bound syndromes that exist only under clearer identification of convergence between the two disci­ certain human conditions. Active collaborations have plines. The nexus between anthropology of emotion and been undertaken periodically since at least the the study of psychopathology identified in her own work time of Sullivan and Sapir. Although the expertise of. by Jenkins looks at normality and abnormality, feeling the two disciplines is divergent, both contribute to and emotion, variability of course and outcome, among the philosophical questions of meaning and experi­ others. She ends the chapter on an optimistic note, high­ ence raised by cultural diversity in mental illness lighting the fact that the convergence between these two and healing. Likewise, both contribute to the practi· disciplines remains a very fertile ground for generating cal problems of how best to treat the distress ideas and issues with the potential to stimulate both disciplines. of patients from diverse ethnic and religious groups, Textbook of Cultural Psychiatry, Dinesh Bhugra and Kamaldeep Bhui (eds.). Published by Cambridge University Press ( Cambridge University Press 2007. Anthropology and psychiatry: the contemporary convergence 21 and how to conceive psychiatric disorder in succes­ that insanity was rare among primitive peoples and sive revisions of the DSM nosology. increased along with civilization and its increas­ My strategy in this chapter does not focus on ing levels of cognitive organization, demands for discriminating the contributions of the two fields, mental production, and occasions for mental excit­ but on outlining a series of topics common to their ation. This apparent observation was eventually contemporary mutual interest in the relation interpreted in racist neurobiological terms such between culture and mental illness/healing. In that the natives' brains were said to be more simple doing so I organize the material in such a way as and crude than those of civilized peoples. to call attention to conceptual contrasts that tran­ Bains (2005) examines the more recent history scend or lie outside the disciplinary distinction of transcultural psychiatry, pointing out that its between anthropology and psychiatry. How, for identity as a distinctive discipline dates from after example, is it different to examine the cultural fac­ World War II. A powerful voice from this postwar tors affecting the use of psychopharmaceuticals period was Ernest Becker (1962, 2005), whose con­ and those affecting the use of alcohol and social cern with meaning resonates more than 40 years drugs? What is the consequence of adopting the later. The 1970s and 1980s saw a rapid development different perspectives implied by the study of psy­ and reformulation, in the midst of which a 'new chiatric treatment and psychiatric services? What cross-cultural psychiatry' emerged from a synthesis the difference in views of human variability that of interpretive approaches from anthropology and out the existence of culture-bound syndromes an increasingly sophisticated academic psychiatry those that recognize cultural variations in psy­ (Martins, 1969; Wittkower and Wintrob, 1969; disorders defined essentially in Western Wittkower and Dubrenil, 1970; Galdston, 1971; Kiev, terms? How much in common is there among 1972; Kennedy, 1974; Cox, 1977; Padilla and Padilla, .··· the perspectives of psychiatric anthropology, 1977; Miller, 1977; Estroff, 1978; Kleinman, 1977, (trans) cultural psychiatry, and ethnopsychiatry? Is 1980; Murphy, 1983, 1984). there a significant difference beyond that of magni­ Summarizing the decade of work since Kleinman's tude of trauma in the mental health of immigrants (1977) watershed definition of the revitalized inter­ that of refugees? disciplinary field, Littlewood (1990) contrasted the new cross-cultural psychiatry's anthropological emphasis on psychiatric epistemology and clinical practice to assess the universality of psychopath­ ology with the old cross-cultural psychiatry's rela­ variety of statements both synthetic and program­ tive emphasis on examining the applicability of have defined the convergence between psychoanalytic concepts to non-Western societies . •.tulltnJ~op,ol<>g and psychiatry since the early essay Writing in the same year Leff (1990) suggested Kraepelin on 'Comparative Psychiatry' in 1904. that the shift in focus and the new agenda for useful is the collection of seminal works investigation was a case of throwing the baby 1880 to 1971 edited by Littlewood and Dein out with the bathwater. Within several years which traces a repertoire of interests ranging Lewis-Fernandez and Kleinman (1995) hailed cross­ defining the normal and abnormal, the cultural psychiatry as a mature discipline address­ ,.,..,..~,us complex, family structure, magic and reli- ing the complexities of sociosomatics and clinically death, suicide, intoxicants, anxiety, symbolism, relevant cultural processes, while decrying the culture-bound syndromes. Raimundo et al. limited impact of the field with respect to cultural examines the historical precursors of cross­ validation of the DSM-IV, persistent misdiagnosis of psychiatry among nineteenth century minority patients, continued presence of racial bias whose work was predicated on the notion in treatment, and inattention to ethnic issues in 22 J. H. jenkins medical ethics. This claim to maturity of the field focusing on the patient's understanding of illness has been reiterated by Lopez and Guarnaccia (2000, episodes, was introduced by Kleinman (1980) and 2005) with reference to the study of cultural psycho­ has inspired a substantial body of research, as weu pathology as the study of culture and the definition, as debate about the concept's use in clinical work experience, distribution, and course of psycho­ (Bhui et al., 2002, 2004, Dein, 2002). Foulks 0991) logical disorders. An important synthesis of the has addressed the underlying concepts of normar, discipline in textbook form has been contributed abnormal, and deviant against the conceptual by Helman (2000). background of social pathology, cultural relativism, The mutual relevance of anthropology and psy­ evolution and the biological basis of mental disor­ chiatry remains an important concern for scholars ders, heredity, and the distinction within DSM and clinicians in the field (Mihanovic et al., 2005; between Axis I and Axis II spectrum disorders. An Stix, 1996; Skultans and Cox, 2000). On the one evolutionary concept of mental disorder has been hand, Kleinman (1987, 1988) has highlighted the elaborated in terms of culture and context by . contribution of anthropology to cross-cultural psy­ Kirmayer and Young (1999). Paris (1994) argues chiatry with respect to issues such as translation, the that evolutionary social science is relevant for trans­ category fallacy in defining psychiatric disorder, and cultural psychiatry insofar as it is consistent with pathoplasticity/pathogenicity, emphasizing anthro­ a biopsychosocial model of etiology, and recog-
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