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Anthropology and Psychiatry a Contemporary Convergence for Global Mental Health Cambridge University Press 978-1-316-62850-8 — Textbook of Cultural Psychiatry Edited by Dinesh Bhugra , Kamaldeep Bhui More Information Chapter Anthropology and Psychiatry A Contemporary Convergence for Global 2 Mental Health Janis H. Jenkins Editors’ Introduction Introduction Anthropology and psychiatry have long shared com- Contemporary emphasis on global mental health can mon intellectual and scientificground.Bothare benefit greatly by a well-informed understanding of interested in human beings, the societies within the long-standing interface of anthropology and which they live and their behaviours. A key starting psychiatry. Indeed, such knowledge is a prerequisite difference between the two is anthropology’s interest for transnational inquiry into specific aspects of men- in relativism, whereas psychiatry has been interested tal health as well as broader questions of human being. in universalism. Also, both anthropology and psych- Nineteenth century eugenic notions of the inferiority iatry have a long history of common interest in of then-considered ‘primitive’ minds were scientific- phenomenology and the qualitative dimensions of ally critiqued and denounced by anthropologist human experience, as well as a broader comparative Franz Boaz (1911), but in comparative psychiatry and epidemiological approach. Jenkins illustrates the implicit or explicit presumptions regarding the simi- common ground by emphasizing that both discip- larity or difference in ‘primitive’ or ‘modern’ minds lines contribute to the philosophical questions of dates back at least as far as the early twentieth century meaning and experience raised by cultural diversity with psychiatrist Emil Kraepelin (1904) and subse- in mental illness and healing. Both disciplines also quent challenges by anthropologist–psychiatrist contribute to the practical problems of identifying W. H. R. Rivers (1918). Psychiatrists since Freud and treating distress of patients from diverse ethnic, have been fascinated with the experiential diversity gender, class and religious backgrounds. Psychiatry of ethnographic data, and anthropologists such as focuses on individual biography and pathology, Margaret Mead (1930, 1935), Ruth Benedict (1934) thereby giving it a unique relevance and transform- and Edward Sapir (1932, 1938), all students of Boaz, ation. Patient narratives thus become of great inter- produced pioneering works which actively engaged est to clinicians and anthropologists. Development the methods and data of psychiatry. All were con- of specializations such as medical or clinical anthro- cerned with the vexing problem of differentiating the pology puts medicine in general and psychiatry in normal and the abnormal, whether conceived dichot- particular under a magnifying glass. Using Jungian omously or on a continuum. Such collaborations led psychology as an exemplar could lead to a clearer to highly productive exchanges, including that of identification of convergence between the two dis- Sapir and psychiatrist Harry Stack Sullivan (1940, ciplines. The nexus between anthropology of emo- 1964), whose scholarly interchange has been docu- tion and the study of psychopathology identified in mented by Helen Swick Perry (1982). Psychiatric her own work by Jenkins looks at normality and anthropologist Cora Du Bois (1944) and Georges abnormality, feeling and emotion, variability of Devereux (1980) wrote convincingly about the unreli- course and outcome, among others. She ends the able boundary between normal and abnormal, as did, chapter on an optimistic note, highlighting the fact in 1943, philosopher of medicine Georges that the convergence between these two disciplines Canguilhem (1991) and anthropologist Claude Levi- remains a very fertile ground for generating ideas Strauss (1962). In addition to the issues surrounding and issues with the potential to stimulate both the normal and the abnormal in defining forms of disciplines. psychopathology, anthropologists and psychiatrists 18 JANIS JENKINS © Cambridge University Press www.cambridge.org Cambridge University Press 978-1-316-62850-8 — Textbook of Cultural Psychiatry Edited by Dinesh Bhugra , Kamaldeep Bhui More Information 2 Anthropology and Psychiatry have struggled together with the question of relativity Delineating the Convergence in debates surrounding the a priori presumption of Diverse formulations both synthetic and programmat- the universality of core symptoms of particular types ic have defined the convergence between anthropol- of disorder in the absence of empirical demonstration. ogy and psychiatry since the early essay by Kraepelin Although the expertise of the two disciplines is dis- on ‘Comparative Psychiatry’ in 1904. A useful collec- tinct, both contribute to the conceptual questions and tion of seminal works from 1880 to 1971 edited experiential questions of meaning in mental illness by Littlewood and Dein (2000) traces a repertoire of and healing. Likewise, both contribute to the immedi- interests ranging across definitions of the normal and ate and significant problems of how best to treat the the abnormal, family structure, cultural symbolism, distress of patients across domains of diversity prom- suicide, anxiety, intoxicants and controversially con- inently to include gender, ethnicity, religion and mar- ceived ‘culture-bound syndromes’. Current thought ginalization by virtue of intolerance, discrimination, among contemporary psychiatric anthropologists warfare and political violence. Productive work on places less stock in the existence of such ‘exotic’ and these questions has been accomplished by the fore- ‘rare’ occurrences and more attention to the way in going scholars not only through interdisciplinary which culturally and historically defined conditions of scholarship but also by their close transnational rela- mental illness or distress typically have culturally dis- tions; in 1942, while giving a speech at the Columbia tinct features worldwide. Cultural psychiatrists and University Faculty Club during which he attacked the psychiatric anthropologists share common interest in Nazis, Franz Boaz died from a stroke in the arms of epidemiological variation of disorders across popula- Levi-Strauss. tions, potential aetiological variation in relation to In this chapter, I outline a series of topics of cultural, biogenetic and structural-institutional fea- common interest for psychiatry and anthropology tures, and the cultural puzzle of significant variations by highlighting areas of mutual interest concerning in the course and outcome of disorders transnationally. the relation between culture and mental illness, and Raimundo et al. (2005) have traced the conver- healing. In doing so, I also organize the material in gence of psychiatry and anthropology to the historical such a way as to call attention to conceptual con- precursors of cross-cultural psychiatry from nine- trasts that transcend or lie outside the disciplinary teenth century alienists who proposed evolutionary distinctions between anthropology and psychiatry. notions of insanity as supposedly rare among ‘primi- How, for example, is it different to examine the tive’ peoples and increased with ‘civilization’ that were cultural factors affecting the use of psychopharma- imagined to require increasing levels of cognitive ceuticals and those affecting the use of alcohol and organization and demands for mental production. social drugs? What is the consequence of adopting While the colonial legacy of racist thinking seemed the different perspectives implied by the study of ‘apparent’ during that historical epoch, it is worth not- psychiatric treatment and services? How to concep- ing that the notion of ‘non-Western’ (non-European) tualize and classify psychiatric disorder in succes- populations as being relatively less ‘sophisticated’ has sive revisions of the Diagnostic and Statistical not entirely disappeared in contemporary discourse. Manual (DSM) or International Classification of Developments in transcultural psychiatry following Diseases (ICD) nosology? How to compare indigen- World War II served to delineate a specific identity ous ritual healing and psychotherapy, as undertaken of transcultural psychiatry as a field concerned with by psychiatrist Jerome Frank (1973), the potential replacing racist evolutionary frameworks with cross- efficacy of distinct cultural genres of treatment? cultural empirical data. At the same time, existential What is the difference in views of human variability and meaning-centred approaches began to appear. A that seek out the existence of culturally peculiar powerful voice from this post-war period was Ernest syndromes and those that recognize cultural vari- Becker (1962, 1963), whose concern with meaning ations in psychiatric disorders defined essentially resonates more than five decades later. The 1970s and by researchers and clinicians from the global north 1980s was a period of rapid development and reformu- or the global south? How much in common is there lation, in the midst of which a ‘new cross-cultural among the perspectives of psychiatric anthropology, psychiatry’ that emerged from a synthesis of interpret- (trans)cultural psychiatry, ethnopsychiatry, and the ive approaches from anthropology and an increasingly burgeoning field of global mental health? 19 JANIS JENKINS © Cambridge University Press www.cambridge.org Cambridge University Press 978-1-316-62850-8 — Textbook of Cultural Psychiatry Edited by Dinesh Bhugra , Kamaldeep Bhui More Information Section 1 Theoretical Background sophisticated academic psychiatry
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