Current Issue Highlight: Vol. 38 Issue 4, December 2014

In our “Current Issue Highlight” series, we provide brief synopses of some of the original articles and commentaries published in our latest issue of Culture, Medicine, and Psychiatry. We hope these glimpses into our recent publications serve as a taste of the research we publish, as well as offer fresh insights on the intersections of culture, disease, health, and healing.

“The Ethics of Ambivalence and the Practice of Constraint in US Psychiatry”

Paul Brodwin

“This article,” the abstract begins, “investigates the ambivalence of front-line mental health clinicians toward their power to impose treatment against people’s will.” Ambivalence is itself a psychological construct that describes the tensions between love and hate, or multiple perspectives, within both individual subjects as well as the collective social group: here, psychiatric health workers. Central to this article is the friction generated between the clinicians’ self-concept as caregivers and their professional drive to control patients. Such ambivalence about clinical work in psychiatry is evident in the ethnographic research presented here.

Brodwin’s piece reminds us that anthropology is perfectly situated to draw meaning from these problematic and conflicted perspectives within a social group. Rather than reconciling the participants’ feelings and drawing one universal message from them, Brodwin presents us with an authentic picture of the complicated world of clinical psychiatric practice. He concludes, “To understand the paradox, fieldwork should focus especially on the moments when people’s sense of unease erupts into collective life.”

Link to article: http://link.springer.com/article/10.1007/s11013-014-9401-z

“A Village Possessed by ‘Witches’: A Mixed-Methods Case–Control Study of Possession and Common Mental Disorders in Rural Nepal”

Ram P. Sapkota, et al.

In this article, the authors probe an important question: if we consider spirit possession and psychopathology as separate categories, rather than assume possession as a form of mental illness, how might we describe mental illness within a population who has experienced spirit possession? For societies in which spirit encounters are frequent and socially normative, reading mental illness as distinct from possession is particularly critical when exploring local psychic events.

Nepal provided fertile intellectual grounds for exploring this question because spiritual possession occurs regularly. When the researchers delivered educational sessions on psychosomatic and psychosocial illnesses, suggesting that spirit possession might be a type of mental distress, villagers in the study resisted this notion. They argued that possession was rooted in cosmological and supernatural disturbances, making them altogether different psychological phenomena.

Instead of casting possession as a brand of psychiatric illness, the authors suggest that we might view possession as a coping mechanism against other mental duress. In another way, we could conceive of possession as a cultural idiom of distress: reframing illness in terms of a socially acceptable category of experience that is widely shared.

Link to article: http://link.springer.com/article/10.1007/s11013-014-9393-8

“Confinement and Psychiatric Care: A Comparison Between High-Security Units for Prisoners and for Difficult Patients in France”

Livia Velpry & Benoît Eyraud

Focusing on French mental health care, this article explores the evolving use of confinement as part of the treatment of mentally ill individuals who exhibit violent behavior. The authors parallel the nature of confinement in French psychiatric wards to the security practices of high-security prison units.

In their research, Velpry and Eyraud discovered that the public appeal to heightened security in psychiatric institutions, as well as executive action from the president, led to a “turn” towards new confinement measures. Second, psychiatrists used this new narrative of control to justify control techniques that they argued gave patients “psychic structure.” Rather than standing as its own therapeutic measure, physicians employed confinement as a means of managing “difficult” patients.

As an object of inquiry, this recent trend in French psychiatry recalls the complementary trajectories of care and justice, power and control, as well as reflects on the changing landscape of what we define as therapy.

Link to article: http://link.springer.com/article/10.1007/s11013-014-9400-0

“Psychiatry with Teeth: Notes on Coercion and Control in France and the United States”

Anne M. Lovell & Lorna A. Rhodes

This commentary piece on the articles published in the current issue highlights the “rough edge” of the use of constraint and coercion to subdue “difficult” psychiatric patients. Lovell and Rhodes note that many of the articles demonstrate how these forms of discipline and control are enacted at the local scale, and remind us that the exchange between psychiatric patient and the care institution is the site of the strongest conflict when we look at systems of control. What is the border between “care and custody,” the issue asks? How do we as anthropologists contribute to the knowledge about these complex social interactions?

Furthermore, the authors observe that the geographic emphasis on psychiatric care in France and the United States is hardly accidental. Although care practices for the mentally ill differ widely between the two countries, the focus on constraint and control is similarly present in the scholarly literature produced on psychiatry in each place. Likewise, in French and American research, there is a mutual tendency to study mental health care in terms of autonomy, freedom, humanism, and democracy.

Link to commentary: http://link.springer.com/article/10.1007/s11013-014-9420-9


Want to see a preview and abstracts of all the articles in the current issue? Find details on the full issue here: http://link.springer.com/journal/11013/38/4/page/1

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