The next few months we’ll be highlighting authors who have published in Culture, Medicine, and Psychiatry.

Giulio Ongaro is a Fellow at the Centre for Humanities and Social Sciences at the Southern University of Science and Technology in Shenzhen, China. Additionally, he is a Visiting Fellow at the Department of Anthropology, London School of Economics and a Team member at Program in Placebo Studies at Harvard Medical School. He obtained a PhD in Social Anthropology from the LSE and a MSc in Philosophy of Mind from the University of Edinburgh.

What is your article “Doctors Speak: A Qualitative Study of Physicians’ Prescribing of Antidepressants in Functional Bowel Disorders” about?

The article explores how gastroenterologists in a US hospital prescribe tricyclic antidepressants to treat irritable bowel syndrome and the challenges they face in doing so. IBS is a functional disorder (a chronic condition with no precise pathophysiology) which is often surrounded by stigma. Prescribing low-dose psychiatric medication, albeit proved to be effective, can be stigma-inducing because it potentially hints that the disorder is “all in the head”. To avoid this, physicians gravitate their explanations towards the known neurophysiological mechanisms of action. Though avoiding psychological talk, their engagement with patients is nevertheless sensitive to the psychology of expectations, which they know can powerfully affect clinical outcomes (when realistic). They thus place a lot of effort in building and managing hope in patients. Overall, the study shows how physicians do their best to help under specific cultural assumptions – about mind and body – that make functional disorders so hard to treat within modern medicine. 

Tell us a little bit about yourself and your research interests.

My research lies in the areas of medical anthropology, cross-cultural psychiatry, and healing ritual. As part of my PhD at the LSE, I did long-term ethnographic fieldwork among the Akha people of highland Laos. I researched their shamanic tradition and medical philosophy, focusing on healing efficacy: on how rituals work and how people think they work. Alongside fieldwork, I have conducted research within the science of ‘placebo effects’ and surrounding areas of philosophy of cognitive science and psychiatry. In collaboration with researchers at the Program for Placebo Studies at Harvard Medical School, I have published on the mechanisms of placebo and nocebo effects and on cultural narratives around medicine-taking, including this highlighted article.  

I’m currently on a fellowship at SUSTech in Shenzhen. What’s nice about it is that gives plenty of academic freedom, so I’ve ended up delving into a somewhat disparate set of topics. I’m writing an article on the notion of ‘externalist psychiatry’, one on downward causation in neuroscience, and one on a shamanic movement that took hold in Laos while I was there. I’ve also kept an interest in global history (rekindled recently by the publication of Graeber and Wengrow’s The Dawn of Everything). Trying to bring all these strands together, I am writing a book on the global history of medicine that centres on the epistemic and therapeutic value of animistic healing traditions.   

What drew you to this project?

It was an invitation from Prof. Ted Kaptchuk and his team at the Program of Placebo Studies at Harvard Medical School. The Program investigates ‘placebo effects’ from an interdisciplinary perspective, bridging clinical sciences with social sciences and humanities, so my research interests fitted in quite well. Dr. Sarah Ballou – who shares first-authorship of the article – conducted interviews with physicians at a Boston hospital on various aspects of prescription of tricyclic antidepressants for IBS (as part of a broader project on how physicians approach functional gastrointestinal disorders). Together with Dr. Julia Haas, we analysed the central themes, which touched on the implications of giving physiological and psychological explanations of functional disorder and its treatment. These are also topics that I investigated ethnographically in highland Laos among the Akha. So, the study for me was also interesting from a cross-cultural point of view.  

What was one of the most interesting findings?

It was the care physicians took to avoid stigmatising narratives by centring their explanation on the neurophysiological processes of treatment. For instance, they’d talk about ‘neuromodulators’ rather than ‘antidepressants’; ‘nerve sensitivity in the gut’ rather than psychological factors involved in IBS. All the same, much of their approach showed a deep awareness of the importance of realistic expectations and hope in treatment, i.e., psychological factors. Though it fell outside the scope of the article, to me the fact that these physicians (who are among the best in the country in this field) had to tread so carefully on this complicated mind/body terrain speaks of some theoretical limits inherent to the biomedical approach to functional disorders. I found this interesting comparatively speaking. Many medical traditions around the world (the Akha being one) do afford rich conceptual resources for dealing with disorders that would be diagnosed as ‘functional’ within biomedicine. Typically, they externalise their causes onto the social environment. In so doing, they pre-empt the kind of stigma that the physicians we interviewed actively try to avoid in the clinical encounter. So, as an anthropologist this study was interesting for highlighting the big role played by culturally-specific explanatory frameworks surrounding the treatment of functional conditions.   

What are you reading, listening to, and/or watching right now?

I have been reading Starhawk for a course I am teaching on the anthropology of magic and healing. Fiction, I have just finished A Man’s Place by Annie Ernaux. Having a long commute, I’ve been listening to a fairly random mix of podcasts like Red Medicine, Hermitix, Srsly Wrong, Tides of History, COMPLEXITY and Mad in America. The last movie I watched was The Banshees of Inisherin and the last song played was by Rosalía. 

If there was one takeaway or action point you hope people will get from your work, what would it be?

That the main way to make progress in psychiatry will depend on externalising mental disorders: on casting both the causes and treatment of psychiatric disorders, partly, onto the social environment. This won’t be the consequence of giving up on the brain, but of knowing more about it as an organ of mediation. And that other healing traditions illuminate the kind of social conditions that enable externalisation (though all this is not something I’ve already written; it’s something that will hopefully come out soon). 

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