From the Archive: Caregiving and Dementia in Urban India

In the “From the Archive” series, we will highlight articles published throughout the journal’s history. We look forward to sharing with our readers these samples of the innovative research that CMP has published on the cultural life of medicine across the globe.

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Recently, one of our readers on the Culture, Medicine, and Psychiatry Twitter account requested that our next “From the Archive” post address an aspect of aging and community. In the spirit of the reader’s suggestion, this week we are featuring a 2008 article by Bianca Brijnath and Lenore Manderson entitled “Discipline in Chaos: Foucault, Dementia and Aging in India.” (you can find out more about the article here: http://link.springer.com/article/10.1007/s11013-008-9111-5.)

The authors posit that caregivers for those with dementia are important providers of structure: they are responsible for the patient’s hygiene, diet, and medical needs, as well as accountable for the actions of people who, experiencing symptoms of dementia, sometimes act out in ways which are not consistent with public cultural norms. Typically in India, such care falls into the hands of younger relatives. Domestic caregiving by these family members “prevents the demented body from threatening the stability of the social body.” There are tremendous “social anxieties,” the authors write, surrounding the potential for someone with dementia to resist normative behaviors per the local codes of social life.

The Foucauldian stream of thought here is quite present: the caregiver must “discipline” the body of the dementia patient to reinforce the cultural codes of the society in which both actors live. Although there exists the notion of seva, or the submission of younger relatives to the direction and advice of older relatives, this idea of the respected and powerful elder is complicated in the face of dementia where the power to attend to another person is rather reversed. Instead of being disciplined by the familial patriarchs or matriarchs, younger relatives must both discipline the elder who is unable to provide the social structure for themselves, as well as their own bodies by taking on new routines and practices to accommodate their family member with the illness.

Power, however, is still bi-directional: those with dementia have extraordinary power in altering the routines of their familial caregivers, and even act out violently: the authors note they may “kick, hit, punch, bite, and threaten with a weapon” when they are upset, and are not necessarily expected to limit these actions on their own due to their condition. The transactions of power, agency, and authority in these relationships are resonant with similar social exchanges as explored via the Foucauldian lens in other Western settings.

Brijnath and Manderson’s piece highlights important features in the care of dementia patients, and demonstrates that community-based models of caregiving for the elderly are not as simple as the removal of power from the elderly individual and the installation of authority in the caregiver. The caregiver, too, is both self-disciplined and disciplined by the acting out of their ward.

From the Archive: Biomedicine, Chinese Medicine, and Psychiatry

In the “From the Archive” series, we will highlight articles published throughout the journal’s history. We look forward to sharing with our readers these samples of the innovative research that CMP has published on the cultural life of medicine across the globe.

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At the journal, we often present fascinating work on psychiatric care throughout the world, including Joshua Breslau’s 2001 article “Pathways through the Border of Biomedicine and Traditional Chinese Medicine: A Meeting of Medical Systems in a Japanese Psychiatry Department” (volume 25 issue 3.) 

In this piece, Breslau recounts stories of the two medical systems interacting during a meeting of clinicians employing, to varying degrees, traditional Chinese medicine (TCM) alongside biomedical interventions within a Japanese psychiatric department. The author asserts that Japan is perhaps the most common ground for the two medical systems to meet, and that it represents the “traffic” of medical knowledge between Japan, the Asiatic mainland, and the rest of the world. Indeed, Japan has had a lengthy history of exchange with foreign medical systems,beginning with the 18th-century import of anatomy textbooks from Holland. Combined with expanded trade with “the West” in the 19th century and the later resurgence of local Japanese interest in Chinese herbal remedies during the 1970s, we see that the two medical systems have both held a prominent position in the dynamic medical landscape in Japan.

Breslau observes that the two medical systems complement one another most strikingly in psychiatry, where kanpo (herbal treatments) are used both to diminish the uncomfortable side effects of psychoactive medications and to treat conditions for which there are few biomedical interventions. Exemplifying this blended approach to care, the author notes that Dr. Nakai, professor of psychiatry at Kobe University, examines the tongue to diagnose his patients. This method of diagnosis has its roots in TCM, and was taught to Dr. Nakai from a visiting Chinese student; many such Chinese students, having studied TCM, go to Japan to learn “Western medicine.” Although there is little formal education in TCM available in Japan, these interpersonal (and intercultural) exchanges are important mechanisms for sharing diverse medical techniques.

Another physician, Dr. Song, initially specialized in the use of acupuncture to treat psychiatric patients in China. Breslau theorizes that although it seems anomalous for traditional medicine to find a niche in conditions that generally fall under the scope of biomedicine, Dr. Song’s work is a productive blend of psychiatric treatments from both medical systems. Whereas patients in the Chinese biomedical settings were admitted alone, patients and their families stayed together in the TCM centers for mental health, thereby offering a support network that the biomedical patients lacked. In Japan, Dr. Song combined TCM and biomedical approaches. She established an “open ward” psychiatric unit that welcomed patients and their families, and employed both pharmaceutical and herbal remedies depending on the severity and the stage of psychiatric distress suffered by the patient.

Breslau’s piece reminds us of the complicated ways in which cultures are in contact with one another. Rather than reading medicine in China and Japan as a contest, where biomedicine and traditional Chinese medicine are at odds in the race to be deemed “most effective,” it is more accurate to describe the ways that the systems are in dialogue– often in the same clinical settings.

You can find the contents of the full issue in which Breslau’s article is published here: http://link.springer.com/journal/11013/25/3/page/1