AAA 2015 Sessions: The Anthropology of Mental Health Care

Posted by jknopes

Beginning last Fall 2014, we began compiling lists of sessions at the Annual Meeting of the American Anthropological Association that we thought would be of interest to our readers attending the conference. These sessions included topics such as drug use and abuse, reproductive medicine, and global health. This year, we again feature our series on the upcoming conference, to be held November 18-22 in Denver, Colorado (more information here.) You can also browse last week’s installment of the blog, where we highlighted sessions on biomedicine and the body at the upcoming Society for Social Studies of Science (4S) meeting, also in Denver, to be held November 11-14 (details here.) This week, we present three paper sessions on the anthropology of mental health care. The sessions are organized chronologically by time and date.

Image via AAA Website

Re-Institutionalizing Care: Anthropological Engagements with Mental Health Courts and Alternative Forensic Psychiatry Interventions in North America

Saturday, November 21st 10:15am-12:00pm (details about this session.)

Topics in this session will include racial disparities in a mental health court in Canada; the relationship between criminal justice officials, psychiatric crisis, and mental health; dogma and psychiatry; and mental health care reform. The session lists itself as particularly of note to applied and practicing anthropologists, especially those with an interest in mental health care, policy, and reform.

From the Streets to the Asylum: Medicalizing Vulnerable Children

Saturday, November 21st 10:15am-12:00pm (details about this session.)

This session includes work on the following topics: humanitarian care and child homelessness in Cairo, Egypt; drug use and treatment amongst juvenile prisoners in Brazil; immigrant youth and mental health in France; and notions of American childhood in the context of mental health. Though the session is sponsored by the Anthropology of Children and Youth Interest Group, its topics overlap with many contemporary issues in medical anthropology and the social study of mental health care.

Making Sense of Mental Health Amidst Rising Rural Social Inequality in North America: Class, Race, and Identity in Treatment-Seeking

Saturday, November 21st, 1:45pm-3:30pm (details about this session.)

Presenters in this session will speak on these issues: mental health and poverty in rural New England; mental health and prescription drug abuse in Appalachia; citizenship and mental health in Oklahoma; care access in remote Alaskan communities; community mental health activism; and inequity and depression in rural Kentucky. These sessions will be of interest to scholars of social justice and medicine, as well as those studying mental health care access and the culture of psychiatry in the United States.

News: UN Releases New Sustainable Development Goals (SDGs)

Posted by jknopes

On Friday, September 25th, the UN released its new plan for global development through 2030: the sustainable development goals (SDGs).[i] This plan replaces the millennium development goal (MDG) plan that expires at the end of 2015, and offers a new 17-point agenda focused on social equality, infrastructure, technology, and environmental conservation.[ii] Of note to medical anthropologists, global health workers, and other scholars in social medicine is the continued focus on health and well being as the third item amidst the seventeen goals. The SDG plan champions health “for all at all ages,” although it proposes no specific goals for improving elder care despite the language stressing health across ages. Maternal and reproductive health, substance abuse, traffic deaths, and universal health care coverage are key issues addressed in the SDGs.

Emblem of the UN via Wikimedia Commons

Proponents of the new SDGs, like the World Bank, argue that the plan’s emphasis on both developed and developing countries creates a shared impetus for bolstering food security, education, and access to quality health care; likewise, it suggests that these issues are global ones that cross national borders, and do not exist at the state level alone.[iii] Others criticize the SDGs as too ambitious, arguing that global authorities already struggle to aid migrants and peoples in crisis[iv], stating that the goals are too broad and thus not focused enough to produce observable change[v], and highlighting the irony of combating climate change while promising electricity for all by 2030.[vi]

Anthropologists have long held an interest in international development as a site of cross-cultural exchange, a relic of colonialism, and as a paternalistic model of societal shepherding of developing nations by the wealthy West and Global North.[vii] Amongst development anthropologists, the sustainable development goals will certainly generate new questions about the connectedness of social inequities with health, autonomy, and human rights in the contemporary age. The goals will similarly continue to attract the interest of scholars studying biomedicine and global health in diverse cultural settings.

In addition, the SDGs will no doubt capture the attention of anthropologists in science and technology studies (STS) with the plan’s robust emphasis on technologies, energy, infrastructure, and the environment. This sharpened focus on the connection between social order, science, and technology attests to the applicability of STS approaches to the study of development.

The SDGs arrive at a time of increased concern over social justice and equity on the transnational scale, particularly in the face of the Syrian refugee crisis[viii] and given wide income gaps that impact people in the United States, Chile, Greece, Mexico, and Turkey alike.[ix] Anthropologists are ideally situated to explore the impact of development goals across cultures, and to question how and why these goals may face considerable challenges as they are translated into action, law, and practice at the local level.

[i] http://www.theguardian.com/global-development/2015/sep/25/global-goals-summit-2015-new-york-un-pope-shakira-malala-yousafzai

[ii] https://sustainabledevelopment.un.org/topics

[iii] https://blogs.worldbank.org/voices/global-goals-economic-transformation-in-an-interconnected-world

[iv] http://www.npr.org/sections/goatsandsoda/2015/09/28/444188463/are-the-new-u-n-global-goals-too-ambitious

[v] http://www.scientificamerican.com/article/sustainable-development-goals-offer-something-for-everyone-and-will-not-work/

[vi] http://www.theatlantic.com/international/archive/2015/09/energy-access-sdgs-un-climate-change/407734/

[vii] http://www.wiley.com/WileyCDA/WileyTitle/productCd-0631228802.html

[viii] http://www.cnn.com/2015/09/28/world/united-nations-main/

[ix] http://www.reuters.com/article/2015/09/27/us-development-goals-challenges-analysis-idUSKCN0RR0TV20150927

Book Release: “The Law of Possession: Ritual, Healing, and the Secular State”

Posted by jknopes

Image via Oxford UP website

Out this November 2015 from Oxford University Press is an edited collection by William S. Sax and Helene Basu entitled The Law of Possession: Ritual, Healing, and the Secular State. The text presents both contemporary and historical case studies of the relationship between spiritual conflict and judicial exchanges across cultures. While rituals to exorcise spirits from the afflicted are typically characterized solely as acts of healing, they are also scenarios in which spirit healers do justice by the possessed by driving out a spirit who has committed an act of evil against the person they inhabit. Spirit possession may similarly provide valuable opportunities for members of a community to contact restless spirits through a human oracle. These otherworldly entities may then offer evidence to the living as to how to avenge or appease them, thereby restoring social harmony. Healing, justice, cosmic order, and religion are thus closely integrated within these culturally meaningful negotiations.

The authors of the text challenge the assumption that these spiritual encounters– which have consequences for both medicine and the law in many societies– are antiquated and do not belong in modern societies or in secular governments. By drawing on examples from East Asia, South Asia, and Africa, the authors assert that spiritual healing and law nevertheless persist in the contemporary age as a way to meet social and religious needs in many cultures.

Learn more about the book (in paperback) by clicking here.

Link to the hardcover copy: https://global.oup.com/academic/product/the-law-of-possession-9780190275747?cc=us&lang=en

About the editors: William Sax teaches at the University of Heidelberg, where he serves as the Chair of Cultural Anthropology at the South Asia Institute. Helene Basu is the director of the Institute of Social Anthropology at Münster University.

Issue Highlight: Vol 39 Issue 3, Suicide in Rural Kenya

Posted by jknopes

When a new issue of Culture, Medicine & Psychiatry is released, we feature a series of blog posts that highlight these latest publications in our journal. The current September issue includes articles that address psychiatric conditions and the experiences of people with mental illness across cultures. Readers may access the full issue at Springer here: http://link.springer.com/journal/11013/39/3/page/1. In this issue highlight, we will discuss an article on ethnographic analyses of suicide and distress amongst three communities in northern Kenya.

Suicide in Three East African Pastoralist Communities and the Role of Researcher Outsiders for Positive Transformation: A Case Study

Bilinda Straight, Ivy Pike, Charles Hilton, and Matthias Oesterle – Pages 557-578

http://link.springer.com/article/10.1007/s11013-014-9417-4

The authors of this article strive to establish a nuanced and ethnographically rich understanding of suicide and mental distress in an under-studied population of three distinct, yet interacting, pastoral communities in northern central Kenya. These three groups– the Pokot, Samburu, and Turkana– are engaged in intercommunity conflicts over territory and land use agreements, despite the communities’ shared and entangled oral histories. Such tensions are only exacerbated by mutual fear of raids by other groups, dearths in food available for forage, and the theft of livestock from individuals who sell the animals to finance political campaigns. Poverty is likewise aggravated by these patterns of loss and violence.

This turbulent social environment creates widespread mental distress amongst the three communities, yet individuals from each group stressed to the research team that they felt obligated to persevere despite these pressures, making admitting psychological suffering (and especially confessing thoughts about suicide) deeply taboo. Therefore, any mental health intervention would have to be responsive to the extent to which Pokot, Samburu, and Turkana culture disallow individuals from discussing or even thinking about suicide: an act which could create even more social strain on the family of the person who committed it. The researchers confirmed this inability to discuss suicide by the high rates of non-response on a survey question which asked participants whether or not they had experienced suicidal thoughts.

Suicide thus proves to be a unique case for anthropological analysis because it is both driven by the social conditions of those who take their own lives, as well as disruptive to the communities in which these people lived. Its treatment by global health workers must in turn be sensitive to cultural beliefs that forbid conversation about suicide, especially in communities where the death of an individual may contribute to already extraordinary social distress.

Issue Highlight: Vol 39 Issue 3, Maya Mental Disorders in Belize

Posted by jknopes

With each new issue of Culture, Medicine & Psychiatry, we feature a series of blog posts that highlight the latest publications in our journal. This September’s issue includes articles that address psychiatric conditions and the experiences of people with mental illness across numerous cultures. Readers may access the full issue at Springer here: http://link.springer.com/journal/11013/39/3/page/1. In today’s issue highlight, we will examine a study on indigenous nosologies of mental illness amongst the Maya of Belize.

Narrative Structures of Maya Mental Disorders

Andrew R. Hatala, James B. Waldram, and Tomas Caal – Pages 449-486

http://link.springer.com/article/10.1007/s11013-015-9436-9

To understand the compatibility of divergent medical traditions, it is first essential to describe how medical systems classify and interpret disorders in particular ways. With this aim in mind, the authors of this ethnographic study sought to develop an picture of indigenous mental illness nosology amongst the Q’eqchi’ Maya of southern Belize. They also asked how this knowledge may alternatively coexist, or compete, with biomedical concepts of suffering.

In order to learn about this indigenous medical epistemology, the authors worked with the Maya Healers’ Association, a professional, self-regulated group of twelve healers who maintain a garden of medicinal plants for research and who strive to reinvigorate traditional medical practice in Belize. Across ninety-four interviews with healers, the authors uncovered four illness categories that the participants used to describe the roots of mental illnesses: “thinking too much,” fright, the day of birth, and spirit “attacks.”

These descriptions are sometimes cross-compatible with DSM-V nosologies, as the researchers discovered that “thinking too much” was also listed as a symptom in biomedical models of mental illness. However, unlike the DSM-V, Maya healers tended to characterize overthinking as a “genre” of illness experience rather than as a discrete symptom. Maya healers also characterize mental illnesses as existing within the heart, the mind, and the spirit: thereby expanding the implications of mental illness beyond brain physiology, the proximate explanation employed by biomedical psychiatry.

The authors conclude that it is essential to understand the similarities in the two nosologies to facilitate collaboration between indigenous and biomedical healers, but add that both groups must also be aware of the differences in classificatory schemes that they use to interpret mental illness. In this way, people with mental disorders in Belize may best receive care that accounts for all of the ways they might seek care and understand their illness across the boundaries of medical systems.

Issue Highlight: Vol 39 Issue 3, Depression & Psychiatry in Iran

Posted by jknopes

With each new issue of Culture, Medicine & Psychiatry, we feature a series of blog posts that highlight the latest publications in our journal. This September’s issue features articles that address psychiatric conditions and the experiences of people with mental illness across cultures. The articles span studies in India, the United States, East Africa, Iran, and Belize. Readers may access the full issue at Springer here: http://link.springer.com/journal/11013/39/3/page/1. In this issue highlight, we will explore the emergence of public discourse about mental illness, suffering, and political struggle in Iran.

Writing Prozak Diaries in Tehran: Generational Anomie and Psychiatric Subjectivities

Orkideh Behrouzan – Pages 399-426

http://link.springer.com/article/10.1007/s11013-014-9425-4

Behrouzan’s study began upon noticing young Iranians discussing mental illness in blogs and in public forums in the early 2000s. At the same time, the author examined unpublished public health records maintained by the state, and noticed that there was a sharp rise in the prescription rate of antidepressants in the mid to late 1990s. This pattern correlated with a shift in the understanding of suffering: during the Iran-Iraq war of the 1980s, PTSD and anxiety disorders were considered the most pressing mental health concerns, but these illnesses became supplanted by a shared culture of loss and hopelessness amongst young Iranians in the period following the war.

Unlike the narrative of depression in other places, however, Behrouzan found that the Iranian category of depreshen held deep political meanings. The illness category reflected the condition of those unable to publicly mourn for friends and family who may have been executed as political prisoners, or to process grief about continued political unrest that seemed to have no resolution, or to understand the loss of a parent during wartime as a young child. As one Iranian blogger described, “our delights were small: cheap plastic footballs, cartoons and game cards… But our fears were big: what if a bomb targets our house?” Thus depreshen becomes an experience of suffering that reverberates throughout a generation.

However, Iranian psychiatry responds to this condition outside of its cultural context, and continues to treat depreshen as an individual patient pathology that can be understood in biological terms. By biomedicalizing depreshen in this way without understanding its connection to political struggle, Iranian psychiatry minimizes suffering and “takes away subjects’ abilities to interpret and/or draw on their pain as a political resource.” When we interpret depreshen from the perspective of patients, therefore, we gain a nuanced view of suffering that is at once culturally specific and politically powerful.

Guest Blog: The Autism Spectrum, Anorexia, and Gender

Posted by jknopes

This week on the blog, we are hosting a guest post by Carolyn Smith, MA, a third-year PhD student in medical anthropology at Case Western Reserve University. Carolyn studies the intersections of mental health, eating, and the body, blending biological and cultural approaches. This blog post complements our July 2015 issue on autism, which you can read more about in the links provided at the end of the guest post.

In Autism spectrum disorders: Toward a gendered embodiment model, Cheslack-Postava and Jordan-Young[1] argue the importance of gender theory in understanding the preponderance of male cases with autism spectrum disorders (ASD) in the United States. In addition to evidence of autism as sex-linked, the authors argue that there is evidence as well for biases in diagnosing autism, and that social environment likely plays a role in male susceptibility. The literature on anorexia nervosa offers a parallel argument: anorexia nervosa, like autism, is often described in terms of biological risk factors[2] yet it remains a socially charged, deeply gendered diagnosis. In the USA and other societies with thin female beauty ideals, for instance, anorexia nervosa is most widely attributed to women.[3]

Both anorexia nervosa and ASD are recognized by the American Psychological Association (APA) and have specific criteria. While these categorizations are justifiably scrutinized by medical anthropologists, here I use the APA criteria as a cultural document that reflect what conditions that biomedical practitioners in the United States are cataloguing when they demarcate mental conditions. Anorexia nervosa is an eating disorder characterized as one of the most fatal mental illnesses in the United States.[4] Diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) includes restrictive eating and an intense fear of gaining weight/persistent behaviors to prevent weight gain. [5] One key criterion for anorexia is being of low body weight with the absence of any other pathology. The inclusion criteria have changed over the years, as have social ideas about the disorder and who suffers from it. Meanwhile, autism is classified as a neurodevelopmental disorder with social deficits and rigid behaviors.[6] The understandings of autism, like anorexia nervosa, have also changed over time in the United States.

Yet gendered categories for these conditions persist. In the realm of psychiatric health, autism is assumed to be a male disorder, and anorexia nervosa, a woman’s diagnosis. This simple categorization overlooks the extent to which anorexia and autism are demonstrably comorbid in studies carried out in the USA and the UK.[7] [8] [9] One study from the UK, in fact, found that anorexics, restrictive-type were five times more likely than the general population to score as high on the Autism Questionnaire as someone with an ASD. ⁹ This finding offers no simple cause-and-effect explanation for how the two disorders are linked. However, this new data suggests that the body, the mind, gender roles, and dieting behaviors may be entwined in ways that resonate with cultural beliefs and categories.

There are competing theories about the etiologies of anorexia as well as autism, each with gendered overtones that do not reflect the findings of associations between the two psychiatric conditions. One theory of autism is that it is linked to a “hypermasculinized” brain.[10] Meanwhile, in a 2012 article for Psychology Today, Maestripieri argues that anorexia may be due to a “hyperfeminine” brain. The two conditions, it seems, appear to be “oppositional.”[11] However, these theories do not capture the wide diversity of cultural perspectives within the USA or UK, meaning there may be unique gendered understandings of psychiatric disorders between social groups that are not accounted for in existing research. In either case, what is clear is that cultural categories of psychiatric conditions in the US and UK may be missing how patients (of any gender, from numerous cultural backgrounds) live and seek care with either condition.

These gendered categories become even more complex for individuals diagnosed as both autistic and anorexic. The comorbidity of ASD and anorexia is complicated by the fact that restrictive dieting in anorexia may lead to cognitive impairment, which subsequently causes behaviors that might be confused with cognitive patterns on the autism spectrum. However, people with anorexia do report having autistic traits prior to the onset of their eating disorder, and people recovering from anorexia appear more often than non-anorexics to fall along the autism spectrum. ^6,7 Thus, the two illnesses co-produce one another in ways that cross traditional gender lines (autism as male, anorexia as female) while also making it difficult, if not impossible, to isolate each condition from the other. Here medical anthropologists can offer valuable perspectives from the view of patients, who may describe their eating patterns and body image in terms that span and challenge existing diagnostic divisions.

Though there may be no empirical means to measure the extent to which ASD and anorexia overlap, existing theories about socialization may shed some light on how these two illnesses co-occur. There are numerous common traits between anorexia nervosa and ASD, including perfectionism, social withdrawal, and obsessive thinking.⁶Girls and women with anorexia appear to have other similar traits to boys and men with autism: systematizing, a fascination with details, and resistance to change. Anorexic individuals with these autistic traits, Baron-Cohen hypothesizes, could become fixated on the systemic relationships behind body weight, shape, and food intake.[12]Of course, this would depend on whether or not the person with autism was brought up in a cultural environment where food intake and body shape are viewed as something that can and should be regulated at all. Here is where socialization may play a crucial role in the development of anorexia nervosa out of behavioral patterns attributed most often to autism.

The comorbidity of ASD and anorexia nervosa presents an anthropologically complex case where discrete classifications of mental illness may not reflect the connectedness of the two conditions. Likewise, the gendering of each illness as dualistic male-autistic and female-anorexic overlooks the extent to which the conditions share behaviors, tendencies, and thought patterns. Though national clinical studies in the USA and the UK suggest a connection between autism and anorexia, cultural readings of gender, eating, and self-regulation amongst patients with comorbid cases might better illuminate how these conditions manifest on the local scale, and between cultural groups.

Additional Reading

Publications:

Jaffa, T., Davies, S., Auyeung, B., Allison, C., & Wheelwright, S. (2013). Do girls with anorexia nervosa have elevated autistic traits. Mol Autism, 4(1), 24.

Nilsson, E. W., Gillberg, C., Gillberg, I. C., & Raastam, M. (1999). Ten-year follow-up of adolescent-onset anorexia nervosa: personality disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 38(11), 1389-1395.

Oldershaw, A., Treasure, J., Hambrook, D., Tchanturia, K., & Schmidt, U. (2011). Is anorexia nervosa a version of autism spectrum disorders?. European Eating Disorders Review, 19(6), 462-474.

Websites:

ASD and Autism

https://www.psychologytoday.com/blog/games-primates-play/201208/the-extreme-female-brain

http://www.medicalnewstoday.com/articles/264666.php

https://books.google.com/books?hl=en&lr=&id=iPGFAgAAQBAJ&oi=fnd&pg=PR10&dq=malson+the+thin+woman&ots=sQPGnzOFN1&sig=ZSv8OMyuNAFQ3UgBOWZTEX5lHAg#v=onepage&q=malson%20the%20thin%20woman&f=false

CMP Special Issue Features: July 2015 Issue on Autism

https://culturemedicinepsychiatry.com/2015/07/08/special-issue-highlight-the-anthropology-of-autism-part-1/

https://culturemedicinepsychiatry.com/2015/07/22/special-issue-highlight-the-anthropology-of-autism-part-2/

https://culturemedicinepsychiatry.com/2015/08/05/autism-in-brazil-and-italy-two-cases-from-the-june-2015-special-issue/

References Cited

[1] Cheslack-Postava, K., & Jordan-Young, R. M. (2012). Autism spectrum disorders: toward a gendered embodiment model. Social science & medicine, 74(11), 1667-1674. “Our argument is fully biosocial, and our main points in advancing it are to articulate a model for autism, specifically for explaining the male-female disparities in prevalence, that does not exclude social environmental variables, and is therefore more biologically satisfying; and to demonstrate concrete mechanisms whereby autism may become more prevalent in males as a result of social structures and processes related to gender (p. 1673).”

[2] Bulik, C. M., Slof-Op’t Landt, M. C., van Furth, E. F., & Sullivan, P. F. (2007). The genetics of anorexia nervosa. Annu. Rev. Nutr., 27, 263-275.

[3] Malson, H. (2003). The thin woman: Feminism, post-structuralism and the social psychology of anorexia nervosa. Routledge.

[4] Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders: A Meta-analysis of 36 Studies. Arch Gen Psychiatry. 2011;68(7):724-731.

[5] IBD

[6] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.).

[7] Zucker, N. L., Losh, M., Bulik, C. M., LaBar, K. S., Piven, J., & Pelphrey, K. A. (2007). Anorexia nervosa and autism spectrum disorders: guided investigation of social cognitive endophenotypes. Psychological bulletin, 133(6), 976.

[8] Nilsson, E. W., Gillberg, C., Gillberg, I. C., & Raastam, M. (1999). Ten-year follow-up of adolescent-onset anorexia nervosa: personality disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 38(11), 1389-1395.

[9] Baron-Cohen., Jaffa, T., Davies, S., Auyeung, B., Allison, C., & Wheelwright, S. (2013). Do girls with anorexia nervosa have elevated autistic traits. Mol Autism, 4(1), 24.

[10] Baron-Cohen, S. (2002). The extreme male brain theory of autism. Trends in cognitive sciences, 6(6), 248-254.

[11] Maestripieri, D. (2012 August 23). The Extreme Female Brain: Where eating disorders really come from. Psychology Today. Retrieved from https://www.psychologytoday.com “Therefore, just like Autism Spectrum Disorders may be the product of the combination of the extremely high systemizing and low empathizing tendencies that characterize the extreme male brain, eating disorders may be a manifestation of high negative evaluation anxiety that originates from the combination of the extremely high empathizing and low systemizing characteristics of the extreme female brain.”

[12] (2013 August 10). Anorexia and autism – are they related? Medical News Today. Retrieved from http://www.medicalnewstoday.com

Book Release: Carlo Caduff’s “The Pandemic Perhaps”

Posted by jknopes

Image via UC Press site

Released this August 2015 from University of California Press is Carlo Caduff’s The Pandemic Perhaps: Dramatic Events in a Public Culture of Danger. In the text, Caduff focuses on alerts in 2005 posted by American experts about a deadly, approaching influenza outbreak. These urgent messages warned that the outbreak would have crippling effects on the economy and potentially end the lives of millions of people. Even though this potentially-catastrophic outbreak ultimately never occurred, preparedness efforts for the slated pandemic carried on.

The text is the product of anthropological fieldwork carried out amongst public health agents, scientists, and other key players in New York City surrounding the influenza scare. Caduff demonstrates how these figures framed the potential outbreak, and how they sought to capture the public’s attention regarding the disease. The book grapples with questions about information, perceived danger, and the meaning of safety in the face of large-scale epidemics. Likewise, Caduff examines how institutions and individuals come to cope with the uncertainty of new outbreaks.

The book will be of interest to cultural medical anthropologists as well as epidemiologists and scholars in public health. Caduff’s work will no doubt shed a timely new light on the way that the threat of epidemics shapes health policy and public perceptions of disease and security.

Caduff is Lecturer in the Department of Social Science, Health, and Medicine at King’s College London. His research addresses the anthropology of science, technology, and medicine, as well as issues surrounding knowledge, expertise, safety, and disease.

For more information on the book, visit the publisher’s website here: http://www.ucpress.edu/book.php?isbn=9780520284098

Autism in Brazil and Italy: Two Cases From the June 2015 Special Issue

Posted by jknopes

Our July 2015 entries on the blog highlighted individual articles from our latest release, the June 2015 Special Issue on the conceptualization of autism (which you can access here.) These articles, focused centrally on anthropological and ethnographic accounts of autism across the world, explore contemporary issues surrounding identity, subjectivity, citizenship, biosociality, neurodiversity, and disability. In this week’s installment, we visit two more articles from the issue to investigate concepts of autism and its treatment in two countries: Brazil and Italy.

Autism in Italy: Rigidity and the Culture of Therapy

Read the full article by M. Ariel Cascio here: http://link.springer.com/article/10.1007/s11013-015-9439-6

In Italy, therapy and educational professionals who work with young adults with autism (ages 14-34) note that autism is often marked by a desire for intense social structure and timeliness: what they describe as “rigidity” or “rigid mind.” While the desire for structure is considered a core feature of the autism diagnosis across the world, Italian professionals who serve in community-based therapy, day centers, and residential homes for people with autism nevertheless have a complex relationship with “rigidity” as a mechanism for treatment.

Cascio interviewed both staff members at centers and programs for young people with autism as well as mental health and social service professionals throughout the region who worked on autism across the life course. These professionals voiced the value in creating structure for people with autism to assist in their development of improved social skills. Therapeutic centers and programs are themselves operated within an institutional structure that facilitates organized social interactions, both between their clients with autism and amongst staff members. However, professionals who worked at these programs often felt stymied by expectations from parents and their peers who wished for children with autism to adhere to a particular therapeutic regimen, diet, or activity schedule. The professionals likewise cautioned one another that taking any staunch, singular, and indeed “rigid” route to therapeutic intervention could prove counterintuitive to helping people with autism develop new social skills. Professionals embraced the idea of providing structure while, simultaneously, seeking to blend behavioral therapies to match individual client needs, as well as to create opportunities for clients to engage in valuable, less structured social activity.

These concerns about rigidity in the treatment of autism arrive at a time when older social structures for the care of neurodiverse individuals have been disassembled. In the 1970s, new social movements led to the deinstitutionalization of mental hospitals and care facilities, replacing the separation of mentally ill and neurodiverse individuals with integration policies that mandated new employment opportunities and equal-opportunity education for the developmentally disabled. Local mental health services attached to the national health care system provide psychiatric, behavioral, and therapeutic services that accompany other integration policies. This state of flux, at the societal level, refutes the notion that social services for autism must remain “rigid” and immmovable: they, too, change and develop with time given broader changes in the resources and services made available by the state to the disabled.

The Italian case presents a unique perspective on both the relationship between care professionals and the nature of diagnosis and treatment, as well as between concepts of autism at the scale of individual treatment and at the level of the state and national systems of health care. Like the discussion on Brazil, Italy similarly provides a fascinating context for the study of autism as a condition that is diagnosed globally, yet treated and conceptualized locally.

Autism in Brazil: Diagnosis, Identity, and Treatment Models

Read the full article by Clarice Rios and Barbara Costa Andrada here: http://link.springer.com/article/10.1007/s11013-015-9448-5

Brazil’s model for delivering social services to the developmentally disabled was directly modeled after the Italian system of deinstitutionalization and social integration of the mentally ill and neurodiverse. Treatment interventions for people with autism, however, were not included in Brazilian social services until the early 2000s, when adolescent and child mental health conditions were integrated into existing mental health systems. This shift increased programming for people with autism, however concerns accompanied this new system about the nature of diagnosis and treatment, as expressed differently by mental health professionals and the parents of children with autism.

Rather than viewing autism as an integral piece of an individual’s identity, Brazilian mental health professionals instead employ a social model of disability that stresses the environment that a person with autism exists within. Therapies emphasize social inclusion and bolstering all mental health clients’ sense of autonomy, so as to combat the exclusion and institutionalization of the individual. This model did not emphasize treatment plans specific to autism, but rather sought to improve the lives of all clients with mental disabilities. Mental health professionals voiced concerns about creating autism-specific services, saying that these programs would exclude people with other forms of mental disability from seeking appropriate care (and exclude people with autism from engagement with people of other mental disabilities.)

Parent activists who have children with autism, on the other hand, take an identity-based approach to championing the rights of people with autism. They argued that by underscoring the specific nature of autism as a mental disability, and providing services tailored to the treatment of autism, their children would be better prepared for social inclusion. Parents feared under-diagnosis of the condition, which would mean that their children– failing to have a certified diagnosis by a health professional– would be unable to seek out care resources and early intervention programs to improve behavioral and social outcomes.

In both instances, the authors stress that the dichotomy between medical and social models of disability is scarcely stable when examining autism in Brazil. Mental health professionals and parents of children with autism both grasp the importance of medical certification of autism (diagnosis) as a means to access services (that are aligned with the social model of illness.) However, parents and professionals disagree on the nature of these services; parents hold that social inclusion for people with autism requires an understanding of their difference from non-autistic people, while professionals strive to avoid employing specific diagnosis categories as a means to separate the kind of care and services they deliver to clients with other mental health conditions.

The Brazilian case thus highlights the nature of autism and mental disability as both a medical and a social condition: one that must be negotiated, treated, and diagnosed in light of its manifold implications for human health, development, and social life.

Special Issue Highlight: The Anthropology of Autism, Part 2

Posted by jknopes

In this week’s entry, we continue our issue highlight on the current special issue of Culture, Medicine & Psychiatry. Released in June 2015, the latest issue explores anthropological research on autism, both across the world and between communities of people with autism and their families. Like the first part of this feature, we will explore two articles in the current special issue.

“But-He’ll Fall!”: Children with Autism, Interspecies Intersubjectivity, and the Problem of ‘Being Social’

Olga Solomon

Autism-spectrum disorders (ASD) are described in diagnostic manuals as an impairment of one’s ability to successfully relate to and understand other people. Yet this definition of autism relies on a specific notion of sociality that, Solomon argues, becomes much more complicated when considering autistic individuals’ interaction with therapy animals.

Solomon compares two cases that highlight autistic children’s understandings of what it means to be social: one without animals, and another with animals featured prominently in the therapeutic intervention. In the first instance, a child she calls Rosalyn is being tested in a psychological facility. The child attempts to engage in conversation with the psychologist and her parent, but is dismissed. She also shows a picture she has drawn to the psychologist, yet is again dismissed and offered a standardized picture book to complete another diagnostic task. Rosalyn’s own experiences and perspectives are cut from the diagnosis, while artificial tasks and measures that are foreign to her—such as the picture book—are substituted for “real” social materials worth engaging with.

Unlike Rosalyn, whose encounter with the psychologist in the office offers her little opportunity to demonstrate her connections to other people on her own terms, a girl named Kid has a much different experience in animal-based therapy. While Kid has no friends in school and struggles to engage socially, she demonstrates concern for her therapy dog. She worries in one interaction that she might drop him from her lap, and in another vignette, notes to her family that she fears the family dog might be jealous of her interactions with the therapy dog.

In Kid’s case, the presence of animals provided an opportunity for her to demonstrate her understandings of their emotional state and to express her feelings towards them. Rosalyn likewise attempted to engage with her psychologist and mother while in the office, but her attempts to interact were brushed aside and supplanted with artificial testing activities that did not elicit an empathetic response.

Solomon posits that these findings align with theory after the post-human turn, whenever the human actor became destabilized as the center of all social interaction and new notions of sociality began to consider interspecies engagements, particularly in the works of Donna Haraway. When animals enter the picture, these non-human actors prove central to understandings of social relationships that might not otherwise be seen in strictly human-to-human interaction, as in the case of Rosalyn.

Click here for the full article: http://link.springer.com/article/10.1007/s11013-015-9446-7

Making Meaningful Worlds: Role-Playing Subcultures and the Autism Spectrum

Elizabeth Fein

Like Solomon, Fein explores another case where individuals on the autism spectrum learn to interact and engage with others on their own, productive terms. Fein draws on ethnographic research of a summer camp for teens with autism, where they role-play as magicians, scientists, and other fantastical characters.

At the camp, the teens posit themselves in new social roles, explore new identities, and forge relationships with others in novel ways. They largely practiced live-action role playing (LARP), stylized as LARPing, an activity where participants dress and act as mythical characters in a live-action fantasy game. The founders of the camp, called the Journeyfolk, realized that ASD youth were drawn to these fantasy role-playing communities, where a shared mythology and a story arc that pitted villains against heroes created a common social space for participants.

Although participants of the games had unique behavioral qualities—in one team, for instance, there was someone who jumped on other players and another with intense hyperactivity—they accepted that they had to overcome these individual differences in order to work together. Likewise, older players who gravitated to the roles of heroes in the LARP events were often instructed to act as villains: challenging them to take on new roles beyond their own desire to act as a specific character.

The game and the camp provided a strong external structure that guided participants through tasks and activities: structure that individuals on the autism spectrum often need to navigate social situations effectively. Conversely, it also promoted a storytelling environment where characters that teens acted struggled with deep, internal, psychological quandaries, such as battling off evil spirits that possessed team mates, and struggling with being a mythological human/inhuman hybrid being. They could draw upon their real-life struggles, such as anger issues, in order to create characters that—like them—were challenged to solve problems in light of these personal difficulties.

Fein concludes, in part, that these camps both provide the structure and the social patterning that autism-spectrum individuals need to engage with others positively, while also encouraging neurodiversity by valorizing fringe nerd culture and allowing individuals to create characters that are informed by the behavioral patterns and psychological struggles of those who play them in the games.

To access this article, click here: http://link.springer.com/article/10.1007/s11013-015-9443-x

To access all of the articles in this issue, click here: http://link.springer.com/journal/11013/39/2/page/1