Interview with Daniel R. George

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

Daniel R. George is an Associate Professor of Humanities & Public Health Sciences at Penn State College of Medicine.

He earned his Ph.D and M.Sc in medical anthropology from Oxford University. He is co-author of The Myth of Alzheimer’s (St. Martin’s Press, 2008) and American Dementia (Johns Hopkins University Press, 2021). 

What is your articleAncient Roots of Today’s Emerging Renaissance in Psychedelic Medicineabout?

We use a historical lens to examine the use of psychedelic therapies over time, translate ancient lessons to contemporary clinical and research practice, and interrogate the practical and ethical questions researchers must grapple with before they can enter mainstream medicine. Given the COVID-19 pandemic and its contributions to the global mental health burden, we also reflect on how psychedelic therapy might serve as a tool for medicine in the aftermath of collective trauma. Ultimately, it is argued that a “psychedelic renaissance” anchored in the lessons of antiquity can potentially help shift healthcare systems—and perhaps the broader society—towards practices that are more humane, attentive to underlying causes of distress, and supportive of human flourishing.

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

My main area of research is dementia and Alzheimer’s disease with a focus on supporting quality of life and using arts-based approaches in long-term care settings. More recently, I have grown interested in the Deaths of Despair crisis that is, in part, lowering life expectancy in the US. I am concerned about the mental health issues in this country, and that has helped lead me to be more open-minded about how psychedelics might have a role in caring for people who are in pain. I have also been thinking recently about how psychedelic approaches—perhaps microdosing—might potentially be useful in long-term care settings, especially given the lack of anti-dementia drugs. I am also broadly interested in public and community health and have helped start a farmers’ market and community garden on our hospital campus.   

What drew you to this project? 

The Deaths of Despair crisis and the magnitude of mental health challenges we face has been a main path into psychedelics research. In this paper, we ask whether we can learn anything in our current therapeutic milieu by studying and appreciating how human beings have used psychedelics for millennia.  

What was one of the most interesting findings?

The preliminary data showing the effectiveness of psychedelics and guided therapy in, for instance, treating depression, death-related anxiety, PTSD, eating disorders, and other conditions is quite striking. Much more needs to be investigated, but there is something here worth exploring, scrutinizing, and pursuing.

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

I just started The Brothers Karamazov. Have also recently been reading random passages from the Bhagavad Gita. 

If there was one takeaway or action point you hope people will get from your work, what would it be? Not to reject psychedelics out of hand and to try to separate these compounds from the culture war discourse that has shaped our perceptions of them since the 1960s. We need to burst out of that paradigm and think imaginatively, empathetically, and, of course, scientifically, especially given the scope of mental health challenges we face. 

Thank you for your time!


Other places to connect:
Website
Twitter

Interview With Dr. Fahimeh Mianji

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

Fahimeh Mianji (Ph.D., R Psych) is a transcultural clinical psychologist and global mental health researcher in the Division of Social and transcultural Psychiatry, McGill University. Dr. Mianji’s research is on globalization of American psychiatric diagnoses and treatments; sociocultural, structural, and political determinants of mental illness; and access and barriers to mental health services for refugees and immigrant populations. As a clinical psychologist, she currently works with minoritized populations in Quebec and British Colombia.

What is your article “Women as Troublemakers”: The Hard Sociopolitical Context of Soft Bipolar Disorder in Iran” about?

Despite the promising trend of women’s health in Iran over the past four decades, there is still a significant difference between women and men with respect to mental, physical, and social health. Among women’s burden of disease, psychological disorders ranked first in this country. We used multi-sited focused ethnography and archive analysis to explore the sociocultural and political dynamics of the over-use of bipolar spectrum disorder (BSD) diagnosis among women in Iran. The dominant biological psychiatry system in Iran has led many psychiatrists to frame sociopolitically and culturally rooted forms of distress in terms of biomedical categories like soft bipolarity and to limit their interventions to medication. This bioreductionist approach silences the voices of vulnerable groups, including those of women, and marginalizes discussions of problematic institutional and social power. To understand the preference for biomedical explanations, we need to consider not only the economic interests at play in the remaking of human identity in terms of biological being and the globalization of biological psychiatry, but also the resistance to addressing the sociocultural, political, and economic determinants of women’s mental suffering in particular contexts.

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

I am a clinical psychologist and global mental health researcher. My clinical work is influenced by my training in transcultural psychiatry at McGill university where ecosocial, anti-oppressive, and community-based perspectives to individual’s mental wellbeing are promoted in both research and clinical domains. My published works focus on the vicissitudes of Bipolar Spectrum Disorder diagnosis and treatment in Iran, medicalization of women’s social and political conflicts in Iran, and cultural and linguistic barriers to access mental health services among refugees and immigrants in Quebec.

What drew you to this project?

When I was a psychology graduate student from 2006 to 2008, I noticed that my psychiatry and psychology professors and colleagues spoke passionately about finding features of “bipolarity” in their patients. And, over the subsequent few years, this diagnosis has become so common that a group of psychiatrists who disagreed with the dramatic increase in bipolar diagnosis started calling their colleagues, “bipolar-minded” psychiatrists. The term “bipolar-minded psychiatrist”—that is, a psychiatrist who looks at everyone through bipolar glasses—has become a popular professional label in Iran. It was at about the same time that I noticed a related jargon of “bipolarity” was being used by friends and families as well. But in this case, it was more than just talking about their bipolarity as a metaphor for emotional ups and downs; it was lay people, mostly women, talking about taking mood stabilizers and antipsychotic medication as easily as taking acetaminophen for the common cold! It appeared the professional embrace of bipolarity was penetrating far into society to affect everyday discourse about emotional distress and the ways that people handled such problems. So, in a way, my first idea for this study came from my experience as trainee in psychology and an observer of the ongoing emergence of new psychiatric disorders. Since then, I have developed a broader interest in the anthropology of psychiatry and in the cultural analysis and critique of the institutions and practices of psychiatry itself.

What was one of the most interesting findings?

To me, understanding how psychiatric institutions can collude with the political and ideological agendas in oppressing voices (particularly youth’s and women’s) that confront the sociocultural and structural factors involved in the violation of individual’s rights and freedom was an interesting finding of this study.

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

In the past two months, I have spent most of my spare time on reading and watching how young women and youth in Iran are using their great energy of injustice anger to break down the walls of a patriarchal and oppressive state; and how these people enact their agency through repositioning their bodies in a society where the state has practiced his power through controlling women’s bodies for over four decades. The videos and stories of the current feminist revolution in Iran as well as people’s resistance and hope are great means for reorienting my research and clinical knowledge, my values, and my first-hand experiences as a woman who had to work hard to protect her beliefs over “knowing what she knows” in the context of a patriarchal and oppressive political, social, and cultural climate in Iran.

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

As mental health clinicians and researchers, we must not forget that our responsibility is to be invested in truth and to protect our patients from the social, cultural, and structural defects instead of colluding with the rigid and oppressive institutions through normalizing and individualizing such defects which affect people’s wellbeing on different levels.


Interview with Mattias Strand

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

Mattias Strand, M.D. Ph.D, (Region Stockholm & Karolinska Institutet) is a post-doctoral researcher at the Centre for Psychiatry Research at the Karolinska Institute and senior psychiatrist at the Transcultural Centre in Stockholm, Sweden. His main research areas are cultural psychiatry, medical humanities, trauma, and eating disorders.

What is your article “Could the DSM-5 Cultural Formulation Interview Hold Therapeutic Potential? Suggestions for Further Exploration and Adaptation Within a Framework of Therapeutic Assessment about?

Our paper is about the so-called Cultural Formulation Interview (CFI) in the DSM-5, which is a person-centered clincial tool for assessing and discussing the importance of cultural issues in health and illness with your patient—a kind of “mini-ethnography” if you will. In the paper, we discuss how the use of the CFI could be further developed by applying a Therapeutic Assessment approach. In brief, Therapeutic Assessment is a collaborative approach to psychological assessment in which the assessment procedure itself is meant to induce therapeutic change. This is achieved by explicitly focusing on the particular questions and queries that patients have about themselves with respect to their mental health or psychosocial well-being, rather than on those issues that the clinician is primarily interested in. We do not offer any definitive answers on how to integrate these models but hope to further the discussion of a therapeutic potential of the CFI.

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

I am a psychiatrist and a postdoctoral researcher based in Stockholm, Sweden. I work at the Transcultural Centre, which is a public health resource centre for issues related to migrant health and cultural psychiatry run by Region Stockholm. Before that, I worked for many years as a psychiatrist at the Stockholm Centre for Eating Disorders, which is one of the largest specialist services for eating disorders in the world. Eating disorders are still very much a main focus of my research—my postdoctoral work is about eating disorders in migrant populations and experiences in treatment in these groups.

What drew you to this project?

I was actually introduced to the Therapeutic Assessment framework by a patient of mine a few years ago, and although I am certainly not an expert in that field I see clear similarities to the concept behind the Outline for Cultural Formulation and the CFI in the DSM-5 that I thought would be interesting to explore.

What was one of the most interesting findings?

To me, one of the most interesting similarities between the CFI and Therapeutic Assessment that we stumbled upon in our exploration is that they both start from what we call a “second-person perspective”, in contrast to a narrative first-person perspective or a supposedly obejctive third-person clinician perspective. The second-person outlook acknowledges that in any clinical encounter, or pretty much any situation in which there are two or more people involved, there are inherent limits to how much we can understand about ‘‘the Other’’—100% empathy can never be achieved.

Rather than mere analogy between the world of the clinician and that of the patient, this perspective presupposes difference that cannot fully be overcome. Importantly, however, instead of resignation, these limits of empathy call for greater efforts in jointly exploring the patient’s world and co-constructing meaningful understanding. All of this may perhaps sound self-evident, but in my experience it is very rarely an explicit starting point in psychiatric assessment.

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

I am reading an old Swedish book on icons in the Russian Orthodox church. I am mostly watching various rock climbing videos on YouTube and trying to catch at least one movie at the Stockholm International Film Festival this month.

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

I would hope that the fields of cultural psychiatry and Therapeutic Assessment, which are now fairly distant, could learn from each other. Not least, there are a lot of case studies describing the use of Therapeutic Assessment in situations in which the cultural backgrounds of the patient and the therapist differ in important ways, and I just wish that therapists working within a Therapeutic Assessment framework would also discover the CFI and incorporate it as part of their toolbox.

Thank you for your time!


Other places to connect:
Website
Transkulturellt Centrum
LinkedIn

Interview with Mar Rosàs Tosas

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

Mar Rosàs Tosas is a full-time lecturer at Blanquerna School of Health Sciences at Ramon Llull University, Barcelona, Spain.

She specializes in how illness narratives are shaped by (and reproduce) mainstream economic, political and cultural logics at stake in that context. She previously coordinated the research on applied ethics of Ethos Chair (Ramon Llull University, Barcelona, 2014-2022) and was the editor in chief of its Ramon Llull Journal of Applied Ethics, was a full-time lecturer at the Department of Romance Languages at the University of Chicago (2012-2014), and held a doctoral scholarship at Pompeu Fabra University (Barcelona, 2008-2011).

What is your articleInterrupting Patients in Healthcare Settings: What is Being Interrupted?about?

Scientific literature since the 1980s examines the phenomenon of healthcare professionals interrupting patients: at which second patients opening expositions are interrupted and how long they take if unrestrained. Although the goal of this literature is strictly numerical—determining interventions’ length—, it reveals several its authors’ views and preferences. Our discourse analysis reveals, first, that, often in between the lines, this literature suggests reasons for letting patients speak freely and tries to dismantle the myth of the overly-loquacious patient. Second, by turning to some philosophical inquiries into the notion of ‘‘interruption,’’ we explore how, within this literature, the ultimate reason for interrupting patients and silencing several of their concerns is often the fear of a certain medical logic being interrupted—a logic that dates back to Vesalius and Bichat, and that informs nowadays biomedicine: patients’ speech is valuable as long as it contributes to a diagnosis in the form of the identification of an underlying tissue damage. This literature presents the interruption of patients as a device of claiming power on the part of an eminently biomedical approach to illness. The paper provides further reasons for not interrupting patients proposed by the biopsychosocial model, ‘‘narrative medicine,’’ and anthropologists who study the functions of illness narratives.

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

I specialize in how illness narratives are shaped by (and reproduce) mainstream economic, political and cultural logics at stake in that context. I hold a PhD in Philosophy in the role that the Jewish messianic tradition plays in philosophy of Jacques Derrida and other contemporary philosophers, such as Rosenzweig, Lévinas, Taubes, Agamben, Badiou, and Zizek.

What drew you to this project?

The frequency with which patients complain that physicians do not listen to them, as well as the training physicians receive to conduct patients’ interviews (which, in my view, all too often does not allow them to become better listeners, but worse listeners).

What was one of the most interesting findings?

 My review of the existing literature since the 1980s on how and why patients are interrupted allows us to conclude that there have been no major changes since then: even those who advocate for listening more to patients seem to suggest that this extra attention is necessary in order to guarantee that the healthcare professional does not miss any ‘‘useful’’ information for diagnosis or in assessing the effect of a previously prescribed treatment. This clashes with the trends in medical humanities in the last four decades that value patients’ speech and narrative for several reasons beyond the contribution to a diagnosis. Within this literature, the ultimate reason for interrupting patients and silencing several of their concerns is often the fear of a certain medical logic being interrupted—a logic that dates back to Vesalius and Bichat, and that informs nowadays biomedicine: patients’ speech is valuable as long as it contributes to a diagnosis in the form of the identification of an underlying tissue damage.   

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

The last book that I read was Idaho by Ruskovich.

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

Don’t be afraid to listen to everything your patients want to say. Your schedule will not collapse. And your work will be clinically and morally better.

Thank you for your time!


Interview With Sydney M. Silverstein

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

Sydney Silverstein is an Assistant Professor at the Center for Interventions, Treatment, and Addictions Research/Department of Population & Public Health Sciences, Boonshoft School of Medicine. She is an anthropologist and filmmaker with a mixed-methods, multimedia research practice. Her scholarship explores the diverse social worlds that come together around the production, circulation, and use of illicit drugs. She conducts research in both Peru and North America.

What is your article “‘Visualizing a Calculus of Recovery: Calibrating Relations in an Opioid Epicenter” about?

This article uses participatory visual methods (photo elicitation) to explore barriers to, and motivators for recovery from drug addiction among a group of people with opioid use disorder living in Dayton, Ohio, an epicenter of overdose death.

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

I came to anthropology later in life – I was nearly 30 and working full-time at a non-profit when I took my first anthropology class at a community college. But after that I was hooked! I have pretty diverse research interests, but mostly I love the research practice of being an anthropologist. Being employed at a medical school—and often the only person advocating for qualitative, let alone ethnographic methods to be incorporated into research design—I have only come to appreciate my training more. For me, there is no substitute for the holistic approach that anthropology brings to studying the human experience.

What drew you to this project?

I got interested in this project because I was trying to carve out a space for my visual and ethnographic research praxis amidst my work on a study that was much more straightforward public health. As an anthropologist, I often felt limited by the kinds of insights I could gather from a one-time qualitative interview. I was constantly trying to figure out ways to develop relationships I was building with participants in the longitudinal, federally funded study that I had been hired on to as the project ethnographer. I thought that the photo-elicitation project would be a good excuse to follow up with some of the study participants that I found interesting and learn more about their worlds.

Another special thing about this project is that my co-authors included three undergraduate students who worked with me as part of a virtual internship over the Summer of 2020. Because I work in a medical school, I don’t often have contact with undergraduate students, but when COVID hit I saw a post from a colleague asking if anyone new of virtual internship opportunities for students who were now unable to complete their summer plans due to the pandemic. So, I created one, and very much enjoyed collaborating with these outstanding and highly motivated students even though we have not, to this day, ever met IRL!

What was one of the most interesting findings?

The profound ambivalence of things in the context of recovery. For instance, I have heard people tell me how their children have been a huge motivator in their recovery, but just as often (perhaps more) participants described how a deep sense of shame over losing custody of their children kept them in their addiction. Same with money. In early stages of recovery, participants described feeling helpless when they did not have enough money to buy a bus pass to get to work, or pay rent, but others told me that they were petrified to start earning money, and especially to have cash in their pocket, lest they get the urge to use and have the resources to do so.

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

I keep track of the all the books I read each year on the last page of my planner, so my book list is available upon request – ha! One of my favorite books that I read this year is called Hostal Amor, by Cayo Vásquez, although this may only appeal to those who have spent time in the beautiful city of Iquitos. I have a long commute, so I listen to a lot of podcasts—All the Smoke, Radio Ambulante, El Hilo, Fresh Air, Ear Hustle, and Mad in America are in the heavy rotation.

As for moving pictures, I just finished the last season of Atlanta and am kind of at a loss for what to watch next. I think that the third season of Atlanta (when Paper Boi is on tour in Europe) was some of the best TV I have ever seen. For now, I’m mostly watching NBA basketball. It is frustrating because I have League Pass, which lets me watch all the games except the ones that are broadcast locally, but my local team (the Cavaliers) are really, really good. But I refuse to get cable just to have Fox Sports!

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

Just how hard and all-encompassing recovery can be. I think that this is not unique to recovery from addiction, but there are consequences that people who use drugs suffer more so that people dealing with other kinds of chronic illnesses. For instance, the fact that so many people who use drugs over a long period of time end up entangled in the criminal justice system makes recovery about a lot more than reckoning with one’s relationship with a substance. Many times, you are also trying to navigate the world with a felony on your record, a wrecked credit score, no employment history, etc. It’s just a lot to deal with, and I think it is hard to understand unless you have direct experience. And treatment centers don’t often help with this. Their goal is to help an individual stop using drugs, but recovery is much more than that. The good news is that there is a growing movement to incorporate peer supporters—individuals with direct, lived experience—into treatment and recovery systems, which I think is a step in the right direction. Shout out to all the amazing peer supporters in Montgomery County who have given me hope during dark times.


Other places to connect:
Wright State University

Interview with Ronita Mahilall and Leslie Swartz

The next few months we’ll be highlighting authors who are in the December 2022 issue of Culture, Medicine, and Psychiatry.

Dr. Ronita Mahilall is a PhD Stellenbosch University, the CEO of St Luke’s Combined Hospices and a Research Fellow at NIH, Clinical Centre, Bethesda, Maryland, USA.

Professor Leslie Swartz is a Distinguished Professor of Psychology at Stellenbosch University and Editor-in-Chief at both the Scandinavian Journal of Disability Research and the South African Journal of Science.

What is your articleI am Dying a Slow Death of White Guilt’: Spiritual Carers in a South African Hospice Navigate Issues of Race and Cultural Diversityabout?

This article focuses on the complex and painful question of whiteness in relation to spiritual care in a diverse country.  We show that volunteer spiritual counsellors working at a hospice in Cape Town, South Africa are acutely aware of and sensitive to issues of diversity and privilege when engaging with clients from a range of backgrounds. Though South Africa has been a nonracial democracy since 1994, the long shadow of apartheid and continuing inequality profoundly affect contemporary palliative care.  Our participants discussed the ways in which they work to create common ground and inclusion, but also how they acknowledge and continue to struggle with challenges related to difference and privilege. In health care work, cultural competence is commonly trumpeted as the solution to working with difference and inequality; our participants show that the issues are not just questions of competence or knowledge but include deeply felt emotional responses to inequality.

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

Ronita Mahilall: I am a social worker by training and my career trajectory focused on health and disability. I am the Chief Exec Office of St Luke’s Combined Hospices (SLCH) and came to this work with an established and personal interest in spirituality. Reviewing the palliative care programmes and interventions that are offered by the Inter-Disciplinary Team (IDT) at SLCH, I have noted a significant absence of formal guidelines that shape spiritual care interventions. For a long time in my organization there was a felt need to develop a national spiritual care curriculum which I learned from many discussions with members of the IDT, and with hospice management. This led me to ask the questions: what are the current spiritual care practices within hospice palliative care settings in SA? What are the spiritual care training needs of hospices in SA? Is there a need to develop a national curriculum for spiritual care intervention? To ask those questions, I needed to establish if there is in fact an appetite, wider than expressed at SLCH, for such a curriculum. 

Leslie Swartz: I have spent much of my career thinking about the politics of culture and mental health, and about access to services and participation by people who are marginalized.  One of the first articles I ever published, in 1985, was on race, politics, and mental health care in apartheid South Africa – this was my first publication in Culture, Medicine and Psychiatry.  There is for me a direct line from that publication of 37 years ago to this article, in which we show that the concerns I raised in the apartheid context have not magically disappeared with the end of apartheid. For me, one thing which tends to distinguish South African mental health researchers from those from countries in the global north, is how embedded we are in thinking about racial and class privilege and how this affects every aspect of our work, including work we do to change things for the better

What drew you to this project?

Ronita Mahilall: My fascination with spirituality was heightened after the loss of my beloved husband and son in 2007; five months apart from each other. While they did not suffer from any longstanding terminal illness, having experienced such deep losses left me questioning life, and death, and the after-death phenomenon. Being a devout Hindu, I am also a believer in reincarnation; yet I found that religion alone did not provide me with the broader existential answers I was seeking. With that as a backdrop and having joined St Luke’s Combined Hospices (SLCH) as CEO, I was introduced more meaningfully to palliative care work, and more in-depth to the spiritual care services offered. I was struck by the scale and scope of the spiritual care services on offer. I was somewhat saddened that, as I and others saw it, spiritual care was not recognised and prioritised as it deserved to be. I was impressed by the work of the spiritual care team at SLCH, and by the spiritual care services provided by other hospices in the Western Cape, and hospices throughout SA. I became interested in questions of why spiritual care services were not given the prominence and recognition that spiritual carers and others in my organization believed they deserved, as part of the overall palliative care service package. Through this research project, I set out to understand how spiritual care is practiced in hospices in SA and crucially if there is a need for a national spiritual care training curriculum. This was accomplished through a three-tiered study.

I was grateful to have in Leslie Swartz a supervisor who is not only an accomplished academic but someone who has an intimate knowledge and firsthand experience with and of death, dying and issues of palliative care and spirituality. Under his mentorship and guidance not only did I grow as an academic, but I also grew emotionally.

Leslie Swartz: This paper comes out of the PhD work of Ronita Mahilall, the first author. Ronita is CEO of the largest hospice organization in Cape Town. I became interested in palliative care through my experiences caring for my mother while she was dying. I have described these experiences in my memoir How I lost my mother (Wits University Press, 2021) – the hospice which Ronita heads was central in helping my family through this process, and after my mother died, I started doing bits of work for the hospice as a way of trying to pay back. Part of this was agreeing to supervise Ronita’s PhD. I honestly did not realise when I started working with Ronita that our work together would lead me back to considering the same issues of privilege and exclusion in health and social care which have preoccupied me throughout my career. I was very lucky to work with Ronita on this.

What was one of the most interesting findings?

Ronita Mahilall: Complex issues of privilege and power, and the emotional effects of these, do not disappear – they are with us always. We need to continually shine a light on these issues and unpack them as they present themselves. 

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

Ronita Mahilall: Alice in Wonderland by Lewis Carroll. It’s my 8th read. I love how I take away something different each time I read it. Reading it now with the hindsight of my PhD work is almost like a spiritual journey to a form of wisdom and understanding and more critically I realize that my work on this subject is not over yet. I have accepted an offer to undertake a 2-year post-doctoral fellowship at National Institutes of Health, Clinical Center (NIH), Bethesda, USA where I seek to advance my work on this subject. This takes place in December 2022.   

Leslie Swartz: I have just started following a wonderful podcast called The Academic Citizen, curated by two South African academics, Nosipho Mngomezulu and Mehita Iqani (available on Apple Podcasts and elsewhere) – a fabulous example of science communication and centered academic citizenship – well worth checking out!

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

Ronita Mahilall: Never think that difficult social problems are ‘solved’- everything is a complex and challenging work in progress!

Thank you for your time!


Other places to connect:
LinkedIn
St. Luke’s Combined Hospice

Interview With Hanna Kienzler

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

Hanna Kienzler is Professor of Anthropology and Global Health at the Department of Global Health and Social Medicine and co-director of the ESRC Centre for Society and Mental Health at King’s College London. She investigates how systemic violence, ethnic conflict and complex emergencies intersect with health and mental health outcomes in the occupied Palestinian territory, Kosovo, and, among refugees, in the UK.

What is your article “SymptomSpeak: Women’s Struggle for History and Health in Kosovo” about?

My article contributes to a new understanding of pain as a shareable language. Fundamentally, I ask: Can we feel the pain of others? How does pain connect and reach across histories, gendered realities, and social politics? How is illness shaped by context, and what kind of life worlds rise from it? I explore these questions among women in Kosovo who use a unique symptomatic language to communicate their pain and suffering about the Kosovo War and post-war hardships. I call this language SymptomSpeak. SymptomSpeak consists of a detailed symptom vocabulary which women variously assemble to exchange concerns about their country’s recent violent past; current local, national, and international political and economic agendas; and dominant power hierarchies. Such exchanges are hard physical and emotional labour. They are exhausting as the language of pain intensifies and, thereby, materializes not only in the speaker’s body, but in the bodies of the listeners. In the article I show that pain straddles a fine line between socio-political commentary and illness; produces gendered political realities; and challenges the status quo through its communicative power.

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

I completed my PhD in cultural and medical anthropology in the Departments of Anthropology and Social Studies of Medicine at McGill University in Montreal. My dissertation explored the impact of war and violence on women survivors of the Kosovo War. Conducting ethnographic research, I lived with a war widow and her children in Krusha e Made and observed and listened to women’s painful expressions as they unfolded in the everyday and were reflected upon by different groups of people including the women themselves, but also by other villagers, aid providers, and health professionals including traditional healers.

Later, I worked as a Postdoctoral Fellow in the Department of Psychiatry and the Psychosocial Research Division at the Douglas Mental Health University Institute at McGill University. This is when I began to conduct research on humanitarian and mental health interventions in fragile states with a particular focus on Kosovo and Palestine, and started a project to explore expressions of distress among torture survivors in Nepal. In 2012, I became Assistant Professor in the newly founded Department of Global Health and Social Medicine at King’s College London. I had the privilege to help build an entirely new department with colleagues from different parts of the world. I also built my own interdisciplinary research programme in the field of war and mental health.

In Palestine, I explore what it means for persons with severe mental illness to live and participate in their communities; wellbeing and access to education among young people with disabilities living in refugee camps; and the association between uncertainty and mental health. In the UK, I co-founded the Refugee Mental Health and Place network to better understand how the hostile environment affects mental health and wellbeing of refugees, asylum seekers and undocumented migrants. I also strengthen research capacity of mental health providers and researchers in the MENA region to contribute to efforts of building a locally driven and locally relevant evidence base.

On top of this, I am co-director of the ESRC Centre for Society and Mental Health where I work with inspiring colleagues to shift public debate about mental health away from a focus on individualised interventions, towards social practices and policies that promote and sustain good mental health in communities.

What drew you to this project?

There is a long story and a short story. The short story is that I had undertaken an internship with the International Committee of the Red Cross in Kosovo in 2004. I shadowed newly trained community mental health workers in the Peja region learning about the horrors of the Kosovo War, their impact on people’s lives and the long-term mental health consequences of violence and deprivation. I wanted to know more about how women expressed their distress in culturally resonant ways and how this led to particular help and health-seeking and evaluation of treatment. This then led me to do my PhD under the supervision of Professor Alan Young and Dr Duncan Pedersen and a long-term engagement with life in Kosovo that lasts until this day. The more personal story is less straightforward and career driven.

As part of my Master’s dissertation, I carried out ethnographic research among Hutterites in the US and Canada. Living on Hutterite colonies for over 6 months, I learned about historical trauma and its effects on community life, community longevity, and identity. This interested me considering that my own family carries a complex history of war and refuge, of perpetrating violence and losing everything. Growing up there was a lot of silence around certain issues and a demand to speak up in the face of injustice. Trying to make sense of these seeming contradictions and complexities was confusing and not easy. To this day, I am learning, slowly and carefully. Most of us who research war, trauma, and mental health don’t come to it from a purely scientific angle. There is always a personal story

What was one of the most interesting findings?

One of my most interesting and maybe important findings was that pain is not unspeakable. Pain itself is a means of communication that brings, in combination with other forms of articulation, complex truths to the fore. It incites memories and enables us to exchange stories. As part of my research, I began compiling lists of symptoms as they arose in conversations, situations and social interactions among women who had survived the Kosovo War. I jotted the symptoms down in notebooks and on scraps of papers before ordering them. The developing “inventory” was obviously fragmented, but it permitted me to shift my attention to the creative interpretation and use of symptoms as something else. Symptoms, I learned were connected to the status of widowhood, which was often experienced as oppressive leading to feelings of nervousness, worry, sadness and pain.

Yet, social and economic insecurities and family conflicts could be just as triggering for symptoms to surface. With time, I became to realize that symptoms were a communicative vehicle through which women connected inner and outer worlds and were able to make claims upon their listeners for recognition of their past and present hardship. It was through such symptomatic exchanges that new framings of the past and novel ways for engaging in the present moment could be created with the power to reveal both uncomfortable truths concerning social inequities, lack of communal support and failing political commitment and imaginaries for a better future filled with possibilities and prosperity. Accordingly, the women’s symptom lexicon was not just about personal trauma and hardship, but a vehicle through which to make visible what needs changing on familial, communal and political levels so as to rebuild their country in the aftermath of war.

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

I always have a novel on the go. Right now, I am reading In the Ditch by Buchi Emecheta. It’s a semi-autobiographical account of a young Nigerian woman living with her children in the slums of North London sometime in the mid-1960s. It’s beautifully written. I just finished watching “Once upon a time in Iraq” on BBC iPlayer – the series shook me, so I am still processing. I am listening to Wheel of Misfortune – it’s very funny and makes me laugh..

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

Action points sounds maybe a bit too technical for my work related to SymptomSpeak. But I wish we paid more attention to the pain of others by giving it, to use Veena Das’ words, a home in our bodies. Thereby, we might be able to hear more clearly and, yes painfully, what people have to tell us and start acting to make the world a better, less painful place. In my article, I write that Barbara Prainsack suggested to me in a personal conversation to think of such exchanges as an act of “conspirare”. I love this idea – conspirare means ‘‘breathing together’’ and is also the foundation of the word to ‘‘conspire,’’ that is, the act of collusion between people who secretly plan to do something against someone else’s wishes. I don’t think that we will change the world for the better by acting according to the wishes of those in power. Rather, we need to conspire to question, complicate, destabilize, and eventually topple the status quo and its dominant versions of history, social structures, and power dynamics.


Other places to connect:
Website
Twitter
Mastodon
Symptom Speak on Twitter and Facebook
ESRC Centre for Society and Mental Health
Refugee Mental Health and Place Network
Get to know us! Our lives with mental illness in the Palestinian community: www.get-to-know-us.com

Announcing our new Editor in Chief and Associate Editor

Hello!

We are excited to announce Culture, Medicine, and Psychiatry‘s new EIC and Associate Editor. You can read Springer’s entire announcement here.

We are pleased to announce that Rebecca’s successors are Neely Myers as Editor-in-Chief and Julia Brown as Associate Editor. Neely has already been involved with the journal for several years as a member of the editorial board and brings both a familiarity with the journal’s core values and a new vision for how to take the journal forward with Julia’s help. Please read the bios they have provided below and join us in welcoming them both. In the weeks and months to come, keep an eye out for additional introductory materials from our new editors.

Springer Announcement

We look forward to bringing back blog posts and connecting with our readers.

Winter 2017 Blog Hiatus

Dear readers,

As we approach the winter holidays, the blog will be taking a brief break from new updates. Posts will resume in January 2018, and we look forward to bringing you exciting and new content in the new year.

As another year draws to a close, we would like to thank all of you for your continued readership and engagement with the journal and our social media!

Warm wishes,

The CMP Editorial Team

AAA 2017 Session Highlight: Jonathan Metzl, “Negroes With Guns: Mental Illness, Gun Violence, and the Racial Politics of Firearms”

This week on the blog we are highlighting an oral presentation given at this year’s annual American Anthropological Association conference in Washington D.C. by Jonathan Metzl entitled Negroes With Guns: Mental Illness, Gun Violence, and the Racial Politics of Firearms. The session was named “Critical Inquiries: Violence, Trauma, and the Right to Health” on Thursday, November 30, 2017. Metzl combined historiographical and ethnographic analysis to explore the connections between gun violence, mental illness, and shifting anxieties about race in the United States. Metzl discussed how decisions about which crimes American culture diagnoses as “crazy,” and which crimes it deems as “sane,” are driven as much by the politics and anxieties of particular cultural moments as by the innate neurobiologies of particular assailants. The presentation concluded by describing how racialized questions of whether “the insane” should be allowed to bear arms become the only publicly permissible way to talk about questions of gun control while other narratives, such as the mass psychology of needing so many guns in the first place or the anxieties created by being surrounded by them, remain silenced.

 


Metzl began his presentation by stating that after the recent and tragic Las Vegas mass shooting, he gave 58 interviews in only two days on “the insane politics of mass shootings.” The two main questions that get asked after each mass shooting are: “Is mental illness the cause of mass shootings?” and, “Will treating mental illness stop gun crime?” Both conservative and liberal media analyses include these types of questions, whether or not they ultimately claim mental illness as the answer (for example: NPR’s On Point, Politico, and Fox News). 

Yet Metzl asked, why do these mental illness questions follow after mass shootings? “Aren’t these questions starting to be ridiculous?” Metzl asked, after referring to a study published in the journal Aggression and Violent Behavior which found some mass murderers and serial killers have something in common: autism and head injury. Yet this study was criticized for fueling judgments about an entire section of society and further contributing to the mental illness-gun violence debate.

In some ways, linking mass shootings and mental illness makes sense. Mass shootings are beyond the realm of “sanity” and understanding. Metzl stated that constructing a binary of sane vs. insane, good vs. evil, may be a means of processing grief and uncertainty. Further, many of the mass shooting perpetrators in the last decades have displayed some kind of mental illness symptomatology before their crimes. Mother Jones published an investigation of US mass shootings from 1982-2017 including information on the shooter’s race, gender, prior signs of mental health issues, mental health details, and whether or not the weapons were obtained legally. But this information cannot lead to a causal argument.

These types of questions have ideological and political roots, and focusing exclusively on issues of mental health force other concerns out of the debate. At a National Rifle Association (NRA) press conference in December 2012, chief executive Wayne LaPierre suggested having “an active national database for the mentally ill” would help prevent gun violence. In 2013, Ann Coulter wrote a Sound Off on Fox Nation entitled “Guns Don’t Kill People, The Mentally Ill Do.” After the 2015 Planned Parenthood shooting in Colorado Springs, Paul Ryan called for a need to look at fixing our nation’s mental illness health system, not it’s gun legislation. Most recently, following news of the mass shooting of parishioners at a Sunday service at a small Baptist church in Texas, Trump proclaimed mental health was the overarching issue, not gun control, even before complete details of the shooter were known. 

Following this overview of political ideologies shaping the mental illness conversation, Metzl then asks, “What can reasonably minded people do to push back?”

Metzl then presented five talking points about important ways to push back against the mental-illness-and-mass-shooting account while still remaining respectful of mental illness, treatments, and medications. These talking points discuss why this association is problematic.

1. “It’s sample bias – and dangerously so…”: Mass shootings come to stand for all shootings. But mass shootings are not the only time we need to talk about gun violence, Metzl stated. When we talk about mass shootings, we are not talking about policy implications for everyday gun death. Every day gun violence, gun proliferation, the ability to buy guns through loop holes should all be part of the national conversation. Worryingly, Metzl states, the situation is about to get much worse. Today (Wednesday, December 6, 2017) the House will vote on a “concealed carry reciprocity” bill, creating a national blanket right to carry a concealed weapon across state lines. For Metzl, the point overall is that the mental illness narrative distracts from daily gun violence and the political negotiations behind gun regulations. 

2. “It’s stigmatizing and misrepresentative…”: Fewer crimes involve people with mental illness. People with sanity are much more dangerous, Metzl stated. People diagnosed with a mental illness are less likely to shot other people, therefore we should really be restricting guns from the sane. Further, Metzl stated that statistically there is no predictive value in using a mental illness diagnosis for gun crime. Individuals with mental illness are more likely to be shot by police than to do the shooting themselves. 

3. “It constructs false psychiatric expertise…”: Psychiatrists are being told they should be able to predict which of their patients may commit violent act. Yet the pool of people they see are not a high risk population. Metzl stated the public culture of fear may lead psychiatrists to feel culpable for the actions of their patients, over-report their concerns, and complicates the doctor-patient confidentiality bond. In the weeks before the Aurora, Colorado movie theater shooting, shooter James Holmes was seeing a psychiatrist specializing in schizophrenia. In June 2012 The Brian Lehrer Show discussed how psychiatrists determine red flags with their patients and when behavior is concerning enough to warrant further action with Columbia University Director of Law, Ethics, and Psychiatry Paul Appelbaum

4. “It detracts from awareness of true predictive factors for everyday gun violence…”: The mental illness narrative also detracts from other risk factors for everyday gun violence and mass shootings. Substance use or abuse, past history of violence, lack of gun training, social networks, and access to firearms are all important predictive factors for gun violence.

5. “It’s racist…”: Last but certainly not least, the construction of a mentally ill, dangerous, white, male, gun-owning “loner” is a political choice. The intentional presentation of the individual-isolated-from-society is not supposed to be representative of white culture. Yet in the 1960s, the FBI openly blamed “crazy” black “culture” for the rise of public black activist groups. In debates leading up to the Gun Control Act of 1968, the U.S. Government and mainstream US culture proclaimed links between African American political protest, guns, and mental illness in ways that intensified fears about black activist groups. For example, FBI profilers diagnosed Malcolm X with “pre-psychotic paranoid schizophrenia” and with membership in the “Muslim Cult of Islam” while highlighting his militancy and his “plots” to overthrow the government. The FBI also hung “Armed and Dangerous” posters throughout the southern states warning citizens about Robert Williams, the controversial head of the Monroe, North Carolina chapter of the NAACP author of a manifesto, Negroes With Guns, that advocated gun rights for African Americans. According to the posters, “Williams allegedly has possession of a large quantity of firearms, including a .45 caliber pistol… He has previously been diagnosed as schizophrenic and has advocated and threatened violence.”

These historical narratives were linked to black culture, not black individuals. Issues of race and insanity produced black male bodies coded as insane. This association fostered fears that helped mobilize significant public and political sentiment for gun control. Yet there are very different politics of the present day. Metzl states were are in a time when white shooters with mental illness beget reaffirmations of gun rights and groups that advocate anti-government platforms and support broadening of gun rights, such as the Tea Party, take seats in Congress rather than being subjected to police scrutiny. For much of our country’s history, guns marked whiteness. 

Metzl concluded his presentation with a discussion of a helplessness narrative. There is a kind of inaction about calling mass shootings and gun violence part of mental illness. Since we can not do anything about whether or not individuals have mental illness, it allows us to ignore the other issues and risk factors. This further constructs a kind of persons, not a composition of something larger and more systemic. The learned helplessness surrounding gun crime in the US makes hard rhetorical work to not look at whiteness and mass culture as part of the problem. 


Jonathan Metzl, MD, PhD is the Frederick B. Rentschler II Professor of Sociology and Medicine, Health, and Society, Director for the Center for Medicine, Health, and Society, and Professor of Psychiatry at Vanderbilt University. He is also the Research Director of the Safe Tennessee Project, a non-partisan, volunteer-based organization that is concerned with gun-related injuries and fatalities in the United States and in the state of Tennessee. His areas of expertise include mental illness and gun violence with a particular focus on gender and race.

Learn more about Jonathan Metzl at his website, available here.