The next few months we’ll be highlighting authors who have published in Culture, Medicine, and Psychiatry.
Jim Waldram is a Distinguished Professor of Anthropology at the University of Saksatchewan. A canadian anthropologist with specializations in applied and medical anthropology, he obtained his PhD from the University of Connecticut in 1983, after completing Bachelor’s (University of Waterloo) and Master’s (University of Manitoba) degrees in Canada. He is the author of several books, including Hound Pound Narrative: Sexual Offender Habilitation and the Anthropology of Therapeutic Intervention (2012, University of California Press) and An Imperative to Cure: Principles and Practice of Q’eqchi’ Maya Medicine in Belize (2020, University of New Mexico Press). He is a Fellow of the Royal Society of Canada, the Canadian Anthropology Society, and the Society for Applied Anthropology.
This article examines the knowledge held by a group of Indigenous people – the Q’eqchi’ Maya of Belize – with respect to fright-related disorders. It challenges the idea that one particular fright disorder, known as susto, is essentially the same everywhere. Susto is well documented in cultural psychiatry, and the term appears in major psychiatric textbooks. But it appears to be an overlay of Indigenous knowledge by western psychiatric researchers, with the result that the complexities and nuances of Indigenous fright disorders are rendered invisible. This article takes that Indigenous knowledge seriously and uses it to talk back to susto, to question the rote applicability to Indigenous peoples of this particular western conceptualization of disorder.
Tell us a little bit about yourself and your research interests.
I live in Saskatchewan, Canada, known for bright sunshine and long,hot summer nights, as well as cold, dark winters. So, researching in Belize is very nice! I have been working with a group of Q’eqchi medical practitioners, and their patients, for almost twenty years. I am intrigued by the concept of ‘healing’ and much of my work has examined therapeutic practice in settings such as northern Indigenous communities, prisons, clinics, and now southern Belizian Q’eqchi’ villages.
What drew you to this project?
I was invited by the Q’eqchi’ medical practitioners to research, document, and share their medical practice and knowledge, in response to efforts by evangelicals and others to paint them as satanic or charlatans.
What was one of the most interesting findings?
I had a notion of ‘healing’ as fundamentally about repairing social relationships and psychological harms, based on my work with Indigenous groups in Canada. I was surprised to find that the Q’eqchi’ medical practitioners – who some would refer to as ‘healers’ – are focused mostly on diagnosing and treating medical conditions and seeking a cure for their patients.
What are you reading, listening to, and/or watching right now?
I don’t have much time for reading outside of my scholarly pursuits and teaching. I do listen to blues music regularly, and I watch a great deal of football (Canadian style).
If there was one takeaway or action point you hope people will get from your work, what would it be?
It is imperative to take seriously the deep and complex knowledge of Indigenous peoples and allow their understandings and explanations to exist equally alongside those of western science.
The next few months we’ll be highlighting authors who have published in Culture, Medicine, and Psychiatry.
Sarah Mars is an Associate Professional Researcher at the University of California, San Francisco. She is an anthropologist and historian who has been researching substance use and policy for several decades. Her current research focus is the US opioid/overdose epidemic and she is the author of The Politics of Addiction: Medical Conflict and Drug Dependence in England since the 1960s (Palgrave).
During our qualitative research in a West Virginia town where an outbreak of HIV was happening, we found strong agreement among people injecting drugs that HIV-related stigma had greatly diminished among their peers since the outbreak. Using Cultural Theory we considered the social and material mechanisms that might underlie this change. West Virginia’s drug overdose death rates are the highest in the US amidst widespread uptake of injecting. Although spending time together, people living homeless and injecting drugs were divided and constrained by extreme poverty and the demands of drug dependence, fostering a fatalistic approach to life events and decision-making. This fatalism undermined individuals’ aspirations to forming a mutually supportive group, the “High Five Club” of the title. (The name is an ingenious pun for ‘HIV’ where the V=5 in Roman numerals.) Yet this fatalism also contributed to mutual tolerance and acceptance of those diagnosed with HIV.
Tell us a little bit about yourself and your research interests.
Substance use and the social and political responses to it have long interested me. I moved to San Francisco from London almost two decades ago and, as a migrant, find that a comparative perspective always helps to spark questions about what we are encountering out in the field or in archives. While some of my research has focused on the urgent questions of emerging drug use during the opioid epidemic, I am also interested in developing under-used theoretical approaches, particularly Cultural Theory. The new online Opioid Industry Document Archive also promises exciting new opportunities for research. As well as work and family, I have spent many years researching cake making, particularly the chocolate varieties.
What drew you to this project?
Since reading Mary Douglas’ paper ‘The Self as Risk Taker: A Cultural Theory of Contagion in Relation to AIDS’ (1990), I have been intrigued about perceptions of risk and protection from HIV. During research in Baltimore, Maryland in 2015, an interviewee commented that although they were engaged in sex work, they only went in their own circle. They saw this boundary as protective against HIV risk and it resonated with Douglas’ ideas about community boundaries as a protective barrier to contagion. I then developed this project as a pilot for investigating the use of Cultural Theory among people who use drugs
What was one of the most interesting findings?
Reducing HIV-related stigma is not only a matter of educating people to be more caring and empathetic. How someone reacts to another’s diagnosis depends on how they see their own place in the world. When unable to control key aspects of their lives, such as where they sleep at night or because of the daily demands of drug dependence, a person may develop a fatalistic viewpoint. From a public health point of view, fatalism can make preventing HIV particularly challenging if people who are considered ‘at risk’ believe the spread of the virus is out of their hands but fatalism may also help them to live in harsh conditions without self-blame and reconcile themselves to difficult news.
What are you reading, listening to, and/or watching right now?
I have been enjoying the BBC podcast of ‘In Our Time’, a discussion with academics of wildly disparate topics from the electron to the origins of the Atlantis myth or George Orwell’s 1984. For viewing, Shetland, a crime drama set on remote Scottish islands, is good for relaxing at the end of the day. For the written word, I recently read an excellent paper by Allison Schlosser and Lee Hoffer that discusses grief after deaths from drug overdose, a previously overlooked subject. (Schlosser, A. V., & Hoffer, L. D. (2022). “I don’t go to funerals anymore”: how people who use opioids grieve drug-related death in the US overdose epidemic. Harm Reduction Journal, 19(1), 1-11.)
If there was one takeaway or action point you hope people will get from your work, what would it be?
There is usually an internal logic to even the most bewildering human behavior but it may take some persistence to discover it.
The next few months we’ll be highlighting authors who have published in Culture, Medicine, and Psychiatry.
Julie SprayJean Hunleth
Julie Spray is a Lecturer in Children’s Studies at the University of Galway. She is an interdisciplinary medical and childhood anthropologist who researches children’s perspectives on health and illness, public health policy and interventions, and health inequalities. She is author of The Children in Child Health: Negotiating Young Lives and Health in New Zealand (Rutgers Series in Childhood Studies, 2020).
Jean Hunleth is an ASsociate Professor in the Division of Public Heath Sciences at the Washingtion University School of medicine in St. Louis. She holds a PhD in cultural anthropology and a Masters of Public Health. Her work focuses broadly on care and caregiving across hospital and home settings in the United States and in Zambia. She is the author of Children as Caregivers: The Global Fight against Tuberculosis and HIV in Zambia (Rutgers Series in Childhood Studies, 2017)
Paediatric professions tend to be oriented around adult caregivers in biomedical approaches to illness management, leaving children marginalised as passive “shadows” in things like policies, guidelines, and clinical models. But the anthropology of child health suggests children are active participants in their health who derive their own self-care practices. So in this article we shift the lens away from caregivers to center children, asking, what are children’s roles in their asthma management? We asked 24 children to show us how they manage asthma, contrasting their accounts with those of 12 health care providers. We heard from children how they actively co-construct their own “protocols” for dealing with asthma with a range of other actors, through relational processes of care and responsibility, and within the spatial contexts and constraints of everyday childhoods. We suggest children’s activities—which are largely absent from asthma guidelines—are foundational to successful asthma management.
Tell us a little bit about yourself and your research interests.
We are both scholars working at the nexus of childhood and medical anthropology. Jean’s current studies are multiple, including a study of young people’s caregiving for adult cancer patients in the US, a study on bedside caregiving in a pediatric hospital in Zambia, a project to implement HPV vaccination into adolescent health services in Zambia, and a photographic examination of children’s experiences with health and care in the rural Midwest (US). These studies may seem quite different, but they are united by an interest in learning from young people to better understand care (in its varied definitions).
Julie has continued her long-term focus on paediatric asthma through a New Zealand based project about how health professionals, adult caregivers and children are differently thinking about children’s roles and responsibilities in asthma management. Additionally, her comic-making project The Pandemic Generation has investigated children’s representation inclusion and participation in Covid-19 public health promotion in New Zealand and, in the near future, Ireland.
What drew you to this project?
We were the two childhood medical anthropologists on an NIH-funded interdisciplinary team investigating caregiving for paediatric asthma. This article is the product of our relentless harping to the rest of the team that children matter too. The team very graciously trusted us to run a subproject working with the children of caregivers who had been previously interviewed for the main grant.
What was one of the most interesting findings?
Neither of us were surprised by our findings, because we knew from our respective previous child-centered projects children have agency and engage in their own self-care practices, and that those practices will be overlooked and underestimated by adults. But one thing we hadn’t expected was the role of drinking water in children’s protocols—so many of the children described drinking water as a firstline response to asthma symptoms. Adult caregivers had described a huge range of their own strategies but almost adult had mentioned water. We think this speaks to how much more constrained children are in their own health management—some of them couldn’t easily access inhalers at school, for example. Water is the one “health” product children have ready access to.
What are you reading, listening to, and/or watching right now?
Julie is reading Danya Gablau’s new book “Food Allergy Advocacy: Parenting and the Politics of Care” and thinking there are many parallels with asthma, and also food allergy would be another important area to investigate children’s own practices.
I (Jean) am reading The Scent Keeper by Erica Bauermeister. I find myself drawn to fiction narrated by child characters, and also fiction that offers new ways of thinking and writing about experience. The focus on scent is compelling to me as an anthropologist because my methods are so multisensorial. I think with fragrances often but haven’t quite figured out how to write them into my work.
If there was one takeaway or action point you hope people will get from your work, what would it be?
To critically consider how adult-centric their thinking is! The naturalisation of age-based bias is one of the few forms of prejudice that still seems unchecked. When we assume children are passive and caregivers are the only people that matter, that children cannot and ought not be responsible for their own health care, or that children’s activities are just “training” for future adulthood and inconsequential to the health of the present child, we do children a huge injustice and leave them without important supports for the roles they must and do play in their own health.
The next few months we’ll be highlighting authors who have published in Culture, Medicine, and Psychiatry.
Boon-Ooi Lee, Ph.D., is Senior Lecturer at the National Institute of Education, Nanyang Technological University in Singapore. He is interested in culture and mental health, in particular, indigenous healing systems, multicultural therapy, cultural psychopathology, alteration of consciousness, health beliefs, somatization, embodiment, and phenomenology.
Early studies usually described spirit mediums as people with mental disorders because of their psychiatric-like behaviors, for example, dissociation, delusions, or hallucinations. But subsequent studies found that mediums were generally in good physical and mental health. To find out whether these positive findings are generalizable to dang-ki healing, a form of Chinese mediumship / shamanism in Singapore, we interviewed eight mediums and assessed their mental health status using psychological questionnaires. Our findings suggest that most of them did not suffer from mental disorders. In fact, they had spiritually transformed through the practice of mediumship, suggesting that dang-ki healing has therapeutic values for the practitioners themselves. It is therefore important to understand mediumship in its cultural context instead of pathologizing it from a Western psychiatric perspective.
Tell us a little bit about yourself and your research interests.
I am a counseling psychologist and researcher. I have always been fascinated by the cultural aspects of psychopathology, mental health, and alteration of consciousness in ritual healing. Research in these areas helps us to understand better the interaction between mind and culture.
What drew you to this project?
I became interested in the relevance of rituals and other indigenous practices to mental health after a relative shared with me her personal story. When she was a child, her mother took her to consult a fortune teller because of her frequent insomnia. According to the master, her sleep had been interrupted by a child spirit who wanted to play with her. To prevent the lonely ghost from entering her bedroom, he asked her mother to paste a talisman on their house entrance. Interestingly, my relative slept soundly after her mother followed the instruction. Whether her recovery is a placebo response, a coincidence or due to some unknown reasons, I don’t know. But I think some aspects of cultural beliefs can be integrated into mental health care or psychotherapy for people who subscribe to these beliefs. With this idea, I moved on to study dang-ki healing, a popular indigenous healing system in the Chinese Singaporean community.
Initially, I focused my research on people consulting dang-kis. Later, I became interested in the dang-kis’ own transformative experiences after reading a study on digital self-representation conducted by Yee, Bailenson and Ducheneaut (2009). They found that the characteristics of an avatar had shaped how a user behaved both inside and outside of a collaborative virtual environment. Although virtual online game differs from spirit mediumship in many aspects, I wondered whether the same transformation would happen to a medium who enacts the “role” of a deity in a particular context as some researchers have perceived spirit possession as a form of social role enactment. In this sense, the “deity” is like an “avatar” while the religious context functions as an online virtual environment. Since a deity usually represents an ideal self with positive qualities, I conducted the current study to find out if a dang-ki would transform by internalizing the divine qualities through recurrent possession.
This transformation may help to explain the therapeutic aspects of the mediumship practice. Although this seems to be the case based on our ethnographic study, I plan to conduct an experiment to triangulate this finding by using the technology of virtual reality to see if a person can modify her behaviors by embodying the disposition of a “deity”. For example, past research has found that immersive virtual reality may induce illusions of ownership over a virtual body (in this sense, a deity’s body).
What was one of the most interesting findings?
The possible internalization of the deity’s disposition, as mentioned earlier. This finding will help to understand the interaction between the mind and body in cultural context
What are you reading, listening to, and/or watching right now?
Mainly Western and Eastern philosophies such as phenomenology, existentialism, and Taoism. I am now reading “The Path: A New Way to Think about Everything” by Michael Puett and Christine Gross-Loh, “The Phenomenological Mind” by Shaun Gallagher and Dan Zahavi, and “How Forests Think: Toward An Anthropology Beyond The Human” by Eduardo Kohn. In the evening, I immerse myself in Tang Dynasty poems, sci-fi movies on Netflix, or Tess Gerritsen’s novels.
If there was one takeaway or action point you hope people will get from your work, what would it be?
To be open-minded, do not stereotype or even pathologize anything we are not familiar with, learn from people from other cultures, and there are local knowledge and healing systems relevant to mental health care.
The next few months we’ll be highlighting authors who have published in Culture, Medicine, and Psychiatry.
Lawrence D. Blum, M.D. is a Clinical Associate Professor of Psychiatry and Adjunct Professor Fanthropology at the University of Pennsylvania. He is also Faculty at Psychoanalytic Center of Philadelphia. He is a psychiatrist/psychoanalyst in private practice. His undergraduate thesis focused on anthropology and psychoanalysis; both became lifelong interests. He has enjoyed teaching trainees in psychiatry, psychology, and psychoanalysis for decades. In recent years he helped found and co-direct the undergraduate minor in psychoanalytic studies at the University of Pennsylvania.
It is nearly impossible to be a good scientist or doctor without the advantage of some obsessive-compulsive personality traits, but these traits can also have significant disadvantages. While obsessive-compulsive traits tend to promote scientific rigor and conscientiousness, they can lead to an emphasis of method over meaning, and measurable behavior over the emotions and fantasies that are also essential aspects of being human. These traits are pervasive enough in professionals, I argue, to create an obsessive-compulsive background within scientific and medical culture. In my article, I discuss the influence of this obsessive-compulsive culture on psychiatry and psychology, using the Diagnostic and Statistical Manual (DSM) and Cognitive-Behavioral Therapy (CBT) as examples. The DSM and CBT have many salient obsessive-compulsive features, but to my knowledge, this article is the first to discuss the obsessive-compulsive qualities of either the DSM or CBT, or of psychiatric and psychological culture in general. One could regard the article as a kind of psychoanalytic ethnography of current psychiatry and psychology.
Tell us a little bit about yourself and your research interests.
One of my principal ongoing research interests is “counterdependency.” This is a term that indicates having objections to “dependent” wishes, i.e., wishes to be taken care of or helped by others.We humans start out as dependent babies, needing and wanting to be taken care of. Though we also grow up and want to be independent, and to be able to take care of others, those early wishes to be taken care of never go away. Some cultures encourage tolerance of and continuing expression of dependent wishes, and others don’t tolerate such wishes and encourage their suppression. In my view, the United States, compared to other countries, is a cultural outlier in its rather extreme counterdependent intolerance of those who need to be taken care of. We have a conquer-the-frontier mythology of extreme self-reliance accompanied by corresponding contempt for anyone who needs to be taken care of, so compared to other developed countries, the United States does far less for new parents, children, the sick, and the poor. As compelling as these observations seem to me, as far as I know, counterdependency has never been empirically studied on a cultural level.
I first became aware of the importance of counterdependency early in my career when I was seeing a lot of women with postpartum depression. They were often very capable, successful women who were used to doing everything themselves and never needed to ask for help. When they had a baby, they couldn’t survive without help but were emotionally unable to ask for help; their way of adapting to life failed and they became acutely depressed and anxious. Those women who, with a bit of help from me would then allow themselves to ask for a bit of help from others (often as little as possible), frequently recovered very quickly. It soon became clear to me that this counterdependent stance was a) an important unrecognized risk factor for postpartum depression, b) a significant factor in individual psychology, and also c) a pervasive aspect of our culture. A colleague and I developed a self-report instrument to assess counterdependency, which we have tested in relation to postpartum depression, and which could easily be used to compare different cultures.
Any reader who may be interested in empirically studying counterdependency, in relation to either culture or individual psychology (or who may have an interested graduate student), should feel free to contact me.
Blum, L.D., Horenstein, A., Carper, M.M., Stange, J.P., Cohen, J.N., Doyle, A. & Smith, V. (2020). A New Instrument to Assess Counterdependency, Evaluated in the Context of Postpartum Depression. Psychoanalytic Psychology, 38:1, pp 49-57, January, 2021. Published online June 25, 2020, https://psycnet.apa.org/doi/10.1037/pap0000317 .
Since reading Mary Douglas’ paper ‘The Self as Risk Taker: A Cultural Theory of Contagion in Relation to AIDS’ (1990), I have been intrigued about perceptions of risk and protection from HIV. During research in Baltimore, Maryland in 2015, an interviewee commented that although they were engaged in sex work, they only went in their own circle. They saw this boundary as protective against HIV risk and it resonated with Douglas’ ideas about community boundaries as a protective barrier to contagion. I then developed this project as a pilot for investigating the use of Cultural Theory among people who use drugs
What was one of the most interesting findings?
I think the most central point is that an obsessive-compulsive professional culture has led to a very narrow biological and behavioral reductionism in psychiatry and psychology, with an unfortunate de-emphasis of humanism, mind, emotion, and fantasy. A more truly scientific approach in these disciplines would incorporate a broader view of what it is like to be human, including all of our irrationality
What are you reading, listening to, and/or watching right now?
A student recently brought to my attention an excellent article called “Melancholy Anthropology,” by the Australian anthropologist, Holly High. She draws on Freud’s “Mourning and Melancholia” and argues that the ethnographer in the field not only, necessarily, becomes deeply emotionally engaged with the people she is studying, but also inevitably becomes the object of their many often deeply irrational desires. She cannot possibly fulfill those desires and tends to feel deeply guilty. High then argues that this intolerable, often unacknowledged, guilt tends to be transformed into needs for ideological purity that characterize some parts of the discipline, thus making an important connection between experience in the field, individual psychology, and the culture of anthropology as a discipline.
If there was one takeaway or action point you hope people will get from your work, what would it be?
From my paper in CMP, I think the most central point is that an obsessive-compulsive professional culture has led to a very narrow biological and behavioral reductionism in psychiatry and psychology, with an unfortunate de-emphasis of humanism, mind, emotion, and fantasy. A more truly scientific approach in these disciplines would incorporate a broader view of what it is like to be human, including all of our irrationality.
For my work in general, I think perhaps what is most central is the wealth of fascinating, bidirectional interaction between individual psychology and culture that is heavily influenced by early developmental experience, and that is typically unconscious.
The next few months we’ll be highlighting authors who have published in Culture, Medicine, and Psychiatry.
Dr. Shannon Hughes, MSW, PhD, is an Associate Professor at the School of Scoial Work at Colorado state University. She teaches, consults, and conducts research on how we use drugs and medicines in our society today. She is a community organizer and leader in articulating the shifting paradigms around our relationships with Self and medicines/drugs.
Dr. Robert Colbert, MA, PhD, LPC-S is Therapist and Owner of An Enduring Love, Co., in Fort Collins, Colorado, and a Sub-Invesitgator for MDMA-Assisted Psychotherapy REsaerch for MAPS Public Benefit Corporation. He is a is a counselor, clinical supervisor, and published researcher on therapeutic and social uses of psychedelics. He has sat on multiple non-profit and advisory boards, and has over 25 years of advocacy, education, and volunteer work in harm reduction and support services for people who use drugs.
Our article explores the use of MDMA (also called Ecstasy or Molly) among couples taking it in the privacy of their own homes for relationship enhancement. MDMA is being tested in clinical trials as a breakthrough treatment for PTSD, but this article investigates its uses outside of the therapist’s office, and too, outside of the recreational party scene that the drug is often associated with. Couples described preparing for their “evening with Molly” through modifying their physical space, communicating their intentions and hopes for the experience, and taking care of their health (e.g., eating healthier, avoiding alcohol) in the days leading up to their MDMA use. Couples further described durable positive impacts on their relationships, including improved communication, enhanced intimacy, and providing a relationship “tune up” when things felt stagnant or stuck. Couples’ MDMA use suggests that non-problematic adult use of the drug is possible outside of clinical settings.
Tell us a little bit about yourself and your research interests.
Dr. Shannon Hughes: I have been a researcher and educator in Social Work for over a decade with a focus on how we use drugs and medicines in our society today. As a researcher, I seek to improve best practices around how psychotropic drugs are prescribed, assessed, and monitored in mental health practice, and empower people with lived experience of mental distress in reclaiming the power to define their own stories and their own paths forward, which may or may not include psychotropic drugs. My research lab at CSU, the Alternatives for Mental Health and Healing Lab, aims to advance holistic, person-centered, and cutting-edge behavioral health alternatives founded in the synthesis of research evidence, innovative thinking, and community partnership. As an educator, I have developed and delivered curriculum for professional social workers, counselors, and administrators on the topics of safety and efficacy of psychoactive substances used in mental health care, shifting paradigms of drug use, and roles of helping professionals in supporting empowered relationships with psychoactive substances. Outside of my academic and professional life, I find balance in the mountains of Colorado and regular travel to places with coastlines and beaches.
Dr. Robert Colbert: I am a social artist who utilizes creative creative artistry within networks of advocates and community members who strive to enact meaningful, lasting social change as it relates to how we use drugs and medicines. In my private psychotherapy practice, he works with clients as a steward for discovery, and to empower change in people’s lives by exploring relationships, identities, and choice points which encourages lasting personal transformations. As a researcher, my primary interest is the discovery of hidden groups and social networks of substance users, with a focus on exploring the lived experiences and complex interactions which exist within our substance-using communities. Outside of my professional life and community organizing, I appreciate the Colorado outdoors and spending time with friends enjoying live music and dance.
Together we are founding members of the The Nowak Society, 501c3, a Colorado-based non-profit providing community education and professional organizing around psychedelics and drug policy reform. We also offer workshops and training to therapists and helping professionals seeking to expand their practice into the emerging field of psychedelic-assisted therapies. We believe that, as exciting as the present psychedelic renaissance is, we must not forget the numerous harms done by decades of prohibitionist drug policies and the propaganda of the Drug War. Critical thinking here requires that we understand our history, bring attention to power, and anchor into our ethics and values.
What drew you both to this project?
MDMA has so many potential therapeutic applications – such as for trauma work and PTSD, eating disorders, social anxiety, autism spectrum disorders, and more – but it also has a very interesting history of use recreationally in the PLUR (Peace, Love, Unity, Respect) and rave culture of the early 90’s and through to today. Drug War fear-mongering painted MDMA as a dangerous drug that would take ice-cream scoops out of your brain, leaving you forever damaged and broken, so it was kept underground and deviant for a long time. We now know, of course, that much of the research at the height of prohibition was skewed and flawed in a way to inflate the dangers of MDMA, but the “dangerous drug” story sticks in our minds. With MDMA nearing completion of Phase III testing for FDA approval, I think most people will easily find it agreeable to open up drug access through a doctor, under tightly controlled and supervised conditions because, we assume, MDMA is otherwise still a dangerous drug. In the spirit of critical thinking and unpacking cultural remnants of the Drug War, we thought it would be interesting to seriously investigate other less explored applications of MDMA.
Outside of the clinic and outside of the rave music scene, we knew there were individuals using MDMA quietly in their own homes, without supervision or therapeutic support, to improve their intimate relationships. We were curious what their use looked like, how they decided to use MDMA and how they prepared themselves for it, what benefits they experienced, and what safety issues or adverse effects they experienced. We thought this line of inquiry might hold implications for present drug policy reform discussions where stakeholders debate the merits and limitations of medicalization, legalization, and decriminalization as different paths forward for MDMA and other psychedelic drugs.
What was one of the most interesting findings?
What was most interesting about our interviews with couples was how thoughtful and deliberate they were in curating their MDMA experiences – including, planning the details of how they would spend the evening together, being sure they were mentally and emotionally ready to be fully present with their partner for the MDMA experience, and taking time following the experience to slow down and revisit the discoveries they made through the experience. One couple described it as “conscious use” of MDMA. We believe this speaks to a potential new model of drug use that opens up possibilities for how we might engage our relationships to drugs. It is not escapist drug use or drug use that creates harm or dysfunction in users’ lives. Neither is it supervised use for treating a mental health condition. It is something else entirely, and if taken seriously, might serve to counteract the cultural baggage of the Drug War by giving us alternative paths toward engaging informed, non-problematic, healthful adult drug use.
What are you reading, listening to, and/or watching right now?
Dr. Shannon Hughes: I am reading “Saving Our Own Lives: A Liberatory Practice of Harm Reduction” by Shira Hassan and “The Mind and the Moon: My Brother’s Story, the Science of our Brains, and the Search for our Psyches” by Daniel Bergner. Also listening to the audiobook, “A Fierce Heart” by Spring Washam
If there was one takeaway or action point you hope people will get from your work, what would it be?
We are steeped in baggage from the Drug War and from a highly medicalized system of mental health care that requires people to defer to western-trained medical authorities to understand the nature of their suffering and which drugs are okay to take for it. From my collective body of work, I hope people will begin to interrogate for themselves taken-for-granted concepts, as simple as “what is medicine?”. We each must do the work of de-colonizing our own minds on the subject of drugs and medicines. For example, Do I believe that some substances are good and others are bad? Where do those beliefs come from? What is medicine – is it a pharmaceutical product only prescribed by a doctor? Is food medicine? Water? And as we enlarge our concept of what is medicine for people, then we can also ask the question: Who owns this medicine? Who owns healing? Who should have rights to access this and how?
The next few months we’ll be highlighting authors who have published in Culture, Medicine, and Psychiatry.
Hilla Nehushtan is an Israel Institute Teaching Exchange Fellow in the Jewish Studies program at the University of Pittsburgh. She wrote her MA master’s thesis on women exiting commercial sex work. Her Ph.D. is from the Hebrew University of Jerusalem, where she investigated the social constructs of weight loss surgeries.
The article discusses some moral issues surrounding higher-weight bodies and their portrayal in consultation sessions between bariatric professionals and patients. I suggest that bariatric surgery becomes a site of a “moral breakdown” (the supposed immorality of people allowing themselves to get “this big”), where professionals advise patients to recuperate through minor everyday moments of experimentation with ethics. Drawing on ethnographic inquiry in a bariatric clinic, I argue that this moral recovery is made in three ways: First, patients are advised to “listen to their bodies” and to reconnect to their embodied sensations. They are further guided to imitate a “thin state of mind.” And finally, they are instructed to “put themselves first” by reorganizing their family and work responsibilities. While these instructions consonant with the common cultural ethos of self-discipline and self-control, they expand and, at times, undermine these notions and contest elements of fat stigma.
Tell us a little bit about yourself and your research interests.
I am a medical anthropologist interested in health and illness and how these issues interact with cultural and social constructs. I also explore gender inequality, primarily body size issues and how the overweight body is perceived and experienced. Today I am an Israel institute teaching exchange fellow and enjoy developing and teaching various courses about gender, body size and health and illness at the welcoming and thought-provoking Jewish studies program at the University of Pittsburgh. I am a passionate qualitative researcher enthusiastic about unmediated encounters with interlocutors.
What drew you to this project?
When I started contemplating this topic for my research, I was fascinated and shocked by the countless stereotypes associated with larger bodies that had never even occurred to me. For instance, a former colleague told me she did not hire the service of a big-bodied Doula because she felt this woman could not have positive relations with her own body. The more I delved into this issue, the more I found its cultural and social constructions intriguing. Furthermore, it is a broad topic that includes numerous dimensions of daily lives: the way larger-bodied people are treated by their family and peers; the discrimination against larger-bodied people in the workplace and the fashion industry; the way people are judged while eating in public; the ways children and adolescents are socialized to dislike their bodies; the evergrowing diet industry that shames larger-bodies, and of course, the biomedical point of view and its influences all of the above. I feel like this is a topic that deserves more nuanced attention.
What was one of the most interesting findings?
The most interesting and surprising finding was how the weight loss professionals’ messages empowered patients. While often medical professionals’ statements are interpreted by critical literature as oppressive and disciplined, the fact that women were encouraged to pass some of their responsibilities and housework to other family members, and take time to eat well and care for themselves, even temporarily after surgery, was experienced by them as empowering and well deserved. Medical professionals legitimized taking a break from daily responsibilities at work and home, encouraging patients to care for their bodies and selves. This was particularly meaningful for women, who are often responsible for house work and child care.
Furthermore, I found that prodessionals frame the reason for larger bodies as derived from constantly putting others first,and not taking care of themselves in terms of healthy eating and bodywork. This, I argue, subverts fat stigma. It diverges the blame for obesity from lack of control or gluttony.
What are you reading, listening to, and/or watching right now?
I recently read (or listened to, more precisely) the book “Hunger: A Memoir of (My) Body “by Roxane Gay. This book is a disturbing and fascinating documentation of her life story, which is often sad and painful. In the book, she emphasizes life with a body size that is considered much larger than average. She describes her physical and health difficulties, but mostly the social challenges of living with a larger body. The book evokes a lot of empathy and enables a deep understanding of her life as a successful award-winning author on the one hand and a person with many daily struggles on the other. I highly recommend it.
If there was one takeaway or action point you hope people will get from your work, what would it be?
A more nuanced listening to interlocutors’ experiences, whether patients or medical professionals, even within critical literature, can benefit our understanding of patients and professionals. Such listening can open new possibilities for a deeper insight into people’s motives and interpretations of these procedures and allow a better understanding of medical professionals who also sometimes struggle to negotiate and rationalize these procedures for themselves.
The next few months we’ll be highlighting authors who have published in Culture, Medicine, and Psychiatry.
Mille Kjærgaard Thorsen holds a position as Assistant Professor at the School of Social Work and at the Research Centre for Health and Welfare Technology both at VIA University College. She obtained her PhD from the Department of Anthropology at Aarhus University in 2019.
The article examines ethnographically the topic of type-2 diabetes in Cairo, Egypt. It depicts two different prevailing understandings of what causes the condition among those living with it and their healthcare providers. It shows how those diagnosed with type-2 diabetes primarily relate their condition to experiences of ḍaghṭ, translated as “stress” or “pressure,” whereas their healthcare providers primarily relate the condition to matters of obesity. The article exemplifies these different understandings of type-2 diabetes by drawing on the topic of food. It argues that whereas those diagnosed with type-2 diabetes relate issues of food scarcity and insecurity to their condition (specifically to the ḍaghṭ brought on by such scarcity and insecurity), their healthcare providers relate an excess consumption of food and calories to the condition. Overall, the article shows how transnational policies, markets and research interfere with the physiology of bodies – manifesting in ailments such as type-2 diabetes.
Tell us a little bit about yourself and your research interests.
I worked as a healthcare assistant in a nursing home and at a hospice during my first formative years as an undergrad student at the Department of Anthropology at Aarhus University. This drew me to the field of Medical Anthropology during my grad and post-grad years. Since finishing my PhD in 2019 (the article above is based on research I conducted as part of my PhD), and through the last couple of years as an Assistant Professor at the School of Social Work in Aarhus, I have grown particularly interested in issues of inequity in relation to healthcare issues. During my PhD I was especially interested in exploring the notion of (mis)trust in relation to such issues; this theoretical interest has more recently evolved into a focus on the relations of (mis)trust, empathy and ethics more broadly.
What drew you to this project?
I have always been keen to learn different languages and decided during my undergrad that I would devote six months to studying Egyptian Arabic in Cairo before resuming to grad school. Of course, I fell for Egypt; its people, history, culture and language. When forming my PhD project several years later I knew from my time in Egypt that the prevalence of type-2 diabetes within the country was as high as, for example, in Denmark, however little research had been conducted locally in regards to understandings and treatment paths in relation to the condition. I also discovered that the Danish-founded medical company Novo Nordisk was quite vested in diabetes care and prevention strategies within the public healthcare system in Egypt, which further drew me to examine the global and local intersections of type-2 diabetes within the country.
What was one of the most interesting findings?
One of the most interesting findings of my overall PhD project (the above article touches upon this briefly) is the fact that ḍaghṭ (translated as “stress” or “pressure”) is in fact biomedically acknowledged as a risk factor of type-2 diabetes; however, it is was not acknowledged in medical practices in Egypt or in Denmark throughout my research. Put differently, certain etiologies of type-2 diabetes transformed into medical practices and others did not. These findings raised the subsequent questions of 1) why this happens, and 2) what we potentially overlook that could make a difference in succeeding with diabetes treatment and prevention strategies within Egypt and within the region at large?
What are you reading, listening to, and/or watching right now?
Staying on the topic of Egypt: I am halfway through Alaa al-Aswany’s “I ran to the Nile” which depicts the time of the uprisings in 2011. It is simultaneously beautiful and painful, but also full of humor and warmth.
If there was one takeaway or action point you hope people will get from your work, what would it be?
To apply the fact that diabetes care and prevention cannot solely take place in a doctor’s office or through treatment targeting individual bodies – it should also take place in the offices of those who form national and transnational policies that affect the conditions in which those individual bodies exist.
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).
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.
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.
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.
Culture, Medicine, and Psychiatry 