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

Ellen E. Kozelka is an Assistant Professor, Anthropology Department, University of Vermont. She is a psychological/medical anthropologist and Global Mental Health Scholar. Her research focuses on cultural conceptions of mental health and illness, specifically how those conceptions shape both available treatment options and health seeking behaviors for systemically marginalized populations in the US and México.

What is your article “Living the Process: Examining the Continuum of Coercion and Care in Tijuana’s Community-Based Rehabilitation Centers” about?

I explore why researchers must attend to cultural conceptions of health issues that expand beyond biomedical frameworks; doing so gives us the opportunity to understand the different forms of knowledge that aid or harm treatment at the individual level. By exploring one community-based (non-biomedical) treatment center’s institutional position on the therapeutic value of coercion, I highlight a different perspective on addiction’s “root problem” as well as how coercion has been incorporated into the proper method to treat that condition. I then examine several cases in which coercion was effective from women’s own perspectives as well as when it was not, challenging dominant assumptions about experience in coerced care while emphasizing its messy ethical and therapeutic reality. In doing so, I present both a method and justification for Global Mental Health researchers to attend to cultural context in a way that will promote equitable engagement with community partners around best care practices.

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

My work examines how structures of inequity shape the formation of, access to, and experience in mental health care systems for marginalized populations in the US and México. I specifically examine why marginalized people seek out novel and “nontraditional” care options to understand how healthcare systems could be made more equitable and welcoming to all.

What drew you to this project?

This article is based on my research in community-based substance use treatment for ethnically Mexican women in the US-MX border zone. Through this work I explored the question: why are there such diverse experiences of treatment and recovery, even within the same community-based therapeutic model? My driving question was straightforward, yet revealed both the complexity and importance of understanding cultural ideas of health and illness, moral ideas of personhood, and the intersection of individual experience with structural forces. My research contributes to the assertion that “addiction” is an individualized biopsychosocial illness, as is the healing process of recovery. As such, available treatment options should be variable enough to match this continuum of experience.

What was one of the most interesting findings?

To me, one of the most interesting elements of this work has been learning the specific reasons why women use drugs, the wide range of reasons and ways they end up in compulsory treatment, and what that tells us about how culture shapes mental health experience for marginalized women in the US and México. By exploring multiple treatment and recovery trajectories, I discuss possibilities for ways to reshape care and contribute to health equity for marginalized women.

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

I currently reading “The Best Minds: A Story of Friendship, Madness, and the Tragedy of Good Intentions” by Jonathan Rosen and watching “Traitors”.

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

I hope that my work demonstrates that anthropological methods and attention to cultural context can be used to bridge gaps in understanding about different forms of mental healthcare in ways that foster equitable collaboration, both across academic/professional disciplines and stakeholder groups.

Other places to connect:
Website

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

Jesse Proudfoot is an Assistant Professor in the Department of Sociology at Durham University. His research focuses on drug use among marginalized and racialized people, the politics of drug policy and treatment, and the relationship between addiction and structural violence.

What is your article “The Dreamwork of the Symptom: Reading Structural Racism and Family History in a Drug Addiction” about?

This article is about the relationship between oppressive social forces and illnesses like drug addiction. It’s common in medical anthropology to argue that seemingly individual illnesses need to be understood as shaped, and often produced, by social forces, but the precise ways that these forces produce illness is difficult to chart in concrete terms. In this article, I try to analyze this process, by looking at the case of one person I interviewed: Leon, an African American man from Chicago who had an addiction to crack cocaine. Drawing on psychoanalysis, and in particular, Freud’s idea of the dreamwork, I attempt to show how latent social forces like structural racism can find expression in symptoms such as drug addiction, but only through the mediation of other proximate layers—in Leon’s case, his complex relationship with his family and his own radical politics.

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

I’ve been interested in drug use and addiction since my PhD, which was an ethnographic study of homeless drug users in Vancouver’s Downtown Eastside. I charted their experiences as the neighbourhood underwent rapid changes due to progressive developments in drug policy, as well as gentrification. My earlier work was more concerned with the politics of harm reduction drug policy, but over the years, I’ve become more interested in the broader question of addiction and the subjective experience of people with problematic relationships to substances. I’m most interested in thinking about symptoms—like addiction—as sites of connection between the social, the political, and the subjective.

What drew you to this project?

This research grew out of an 18 month period of fieldwork I conducted in Chicago in 2012-13. I was working in a halfway house for people being released from prison who were struggling with drug addictions. I was struck by the diversity of people’s experiences of addiction, which ranged from what we might call acute self-medication, in order to deal with intolerable life circumstances, to much more complex, unconscious dynamics related to childhood trauma. Having written about these different forms of addiction in an earlier paper (‘Traumatic Landscapes’, 2019), I became interested in understanding what else we can read in addictions and the broader question of how to understand the relationship between politics and symptoms.

What was one of the most interesting findings?

The hook of this paper is that understanding the causes of your illness is not the same as treating it. Critical medical anthropology places a lot of emphasis on the demystification of symptoms, implicitly arguing that by uncovering the social causes of illnesses, we can alleviate them. Even though it now sounds obvious, I was struck during this research by the gap between demystification and therapeutics. My interlocutor Leon had a very well-developed political analysis of his addiction, grounded in critical political economy and anti-racism, and we talked about this often. But these insights failed him where he needed them most, in changing his own relationship to drugs. Making sense of this gap was what prompted me to think more deeply about how we approach the question of demystification.

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

I started running last year, which means I’m listening to a lot of podcasts. My current favorites are Know Your Enemy, which is a deep dive into American conservative thought for people on the Left, and Love is the Message by Tim Lawrence and Jeremy Gilbert, which is focused on dance music, counterculture, and collective joy—things I’ve spent a lot of time thinking about. The most recent novel I read was A Gate at the Stairs, by Lorrie Moore; a very funny and sad book about going to college, grief, and loss.

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

The demystification of illness is a complex business and our critical efforts must be attentive to the highly particular ways that people experience and embody those social forces that medical anthropologists are often interested in. As I hope to show in the article, this is essential not only to more accurately theorize illness, but also to help people with addictions to make sense of their lives and navigate their recoveries. Care must be ‘structurally competent’ in Jonathan Metzl and Helena Hansen’s terms, but also—in the spirit of the best traditions within psychoanalysis—grounded in the particularities of life histories.

Other places to connect:
Website

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

Hanne Apers, a female PhD candidate at the University of Antwerp’s Centre for Population, Family, and Health, specializes in mental health and migration. With a background in psychology and anthropology, she is currently completing her PhD-research on the explanatory models of mental health among East-African migrants in Belgium.

What is your article “Explanatory Models of (Mental) Health Among Sub-Saharan African Migrants in Belgium: A Qualitative Study of Healthcare Professionals’ Perceptions and Practices” about?

This study explores how mental health professionals in Belgium perceive the mental health understandings of their patients with a sub-Saharan African (SSA). 22 professionals were interviewed, including ten who also have a SSA migration background. The study explores three main aspects. Firstly, it examines how professionals perceive their SSA patients’ explanatory models of mental health. Secondly, it investigates the impact of these perceptions on their treatment approaches. Lastly, it considers the influence of professionals’ cultural backgrounds, comparing those with and without an SSA background.

The findings highlight noticeable differences in explanatory models, the main distinction was found in the beliefs about what causes mental health issues. Professionals’ understanding of SSA models affects their treatment practices, those familiar with SSA views faced fewer language and interpretation challenges. Non-migrant professionals emphasized cultural sensitivity and SSA-background professionals adopted an integrated approach. These findings contribute to discussions about what it means to be “culturally competent” in mental health care.

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

With a background in psychology and anthropology, my interest lies in exploring how different cultural views on mental health affect how people live, seek and prefer healthcare. As an anthropologist, I focus on qualitative research, favoring participatory, community-based methods to better understand the impact of cultural perspectives on healthcare dynamics.

What drew you to this project?

Numerous barriers and factors continue to hinder migrants’ access to healthcare. My aim was to contribute to lowering these barriers by comprehending the role of cultural understandings and illustrating how the organization of healthcare systems can be adapted to these differing understandings, and contribute to closing the treatment gap.

What was one of the most interesting findings?

The comparison between professionals with and without a similar migration background yielded intriguing insights, advocating for improved representation within healthcare systems.

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

The book ‘Crazy Like Us’ by Ethan Watters provides a compelling non-academic exploration of how global mental healthcare is shaped by a prevailing Global North perspective, sometimes with detrimental effects.

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

I hope to underscore the significance of recognizing cultural understandings and conceptualizations of health. It’s a crucial factor to consider if we aspire to develop and advocate for healthcare approaches that are truly inclusive.

Other places to connect:
Website
LinkedIn

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

Mary Hawk (DrPH) is the LSW professor and chair at the University of Pittsburgh School of Public Health, Department of Behavioral and Community Health Science. Dr. Hawk’s work includes the implementation and assessment of structural interventions to improve health outcomes for oppressed populations and the development of community-engaged approaches to optimize public health. She is co-founder of The Open Door, a harm reduction housing program created to improve health outcomes for chronically homeless people with HIV.

What is your article “Harm Reduction Principles in a Street Medicine Program: A Qualitative Study” about?

In this study we partnered with Operation Safety Net (OSN), a nonprofit that provides street medicine services to rough sleepers – people who are unhoused. We conducted qualitative interviews with OSN providers to pinpoint ways that street medicine differs from other kinds of healthcare and what elements of care were most helpful to patients.  We learned this care is built on relational harm reduction, which centers the patient-provider relationship. Ways that harm reduction played out included meeting patients where there are (both emotionally and practically, in this case on the street), offering genuine concern and dignity to patients, and supporting patients them in non-judgmental ways were found to be important aspects of this work. We hope these findings help others who care for marginalized patients consider how they can engage them in care and bridge them to other healthcare services, and ultimately help expand the field of street medicine.

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

I worked in nonprofit settings for many years, mostly providing services to people with HIV (PWH) who experience oppression and marginalization. This community-based work is the foundation of my research. I’m interested in building evidence for community-driven approaches that advance health equity for historically excluded populations.  All my work centers on harm reduction, especially as a relational approach to care, which considers ways that patient-provider relationships can improve care outcomes. At the moment, I am working on a National Institute of Mental Health (NIMH)-funded study that explores the impact of a harm reduction-based financial management intervention on adherence among unstably housed PWH, as well as a National Institute of Drug Abuse-funded study using mixed methods to investigate experiences of stigma in healthcare settings by PWH who use drugs.

What drew you to this project?

Operation Safety Net is an amazing organization.  When we first started meeting with Dr. Jim Withers, who has made an immeasurable impact on rough sleepers and street medicine providers across the world, we had an “aha moment” and realized that an essential piece of his work seemed to be rooted in relational harm reduction. It was exciting to explore these ideas with OSN providers. At the core of relational harm reduction is the idea that all patients are worthy of respect and autonomy, and we really saw that play out with the OSN team.

What was one of the most interesting findings?

In our planning meetings with Dr. Withers and other OSN leadership we could hear the genuine care they have for their patients, but seeing this through the interview data was very compelling. But the loss and grief they experience when their patients die was also clear. We talk about burnout in healthcare, but don’t often think about that in terms of grief experienced by providers.

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

I’m right in the middle of “The Call,” an episode of This American Life that details an overdose prevention hotline, which is a great example of how we can show care for people who are too often stigmatized through harm reduction work.  I’m also a diehard Survivor fan!

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

Humanism is at the heart of harm reduction approaches to care, including street medicine.  Affording people dignity and genuine concern is the jumping off point for engaging anyone in care, but especially those who regularly experience trauma and systematic oppression. It can make all the difference to not only their experiences of care but also their retention in care and, ultimately, clinical outcomes. 

Other places to connect:
Website
Twitter
LinkedIn
Instagram

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

Lamia Moghnieh (Postdoctoral Fellow, University of Copenhagen) is an anthropologist and mental health practitioner. Her research looks at the impact of psychiatry on understandings of self and illness in postcolonial and postconflict societies of the MENA/SWANA. She is interested in exploring the relationship between psychiatry and subject formation in the context of global mental health and patient subjectivities.

What is your article “The Broken Promise of Institutional Psychiatry: Sexuality, Women and Mental Illness in 1950s Lebanon” about?

I am an anthropologist, psychologist, and a social worker, and more recently, I am also a patient of analytical therapy. I try to let my research be informed from all of these positionalities together or provide insights from all of these places (as a researcher, practitioner and from the more intimate and vulnerable position of being a patient). I work in the field of mental health, and I do research on the histories and ethnographies of psychiatry, tracing various discourses on mental health from the Middle East and North Africa/ Southwest Asia and North Africa). I am currently writing my book manuscript provisionally entitled “Psychiatric Afterlives: Narrating Illness, Gender and Violence in Lebanon”. The book builds on multi-disciplinary frameworks from medical humanities to examine the role of psychiatric expertise in shaping patient and social imaginaries of madness and violence in Lebanon.

What drew you to this project?

I always wanted to be a clinical psychologist until I enrolled in the MAPSS program (Masters’ in the Social Sciences) at the university of Chicago. There, I was introduced to the various historical, philosophical and political critiques of psychology and I was drawn to medical anthropology. After I finished my PhD, which focused on trauma, humanitarianism and the politics of suffering in Lebanon, I was interested in learning more about the history of psychiatry in Lebanon and the region. My background and research interests are interdisciplinary. I am lucky to be in an academic position (at the upcoming research center “Culture and the Mind” head by Ana Antić at the University of Copenhagen) that welcomes and values this interdisciplinarity in the study of psy disciplines.

What was one of the most interesting findings?

One of the findings that interest me is the ways in which the family acts as an equal diagnoser of mental illness to psychiatric expertise. As shown in the article, the story of Hala invites more attention to the ways in which women (and maybe non-normative persons) become chronically institutionalized by institutional psychiatry and the family. This is not to dismiss the psychological and financial effects that mental illness might have on family members. The article rather approaches the family as a sociological unit that governs and defines normality, and is interested in the dialogue, tensions and challenges of care and normality between the family and institutional psychiatry, as shown in the story of Hala.

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

Audre Lorde’s Zami: A New Spelling of My Name
Roberto Bolaño’s Cowboy Graves
سارة اب وغزال “احلمي يا سيدي
هلال شومان “حزن في قلبي
Couch Fiction: A Graphic Tale of Psychotherapy
Jonathan Sadowsky’s Empire of Depression: A New History

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

That psychiatry is both a form of governance and a mode of healing whose authority and reach transforms and changes over time. That patient voices and narratives are a crucial part of the history of psychiatry and of its contemporary practices. And that medical humanities, including anthropology, is a field that can offer useful and critical insights on the status of global mental health.

Other places to connect:
Website
Twitter
LinkedIn