Interview With Galia Plotkin-Amrami

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

Galia Plotkin-Amrami is a Senior Lecturer (Assistant Professor) in the School of Education, University of Ben-Gurion in the Negev, Israel. Her academic track began with training in anthropology and school counseling and evolved into historical anthropological research on therapeutic discourse during her PhD and several years thereafter. Galia’s more recent research focuses on the medicalization of childhood, parental subjectivity, and stigma in relation to neurodevelopmental disorders and atypical gender performance.

What is your article “Sensitive Child, Disturbed Kid: Stigma, Medicalization, and the Interpretive Work of Israeli Mothers of Children with ADHDs” about?

The article focuses on Israeli mothers of children with ADHD. We explored how mothers understand the category of ADHD, their children’s experiences, and their own role over the course of their children’s lives. Our analysis of mothers’ narratives revealed they did not experience the formal diagnosis as an endpoint that settled the understanding of the child’s condition. Rather, they continued to revisit their perceptions of ADHD and their own responsibilities. As an invisible, yet socially disturbing disability, the diagnosis of ADHD does not bring relief from blame. We discuss some features of the Israeli cultural portrait of the child with ADHD that differ from aspects of the ADHD life experience that are emphasized in ethnographies in North American families. We show that emotional vulnerability and risk of social isolation of the child reflect cultural notions of Israeli childhood and shape Israeli mothers’ experiences and decisions related to the child.

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

For several years, my main research interest was mental health knowledge and practices in the areas of immigration, trauma treatment, and resilience education. I explored the interrelations between professional knowledge, national ethos, religious narratives, and ethics in the Israeli cultural and political context.

I have begun exploring a different topic—the medicalization of childhood. My recent project focuses on how parents and teachers understand and apply the ADHD category within the school and family context in Israel. In addition, I conduct research with colleges on homeroom teachers’ roles and perceptions of mainstreaming students with emotional-behavioral difficulties within the regular school setting.  

Another research project focuses on the parenting of transgender and gender-variant children. It examines how children’s atypical gender performance and gender transition are navigated in the family and school arenas within different educational settings in Israel: Jewish state (secular) schools, Jewish state-religious schools, and independent schools.

What drew you to this project?

The idea of this project emerged from my teaching. My general interest in diagnostic categories and “making up people” led me to teach on the subject. Based on discussions with my students and the understanding that there is no anthropological-historical research in Israel, a highly medicalized society, on medicalization of childhood, I thought it would be appropriate to study the topic. The project focuses on the knowledge and practices of mothers of children with ADHD and teachers who meet such children in the school arena, but I intend to continue to study medicalization, this time by exploring the epistemic culture of the experts involved in diagnosing and treating the disorder among children in Israel. My previous projects on professional discourses in the field of trauma or immigration showed the importance of an anthropological examination of processes of knowledge–generation on mental phenomena. After studying the narratives of mothers and teachers, I see great value in research on medicalization at different levels, macro and micro, institutional and interactive, through the knowledge of formal experts and the expertise of laypeople. Ultimately, the role of mothers or teachers is critical in medicalization processes and, more generally, in the way we understand the concept of disability, norm, and pathology and perceive personal and social responsibility. I hope to continue this research in order to produce additional insights into the uniqueness of the globalized tendency of medicalization in a local context.  

What was one of the most interesting findings?

One of the interesting findings for me was the variety of the effects of diagnoses and biomedical explanations on people’s lives and subjectivity and how important it is to pay attention to the narrative, institutional, and moral effects of the diagnosis. For the mothers in our study, the diagnosis of ADHD allowed them to achieve very different goals and was translated into very different decisions, moral experiences, and practices. In addition, we saw the extent to which local perceptions of childhood, well-being, and normative functioning shaped mothers’ decisions to diagnose their children and influenced their interactions with professionals and educators.

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

I’ve been listening to a local podcast “On Life and Death.” This podcast is built on an Israeli journalist’s in-depth interviews with people of different ages, mostly writers or those who write, about their experiences of loss at different stages of their lives, their insights around grieving, commemoration, and life, and their moral significance. I began to listen this podcast after a loss in my personal life. I find it sensitive, humane, wise, and entertaining.  

I am also listening to an audio book by Svetlana Alexievich, Secondhand Time: The Last of the Soviets. I was born in the Former Soviet Union and left a few years after Perestroyka. I find this to be a fascinating chronicle about how everyday Russian citizens recount their past: what life was like during the fall of the Soviet Union and what it was like to live in the new, post-Soviet Russia.

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

In the uncertain spaces of controversial diagnostic categories, such as ADHD, there is a need to respect and take into account mothers’ daily experiences and knowledge to create and maintain an inclusive environment for “troubled” children, on the one hand, and to challenge common cultural expectations from mothers, on the other.

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Interview With Giulio Ongaro

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

Giulio Ongaro is a Fellow at the Centre for Humanities and Social Sciences at the Southern University of Science and Technology in Shenzhen, China. Additionally, he is a Visiting Fellow at the Department of Anthropology, London School of Economics and a Team member at Program in Placebo Studies at Harvard Medical School. He obtained a PhD in Social Anthropology from the LSE and a MSc in Philosophy of Mind from the University of Edinburgh.

What is your article “Doctors Speak: A Qualitative Study of Physicians’ Prescribing of Antidepressants in Functional Bowel Disorders” about?

The article explores how gastroenterologists in a US hospital prescribe tricyclic antidepressants to treat irritable bowel syndrome and the challenges they face in doing so. IBS is a functional disorder (a chronic condition with no precise pathophysiology) which is often surrounded by stigma. Prescribing low-dose psychiatric medication, albeit proved to be effective, can be stigma-inducing because it potentially hints that the disorder is “all in the head”. To avoid this, physicians gravitate their explanations towards the known neurophysiological mechanisms of action. Though avoiding psychological talk, their engagement with patients is nevertheless sensitive to the psychology of expectations, which they know can powerfully affect clinical outcomes (when realistic). They thus place a lot of effort in building and managing hope in patients. Overall, the study shows how physicians do their best to help under specific cultural assumptions – about mind and body – that make functional disorders so hard to treat within modern medicine. 

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

My research lies in the areas of medical anthropology, cross-cultural psychiatry, and healing ritual. As part of my PhD at the LSE, I did long-term ethnographic fieldwork among the Akha people of highland Laos. I researched their shamanic tradition and medical philosophy, focusing on healing efficacy: on how rituals work and how people think they work. Alongside fieldwork, I have conducted research within the science of ‘placebo effects’ and surrounding areas of philosophy of cognitive science and psychiatry. In collaboration with researchers at the Program for Placebo Studies at Harvard Medical School, I have published on the mechanisms of placebo and nocebo effects and on cultural narratives around medicine-taking, including this highlighted article.  

I’m currently on a fellowship at SUSTech in Shenzhen. What’s nice about it is that gives plenty of academic freedom, so I’ve ended up delving into a somewhat disparate set of topics. I’m writing an article on the notion of ‘externalist psychiatry’, one on downward causation in neuroscience, and one on a shamanic movement that took hold in Laos while I was there. I’ve also kept an interest in global history (rekindled recently by the publication of Graeber and Wengrow’s The Dawn of Everything). Trying to bring all these strands together, I am writing a book on the global history of medicine that centres on the epistemic and therapeutic value of animistic healing traditions.   

What drew you to this project?

It was an invitation from Prof. Ted Kaptchuk and his team at the Program of Placebo Studies at Harvard Medical School. The Program investigates ‘placebo effects’ from an interdisciplinary perspective, bridging clinical sciences with social sciences and humanities, so my research interests fitted in quite well. Dr. Sarah Ballou – who shares first-authorship of the article – conducted interviews with physicians at a Boston hospital on various aspects of prescription of tricyclic antidepressants for IBS (as part of a broader project on how physicians approach functional gastrointestinal disorders). Together with Dr. Julia Haas, we analysed the central themes, which touched on the implications of giving physiological and psychological explanations of functional disorder and its treatment. These are also topics that I investigated ethnographically in highland Laos among the Akha. So, the study for me was also interesting from a cross-cultural point of view.  

What was one of the most interesting findings?

It was the care physicians took to avoid stigmatising narratives by centring their explanation on the neurophysiological processes of treatment. For instance, they’d talk about ‘neuromodulators’ rather than ‘antidepressants’; ‘nerve sensitivity in the gut’ rather than psychological factors involved in IBS. All the same, much of their approach showed a deep awareness of the importance of realistic expectations and hope in treatment, i.e., psychological factors. Though it fell outside the scope of the article, to me the fact that these physicians (who are among the best in the country in this field) had to tread so carefully on this complicated mind/body terrain speaks of some theoretical limits inherent to the biomedical approach to functional disorders. I found this interesting comparatively speaking. Many medical traditions around the world (the Akha being one) do afford rich conceptual resources for dealing with disorders that would be diagnosed as ‘functional’ within biomedicine. Typically, they externalise their causes onto the social environment. In so doing, they pre-empt the kind of stigma that the physicians we interviewed actively try to avoid in the clinical encounter. So, as an anthropologist this study was interesting for highlighting the big role played by culturally-specific explanatory frameworks surrounding the treatment of functional conditions.   

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

I have been reading Starhawk for a course I am teaching on the anthropology of magic and healing. Fiction, I have just finished A Man’s Place by Annie Ernaux. Having a long commute, I’ve been listening to a fairly random mix of podcasts like Red Medicine, Hermitix, Srsly Wrong, Tides of History, COMPLEXITY and Mad in America. The last movie I watched was The Banshees of Inisherin and the last song played was by Rosalía. 

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

That the main way to make progress in psychiatry will depend on externalising mental disorders: on casting both the causes and treatment of psychiatric disorders, partly, onto the social environment. This won’t be the consequence of giving up on the brain, but of knowing more about it as an organ of mediation. And that other healing traditions illuminate the kind of social conditions that enable externalisation (though all this is not something I’ve already written; it’s something that will hopefully come out soon). 

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Interview With Ellen E. Kozelka

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:
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Interview With Jesse Proudfoot

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.

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Interview With Hanne Apers

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:
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Interview With Mary Hawk

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. 

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Interview With Lamia Moghnieh

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:
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Interview with Michael Galvin

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

Dr. Michael Galvin is a Global Psychiatry Clinical Research Fellow and in the Department of Psychiatry at Harvard University and the Department of Psychiatry at Boston University. Dr. Michael Galvin is a global health researcher and psychotherapist.  His primary research interests center on mental health and the role that one’s environment, culture, and belief systems play in mental illness and treatment.  In particular, his work focuses on elucidating cultural models of mental illness and exploring relationships to pathways to care, with the goal of improving cultural adaptation of mental health interventions.  

What is your article “Examining the Etiology and Treatment of Mental Illness Among Vodou Priests in Northern Haiti about?

This article is about the way that traditional healers (ougan) conceptualize and treat mental illness in rural Northern Haiti.  While the vast majority of people with mental illness seek treatment from ougan in this region – as few biomedical services exist – very little research has examined what ougan actually do when treating patients.  The article also tries to understand how mental illness is viewed from the healer’s perspective, delving into the broader Vodou cosmology which remains very influential in rural parts of Haiti.

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

My interests mostly center around mental illness and how we conceptualize it in different cultures and settings.  Historically, mental illness has always been hard for people to understand, getting wrapped up in ideas of spirit and demon possession.  Rarely have people thought it was something to treat like a broken leg or even a bacterial infection.  This is partly because there are no biomarkers to test for it thus patients recount what they are experiencing solely via self-report.  But it’s also because mental illness affects the basic ways in which people act and simply exist in the world.  When our loved ones have significant behavioral changes without physical symptoms of illness or infection it can often lead us to suspect the supernatural.

What drew you to this project?

I have been working and living in Haiti on and off since 2012 and knew I wanted to focus my dissertation research in Cap-Haïtien.  I found out about the Mental Health Center at Morne Pelé in 2018 and spent the entire summer of 2019 volunteering with them so we could get to know each other, for me to better understand what their work was like, and to start exploring different angles for my dissertation research which I conducted in the second half of 2020.  It was during the summer of 2019 that I learned about the extent to which patients held explanatory models based in Vodou and I knew that had to become a significant part of my research there.  I’m currently the director of the Mental Health Center at Morne Pelé’s new Research Laboratory so it’s very exciting to continue to collaborate together.

What was one of the most interesting findings?

One of the most interesting findings was this treatment called fiksyon that almost all the healers I interviewed used.  Barely anything has been written about these concoctions so this was really one of the first times they’ve been explored.  Fiksyon are different liquids – usually rum mixed with ground plants and animals – that are kept in large unmarked semi-transparent plastic bottles.  There’s a lot of mystery surrounding fiksyon with many people saying they have mystical properties.  It would be interesting to explore more about what is actually in them and the places where they are manufactured

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

I’m reading a really interesting book that was written in the 1970s called Plagues and Peoples.  It’s a great dive into the history of pandemics over the centuries.  It’s not a hard read at all, very enjoyable and easy to understand with lots of nice anecdotes.  Apparently the findings have held up really well over the last 50 years too.

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

That religion and culture have deep impacts in the way we conceive of mental illness.  That we still know relatively little about how mental illness develops, manifests, and is best treated.  That the relationship between our minds and our bodies is exceedingly complex and there are often no easy solutions.

Thank you for your time!



Interview with Sarah Rubin and Joselyn Hines

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

Sarah Rubin is an Associate Professor at the Ohio University Heritage College of Osteopathic Medicine at the Cleveland campus. She is a medical anthropologist who studies motherhood in the US and South Africa. She’s an advocate for health equity and reproductive justice. She lives in rural northeast Ohio with her family.

Joselyn Hines is a fourth-year medical student at the Ohio University Heritage College of Osteopathic Medicine at the Cleveland campus and psychiatry residency applicant. She has held many leadership positions within her medical school and local community. She is an active advocate and leader for underrepresented minority medical students and marginalized patient populations. She is passionate about destigmatizing mental illnesses and connecting the community to proper psychiatric care.

What is your article As Long as I Got a Breath in My Body’’: Risk and Resistance in Black Maternal Embodimentsabout?

This article explores the everyday experiences of Black mothers in Cleveland, OH as they navigate pregnancy and postpartum in the context of the racially disparate risk of infant death due to structural racism. These mothers articulated awareness of ways that racism causes them stress as they strive to have a healthy pregnancy and birth and raise their children well. We describe an embodied orientation toward motherhood that we call “betterment” where women attempt to overcome the disadvantages and oppressions of structural racism by centering their children, reconsidering and reconfiguring the social support they need to raise them, and by focusing on the future.

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

Rubin: I’ve always been fascinated by reproduction and motherhood and understanding “what it’s like” to mother in different contexts and circumstances. I work with mothers in South Africa as well as the US.  Ethnography is my favorite way of engaging in research, but I also enjoy the breadth and multidimensionality of interdisciplinary collaborations. My favorite way to do research, though, is by engaging and mentoring students.

Hines: I am passionate about research on chronic stress in Black woman and its impact on the maternal and infant mortality health disparity in Cleveland, Ohio. I am interested in women’s mental health, reproductive psychiatry and child and adolescent psychiatry.

What drew you to this project?

Rubin: When I learned about the great racial disparity in infant mortality around our campus in Cleveland, OH and the role of chronic stress in creating and maintaining that disparity, I wondered what it looked like and felt like to mother under those conditions. We started with that phenomenological question, and it led us to an understanding of how structural racism is experienced and resisted by Black mothers.

Hines: Black women’s voices are often silenced and objectified in medicine. This project amplifies the voices and stories of Black women and sheds light on the struggles and obstacles that black women face and overcome to successfully parent.

What was one of the most interesting findings?

The Black mothers in our study demonstrate a love and commitment to their children that defy pathologizing discourses like “Welfare Queen;” but they also disrupt the positive trope of the “Superstrong Black mother,” which renders invisible the hardship and grief of living and mothering in a racist society. Our findings forge a middle path by showing how Black mothers’ bodies are shaped by the chronic stressors of structural racism but are also a source of resistance, especially in service to their children.

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

Rubin: I’m reading Birthing Black Mothers by Jennifer C Nash. It’s a fascinating analysis of “Black motherhood” as a political symbol. It’s prompting me to reconsider my own analysis of Black motherhood, and also my positionality as a scholar. I’m also watching Season 10 of the Great British Baking Show. It’s a hug, nap, and cup of tea all rolled into one flaky pie crust. A working mother’s salve.

Hines: The Deepest Well: Healing the Long-Term Effects of Childhood Adversity by Dr. Nadine Burke Harris

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

Rubin: Listen to Black Mothers!

Hines: This project shows how social determinants of health are lived and embodied by vulnerable populations. Readers can use this information to better understand their perspective, provide holistic quality care, and to better advocate for systemic changes in society that can ultimately provide better health outcomes for and save the lives of Black mothers and babies.

Thank you for your time!


Other ways to connect:
Twitter: Sarah Rubin | Joselyn Hines
LinkedIn: Sarah Rubin
Other applicable website: Sarah Rubin

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.