mental health

In the “From the Archive” series, we will highlight articles published throughout the journal’s history. We look forward to sharing with our readers these samples of the innovative research that CMP has published on the cultural life of medicine across the globe.

At the journal, we often present fascinating work on psychiatric care throughout the world, including Joshua Breslau’s 2001 article “Pathways through the Border of Biomedicine and Traditional Chinese Medicine: A Meeting of Medical Systems in a Japanese Psychiatry Department” (volume 25 issue 3.)

In this piece, Breslau recounts stories of the two medical systems interacting during a meeting of clinicians employing, to varying degrees, traditional Chinese medicine (TCM) alongside biomedical interventions within a Japanese psychiatric department. The author asserts that Japan is perhaps the most common ground for the two medical systems to meet, and that it represents the “traffic” of medical knowledge between Japan, the Asiatic mainland, and the rest of the world. Indeed, Japan has had a lengthy history of exchange with foreign medical systems,beginning with the 18th-century import of anatomy textbooks from Holland. Combined with expanded trade with “the West” in the 19th century and the later resurgence of local Japanese interest in Chinese herbal remedies during the 1970s, we see that the two medical systems have both held a prominent position in the dynamic medical landscape in Japan.

Breslau observes that the two medical systems complement one another most strikingly in psychiatry, where kanpo (herbal treatments) are used both to diminish the uncomfortable side effects of psychoactive medications and to treat conditions for which there are few biomedical interventions. Exemplifying this blended approach to care, the author notes that Dr. Nakai, professor of psychiatry at Kobe University, examines the tongue to diagnose his patients. This method of diagnosis has its roots in TCM, and was taught to Dr. Nakai from a visiting Chinese student; many such Chinese students, having studied TCM, go to Japan to learn “Western medicine.” Although there is little formal education in TCM available in Japan, these interpersonal (and intercultural) exchanges are important mechanisms for sharing diverse medical techniques.

Another physician, Dr. Song, initially specialized in the use of acupuncture to treat psychiatric patients in China. Breslau theorizes that although it seems anomalous for traditional medicine to find a niche in conditions that generally fall under the scope of biomedicine, Dr. Song’s work is a productive blend of psychiatric treatments from both medical systems. Whereas patients in the Chinese biomedical settings were admitted alone, patients and their families stayed together in the TCM centers for mental health, thereby offering a support network that the biomedical patients lacked. In Japan, Dr. Song combined TCM and biomedical approaches. She established an “open ward” psychiatric unit that welcomed patients and their families, and employed both pharmaceutical and herbal remedies depending on the severity and the stage of psychiatric distress suffered by the patient.

Breslau’s piece reminds us of the complicated ways in which cultures are in contact with one another. Rather than reading medicine in China and Japan as a contest, where biomedicine and traditional Chinese medicine are at odds in the race to be deemed “most effective,” it is more accurate to describe the ways that the systems are in dialogue– often in the same clinical settings.

You can find the contents of the full issue in which Breslau’s article is published here: http://link.springer.com/journal/11013/25/3/page/1

Welcome back to the CMP blog! For the next two weeks we will post short descriptions of our newest articles from September 2014, which includes a special section addressing medical learning in South Asia as well as other thought-provoking pieces in the cultural construction of medicine, health, and illness. These updates are intended to offer a taste of the research we’re excited to share with you through the journal.

Knowledge and Skill in Motion: Layers of Tibetan Medical Education in India
Laurent Pordié & Calum Blaikie

In this article, the authors discuss the various ways that a student can be trained in Tibetan medical practice. They argue that there is not one means of medical training for Tibetan medicine, but rather numerous means of learning that alter the way the Tibetan practitioners learn and deliver medical care. In particular, three means of learning are highlighted: traditional apprenticeship under a Tibetan medical caregiver, classroom learning through a Buddhist institute, and lastly at a Tibetan medical organization intended to educate future practitioners from poorer rural regions with fewer resources than those attending the elite Buddhist school. The argument weighs the prestige and the social acceptance of each methods of training, noting that “institutionalisation tends to relegate ‘traditional training’ to an inferior level, in particular due to its heterogeneity and the social image of rural backwardness it presents.” It also addresses how different forms of learning are legitimated by the government and local authorities, and demonstrates the shift from skill-based learning via apprenticeship towards formal, institutional learning that emphasizes education over “enskillment.”

Of Shifting Economies and Making Ends Meet: The Changing Role of the Accompagnant at the Fann Psychiatric Clinic in Dakar, Senegal
Katie Kilroy-Marac

Kilroy-Marac draws from her ethnographic research in Senegal to offer a vivid picture of the shift in the role of the accompagnant, an attendant who stays with mental health patients for the duration of their hospitalization. Although this attendant was in previous generations a family member of the patient, there has been a sudden rise in professional accompagnants who are paid to stay with the patient at the clinic. The author notes that the “neoliberal turn” in Senegal towards increased wealth and commodification of services is exemplified in the professional accompagnant, whose services form a monetary transaction in lieu of fulfilling a familial duty to the patient: providing work for others and freeing up families who, in the newly-bolstered economy, often have other career and personal obligations. However, the author complicates this notion by noting how much the families cherish the attendant’s work and offer them gifts outside of typical payment agreements, and how these connections can often be special between families and the accompagnants.