Autism in Brazil and Italy: Two Cases From the June 2015 Special Issue

Posted by jknopes

Our July 2015 entries on the blog highlighted individual articles from our latest release, the June 2015 Special Issue on the conceptualization of autism (which you can access here.) These articles, focused centrally on anthropological and ethnographic accounts of autism across the world, explore contemporary issues surrounding identity, subjectivity, citizenship, biosociality, neurodiversity, and disability. In this week’s installment, we visit two more articles from the issue to investigate concepts of autism and its treatment in two countries: Brazil and Italy.

Autism in Italy: Rigidity and the Culture of Therapy

Read the full article by M. Ariel Cascio here: http://link.springer.com/article/10.1007/s11013-015-9439-6

In Italy, therapy and educational professionals who work with young adults with autism (ages 14-34) note that autism is often marked by a desire for intense social structure and timeliness: what they describe as “rigidity” or “rigid mind.” While the desire for structure is considered a core feature of the autism diagnosis across the world, Italian professionals who serve in community-based therapy, day centers, and residential homes for people with autism nevertheless have a complex relationship with “rigidity” as a mechanism for treatment.

Cascio interviewed both staff members at centers and programs for young people with autism as well as mental health and social service professionals throughout the region who worked on autism across the life course. These professionals voiced the value in creating structure for people with autism to assist in their development of improved social skills. Therapeutic centers and programs are themselves operated within an institutional structure that facilitates organized social interactions, both between their clients with autism and amongst staff members. However, professionals who worked at these programs often felt stymied by expectations from parents and their peers who wished for children with autism to adhere to a particular therapeutic regimen, diet, or activity schedule. The professionals likewise cautioned one another that taking any staunch, singular, and indeed “rigid” route to therapeutic intervention could prove counterintuitive to helping people with autism develop new social skills. Professionals embraced the idea of providing structure while, simultaneously, seeking to blend behavioral therapies to match individual client needs, as well as to create opportunities for clients to engage in valuable, less structured social activity.

These concerns about rigidity in the treatment of autism arrive at a time when older social structures for the care of neurodiverse individuals have been disassembled. In the 1970s, new social movements led to the deinstitutionalization of mental hospitals and care facilities, replacing the separation of mentally ill and neurodiverse individuals with integration policies that mandated new employment opportunities and equal-opportunity education for the developmentally disabled. Local mental health services attached to the national health care system provide psychiatric, behavioral, and therapeutic services that accompany other integration policies. This state of flux, at the societal level, refutes the notion that social services for autism must remain “rigid” and immmovable: they, too, change and develop with time given broader changes in the resources and services made available by the state to the disabled.

The Italian case presents a unique perspective on both the relationship between care professionals and the nature of diagnosis and treatment, as well as between concepts of autism at the scale of individual treatment and at the level of the state and national systems of health care. Like the discussion on Brazil, Italy similarly provides a fascinating context for the study of autism as a condition that is diagnosed globally, yet treated and conceptualized locally.

Autism in Brazil: Diagnosis, Identity, and Treatment Models

Read the full article by Clarice Rios and Barbara Costa Andrada here: http://link.springer.com/article/10.1007/s11013-015-9448-5

Brazil’s model for delivering social services to the developmentally disabled was directly modeled after the Italian system of deinstitutionalization and social integration of the mentally ill and neurodiverse. Treatment interventions for people with autism, however, were not included in Brazilian social services until the early 2000s, when adolescent and child mental health conditions were integrated into existing mental health systems. This shift increased programming for people with autism, however concerns accompanied this new system about the nature of diagnosis and treatment, as expressed differently by mental health professionals and the parents of children with autism.

Rather than viewing autism as an integral piece of an individual’s identity, Brazilian mental health professionals instead employ a social model of disability that stresses the environment that a person with autism exists within. Therapies emphasize social inclusion and bolstering all mental health clients’ sense of autonomy, so as to combat the exclusion and institutionalization of the individual. This model did not emphasize treatment plans specific to autism, but rather sought to improve the lives of all clients with mental disabilities. Mental health professionals voiced concerns about creating autism-specific services, saying that these programs would exclude people with other forms of mental disability from seeking appropriate care (and exclude people with autism from engagement with people of other mental disabilities.)

Parent activists who have children with autism, on the other hand, take an identity-based approach to championing the rights of people with autism. They argued that by underscoring the specific nature of autism as a mental disability, and providing services tailored to the treatment of autism, their children would be better prepared for social inclusion. Parents feared under-diagnosis of the condition, which would mean that their children– failing to have a certified diagnosis by a health professional– would be unable to seek out care resources and early intervention programs to improve behavioral and social outcomes.

In both instances, the authors stress that the dichotomy between medical and social models of disability is scarcely stable when examining autism in Brazil. Mental health professionals and parents of children with autism both grasp the importance of medical certification of autism (diagnosis) as a means to access services (that are aligned with the social model of illness.) However, parents and professionals disagree on the nature of these services; parents hold that social inclusion for people with autism requires an understanding of their difference from non-autistic people, while professionals strive to avoid employing specific diagnosis categories as a means to separate the kind of care and services they deliver to clients with other mental health conditions.

The Brazilian case thus highlights the nature of autism and mental disability as both a medical and a social condition: one that must be negotiated, treated, and diagnosed in light of its manifold implications for human health, development, and social life.

June 2015 Issue Preview: Guest Editor M. Ariel Cascio, on Global Autism Studies

Posted by jknopes

Culture, Medicine & Psychiatry’s second installment of the year arrives June 2015. This special issue will address anthropological studies of autism throughout the world. To give our readers a preview of the upcoming issue, special issue guest editor M. Ariel Cascio, PhD joined our social media editor for an interview to discuss compiling the issue, what topics the articles will address, and new themes in the study of autism.

Can you tell us a little about the upcoming June 2015 special issue?

The special issue, “Conceptualizing autism around the globe,” shares anthropological (and allied field) research on autism in Brazil, India, Italy, and the United States. We talk about “conceptualizing” autism as a way to counter the idea that autism “is” or “means” one specific thing. Sometimes autism means the diagnosis measured by a certain instrument (such as ADOS), sometimes it means a more broadly defined set of characteristics (such as those in the DSM), sometimes it means an individual identity, and so many more things. The articles in this issue explore how autism is conceptualized at several different levels: in national policy, in treatment settings, and in the home.

What’s been your favorite part of working on the special issue?

I’ve just enjoyed the opportunity to greater familiarize myself with the group of scholars who are pursuing the anthropology of autism, and to work alongside scholars whose work I have long followed.

So how did you become interested in the study of autism?

I’ve been studying autism since 2008. I actually came to anthropology before I came to autism, and when I first began learning about autism, I saw it as rich for anthropological inquiry (isn’t everything!) because of anthropology’s strengths in focusing on lived experience, challenging deficit narratives of so-called “disorders,” and placing medicine and psychiatry in sociocultural context.

What was it like doing fieldwork in Italy? How do Italians see autism differently than other places in the world?

I’ve studied the autism concept more in Italy than in any other place in the world, and I’m very grateful to everyone there from whom I learned – autism professionals, family members of people with autism, and people on the spectrum themselves. I could hazard comparisons with the literature that address perceptions in other parts of the world – and some of these comparisons come through in the special issue – but for now I would like to focus on the strength of the rich description of the Italian context without external comparison. As my article in the special issue shows, autism professionals tended to take a social model of autism, focusing on creating environments that were tailored to the needs of people on the spectrum and structured to help them learn.

What are some of the challenges you’ve faced in studying autism?

As in many areas of inquiry familiar to readers of CMP, it can be challenging to communicate information about my study to people who study autism in other fields (clinical, psychological, social work, etc.). A lot of research about autism takes a positivist stance, whereas my research takes an interpretivist stance and focuses on autism as a concept whose meaning may vary rather than a diagnosis measured in a particular way. Nonetheless, I love talking about my research interests with a broad audience because in many contexts (especially in the U.S.), so many people have personal or professional interest in autism and we can always have interesting and stimulating conversations.

What’s something you think would surprise non-anthropologists about the anthropology of autism?

I would imagine non-anthropologists would be surprised by the anthropology of autism for the same reasons they might be surprised by anthropology (or medical anthropology) in general. For example, they might be surprised that anthropologists study autism all over the world, particularly if they think of the autism concept as something that represents a universal set of characteristics and experiences that are unaffected by context. The articles in this special issue really show that context matters in all conceptualizations of autism, from Brazil to the United States, from national policy to the family home.

Where do you see the anthropology of autism heading next?

I see the anthropology of autism becoming more inclusive. In her commentary, Pamela Block expresses optimism that the anthropology of autism will increasingly include researchers who identify as autistic themselves, and I agree. In addition to including more researchers with autism, I anticipate that the anthropology of autism will increasingly work to include participants with higher levels of support needs (those whom some people call “people with low-functioning autism”), and delve deeper into their lived experiences as well.

Many thanks to Dr. Cascio for sharing her insights! Look for the special issue on conceptualizing autism in June 2015, and be sure to check back for more previews of the issue, article features, and other blog entries about the new installment here on our website.

AAA 2014: Sessions on Psychiatry, Mental Illness, and Drugs

Posted by jknopes

For our readers attending the American Anthropological Association annual meeting this year, we’re featuring a list of sessions sure to pique your interest in various aspects of mental illness, health, drugs, and psychiatric care. The following selection of sessions was drawn from this year’s AAA online presentation schedule for the 2014 annual meeting, to be held this year in Washington, DC from December 3-7th (for more information, click here: http://www.aaanet.org/meetings). Sessions in the list are organized by chronological date and time.

If you would like your session to be added to this list, please email a link to the session description on the AAA website to: jcb193@case.edu.

Global Mental Healthcare: Challenges, Controversies and Innovations

Wednesday, December 3rd 2pm-3:45pm

http://aaa.confex.com/aaa/2014/webprogram/Session12926.html

“Global” Knowledge, “Local” Care, and Subjectivity: Producing an Anthropology of Psychosis

Wednesday, December 3rd 2pm-3:45pm

http://aaa.confex.com/aaa/2014/webprogram/Session11392.html

Psyche and the Brain in the 21st Century

Wednesday, December 3rd 4pm-5:45pm

http://aaa.confex.com/aaa/2014/webprogram/Session11636.html

Transcendance and the Everyday in Responses to Trauma

Thursday, December 4th 2:30-4:15pm

http://aaa.confex.com/aaa/2014/webprogram/Session11838.html

What Drugs Produce

Saturday, December 6th 9am-10:45am

http://aaa.confex.com/aaa/2014/webprogram/Session11124.html

Psychological Disorder and Subjectivity in Socio-Political Context

Saturday, December 6th 11am-12:45pm

http://aaa.confex.com/aaa/2014/webprogram/Session12768.html

Ordering, Morality and Triage: Producing Medical Anthropology Beyond the Suffering Subject Part 2: Mental Health and Illness

Saturday, December 6th 2:30pm-4:15pm

http://aaa.confex.com/aaa/2014/webprogram/Session11809.html

Professional Perspectives in the Anthropology of Drugs

Saturday, December 6th 6:30pm-8:15pm

http://aaa.confex.com/aaa/2014/webprogram/Session11263.html

From the Archive: Biomedicine, Chinese Medicine, and Psychiatry

Posted by jknopes

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

Current Issue Highlight: September 2014 (Vol 38 Issue 3) Part One

Posted by jknopes

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.