SPA Interview with Dr. Greg Downey and Dr. Daniel Lende

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This week on the blog we are featuring a partial summary of an interview with Dr. Greg Downey and Dr. Daniel Lende, conducted by Kathy Trang, as part of the Society for Psychological Anthropology “Voices of Experience” series. In this audio conversation, available in full here, the doctors discuss their work establishing the field of nueroanthropology. Together, they served as co-editors of The Encultured Brain: an Introduction to Neuroanthropology, available from MIT Press.

The SPA “Voices of Experience” series is a venue to showcase the range of work that psychological anthropologists engage in, and to give listeners, virtually attending the live events, the opportunity to ask prominent scholars in the field about their work.


spa voices logoThe interview begins with an introduction of the authors and an acknowledgement of the wide diversity of interests and geographic locations of the audience. Then, Kathy Trang launches into a general discussion about the academic frustrations that led to the foundation of neuroanthropology.

Kathy Trang: We’ll start with the origins of neuroanthropology. As you guys detailed in the nueroanthroplogy book which was published in 2015, as well as various other platforms, such as the blog, one of the impetus behind nueroanthropology was the dissatisfaction that you both felt with either sociocultural theory or with biological anthropology. Could you tell us a little bit more about your frustration at that time? And what you felt from the standpoint of your research was missing?

Dr. Greg Downey: My dissatisfaction was really quite simple. When I was in Brazil, I was working on with Capoeira practitioners, practitioners of this Afro-Brazilian martial art. It’s pretty arduous, pretty demanding, like a lot of martial arts and acrobatics. This was a physical discipline. And the people there were claiming that it has all these effects. And I was trained straight up cultural anthropology, University of Chicago, They would say, the people I was interviewing were always working and learning alongside, would say “Oh, it changes the way you move, it changes the way you perceive. You see differently, you balance differently.”

I kept writing this down, good classic social constructionist, interpretive anthropology. At some point, I was like “is this plausible?” I mean, could it really do this? I realize that it was an empirical question that in fact I had to look outside the culture anthropology I had been taught to find out. As I started to explore sort of the neuropsychology of skill acquisition and training and sports, I found out that not only was it plausible but there were all kinds of interesting documented effects. I realized the culture theory, in this sense, around the question of embodiment, I’ll come back to the word embodiment at some point, it was pointing in the direction of neurological change without actually attempting to theorize about neurological change or explore neurological change. In a sense, I kind of felt like the cultural theory I had been taught was under ambitious. There was a clear boundary with the biological and they didn’t want to cross it, but in the process that meant that they were ignoring a lot of the effects of the enculturation I was seeing.

In a sense, it was feeling like I was up against an artificial boundary that had been drawn for me by my training, and I was dissatisfied with that. Maybe I should hand that over to Daniel. Where were you?

Dr. Daniel Lende: I would more emphasize the excitement of trying to combine neuroscience and anthropology. In my case, I had worked as a councilor to kids that had drug problems in Colombia prior to starting grad school. And then I went to grad school in the biocultural program at Emory University, and so it was an integrative program but nonetheless there was a biological/cultural split there.

I didn’t find ways to always connect what I was learning with social theory or from evolutionary theory to what I already knew about these kids’ lives in Bogata, Colombia.

For example, addiction is often referred to in shorthand as “queire mas y mas” – to want more and more – in Colombia. I came across a paper, a 1993 paper by Kent Berridge and Ann Robinion, that talked about addiction and correspondence between neuroscience and anthropology. I wanted to pursue that more.

Trang: Coming in pursuit of neuroanthropology, to you guys what really defines neuroanthropology? That is, how do you demarcate neuroanthropology from closely related disciplines, such as psychological anthropology, for instance, or cultural neuroscience, and/or population neuroscience?

 

Daniel  Lende

Dr. Daniel Lende, via the University of Southern Florida Department of Anthropology

Lende: I’m going to tackle the first part of that, more in relation to psychological anthropology. I think Greg and I have always been pretty clear that neuroanthropology is what it says, the combination of neuroscience and anthropology. The word anthropology is full, so it’s more emphasis on anthropology than neuroscience. We’re both anthropologists.

 

It is an approach that aims to, at the one hand permit anthropologists to draw cognitive science broadly, I would say, in pursing their own research questions, specifically questions they have that are field-based, get data in field-based settings. But as an outcome of doing that type of work, suddenly we have a rich appreciation of what we call “brains in the wild.” That then can provide feedback to neuroscientists, cognitive scientists working in laboratory settings, and also, in both our cases, but for example in my case, clinicians working with addiction, or in Greg’s case, coaches and other people working in applied sciences. So our field-based approach is something that makes neuroanthropology distinctive from some of the other traditions that emphasize the nuero side.

In terms of psychological anthropology, I think we drew a lot on how psychological anthropology recognizes cross cultural variation and mental processes and how psychological anthropology emphasizes the individual in context. But I would say that we have found more inspiration in neuroscience in the third way of cognitive science as a way to really try to grapple with empirical questions that came up during fieldwork. Now today we can develop it differently and take that integration of neuroscience and anthropology to sort of develop new framework to examine patterns of human variation in more naturalistic settings.

Downey: I’m going to pick up the cultural neuroscience side of this, because I end up talking to a lot of cultural neuroscientists and I really admire their work but one of the things they run against is they are neuroscientists first, not cultural theorists first. They work with a cultural model they can operationalize quite easily. That’s often a very limited model. Frankly, it looks very old fashioned; it often looks like it’s just running the same tests on different what are basically ethnic groups, wherever they have an fMRI machine and comparing the results and calling the differences the culture. There’s all kinds of intellectual problems with that, but it shows that if you put the experimental design first and the cultural theory kind of a distant, last place, you can wind up with some very unsophisticated accounts of what you’re actually getting in the fMRI, especially when you’re just contrasting populations that we know that there’s a long history of drawing these very blunt comparisons between, say Asians and Westerners. Cultural neuroscience I think in some ways there’s a good conversation to have but we have to bring an operationalizable cultural theory to that.

Lende: Similarly, the whole population neurosciences or population-based epidemiological models for thinking about neurological variation, they’re really interesting but they’re very much based on a kind of exposure-epidemiological demographic model.  I think they’re a little less developed than the cultural neurosciences, so there’s an idea of exposures.  We can talk about brain differentiation as a result of exposure. Culture isn’t just an exposure, like being exposed to an environment insult or a pathogen of some sort. The danger of medicalization in this case is that it removes a lot of the most interesting interesting phenomena. Certainly, my work in skill acquisition and sensory training, it’s very difficult to model this as exposure because it’s this really, really long term projects that unfold over time and stages to enculture the brain in a particular way. We have a lot of conversation with all three of those, but there’s limits that we run up against.

TrangI know that in one of your publications, Greg, you had critiqued this sort of return to cultural dimensions. What to you guys is culture for neuroanth? What is the best take, or an adequate take, of culture for neuroanthros?

GregandLouis

Dr. Greg Downey, via his personal website

Downey: Daniel and I have been arguing about this for the past week, just so you realize. I just think of culture as a really lousy ptolemaic kind of category, a pre-Copernicus category in which people slap on any difference between groups and they’re often times applying it to completely different sorts of things. They’re using a Parsonian model of what’s causing it, a pure symbolic layer of existence. To me, every time I read cultural theory it’s like we’re theorizing fifteen different things at once. And it’s no wonder we have a morass. What people are getting at with culture is just the idea that there are some differences between groups, between peoples, that are induced, that are not innate in their biology. How do we think about that pattern of both similarity with group and differences between group? The whole sort of hermeneutic model that culture is interpretation is part of what limits us from seeing the neurological impacts of enculturation process. I think we’re going to have to disassemble culture into pieces to figure out how to theorize it.

 

LendeI have a more pragmatic approach to how to think about culture as neuroscientist and anthropologist. One of the first things is to recognize that most of the models of human variation used in psychology and cognitive science broadly, are models of individual variation, often based on the idea of a bell curve. Whereas most of the phenomena anthropologists, particularly cultural anthropologists, study are shared phenomena. In other words, most people share the same amount of variation, which is why on the individual basis approach of assessing culture doesn’t necessarily get at the shared depth that can tie a group together and make them distinctive from other groups, whatever level you’re talking about. In Greg’s case it can be the Capoeira practitioners, in my case it can be people who gather together in certain scenes, drug use scenes in Bogata, up to talking about much broader things, in my case for example, why Colombia might have had, at the time of doing research there, lower drug use rates than the United States. What sort of sociocultural reasons explain that? It’s not necessarily an exposure because the epidemiological exposures are actually quite similar between the United States and Colombia.

From that recognition of looking at the shared aspect of human life, I would just outline that those series of different types of cultural approaches that can be useful to different types of research questions. I think in many ways the interpretive approach, coming from Geertz, can be quite useful in understanding certain things that people report. For example, a lot of the interpretation of what drug use meant to my informants were accessible to using psychological anthropology approaches. But that’s a different type of culture theory than one that’s more place-based, that would have drawn ritual or what’s happening in a particular scene. That’s different from an approach that might emphasized by the idealogical dimensions that surround our understanding of neuroscience and the production of neuroscience. Those are also different from more practice-based approaches which Greg engages with more than I do. I think there’s a variety of types of culture theory and they can be useful in different ways and at different times just as there’s a  variety of neuroscientific approaches out there.

 


The interview with Dr. Downey and Dr. Lende continues, and concludes with a question and answer session with listeners who were virtually tuned in during the live recording of the interview. The full audio interview recording is available here.


Dr. Greg Downey is a Professor of Anthropology at Macquarie University in Sydney, Australia. He attended the University of Chicago. His work is focused in Brazil, the Pacific, and the United States and his research interests include the census, sports, dance, and skill acquisition. His current project is human echolocation among the blind.  Dr. Downey is the author of several books, including Frontiers of Capital: Ethnographic Reflections on the New Economy (2006) from Duke University Press and Learning Capoeira: Lessons in Cunning from an Afro-Brazilian Art (2005) from Oxford University Press.

Dr Daniel Lende is an Associate Professor of Anthropology at the University of South Florida. He trained at Emory University. His research interests include substance use and abuse, stress and resilience, the intersection of anthropology and nueroscience, and public and applied anthropology. He has done work in Colombia and the United States. His book, Addiction: A Search for Understanding, is currently in preparation.

Kathy Trang is the Electronic Publications Editor and Anthropology New co-Editor for SPA.

 

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Issue Highlight Vol 40 Issue 3: Asperger’s Syndrome, Subjectivity and the Senses

This week, we will highlight an Illness Narrative from the September 2016 issue of the journal (available here). Here we feature Ellen Badone, David Nicholas, Wendy Roberts, and Peter Kien’s article “Asperger’s Syndrome, Subjectivity and the Senses.” To read the full article, click here.


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As previous blog highlights suggest, the intersections of research and illness narratives are important to an anthropological perspective on subjectivity and experience. Badone and colleagues situate their article within narrative phenomenology. They discuss how constructing an illness narrative gives patients and families hope, and frames their experiences in a positive direction. The personal narrative, then, allows individuals to express their agency in hostile structural and environmental settings. The narrative also serves as a valuable first-hand account from which medical anthropologists can learn more about the subjective experience of illness.

The authors perform a close reading of an autobiographical narrative recounted by Peter, a young man diagnosed with Asperger’s Syndrome, a type of autism spectrum disorder (ASD.) Badone and colleagues aim to describe Peter’s case to widen understandings of the lived experience of people with autism. Responding to Olga Solomon’s 2010 article “Sense and the Senses: Anthropology and the Study of Autism,” this paper calls into question key assumptions in the clinical and popular literature about ASD relating to theory of mind, empathy, capacity for metaphorical thinking, and ASD as a life-long condition.

Badone and colleagues begin with a brief history of the diagnostic label of ASD, then describe the ethnographic-autobiographical process. Peter, the pseudonym chosen by the young man whose story is told in this article, reflects on his life experiences and articulates his awareness of autism and its impact on his life. An important recognition that Peter makes is that he senses many of the places he encountered were characterized by the “opposite of accommodation.” In the context of his elementary and high school for example, Peter describes how his need for calm and respite were disregarded in the noisy, abrasive environments. But it is Peter’s mother who is his metaphorical, and social, link to the world he felt dislocated from. Peter describes how it was his mother’s love and guidance which kept him alive and motivated to improve his life.

As Peter continues to narrate his experiences, however, he begins to intentionally seek out interactions in unwelcoming social environments. To Badone, Peter’s later decisions to submerse himself in activities that he found difficult, such as unexpected social situations and interactions, was an unconscious therapeutic response. This response mirrored the principles of cognitive behavioral therapy (CBT). To Badone’s astonishment, Peter had unintentionally started a treatment regimen to gradually lessen his anxiety, decrease his “meltdowns,” and become more independent. But to do so, Peter had to alter his own connection to a social environment that initially felt closed to him.

Badone and colleagues conclude, upon analyzing Peter’s narrative, that quality of life improves when individuals with autism are allowed to flourish in a social milieu of acceptance and understanding. Through the narrative, and through phenomenological examination of moments in Peter’s life, Badone and Peter hope to foster understanding and to urge others to create inclusive communities where social interaction is supported and individuals are not made to feel unwelcome. They seek to make autism more coherent to the non-autistic world and thereby to promote the larger ethical goal of creating flexible communities open to accommodating neurodiversity.

Blog Archive: Neuropsychiatry and Culture

This week on the blog, we revisit a guest commentary piece written last year by M. Ariel Cascio, PhD (originally posted here.) Dr. Cascio is an anthropologist specializing in the cultural study of science and biomedicine, psychological anthropology, and the anthropology of youth. Her research explores the biopolitical dimensions of autism and autism-related services in northern Italy. She can be reached at ariel.cascio@case.edu.

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In the 21st century, anthropologists and allied scholars talk frequently of the biologization, cerebralization or neurologization of psychiatry. Many make reference to the 1990s, the “Decade of the Brain” that closed out the last century. They talk about “brain diseases” as a dominant discourse in discussions of mental illness. The 2014 Annual Meeting of the American Anthropological Association hosted a panel on “reflections on mind and body in the era of the ‘cerebral subject.’” In these and other ways, scholars write and talk about increasing dominance of brain discourses in discussion of psychological and psychiatric topics. This dominance has historical roots, for example in German (Kraepelinian) psychiatry, and authors in Culture, Medicine & Psychiatry and elsewhere have written about the historical context and local manifestations of this dominance of the neurological in the psy- sciences.

In this blog post I explore a situation in which neurology and psychiatry have long co-existed: the Italian field of neuropsychiatry. While the field “neuropsychiatry” is not unknown in the United States, and similar terms are used in other countries as well, I offer some comments specifically on the Italian context. The example of Italian neuropsychiatry provides one case of a particular historical relationship between neurology, psychiatry, and psychology that would be of interest to any historical or anthropological scholars of psychiatry.

The Italian medical system distinguishes between neuropsychiatry and psychiatry, neuropsichiatria infantile and psichiatria. Neuropsichiatria infantile (child neuropsychiatry), abbreviated NPI but sometimes referred to simply as neuropsichiatria (neuropsychiatry), addresses neurological, psychiatric, and developmental problems in children under age 18. Psichiatria (psychiatry) treats adults starting at age 18. As such, it is tempting to simply distinguish child and adult psychiatry. However, neuropsychiatry and psychiatry actually have distinct origins and practices. As the names imply, neuropsychiatry links neurology and psychiatry. Adult psychiatry, however, does not.

While Italian psychiatry has its roots in early 19th century organicist and biological approaches, in the 1960s a younger generation of psychiatrists, most prominently Franco Basaglia, aligned themselves with phenomenology and existential psychiatry. These psychiatrists crystallized their ideas into the ideology of Psichiatra Democratica (Democratic Psychiatry) and the initiative of “Basaglia’s Law,” the 1978 Law 180 which began Italy’s process of deinstitutionalization, generally considered to be very successful (Donnelly 1992). While childhood neuropsychiatry is indeed the counterpart to adult psychiatry, more than just the age group served differentiates these fields. If Italian psychiatry has its roots in Basaglia and the ideology of democratic psychiatry, neuropsychiatry has its roots at the turn of the 20th century, in the works of psychiatrist Sante de Sanctis, psychopedagogue Giuseppe F. Montesano, and pedagogue Maria Montessori.

In this way, neuropsychiatry’s origins bridged psychiatry and pedagogy (Bracci 2003; Migone 2014). Giovanni Bollea has been called the father of neuropsychiatry for his role in establishing the professional after World War II (Fiorani 2011; Migone 2014). Fiorani (2011) traces the use of the term neuropsychiatry (as opposed to simply child psychiatry, for example) to Bollea’s desire to honor the distinctly Italian tradition and legacy following Sante de Sanctis.

Several features distinguish psychiatry and neuropsychiatry. Migone (2014) argues that child neuropsychiatry has taken more influence from French psychoanalytic schools, whereas adult psychiatry has taken more influence from first German and then Anglo-Saxon psychiatries. Migone further explains:

Child and adolescent psychiatry in Italy is therefore characterized by a reduced use of medications (if compared to the United States), and by a diffuse use of dynamic psychotherapy, both individual and family therapy (from the mid-1970s systemic therapy spread). The attention to the family and the social environment is extremely important for understand the clinical case during the developmental years. [My translation]

Moreover, neuropsychiatry is known for being multidisciplinary and working in equipe, teams of psychiatrists, psychologists, social workers and so on. It incorporates psychoanalysis, psychotherapy, dynamic psychology, psychological testing, social interventions, and more (Fiorani 2011).

This extremely brief overview outlines key characteristics of Italian neuropsychiatry and the ways it is distinguished from Italian psychiatry, as well as from U.S. psychiatry. Italian neuropsychiatry provides one example of a long-standing relationship between neurology, psychiatry, psychology, philosophy, and pedagogy. By drawing attention to this medical specialty and the complexities of the different fields it addresses, I hope to have piqued the interest of historical and anthropological scholars. I include English and Italian language sources for further reading below.

References and Further Reading – English

Donnelly, Michael. 1992. The Politics of Mental Health in Italy. London ; New York: Routledge.

Feinstein, Adam. 2010. A History of Autism: Conversations with the Pioneers. Malden, MA: Wiley-Blackwell.

Levi, Gabriel, and Paola Bernabei. 1997. Italy. In Handbook of Autism and Pervasive Developmental Disorders. 2nd edition. Donald J. Cohen and Fred R. Volkmar, eds. New York, NY: John Wiley & Sons.

Nardocci, Franco. 2009. The Birth of Child and Adolescent Neuropsychiatry: From Rehabilitation and Social Inclusion of the Mentally Handicapped, to the Care of Mental Health during Development. Ann Ist Super Sanità 45: 33–38.

References and Further Reading – Italian

Bracci, Silvia. 2003. Sviluppo della neuropsichiatria in Italia ed Europa. Storia delle istituzioni psichiatriche per l’infanzia. In L’Ospedale psichiatrico di Roma. Dal Manicomio Provinciale alla Chiusura. Antonio Iaria, Tommaso Losavio, and Pompeo Martelli, eds. Pp. 145–161. Bari: Dedalo.

Fiorani, Matteo. 2011. Giovanni Bollea, 1913-2011: Per Una Storia Della Neuropsichiatria Infantile in Italia. Medicina & Storia 11(21/22): 251–276.

Migone, Paolo. 2014. Storia Della Neuropsichiatria Infantile (prima Parte). Il Ruolo Terapeutico 125: 55–70.

Russo, Concetta, Michele Capararo, and Enrico Valtellina. 2014. A sé e agli altri. Storia della manicomializzazione dell’autismo e delle altre disabilità relazionali nelle cartelle cliniche di S. Servolo. 1. edizione. Milano etc.: Mimesis.

 

Special Issue Highlight: The Anthropology of Autism, Part 1

The newly released June 2015 special issue of Culture, Medicine & Psychiatry addresses anthropological studies of autism from around the world, including the United States, India, and Italy. In this installment and the next entry on the blog, we will explore four articles published in the latest issue. This research spans the fields of disability studies, psychological anthropology, and medical anthropology, and touch on themes of identity, subjectivity, family caregiving, and community. Here, we will focus on two articles in this publication.


Parenting a Child with Autism in India: Narratives Before and After a Parent–Child Intervention Program

Rachel S. Brezis, et al.

Throughout India, there are limited social services and support networks for individuals with autism and their families. Furthermore, neurodiverse (and mentally ill) individuals have historically been cared for in private by family members in India, where they are hidden from the community and may be treated as a mark of shame on the household. However, despite these challenges, Indian parents of children with autism are increasingly seeking out professional programs that educate them about autism and appropriate caregiving strategies.

One such program in New Delhi, the Parent-Child Training Program (PCTP), evidences the changing view towards autism in India. The program aims to educate parents about autism and, in so doing, encourage them to educate others about the experience of raising a child with the condition. Parents bring their child to PCTP and learn alongside them. As the first program in India to provide such training, its examination proves essential in understanding the way that various populations (here in India) are now approaching the shifting landscape of autism.

Brezis and colleagues studied the PCTP to discover how the training was altering parents’ perceptions of autism and relationships with their children. They interviewed 40 pairs of parents at the beginning and end of the 3-month program, encouraging the parents to speak for five minutes without prompts regarding their child and their relationship to the child.

The authors found that parents who participated in the three-month program were less likely to describe their children in relation to an assumed “normality,” although mothers proved to be more likely than fathers to self-reflect on their relationship with their child. Similarly, while parents described their child’s behaviors no less frequently in the second and final interview, they did not note behavior in relation to other individuals’ behavior perceived as “normal.”

To learn more about this research, click here for a link to the article: http://link.springer.com/article/10.1007/s11013-015-9434-y

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Custodial Homes, Therapeutic Homes, and Parental Acceptance: Parental Experiences of Autism in Kerala, India and Atlanta, GA USA

Jennifer C. Sarrett

Like Brezis et al, Sarrett also investigates Indian caregiving and parental experiences of autism, while comparing this context to autism and the family in the United States. In both cases, Sarrett asks how the home as space and place impacts the meaning of disability for people with autism. She interviewed seventeen caregivers in Atlanta and thirty-one in Kerala, and observed seventeen families in Kerala and five families in Atlanta who had also participated in interviews. Sarrett concludes that though there are some similarities in the constellation of autism-specific and biomedical services that may be available to Keralite and American families, the arrangement of households themselves drastically changes the way autistic children are cared for in each location.

In Kerala, for example, mothers serve as both full-time child caregivers as well as domestic laborers, often spending long hours washing clothes by hand and cooking from scratch. Keralite children with autism have few interactive toys that are specifically geared to engaging them, few devices that may control their movements and behaviors (such as baby gates) or assist them in communication (such as an electronic device that voices requests for food or other needs.) Such tools are common in Atlanta households. However, they have consistent household care from mothers who manage all domestic labor with no outside employment.

Households with autistic children in Atlanta, meanwhile, are specifically retrofitted for the needs of the child. There are picture cards that children may use to show caregivers and parents an item of food that they wish to eat, as well as a calendar in the kitchen or office that marks doctors’ appointments and family events geared for socialization with the autistic child. Baby gates, cabinet locks, and other safety devices ensure the child does not come into contact with household dangers (such as kitchen knives and cleaning solutions.)

In sum, these tools are designed to change and improve the behavior of the child. The home itself is structured to be a therapeutic space: requiring material and financial resources that Keralite families do not have to physically adjust their households. Instead, Keralite families focus not on improving or altering an autistic child’s behavior, but rather emphasize consistent caregiving for the child. In both cases, however, parents are committed to creating an environment (be it material or social) in which a child with autism can be integrated into the activities of the household, and thus into the family’s social world. Despite cultural, and certainly resource, differences between Indian and American families, they share a common commitment to building home support systems for their developmentally disabled children.

Click here to access the full text of this article: http://link.springer.com/article/10.1007/s11013-015-9441-z


To access all of the articles in this issue, click here: http://link.springer.com/journal/11013/39/2/page/1

Guest Blog: Culture, Medicine, and Neuropsychiatry

This week, we are featuring a special guest blog post by M. Ariel Cascio, PhD. Here, she discusses neuropsychiatry in the Italian context and within the United States.

In the 21st century, anthropologists and allied scholars talk frequently of the biologization, cerebralization or neurologization of psychiatry. Many make reference to the 1990s, the “Decade of the Brain” that closed out the last century. They talk about “brain diseases” as a dominant discourse in discussions of mental illness. The 2014 Annual Meeting of the American Anthropological Association hosted a panel on “reflections on mind and body in the era of the ‘cerebral subject.’” In these and other ways, scholars write and talk about increasing dominance of brain discourses in discussion of psychological and psychiatric topics. This dominance has historical roots, for example in German (Kraepelinian) psychiatry, and authors in Culture, Medicine & Psychiatry and elsewhere have written about the historical context and local manifestations of this dominance of the neurological in the psy- sciences.

In this blog post I explore a situation in which neurology and psychiatry have long co-existed: the Italian field of neuropsychiatry. While the field “neuropsychiatry” is not unknown in the United States, and similar terms are used in other countries as well, I offer some comments specifically on the Italian context. The example of Italian neuropsychiatry provides one case of a particular historical relationship between neurology, psychiatry, and psychology that would be of interest to any historical or anthropological scholars of psychiatry.

The Italian medical system distinguishes between neuropsychiatry and psychiatry, neuropsichiatria infantile and psichiatria. Neuropsichiatria infantile (child neuropsychiatry), abbreviated NPI but sometimes referred to simply as neuropsichiatria (neuropsychiatry), addresses neurological, psychiatric, and developmental problems in children under age 18. Psichiatria (psychiatry) treats adults starting at age 18. As such, it is tempting to simply distinguish child and adult psychiatry. However, neuropsychiatry and psychiatry actually have distinct origins and practices. As the names imply, neuropsychiatry links neurology and psychiatry. Adult psychiatry, however, does not.

While Italian psychiatry has its roots in early 19th century organicist and biological approaches, in the 1960s a younger generation of psychiatrists, most prominently Franco Basaglia, aligned themselves with phenomenology and existential psychiatry. These psychiatrists crystallized their ideas into the ideology of Psichiatra Democratica (Democratic Psychiatry) and the initiative of “Basaglia’s Law,” the 1978 Law 180 which began Italy’s process of deinstitutionalization, generally considered to be very successful (Donnelly 1992). While childhood neuropsychiatry is indeed the counterpart to adult psychiatry, more than just the age group served differentiates these fields. If Italian psychiatry has its roots in Basaglia and the ideology of democratic psychiatry, neuropsychiatry has its roots at the turn of the 20th century, in the works of psychiatrist Sante de Sanctis, psychopedagogue Giuseppe F. Montesano, and pedagogue Maria Montessori.

In this way, neuropsychiatry’s origins bridged psychiatry and pedagogy (Bracci 2003; Migone 2014). Giovanni Bollea has been called the father of neuropsychiatry for his role in establishing the professional after World War II (Fiorani 2011; Migone 2014). Fiorani (2011) traces the use of the term neuropsychiatry (as opposed to simply child psychiatry, for example) to Bollea’s desire to honor the distinctly Italian tradition and legacy following Sante de Sanctis.

Several features distinguish psychiatry and neuropsychiatry. Migone (2014) argues that child neuropsychiatry has taken more influence from French psychoanalytic schools, whereas adult psychiatry has taken more influence from first German and then Anglo-Saxon psychiatries. Migone further explains:

Child and adolescent psychiatry in Italy is therefore characterized by a reduced use of medications (if compared to the United States), and by a diffuse use of dynamic psychotherapy, both individual and family therapy (from the mid-1970s systemic therapy spread). The attention to the family and the social environment is extremely important for understand the clinical case during the developmental years. [My translation]

Moreover, neuropsychiatry is known for being multidisciplinary and working in equipe, teams of psychiatrists, psychologists, social workers and so on. It incorporates psychoanalysis, psychotherapy, dynamic psychology, psychological testing, social interventions, and more (Fiorani 2011).

This extremely brief overview outlines key characteristics of Italian neuropsychiatry and the ways it is distinguished from Italian psychiatry, as well as from U.S. psychiatry. Italian neuropsychiatry provides one example of a long-standing relationship between neurology, psychiatry, psychology, philosophy, and pedagogy. By drawing attention to this medical specialty and the complexities of the different fields it addresses, I hope to have piqued the interest of historical and anthropological scholars. I include English and Italian language sources for further reading below.


References and Further Reading – English

Donnelly, Michael. 1992. The Politics of Mental Health in Italy. London ; New York: Routledge.

Feinstein, Adam. 2010. A History of Autism: Conversations with the Pioneers. Malden, MA: Wiley-Blackwell.

Levi, Gabriel, and Paola Bernabei. 1997. Italy. In Handbook of Autism and Pervasive Developmental Disorders. 2nd edition. Donald J. Cohen and Fred R. Volkmar, eds. New York, NY: John Wiley & Sons.

Nardocci, Franco. 2009. The Birth of Child and Adolescent Neuropsychiatry: From Rehabilitation and Social Inclusion of the Mentally Handicapped, to the Care of Mental Health during Development. Ann Ist Super Sanità 45: 33–38.

References and Further Reading – Italian

Bracci, Silvia. 2003. Sviluppo della neuropsichiatria in Italia ed Europa. Storia delle istituzioni psichiatriche per l’infanzia. In L’Ospedale psichiatrico di Roma. Dal Manicomio Provinciale alla Chiusura. Antonio Iaria, Tommaso Losavio, and Pompeo Martelli, eds. Pp. 145–161. Bari: Dedalo.

Fiorani, Matteo. 2011. Giovanni Bollea, 1913-2011: Per Una Storia Della Neuropsichiatria Infantile in Italia. Medicina & Storia 11(21/22): 251–276.

Migone, Paolo. 2014. Storia Della Neuropsichiatria Infantile (prima Parte). Il Ruolo Terapeutico 125: 55–70.

Russo, Concetta, Michele Capararo, and Enrico Valtellina. 2014. A sé e agli altri. Storia della manicomializzazione dell’autismo e delle altre disabilità relazionali nelle cartelle cliniche di S. Servolo. 1. edizione. Milano etc.: Mimesis.


ABOUT THE AUTHOR

M. Ariel Cascio is an anthropologist specializing in the cultural study of science and biomedicine, psychological anthropology, and the anthropology of youth. She recently successfully defended her dissertation on autism in Italy at Case Western Reserve University. She can be reached at ariel.cascio@case.edu. Her blog, written in Italian and English, can be viewed here: https://arielcascio.wordpress.com/.