psychiatry

2016 Preview: Books Received at the Journal

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First made available online last month, Culture, Medicine & Psychiatry has released its most recent lists of books received for review at the journal (which you can access on our publisher’s website at this link.) These books include Carlo Caduff’s The Pandemic Perhaps: Dramatic Events in a Public Culture of Danger and Janis Jenkins’ Extraordinary Conditions: Culture and Experience in Mental Illness. Last year, we featured Caduff’s text (here) and Jenkin’s text (here) in book release features here on the blog.

The journal has also received the following two books for review. Here are the two releases:

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Image via UPenn Press website

New from the University of Pennsylvania Press is a collection of essays entitled Medical Humanitarianism: Ethnographies of Practice (available here.) Edited by Sharon Abramowitz and Catherine Panter-Brick, with a foreword by Peter Piot, the book explores the experiences of health workers and other practitioners who deliver humanitarian medical aid throughout the world. The book promises a “critical” yet “compassionate” account of humanitarian projects spanning Indonesia, Ethiopia, Haiti, Liberia, and other nations.

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Image via Cornell UP website.

From Cornell University Press comes Gabriel Mendes’ Under the Strain of Color:
Harlem’s Lafargue Clinic and the Promise of an Antiracist Psychiatry (available here.) This historical text examines a mental health clinic in the 1940s established to treat psychiatric complaints amongst a primarily black, urban, underserved population. Unlike other treatment centers for mental illness at the time, the Lafargue Clinic was unique in its emphasis on the medical as well as the social contexts in which its patients experienced distress. The clinic challenged existing notions of “color-blind” psychiatry and became both a scientific and equally political institution, highlighting the “interlocking relationships” between biomedicine, the state, racial inequity, and community-based health care.

Book Release: Kleinman and Wilkinson’s “A Passion for Society”

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To herald in the New Year 2016, today we feature a book publication highlight of a new text in medical anthropology co-authored by Culture, Medicine & Psychiatry‘s 2016 Honoree, Arthur Kleinman. Read our editor-in-chief Atwood Gaines’ announcement of the annual honoree here.

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Image via UC Press website.

Out this month from the University of California Press is Arthur Kleinman and Iain Wilkinson’s A Passion for Society: How We Think About Human Suffering (paperback edition details here.) The book examines the concept of suffering as a broader social “problem,” both in the contemporary age and through history. The authors explore how notions of suffering and care are reflective of present social and moral conditions, and how social science as a profession responds to “social suffering.” They argue that enlivened discussions about care have invigorated a new approach to the study of suffering by social scientists, who no longer engage with human suffering dispassionately. This shift has widespread implications for an “engaged social science” that takes a humanitarian approach to analyzing, understanding, and ameliorating human suffering. The text will interest applied social scientists as well as medical anthropologists and scholars of social medicine, who study illness and social inequities both across time and in cross-cultural contexts. The book can be purchased in hardcover here.

About the Authors: Arthur Kleinman is a medical anthropologist and psychiatrist who serves as professor in the departments of Anthropology, Social Medicine, and Psychiatry, and Director of the Asia Center, at Harvard University. Iain Wilkinson is a sociologist and Reader in Sociology in the School of Social Policy, Sociology and Social Research at the University of Kent.

Issue Highlight: Vol 39 Issue 4, Stimulant Use in the University

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This blog post is the last in a three-part series highlighting our newest installment of Culture, Medicine & Psychiatry (released December 2015) which readers can access here. This week, we explore Petersen, Nørgaard, and Traulsen’s research on the use of prescription stimulants amongst university students in New York City. The full article is available here.

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In recent dialogues on the widespread use of prescription stimulants amongst university students, drugs are often described as enhancing productivity or a student’s ability to successfully focus on academic work. However, Petersen, Nørgaard, and Traulsen found that university students in New York City often cited the use of these drugs as rendering their work more pleasurable, “fun,” and “rewarding.” Their study included 20 students spanning BA, MA, and PhD programs: representing a diverse sample that, in the aggregate, universally suggested that the use of stimulants in an educational setting was not centrally connected to academic output or production. This outcome, the researchers assert, complicates existing neoliberal readings of American personhood, premised on the idea that the self is primarily cultivated and disciplined through labor and individual productivity.

For example, rather than feeling shameful about using stimulants to improve study skills or produce better work, the students instead expressed guilt for enjoying their academic labors and for transforming “monotonous” and “boring” activities into an engaging experience. The “optimization” of the mind to perform intensive intellectual labor was not related strictly to productivity, which would evoke traditional neoliberal notions of the person-as-producer. Instead, the students described the drugs as optimizing pleasure first, which rendered them more productive as a secondary consequence.

Take this instance: a 32-year old PhD student, identified as Ben, reported using Adderall when he felt too “lazy” to initiate work. Rather than continuing by discussing the extent of his productivity while on the drug, he instead explains that the drug makes him eager “to tackle” his projects. This is often the case for students who struggle to find the desire to complete academic tasks that are not interesting enough to begin without being made pleasurable through stimulant use. Further, another student added that using stimulants helped him to “reconnect” with his interest in sociology during a difficult class on social science theory. In other cases, using Adderall kept students from being distracted from social media or entertainment websites: not because they lacked the inherent ability to be productive, but because without the drug, these sources of interest were simply more engaging than the work at hand. In other instances, students noted that stimulants made them feel more secure and positive about the quality of their work, and helped them to diminish the physical and mental stresses that came with “all-nighters,” or extended overnight studying stints.

Throughout all these cases, enhancement is not described as a means to make the human brain meet the demands of a “high-speed society.” Instead, “enhancement” relates to students’ satisfaction with their resulting work, to their enjoyment of otherwise “boring” tasks, and to reduced the negative psychosomatic effects of studying or working on a limited time frame.

The authors do not eschew the neoliberal model through these cases: indeed, they suggest that the use of stimulants does have cognitive effects that bolster students’ abilities to produce academic work. However, they note that we must complicate a strictly neoliberal model that would indicate that stimulants are employed by students strictly in order to achieve a certain amount of studying or to complete an assigned amount of work. Enhancement may include productivity, but for students who use stimulant drugs, it also involves increasing the pleasure of finishing intellectual labors, and decreasing the negative consequences of engaging in challenging or otherwise tedious academic work.

In this way, cognitive-enhancing drugs indeed fortify the mind and the conception of the self as a producer and academic laborer. However, they also shape human experience by altering students’ sense of confidence, their satisfaction with academic work, and their passion for their chosen topics of study. In these ways, enhancement drugs not only increase productivity in the neoliberal sense: they also broadly impact notions of pleasure and individual ability related to students’ quest to heighten academic production.

 

 

AAA 2015 Sessions: The Anthropology of Mental Health Care

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Beginning last Fall 2014, we began compiling lists of sessions at the Annual Meeting of the American Anthropological Association that we thought would be of interest to our readers attending the conference. These sessions included topics such as drug use and abuse, reproductive medicine, and global health. This year, we again feature our series on the upcoming conference, to be held November 18-22 in Denver, Colorado (more information here.) You can also browse last week’s installment of the blog, where we highlighted sessions on biomedicine and the body at the upcoming Society for Social Studies of Science (4S) meeting, also in Denver, to be held November 11-14 (details here.) This week, we present three paper sessions on the anthropology of mental health care. The sessions are organized chronologically by time and date.

Image via AAA Website

Image via AAA Website

Re-Institutionalizing Care: Anthropological Engagements with Mental Health Courts and Alternative Forensic Psychiatry Interventions in North America

Saturday, November 21st 10:15am-12:00pm (details about this session.)

Topics in this session will include racial disparities in a mental health court in Canada; the relationship between criminal justice officials, psychiatric crisis, and mental health; dogma and psychiatry; and mental health care reform. The session lists itself as particularly of note to applied and practicing anthropologists, especially those with an interest in mental health care, policy, and reform.

From the Streets to the Asylum: Medicalizing Vulnerable Children

Saturday, November 21st 10:15am-12:00pm (details about this session.)

This session includes work on the following topics: humanitarian care and child homelessness in Cairo, Egypt; drug use and treatment amongst juvenile prisoners in Brazil; immigrant youth and mental health in France; and notions of American childhood in the context of mental health. Though the session is sponsored by the Anthropology of Children and Youth Interest Group, its topics overlap with many contemporary issues in medical anthropology and the social study of mental health care.

Making Sense of Mental Health Amidst Rising Rural Social Inequality in North America: Class, Race, and Identity in Treatment-Seeking

Saturday, November 21st, 1:45pm-3:30pm (details about this session.)

Presenters in this session will speak on these issues: mental health and poverty in rural New England; mental health and prescription drug abuse in Appalachia; citizenship and mental health in Oklahoma; care access in remote Alaskan communities; community mental health activism; and inequity and depression in rural Kentucky. These sessions will be of interest to scholars of social justice and medicine, as well as those studying mental health care access and the culture of psychiatry in the United States.

Issue Highlight: Vol 39 Issue 3, Maya Mental Disorders in Belize

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With each new issue of Culture, Medicine & Psychiatry, we feature a series of blog posts that highlight the latest publications in our journal. This September’s issue includes articles that address psychiatric conditions and the experiences of people with mental illness across numerous cultures. Readers may access the full issue at Springer here: http://link.springer.com/journal/11013/39/3/page/1. In today’s issue highlight, we will examine a study on indigenous nosologies of mental illness amongst the Maya of Belize.

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Narrative Structures of Maya Mental Disorders

Andrew R. Hatala, James B. Waldram, and Tomas Caal – Pages 449-486

http://link.springer.com/article/10.1007/s11013-015-9436-9

To understand the compatibility of divergent medical traditions, it is first essential to describe how medical systems classify and interpret disorders in particular ways. With this aim in mind, the authors of this ethnographic study sought to develop an picture of indigenous mental illness nosology amongst the Q’eqchi’ Maya of southern Belize. They also asked how this knowledge may alternatively coexist, or compete, with biomedical concepts of suffering.

In order to learn about this indigenous medical epistemology, the authors worked with the Maya Healers’ Association, a professional, self-regulated group of twelve healers who maintain a garden of medicinal plants for research and who strive to reinvigorate traditional medical practice in Belize. Across ninety-four interviews with healers, the authors uncovered four illness categories that the participants used to describe the roots of mental illnesses: “thinking too much,” fright, the day of birth, and spirit “attacks.”

These descriptions are sometimes cross-compatible with DSM-V nosologies, as the researchers discovered that “thinking too much” was also listed as a symptom in biomedical models of mental illness. However, unlike the DSM-V, Maya healers tended to characterize overthinking as a “genre” of illness experience rather than as a discrete symptom. Maya healers also characterize mental illnesses as existing within the heart, the mind, and the spirit: thereby expanding the implications of mental illness beyond brain physiology, the proximate explanation employed by biomedical psychiatry.

The authors conclude that it is essential to understand the similarities in the two nosologies to facilitate collaboration between indigenous and biomedical healers, but add that both groups must also be aware of the differences in classificatory schemes that they use to interpret mental illness. In this way, people with mental disorders in Belize may best receive care that accounts for all of the ways they might seek care and understand their illness across the boundaries of medical systems.

Issue Highlight: Vol 39 Issue 3, Depression & Psychiatry in Iran

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With each new issue of Culture, Medicine & Psychiatry, we feature a series of blog posts that highlight the latest publications in our journal. This September’s issue features articles that address psychiatric conditions and the experiences of people with mental illness across cultures. The articles span studies in India, the United States, East Africa, Iran, and Belize. Readers may access the full issue at Springer here: http://link.springer.com/journal/11013/39/3/page/1. In this issue highlight, we will explore the emergence of public discourse about mental illness, suffering, and political struggle in Iran.

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Writing Prozak Diaries in Tehran: Generational Anomie and Psychiatric Subjectivities

Orkideh Behrouzan – Pages 399-426

http://link.springer.com/article/10.1007/s11013-014-9425-4

Behrouzan’s study began upon noticing young Iranians discussing mental illness in blogs and in public forums in the early 2000s. At the same time, the author examined unpublished public health records maintained by the state, and noticed that there was a sharp rise in the prescription rate of antidepressants in the mid to late 1990s. This pattern correlated with a shift in the understanding of suffering: during the Iran-Iraq war of the 1980s, PTSD and anxiety disorders were considered the most pressing mental health concerns, but these illnesses became supplanted by a shared culture of loss and hopelessness amongst young Iranians in the period following the war.

Unlike the narrative of depression in other places, however, Behrouzan found that the Iranian category of depreshen held deep political meanings. The illness category reflected the condition of those unable to publicly mourn for friends and family who may have been executed as political prisoners, or to process grief about continued political unrest that seemed to have no resolution, or to understand the loss of a parent during wartime as a young child. As one Iranian blogger described, “our delights were small: cheap plastic footballs, cartoons and game cards… But our fears were big: what if a bomb targets our house?” Thus depreshen becomes an experience of suffering that reverberates throughout a generation.

However, Iranian psychiatry responds to this condition outside of its cultural context, and continues to treat depreshen as an individual patient pathology that can be understood in biological terms. By biomedicalizing depreshen in this way without understanding its connection to political struggle, Iranian psychiatry minimizes suffering and “takes away subjects’ abilities to interpret and/or draw on their pain as a political resource.” When we interpret depreshen from the perspective of patients, therefore, we gain a nuanced view of suffering that is at once culturally specific and politically powerful.

Guest Blog: The Autism Spectrum, Anorexia, and Gender

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This week on the blog, we are hosting a guest post by Carolyn Smith, MA, a third-year PhD student in medical anthropology at Case Western Reserve University. Carolyn studies the intersections of mental health, eating, and the body, blending biological and cultural approaches. This blog post complements our July 2015 issue on autism, which you can read more about in the links provided at the end of the guest post.

In Autism spectrum disorders: Toward a gendered embodiment model, Cheslack-Postava and Jordan-Young[1] argue the importance of gender theory in understanding the preponderance of male cases with autism spectrum disorders (ASD) in the United States. In addition to evidence of autism as sex-linked, the authors argue that there is evidence as well for biases in diagnosing autism, and that social environment likely plays a role in male susceptibility. The literature on anorexia nervosa offers a parallel argument: anorexia nervosa, like autism, is often described in terms of biological risk factors[2] yet it remains a socially charged, deeply gendered diagnosis. In the USA and other societies with thin female beauty ideals, for instance, anorexia nervosa is most widely attributed to women.[3]

Both anorexia nervosa and ASD are recognized by the American Psychological Association (APA) and have specific criteria. While these categorizations are justifiably scrutinized by medical anthropologists, here I use the APA criteria as a cultural document that reflect what conditions that biomedical practitioners in the United States are cataloguing when they demarcate mental conditions. Anorexia nervosa is an eating disorder characterized as one of the most fatal mental illnesses in the United States.[4] Diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) includes restrictive eating and an intense fear of gaining weight/persistent behaviors to prevent weight gain. [5] One key criterion for anorexia is being of low body weight with the absence of any other pathology. The inclusion criteria have changed over the years, as have social ideas about the disorder and who suffers from it. Meanwhile, autism is classified as a neurodevelopmental disorder with social deficits and rigid behaviors.[6] The understandings of autism, like anorexia nervosa, have also changed over time in the United States.

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Yet gendered categories for these conditions persist. In the realm of psychiatric health, autism is assumed to be a male disorder, and anorexia nervosa, a woman’s diagnosis. This simple categorization overlooks the extent to which anorexia and autism are demonstrably comorbid in studies carried out in the USA and the UK.[7] [8] [9] One study from the UK, in fact, found that anorexics, restrictive-type were five times more likely than the general population to score as high on the Autism Questionnaire as someone with an ASD. 9 This finding offers no simple cause-and-effect explanation for how the two disorders are linked. However, this new data suggests that the body, the mind, gender roles, and dieting behaviors may be entwined in ways that resonate with cultural beliefs and categories.

There are competing theories about the etiologies of anorexia as well as autism, each with gendered overtones that do not reflect the findings of associations between the two psychiatric conditions. One theory of autism is that it is linked to a “hypermasculinized” brain.[10] Meanwhile, in a 2012 article for Psychology Today, Maestripieri argues that anorexia may be due to a “hyperfeminine” brain. The two conditions, it seems, appear to be “oppositional.”[11] However, these theories do not capture the wide diversity of cultural perspectives within the USA or UK, meaning there may be unique gendered understandings of psychiatric disorders between social groups that are not accounted for in existing research. In either case, what is clear is that cultural categories of psychiatric conditions in the US and UK may be missing how patients (of any gender, from numerous cultural backgrounds) live and seek care with either condition.

These gendered categories become even more complex for individuals diagnosed as both autistic and anorexic. The comorbidity of ASD and anorexia is complicated by the fact that restrictive dieting in anorexia may lead to cognitive impairment, which subsequently causes behaviors that might be confused with cognitive patterns on the autism spectrum. However, people with anorexia do report having autistic traits prior to the onset of their eating disorder, and people recovering from anorexia appear more often than non-anorexics to fall along the autism spectrum. 6,7 Thus, the two illnesses co-produce one another in ways that cross traditional gender lines (autism as male, anorexia as female) while also making it difficult, if not impossible, to isolate each condition from the other. Here medical anthropologists can offer valuable perspectives from the view of patients, who may describe their eating patterns and body image in terms that span and challenge existing diagnostic divisions.

Though there may be no empirical means to measure the extent to which ASD and anorexia overlap, existing theories about socialization may shed some light on how these two illnesses co-occur. There are numerous common traits between anorexia nervosa and ASD, including perfectionism, social withdrawal, and obsessive thinking.6 Girls and women with anorexia appear to have other similar traits to boys and men with autism: systematizing, a fascination with details, and resistance to change. Anorexic individuals with these autistic traits, Baron-Cohen hypothesizes, could become fixated on the systemic relationships behind body weight, shape, and food intake.[12]Of course, this would depend on whether or not the person with autism was brought up in a cultural environment where food intake and body shape are viewed as something that can and should be regulated at all. Here is where socialization may play a crucial role in the development of anorexia nervosa out of behavioral patterns attributed most often to autism.

The comorbidity of ASD and anorexia nervosa presents an anthropologically complex case where discrete classifications of mental illness may not reflect the connectedness of the two conditions. Likewise, the gendering of each illness as dualistic male-autistic and female-anorexic overlooks the extent to which the conditions share behaviors, tendencies, and thought patterns. Though national clinical studies in the USA and the UK suggest a connection between autism and anorexia, cultural readings of gender, eating, and self-regulation amongst patients with comorbid cases might better illuminate how these conditions manifest on the local scale, and between cultural groups.

Additional Reading

Publications:

Jaffa, T., Davies, S., Auyeung, B., Allison, C., & Wheelwright, S. (2013). Do girls with anorexia nervosa have elevated autistic traits. Mol Autism, 4(1), 24.

Nilsson, E. W., Gillberg, C., Gillberg, I. C., & Raastam, M. (1999). Ten-year follow-up of adolescent-onset anorexia nervosa: personality disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 38(11), 1389-1395.

Oldershaw, A., Treasure, J., Hambrook, D., Tchanturia, K., & Schmidt, U. (2011). Is anorexia nervosa a version of autism spectrum disorders?. European Eating Disorders Review, 19(6), 462-474.

Websites: 

ASD and Autism

https://www.psychologytoday.com/blog/games-primates-play/201208/the-extreme-female-brain

http://www.medicalnewstoday.com/articles/264666.php

https://books.google.com/books?hl=en&lr=&id=iPGFAgAAQBAJ&oi=fnd&pg=PR10&dq=malson+the+thin+woman&ots=sQPGnzOFN1&sig=ZSv8OMyuNAFQ3UgBOWZTEX5lHAg#v=onepage&q=malson%20the%20thin%20woman&f=false

CMP Special Issue Features: July 2015 Issue on Autism

https://culturemedicinepsychiatry.com/2015/07/08/special-issue-highlight-the-anthropology-of-autism-part-1/

https://culturemedicinepsychiatry.com/2015/07/22/special-issue-highlight-the-anthropology-of-autism-part-2/

https://culturemedicinepsychiatry.com/2015/08/05/autism-in-brazil-and-italy-two-cases-from-the-june-2015-special-issue/

References Cited

[1] Cheslack-Postava, K., & Jordan-Young, R. M. (2012). Autism spectrum disorders: toward a gendered embodiment model. Social science & medicine, 74(11), 1667-1674. “Our argument is fully biosocial, and our main points in advancing it are to articulate a model for autism, specifically for explaining the male-female disparities in prevalence, that does not exclude social environmental variables, and is therefore more biologically satisfying; and to demonstrate concrete mechanisms whereby autism may become more prevalent in males as a result of social structures and processes related to gender (p. 1673).”

[2] Bulik, C. M., Slof-Op’t Landt, M. C., van Furth, E. F., & Sullivan, P. F. (2007). The genetics of anorexia nervosa. Annu. Rev. Nutr., 27, 263-275.

[3] Malson, H. (2003). The thin woman: Feminism, post-structuralism and the social psychology of anorexia nervosa. Routledge.

[4] Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders: A Meta-analysis of 36 Studies. Arch Gen Psychiatry. 2011;68(7):724-731.

[5] IBD

[5] IBD

[6] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.).

[7] Zucker, N. L., Losh, M., Bulik, C. M., LaBar, K. S., Piven, J., & Pelphrey, K. A. (2007). Anorexia nervosa and autism spectrum disorders: guided investigation of social cognitive endophenotypes. Psychological bulletin, 133(6), 976.

[8] Nilsson, E. W., Gillberg, C., Gillberg, I. C., & Raastam, M. (1999). Ten-year follow-up of adolescent-onset anorexia nervosa: personality disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 38(11), 1389-1395.

[9] Baron-Cohen., Jaffa, T., Davies, S., Auyeung, B., Allison, C., & Wheelwright, S. (2013). Do girls with anorexia nervosa have elevated autistic traits. Mol Autism, 4(1), 24.

[10] Baron-Cohen, S. (2002). The extreme male brain theory of autism. Trends in cognitive sciences, 6(6), 248-254.

[11] Maestripieri, D. (2012 August 23). The Extreme Female Brain: Where eating disorders really come from. Psychology Today. Retrieved from https://www.psychologytoday.com “Therefore, just like Autism Spectrum Disorders may be the product of the combination of the extremely high systemizing and low empathizing tendencies that characterize the extreme male brain, eating disorders may be a manifestation of high negative evaluation anxiety that originates from the combination of the extremely high empathizing and low systemizing characteristics of the extreme female brain.”

[12] (2013 August 10). Anorexia and autism – are they related? Medical News Today. Retrieved from http://www.medicalnewstoday.com

Book Release: Jenkin’s “Extraordinary Conditions: Culture and Experience in Mental Illness”

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Via UC Press website

Via UC Press website

Out this August 2015 from the University of California Press is Janis H. Jenkin’s Extraordinary Conditions: Culture and Experience in Mental Illness. This ethnographic text explores the lives of patients of diverse ethnic and cultural backgrounds experiencing trauma, depression, and psychosis, taking into account the identity, self, desires, gender, and cultural milieu of the participants. Jenkins’ text pays special attention to the reduction of the severely mentally ill to a subhuman status, and the nature of this social repression.

Jenkins argues for a new, dynamic model of mental illness as a struggle rather than a constellation of discrete symptoms, noting that such a model should consider the ways that culture is implicated in mental illness experience from onset through recovery. The book posits that inclusion of culture into the clinical practice of psychiatry is crucial to the successful treatment of patients, and that anthropologists must not only consider the normative, day-to-day lives of participants but also the “extraordinary” and uncommon conditions regularly faced by those with mental illness.

This book will be of interest to psychological and psychiatric anthropologists, as well as those studying mental health care delivery systems. It will also shed light on medical narratives in mental health, and on generating new theories of human experience and medicalization.

For more information about this book, click on the publisher’s website here: http://www.ucpress.edu/book.php?isbn=9780520287112

From the Archive: Eating Disorders Amongst Japanese Women

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In our “From the Archive” series, we revisit an article published in past issues of Culture, Medicine & Psychiatry. This week, we’re highlighting a piece on eating disorders in Japan, originally featured in our December 2004 issue.

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Kathleen Pike and Amy Borovoy’s article “The Rise of Eating Disorders in Japan: Issues of Culture and Limitations of the Model of ‘Westernization'” makes a poignant case for the importance of context when examining eating disorders across the world. In this piece, they argue that studies of eating disorders abroad have often attributed the etiology of these illnesses to an increasing visibility and presence of Western beauty standards that accompany the spread of new technologies, medias, and communication tools. While Western beauty ideals have been problematically exported to the non-Western and developing worlds in other cases, Pike and Borovoy suggest that this model does not account for the experience of eating disorders in Japan.

Westernization and modernization, they note, are two distinct processes: and Japan, which has developed economically but retained many of its traditional social roles, exemplifies this difference. Modernization is the process of economic and technological development as a nation shifts from traditional to modern (often, mechanized). Westernization may be defined as the process of integrating the lifestyle, values, and experiences of Western cultures into the fabric of society, especially during periods of modernization and economic change.

Despite the drive for modernization, Japanese women are still expected to be homemakers and mothers rather than career women in the new economy. The Japanese have not adopted the individualistic and feministic sensibilities of the Western world, and the domestic burden– both caring for the home and children, and tending to older family members– squarely falls upon wives and mothers. This creates enormous stress for young women, who wish to extend their adolescent years and savor the freedom between childhood and their adult lives, as defined by marrying and becoming a homemaker. Modernization allows young Japanese women to obtain jobs, travel widely, and earn an education, but traditional social roles do not create a space for women to enjoy such a designated period of freedom without familial commitment. The inevitability of domestic life, then, is ever-present in the lives of women who yearn for fewer responsibilities– even if just for a time. This creates feelings of distress, unease, or unhappiness in many young women.

Pike and Borovoy observe that Japanese women do not reject food (anorexic behavior) or induce vomiting (bulimic behavior) out of a desire for thinness or due to fat phobia, as women with eating disorders almost universally experience in Western nations. Rather, Japanese women stress that they reject food because it worsens their digestive complaints, which are connected to the anxiety and stress they feel out of dissatisfaction with their social role (or lack thereof.) The tension between women’s expected social functions, and their desire to live and work in some other way, therefore spurs disordered eating within this broader frame of mental distress.

As we see, women’s experiences of Japanese eating disorders are entwined in the fabric of traditional social life, and not rooted exclusively in imported ideas of the body, independence, and individualism per the Western way of life. Indeed, the non-fat phobic symptomatology of eating disorders reflects the essential differences between Japanese women with eating disorders and their peers in Western nations. The study highlights the centrality of culture in studies of mental illness, and the way that these conditions emerge out of a local social world.

To find the full article online, click here: http://link.springer.com/article/10.1007/s11013-004-1066-6

Guest Blog: Culture, Medicine, and Neuropsychiatry

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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/.