From the Archive: Eating Disorders Amongst Japanese Women

Posted by jknopes

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.

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

Posted by jknopes

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/.

Current Issue Highlight: Vol. 38 Issue 4, December 2014

Posted by jknopes

In our “Current Issue Highlight” series, we provide brief synopses of some of the original articles and commentaries published in our latest issue of Culture, Medicine, and Psychiatry. We hope these glimpses into our recent publications serve as a taste of the research we publish, as well as offer fresh insights on the intersections of culture, disease, health, and healing.

“The Ethics of Ambivalence and the Practice of Constraint in US Psychiatry”

Paul Brodwin

“This article,” the abstract begins, “investigates the ambivalence of front-line mental health clinicians toward their power to impose treatment against people’s will.” Ambivalence is itself a psychological construct that describes the tensions between love and hate, or multiple perspectives, within both individual subjects as well as the collective social group: here, psychiatric health workers. Central to this article is the friction generated between the clinicians’ self-concept as caregivers and their professional drive to control patients. Such ambivalence about clinical work in psychiatry is evident in the ethnographic research presented here.

Brodwin’s piece reminds us that anthropology is perfectly situated to draw meaning from these problematic and conflicted perspectives within a social group. Rather than reconciling the participants’ feelings and drawing one universal message from them, Brodwin presents us with an authentic picture of the complicated world of clinical psychiatric practice. He concludes, “To understand the paradox, fieldwork should focus especially on the moments when people’s sense of unease erupts into collective life.”

Link to article: http://link.springer.com/article/10.1007/s11013-014-9401-z

“A Village Possessed by ‘Witches’: A Mixed-Methods Case–Control Study of Possession and Common Mental Disorders in Rural Nepal”

Ram P. Sapkota, et al.

In this article, the authors probe an important question: if we consider spirit possession and psychopathology as separate categories, rather than assume possession as a form of mental illness, how might we describe mental illness within a population who has experienced spirit possession? For societies in which spirit encounters are frequent and socially normative, reading mental illness as distinct from possession is particularly critical when exploring local psychic events.

Nepal provided fertile intellectual grounds for exploring this question because spiritual possession occurs regularly. When the researchers delivered educational sessions on psychosomatic and psychosocial illnesses, suggesting that spirit possession might be a type of mental distress, villagers in the study resisted this notion. They argued that possession was rooted in cosmological and supernatural disturbances, making them altogether different psychological phenomena.

Instead of casting possession as a brand of psychiatric illness, the authors suggest that we might view possession as a coping mechanism against other mental duress. In another way, we could conceive of possession as a cultural idiom of distress: reframing illness in terms of a socially acceptable category of experience that is widely shared.

Link to article: http://link.springer.com/article/10.1007/s11013-014-9393-8

“Confinement and Psychiatric Care: A Comparison Between High-Security Units for Prisoners and for Difficult Patients in France”

Livia Velpry & Benoît Eyraud

Focusing on French mental health care, this article explores the evolving use of confinement as part of the treatment of mentally ill individuals who exhibit violent behavior. The authors parallel the nature of confinement in French psychiatric wards to the security practices of high-security prison units.

In their research, Velpry and Eyraud discovered that the public appeal to heightened security in psychiatric institutions, as well as executive action from the president, led to a “turn” towards new confinement measures. Second, psychiatrists used this new narrative of control to justify control techniques that they argued gave patients “psychic structure.” Rather than standing as its own therapeutic measure, physicians employed confinement as a means of managing “difficult” patients.

As an object of inquiry, this recent trend in French psychiatry recalls the complementary trajectories of care and justice, power and control, as well as reflects on the changing landscape of what we define as therapy.

Link to article: http://link.springer.com/article/10.1007/s11013-014-9400-0

“Psychiatry with Teeth: Notes on Coercion and Control in France and the United States”

Anne M. Lovell & Lorna A. Rhodes

This commentary piece on the articles published in the current issue highlights the “rough edge” of the use of constraint and coercion to subdue “difficult” psychiatric patients. Lovell and Rhodes note that many of the articles demonstrate how these forms of discipline and control are enacted at the local scale, and remind us that the exchange between psychiatric patient and the care institution is the site of the strongest conflict when we look at systems of control. What is the border between “care and custody,” the issue asks? How do we as anthropologists contribute to the knowledge about these complex social interactions?

Furthermore, the authors observe that the geographic emphasis on psychiatric care in France and the United States is hardly accidental. Although care practices for the mentally ill differ widely between the two countries, the focus on constraint and control is similarly present in the scholarly literature produced on psychiatry in each place. Likewise, in French and American research, there is a mutual tendency to study mental health care in terms of autonomy, freedom, humanism, and democracy.

Link to commentary: http://link.springer.com/article/10.1007/s11013-014-9420-9

Want to see a preview and abstracts of all the articles in the current issue? Find details on the full issue here: http://link.springer.com/journal/11013/38/4/page/1

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

Publication Highlight: “Online First” Articles (Oct 2014), Part Two

Posted by jknopes

Welcome to the second installment of this series. The following collection of articles are from our “Online First” file at our publisher’s website: http://link.springer.com/journal/11013. The full text of these articles will be released in upcoming issues of Culture, Medicine, and Psychiatry, but here we’d like to lend our readers a glimpse into the innovative research in medical anthropology and social medicine that the journal publishes.

Clicking the title of each paper will send you to the “Online First” page for each article, including a full list of authors and abstracts.

Confinement and Psychiatric Care: A Comparison Between High-Security Units for Prisoners and for Difficult Patients in France

Livia Velpry & Benoît Eyraud

Learning Constraint. Exploring Nurses’ Narratives of Psychiatric Work in the Early Years of French Community Psychiatry

Nicolas Henckes

The Ethics of Ambivalence and the Practice of Constraint in US Psychiatry

Paul Brodwin

Between Jewish Settlers and Palestinian Citizens of Israel: Negotiating Ethno-national Power Relations Through the Discourse of PTSD

Keren Friedman-Peleg

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