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

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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

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

Current Issue: Preview of Books Received, Part One

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In this special feature on the blog, we’re highlighting recent book publications that have been submitted for review to Culture, Medicine, and Psychiatry. This week, we’d like to give you a short overview of Sarah Pinto’s new book Daughters of Parvati: Women and Madness in Contemporary India, from the University of Pennsylvania Press (more information here: http://www.upenn.edu/pennpress/book/15224.html)

Book cover image courtesy of the University of Pennsylvania Press website

Released earlier this year, Sarah Pinto’s book chronicles the experiences of women at a number of different psychiatric care institutions throughout Northern India. Pinto questions the poor treatment of female patients, the licensing process for mental health caregivers in these settings, as well as the overprescription of psychoactive medications to Indian women. Pinto pays close attention to the ways women in particular experience difficulty and distress as the primary caretakers of their families and households.

The goddess Parvati, whom the book is in part titled after, represents intense love for someone far away that borders on, and becomes, a form of suffering. Pinto invokes the name of this figure as a way to remind us of the mental strain that familial love can cause, especially for the Indian women at the heart of her moving ethnographic account.

These brief summaries are intended to give our readers a glimpse into the newest academic publications that we’re excited to discuss in our journal and with our followers on social media. For a full list of books that have been submitted for review at CMP, click this link: http://link.springer.com/article/10.1007/s11013-014-9383-x. This page also has information regarding the submissions process for authors who’d like their academic releases reviewed in the journal, as well as information for those interested in composing a review. For more information on this process, please contact managing editor Brandy Schillace.

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

Posted by jknopes

Welcome back to our two-week special update featuring glimpses into some of the articles published in the latest release of Culture, Medicine, and Psychiatry. These brief synopses of a few of our newest pieces from the September 2014 issue are only some of the publications that the current issue has to offer. We hope they invite you to explore the many other fascinating articles housed in this issue and in past volumes of CMP.

Swapnaushadhi: The Embedded Logic of Dreams and Medical Innovation in Bengal
Projit Bihari Mukharji

Mukharji’s article discusses the prevalent but little-researched history of indigenous therapeutic practices in Bengal that stem from therapies revealed in healers through dreams. Instead of grouping this practice into the indiscriminate category of “indigenous practice” or “dream culture,” the author asserts that all dream cultures are locally specific. They also do not draw stringent religious boundaries, as healers (and their patients) may receive visions of divine figures like Jesus or Muhammed despite not being of the creed the prophet represents. Because of this cross-cultural and “borderless” dialogue, medical innovation in dream medicine occurs regularly as the product of contact between numerous religious, spiritual, and local traditions. As Mukharji argues, “the logic of dreams opens up a space: the swapna-sthana or the dreamland where such cross-boundary transactions can take place without undermining the sanctity of the boundary itself in everyday social life.”

‘‘Pensando Mucho’’ (‘‘Thinking Too Much’’): Embodied Distress Among Grandmothers in Nicaraguan Transnational Families
Kristin Elizabeth Yarris

Yarris chronicles the difficulties faced by Nicaraguan grandmothers serving as the primary caregivers of grandchildren whose mothers have migrated to another country for employment. The author asks us to reconsider the simplistic mind-body connection in lieu of a more complicated view of the body and mind as experiencing distress: physical, emotional, and cultural all at once. In this paper, we discover that the term “thinking too much” ultimately describes the difficult self-sacrifice faced by grandmothers who tend to their grandchildren to allow their own children to succeed elsewhere. The stress of geographically dispersed and fractured families, the burden of caregiving later in life, and anxieties surrounding the grandmothers’ “hopes for the future” generate a particular form of psychosomatic suffering connected to broader economic, social, and political pressures manifested at the local level among these Nicaraguan families.