Article Highlight: Vol 40 Issue 4, Social Withdrawal in Japan

Posted by jknopes

The December 2016 issue of Culture, Medicine & Psychiatry is now available here. In this series of article highlights, we will explore publications included in the latest issue. This week, we present a highlight on Ellen Rubinstein’s article “Emplotting Hikikomori: Japanese Parents’ Narratives of Social Withdrawal” (which you can access here.) Rubinstein observes that there has been a flurry of public attention to hikikomori, a socio-medical condition typically experienced by young people that is characterized by increasing, marked social withdrawal.

Rubinstein notes that though there is a perception of hikikomori as a condition of isolation, parents of “hikikomori children” often crafted narratives about their children’s illness that suggested it had discernible stages, signs of progress, and possibility of recovery. These narratives engaged parents in the present, facilitating connectedness between hikikomori children and their families, and thus challenging the assumption that hikikomori is a condition of perpetual or crippling isolation. For instance, some parents at a support group for hikikomori children and their families stated that their children were more mature than others, as their time away from other people encouraged them to be meditative and thoughtful.

One mother, named Kawano-san, first described her son’s hikimori as a process of productive, but not permanent, isolation in an interview with Rubinstein. Kawano-san said that her son’s withdrawal might lend him an opportunity to step away from the social world, assess his future, and prepare for college after initially failing to pass university entrance exams. She felt certain that this period would be one of reflection and reassessment, before the son eventually entered university. Kawano-san also criticized the expectation amongst many Japanese families that children should be extroverted and talkative, instead saying that her son was not pathologically isolated but simply different. Eight months after this initial interview, Kawano-san was interviewed for the second time about her son’s condition. The son had not entered college as Kawano-san expected, but the mother had readjusted her narrative such that she began to acknowledge that path might not be viable for her son. She instead noted that her son could have a disability, or that he simply needed more time to process his feelings. Kawano-san ultimately accepted that her initial expectations did not match her son’s experience, and began to try new approaches to her son’s condition: like encouraging her husband and daughter to write birthday messages to him that might make him feel more welcomed and included in their family unit.

Rubinstein examines similar cases to Kawano-san and her son, finding that many families engaged in a process of narrative emplotment and un-emplotment of their children’s hikikomori. Their narratives thereby gave order or meaning to what otherwise seemed like an ongoing and static psychological condition. Alternatively, they situated their children’s experiences in other contexts: such as expected developmental and social growth, and the efficacy of biomedical interventions or support groups for the condition. Parents of hikikomori children were not inactive bystanders, but rather active interpreters of their children’s experiences and advocates of their unique individual needs. The parents learned to read their children’s condition and support them accordingly, complicating the notion that hikikomori is solely about individual isolation or inaction.

Interview: Incoming Social Media Editor Sonya Petrakovitz

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This week on the blog, we are featuring an interview with Culture, Medicine & Psychiatry social media intern Sonya Petrakovitz. Sonya will begin her tenure as the new social media editor on the journal’s blog, Twitter, and Facebook accounts in January 2017. As an intern, she has written an article highlight on Asperger’s syndrome, a conference feature, and a news piece on the Rio 2016 Summer Olympics.

Here, we discuss Sonya’s background, research interests, and vision for the journal in the months to come.

What is your academic background? How did you become interested in medical anthropology and humanities?

I began my interdisciplinary training in the humanities with Classical History, studying both the historical complexities of the Greco-Roman period, and the French war icons of the 1400s. While historical analysis is crucial to contextualizing culture and social change, I wanted to focus my studies more on the personal, individual aspects of daily experience in contemporary life. I then completed a second Bachelor’s in Photojournalism, bringing together intimate stories and visual narratives. I next spent a year working at an acute, inpatient psychiatric hospital for children and adolescents in Maine, mostly working with girls ages 12-18. Witnessing adolescents’ experience of illness and suffering further motivated me to want to understand subjectivity, personhood, and suffering in the context of medicine. I began my PhD studies in medical anthropology at Case Western Reserve University to pursue these interests. Both history and photojournalism seek to understand human experience, but anthropology has given me the theoretical frameworks and methodology that now characterize my research.

What are your research interests as a PhD student in medical anthropology?

My research is located at the intersection of globalization, decolonization, ethnomedical systems, identity, and tourism. Specifically, I study native medical systems in the context of tourism and modernization on the island of Rapa Nui (Easter Island, Chile.) Rapa Nui is an excellent place to study these intersecting processes and phenomena, particularly due to an unusual juxtaposition of simplistic tourist discourses of a fabricated “Easter Island” with the internal narrative of a historical struggle for self-determination. Situated on the most remote, inhabited island in the world, my research will investigate whether the ancestral medicine on Rapa Nui– practiced in indigenous exclusivity– could not only bolster health: its use may also be a symbolic form of resistance against post-colonial development. Expanding upon anthropological theories of identity, decolonization, globalization, and medical pluralism within a healthcare setting, combined with an environment of rapid cultural change and commodification, I hope to investigate whether the ancestral medicine on Rapa Nui could be a symbolic gesture of resistance to the historical and residual present restrictions on their self-determination while an international tourism economy destabilizes the meaning of being Rapanui.

What is your favorite running feature on the blog?

My favorite running features on the blog are Guest Blogs and Conference Features. It’s important to connect with current scholars and researchers in the medical humanities and share their work. Guest Blogs such as ‘In-Betweenness’: Liminality, Legality, and migrant Health in Siracusa, Italy with Adam Kersch (available here) highlights the importance of validating the suffering of migrants and how policies can impact health status. Conference Features, such as the latest American Anthropological Association Session Highlights (Part 1 and Part 2) also connect the Culture, Medicine, and Psychiatry Journal to a wider academic community and emphasizes interdisciplinary collaboration.

What new features or ideas will you bring to the blog in the coming year?

I am looking forward to encouraging more guest posts and bringing together current events with article highlights and book releases. I am also hoping to introduce a new type of interview feature to the blog. My hope is to present the perspectives of experts from various disciplines to explore connections between current events and articles within CMP, fostering interdisciplinary communication. I am very much looking forward to joining the Culture, Medicine, and Psychiatry team!

News: UN Releases New Sustainable Development Goals (SDGs)

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On Friday, September 25th, the UN released its new plan for global development through 2030: the sustainable development goals (SDGs).[i] This plan replaces the millennium development goal (MDG) plan that expires at the end of 2015, and offers a new 17-point agenda focused on social equality, infrastructure, technology, and environmental conservation.[ii] Of note to medical anthropologists, global health workers, and other scholars in social medicine is the continued focus on health and well being as the third item amidst the seventeen goals. The SDG plan champions health “for all at all ages,” although it proposes no specific goals for improving elder care despite the language stressing health across ages. Maternal and reproductive health, substance abuse, traffic deaths, and universal health care coverage are key issues addressed in the SDGs.

Emblem of the UN via Wikimedia Commons

Proponents of the new SDGs, like the World Bank, argue that the plan’s emphasis on both developed and developing countries creates a shared impetus for bolstering food security, education, and access to quality health care; likewise, it suggests that these issues are global ones that cross national borders, and do not exist at the state level alone.[iii] Others criticize the SDGs as too ambitious, arguing that global authorities already struggle to aid migrants and peoples in crisis[iv], stating that the goals are too broad and thus not focused enough to produce observable change[v], and highlighting the irony of combating climate change while promising electricity for all by 2030.[vi]

Anthropologists have long held an interest in international development as a site of cross-cultural exchange, a relic of colonialism, and as a paternalistic model of societal shepherding of developing nations by the wealthy West and Global North.[vii] Amongst development anthropologists, the sustainable development goals will certainly generate new questions about the connectedness of social inequities with health, autonomy, and human rights in the contemporary age. The goals will similarly continue to attract the interest of scholars studying biomedicine and global health in diverse cultural settings.

In addition, the SDGs will no doubt capture the attention of anthropologists in science and technology studies (STS) with the plan’s robust emphasis on technologies, energy, infrastructure, and the environment. This sharpened focus on the connection between social order, science, and technology attests to the applicability of STS approaches to the study of development.

The SDGs arrive at a time of increased concern over social justice and equity on the transnational scale, particularly in the face of the Syrian refugee crisis[viii] and given wide income gaps that impact people in the United States, Chile, Greece, Mexico, and Turkey alike.[ix] Anthropologists are ideally situated to explore the impact of development goals across cultures, and to question how and why these goals may face considerable challenges as they are translated into action, law, and practice at the local level.

[i] http://www.theguardian.com/global-development/2015/sep/25/global-goals-summit-2015-new-york-un-pope-shakira-malala-yousafzai

[ii] https://sustainabledevelopment.un.org/topics

[iii] https://blogs.worldbank.org/voices/global-goals-economic-transformation-in-an-interconnected-world

[iv] http://www.npr.org/sections/goatsandsoda/2015/09/28/444188463/are-the-new-u-n-global-goals-too-ambitious

[v] http://www.scientificamerican.com/article/sustainable-development-goals-offer-something-for-everyone-and-will-not-work/

[vi] http://www.theatlantic.com/international/archive/2015/09/energy-access-sdgs-un-climate-change/407734/

[vii] http://www.wiley.com/WileyCDA/WileyTitle/productCd-0631228802.html

[viii] http://www.cnn.com/2015/09/28/world/united-nations-main/

[ix] http://www.reuters.com/article/2015/09/27/us-development-goals-challenges-analysis-idUSKCN0RR0TV20150927

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.

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.

News: WHO Release on Worldwide Hearing Loss

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When medical anthropologists consider the impacts of technology on human health, we envision life-saving drugs, surgeries, or diagnostic tools to detect disease. Technology in these ways can prove instrumental– quite literally — in improving patients’ health outcomes. However, it is equally important to think about the ways in which technology can diminish health, particularly in an age where the global spread of technology deserves the attention of clinicians and anthropologists alike.

This is the nature of the concern posed by the latest World Health Organization (WHO) report, released on February 27th 2015. After studying noise exposure in middle and high income countries and among participants ages 14-35, WHO officials stated that an estimated 1.1 billion people are at risk for hearing loss due to “recreational noise.” This includes music piped through headphones and noise experienced at entertainment venues. Exposure to high decibels of sound is not itself harmful: for instance, hearing a heavy pot fall from the counter and crash onto the floor would not cause hearing damager. Rather, the extended length of exposure to such loud noises is what proves detrimental. The WHO defines dangerous levels of noise exposure as 85 decibels for eight hours or 100 decibels for 15 minutes. The report notes that a rock concert that lasts for two hours may cause temporary hearing loss or lead to other symptoms such as a ringing sensation in the ears, and regular extended exposure may lead to more permanent damage.

The WHO flag, via Wikimedia Commons

What does the WHO recommend to address this global health concern? The report singles out teenagers and implores them to take noise management into their own hands: purchasing noise-canceling headphones, taking “sound breaks” if extended exposure to loud sounds is unavoidable, or wearing ear plugs to loud music venues. This places the responsibility to manage noise exposure on young people rather than on their families and caregivers. Likewise, the report suggests that patrons of entertainment venues like clubs and bars that feature loud music and sounds should limit their time spent in such environments. There are no extensive recommendations listed in the report for those who work in loud venues, other than limiting shifts to eight hours to shorten exposure.

From a medical anthropological standpoint, many of the factors in sound environments are tangled with social life. For instance, in many developed countries, concerts are an important social gathering place for young people. Teens may not avoid these events, but if they follow the WHO recommendations and wear earplugs to the venue, they may be ostracized by their peers for looking out of place. Likewise, neighborhood bars and clubs are important hubs of activity for locals, and avoiding them may come at the cost of social isolation. As technologies spread both to developing and developed countries, the ways that people integrate audio technologies, new entertainment venues, and popular music into their lives is worth considering given the impacts of these tools, sounds, and social spaces on hearing health.

To read the WHO’s news release, click here: http://www.who.int/mediacentre/news/releases/2015/ear-care/en/