Culture Medicine and Psychiatry

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  • Soha BayoumiSoha Bayoumi
  • Sherine HamdySherine Hamdy
In this article, we investigate the links between medical practice and expertise, on the one hand, and nationalist discourses, on the other, in the 2011 Egyptian uprising and the years that followed, which witnessed a consolidation of authoritarianism. We ask how it is that doctors, whose social capital in part rests on their being seen as “apolitical,” played a significant role in countering consecutive regimes’ acts of violence and denial. We trace the trajectory of the doctors’ mobilization in the 2011 uprising and beyond and demonstrate how the doctors drew on their professional expertise and nationalist sentiment in their struggles against a hypernationalistic military state. Borrowing the ideas of immanence and transcendence from religious studies and philosophy, we argue that the doctors put forth an immanent vision of the nation as a force that is manifested in the lives of its citizens, in contrast with the State’s transcendent vision of nationalism, in which the nation resides outside of and beyond citizens’ lives. Relying on interviews and media analysis, we show how medicine has served as a site of awakening, conversion narratives, and building of bridges in a polarized society where the doctors were able to rely on their “neutral” expertise to present themselves as reliable witnesses, narrators, and actors.
 
Article
This article traces the development of a transnational psychiatric collaboration between psychiatrists and psychologists in Turkey and Israel in the wake of a massive earthquake that struck Turkey in 1999. Based on extended ethnographic fieldwork in sites across the earthquake region, the project on which this article is based is concerned with how the Turkish mental health professionals who responded to the earthquake struggled to improvise a therapeutic response that could address the scale of psychological suffering precipitated by the earthquake. This article considers the development of a specific intervention in order to examine, first, the striking adaptability and mobility of these forms of psychiatric expertise and, second, their distinct capacity to draw together two divergent contexts—one characterized by the effects of a destructive seismic event, the other by a lasting politics of colonial occupation—into a common technical, psychiatrically constituted space. Tracing these transnational entanglements will offer a means for understanding the conditions of possibility for the circulation of medical expertise in the region and, with it, emerging transregional arrangements of psychiatry, disaster, and security.
 
The mobile converted minivan where consultations of the general medical consultation hour take place. The minivan visits places in Amsterdam and Rotterdam (two major cities in the Netherlands) where UMs reside, like night shelters, squats, a community centre for UMs, and central places in certain neighbourhoods. When volunteers visit these locations, UMs are actively invited to visit the van if they are in need of medical help
Percentage of Ums scoring above clinical cut-off on the SQR-20 for Common Mental Disorders (CMD). SRQ-20 Self-Reporting Questionnaire, the 20 item version
Percentage* of symptoms present on SRQ-24 per group
Mean scores SRQ-20 and SRQ-24
Article
Undocumented migrants are a particularly vulnerable group regarding (mental) health, living conditions, and restricted access to health care. The aim and objective of the study was to examine the prevalence and correlates of mental health problems in a help-seeking population of undocumented migrants. Observational study was performed by integrating cross-sectional questionnaire data with retrospective electronic patient record data. Undocumented migrants attending medical and psychological consultation hours of a Netherlands-based non-governmental organization completed the Self-Reporting Questionnaire (SRQ). We examined scores of the instrument's 24 items version (SRQ-24) and its 20 items version (SRQ-20). Correlates of mental health were estimated using parametric tests. On the SRQ-20, 85% (95% CI 77-91%) of the sample (N = 101) scored C 8, the clinical cutoff & Jentien M. Vermeulen j.m.vermeulen@amsterdamumc.nl Sandrine J. C. Vollebregt value for common mental disorders; mean = 12.4 ± 4.6, range 0-20. Adverse life events like physical and sexual assault were reported in 37% of the medical records (N = 99) and had a medium-to-large effect (Cohen's d = 0.76) on SRQ-24 scores. Mental health problems are common in help-seeking undocumented migrants. This study underlines the need of improving access to mental health care for undocumented migrants.
 
Article
Building on 12 months of ethnographic fieldwork among people with Alzheimer’s disease living in Denmark, I argue that the loss of a sense of time caused by Alzheimer’s is not a subjective loss, but rather an intersubjective one. Alzheimer’s disease entails living with desynchronized rhythms, time that can be made painfully explicit, and numbers becoming increasingly tricky to manage. Drawing on Thomas Fuchs’ theory of how individuals live in “basic contemporality,” I explore moments of temporal rupture, and how people with Alzheimer’s challenge their social relations due to their different sense of time. The article contributes to ongoing discussions about belonging. Taking inspiration from Tine Gammeltoft’s description of how belonging entails fragile attempts at being part of something larger, and is thus a joint social practice, I show how one dimension of belonging’s fragility is the inability to be in synch with social time. By proposing the notion of temporal belonging, I suggest that sustaining a sense of belonging is also about being able to participate in the rhythms and tempo of social life.
 
Article
It is commonplace to state that dementia is a complex condition. Such complexity involves the limits between pathological and normal aging, diagnosis with no simple organic causation, and the use of psychiatric medication that does not cure but generates hope to alleviate symptoms such as forgetfulness and delirium. Based on an ethnography of one year and a half (2017–2018) in a Brazilian metropolis, within a Public Geriatric center and the households of three families, I argue that dementia, more than a complex condition, is a generator of drug complexity. Following Stefan Ecks' reflections on multimorbidity and polyiatrogenesis and Karen Barad's understanding of intra-action, I discuss the polypharmacy present in most cases of dementia that I have known. Considering the complicated relations of medications with themselves and with time and places, I conclude that dementia should be seen a polypharmaceutical phenomenon.
 
Article
In most Mediterranean countries, people diagnosed with severe mental disorders (SMDs) are typically cared for by the mother, causing a significant burden on people in this family role. Based on a broader mental health participatory action and qualitative research carried out in Catalonia (Spain) of 12 in-depth interviews and 3 focus groups, this article analyses the mother-caregivers' experience in the domestic space. The results show that patients and caregivers are engaged in a relationship of ''nested dependencies'', which create social isolation. This produces the conditions of ''reactionary care'', practices that limit the autonomy of those affected and that reproduce forms of disciplinary psychiatric institutions. We conclude that both institutional violence derived from economic rationality and that which stems from the gender mandate feed off each other into the domestic sphere. This research argues for placing care at the center of clinical practice and shows the need to consider the structural forces shaping it.
 
Article
‘Nostalgic environments’ are increasingly being created in museums and institutional care settings for people with dementia, to support residents’ capacities for memory and recognition. Drawing upon ethnography carried out in a public nursing home specialized in dementia care in Copenhagen, Denmark, this paper engages conceptually the employment of material heritage within dementia care environments, proposing dementia care as a ‘curatorial’ practice: caregivers act as ‘curators’ who re-establish and reorganize the ‘meaning’ of the residents by preserving their individual biographies and societal belonging. The analytical alignment of dementia care with the curating of cultural valuables reveals that the human is not only the subject within—and the creator of—cultural heritage, but also the object: the person with dementia is simultaneously an acting subject in care and an object for performances of the category of the human. As the curatorial care performed in nursing homes preserves not only individual, but also collective memories of what it takes to be human and belong in society, these institutions should be recognized as significant sites within society concerned with the production of meaning, value and cultural heritage.
 
Article
The latest form of cognitive behavioral therapy, virtual reality therapy has been developing in France since 2012, in both university hospitals and private practices. Patients receiving this therapy are immersed in a digitally created environment, using a virtual reality headset, in order to be exposed to their phobias. How does the introduction of technical objects such as the virtual reality headset affect and transform the care relationship between the patient and the therapist? Based on an ethnographic study conducted between 2012 and 2018 in the psychiatric unit of a French university hospital, this article outlines the emergence of virtual reality therapy, describes how it operates, and analyzes how it shapes the patient-therapist relationship. I argue that this device—namely virtual reality therapy—promotes a new therapeutic style in psychiatry, whose format and therapeutic indications align with the requirements of evidence-based medicine.
 
Article
The notion of ‘mental health literacy’ has been proposed as a way of improving mental health problem recognition, service utilisation and reducing stigma. Yet, the idea embodies a number of medical-model assumptions which are often at odds with diverse communities’ spiritual traditions and local belief systems. Twenty participants were recruited to this study consisting of mental health service users (N = 7), family carers (N = 8) and community members (N = 5) in a temple town in Kerala, South India participated in semi-structured interviews exploring the variety of beliefs and practices relating to mental health. Our findings indicate that the issue may be better understood in terms of multiple mental health literacies which people deploy in different circumstances. Even those sceptical of traditional and spiritual approaches are knowledgeable about them, and the traditional practices themselves often involve detailed regimes of activities aimed at effecting an improvement in the person’s mood or condition. Therefore, we argue it is appropriate to consider mental health literacy not as a unitary universal phenomenon but instead as a mosaic of different literacies which may be deployed in different settings and in line with different experiences and which may operate in synergy with each other to enable treatment but also facilitate a sense of meaning and purpose in life.
 
Article
Based on ethnographic fieldwork and interviews conducted with Turkish egg donors at a Northern Cypriot clinic, this article investigates tactical biosociality of cross-border egg donors that allows them to manage social relations and orient themselves in transnational egg donation (including the processes from recruitment to self-management in and beyond the clinic) under legally restrictive and socially stigmatizing conditions. Addressing the social and collective dimensions of tactics and recognizing the fragmented and conflictual forms of biosociality, it aims to shed light on the complex and ambivalent aspects of tactical biosociality in relation to selective disclosure and stigma within the context of transnational egg donation. Tactical biosociality involves possibilities for solidarity and alliances, and also for conflict and competition among egg donors. It is because for young Turkish women, egg donation retains both gendered moral and financial values that must be tactically negotiated while navigating the wider context of heteropatriarchal cultural norms and expectations, precarious economic and social conditions, biomedical profit and biopolitical control.
 
Article
In this article, I address the experiences of family members of people with dementia, as they expressed the sensation of gradually losing the person with dementia. Based on ethnographic fieldwork in nursing homes in the Netherlands, and contributing to the anthropology of grief, I explore the co-existence of experiences of anticipatory grief and manifestations of care to maintain meaningful relations. I show how my interlocutors adapted to changing circumstances as the disease progressed, and in so doing found new ways to relate, as well as prepared for future losses and the expected end of life. I argue that anticipatory grief is temporal and relational, encompassing both present and future losses, and involving a continuous negotiation between the loss and the continuing relationship. I underscore the entanglement of loss and connection, showing how both exist parallel to, and may emerge from one another, and demonstrating how an anthropological approach to anticipatory grief can reveal the nuanced and equivocal character of experiences of illness and at the end of life.
 
Article
Tricyclic antidepressants (TCAs) are frequently prescribed for chronic functional pain disorders. Although the mechanism of action targets pain perception, treating patients with TCAs for disorders conceptualized as “functional” can promote stigmatization in these patients because it hints at psychological dimensions of the disorder. The goal of this study was to understand how physicians prescribe TCAs in the face of this challenge. We interviewed eleven gastroenterologists in tertiary care clinics specializing in functional gastrointestinal disorders, such as irritable bowel syndrome. We found that the physicians interviewed (1) were aware of the stigma attached to taking antidepressants for a medical condition, (2) emphasized biological, as opposed to psychological, mechanisms of action, (3) while focusing on biological mechanisms, they nevertheless prescribed TCAs in a way that is highly attentive to the psychology of expectations, making specific efforts to adjust patients’ expectations to be realistic and to reframe information that would be discouraging and (4) asked patients to persist in taking TCAs despite common and, at times, uncomfortable side effects. In this context of shared decision making, physicians described nuanced understanding and behaviours necessary for treating the complexity of functional disorders and emphasized the importance of a strong patient-provider relationship.
 
Autscape initiation badges
Article
Autscape is an autistic-led conference, organised annually in varying locations around England. Governed by a strict set of rules and regulations, Autscape is a social and spatial setup explicitly devised to accommodate the tendencies, sensitivities, and preferences of people on the autism spectrum. It is a design, in other words—as organisers and participants alike often profess—for an altogether autistic space. The uniqueness of the event, and consequently its value to anthropological theory, lies in the shared imagination of the setting by those who inhabit it as one in which neurotypical masks, otherwise worn daily in keeping with hegemonic society's expectation of conformity, can finally be removed. I introduce the concept of un-festival as a means of depicting this event, similar to festival in its goals of defiance and inversion, but different from—and in important ways, opposite to—festival in its style and architecture, in the dispositions it encourages and mobilises, and in its potential implications. The un-festival offers a powerful comment on this moment in history, whereby masks are no longer seen as an item that affords freedom, but as one that stifles it. While Autscape participants remain doubtful as to the actual effect of this event on neurotypical society, they do nevertheless express a desire that this project will have some longstanding effects. That once a space has been designed for autistic people that considers their specific needs and tendencies, autism may then finally cease to be interpreted through a neuro-normative prism and freed to be understood in autistic people’s own terms.
 
Article
This study assesses the perspectives and experiences of Vodou priests (ougan) in the treatment of mental illness in northern Haiti. Our goal is to explore the etiology and popular nosologies of mental illness in the context of Haitian Vodou, through understandings of illness and misfortune which are often viewed as a result of sent spirits—or spirits sent supernaturally by others with the intent to cause harm. Using a qualitative approach, this study conducted semi-structured in-depth interviews with 20 ougan living near the city of Cap-Haïtien. Interviews highlight a sample of healers with little formal training who maintain beliefs and practices that differ significantly from current biomedical models. Ougan treat mental illness through a variety of means including prayer and conjuring of spirits, leaves for teas and baths, as well as combinations of perfumes, rum, human remains, and other powdered concoctions that are either imbibed or rubbed on the skin. The primary purpose of these treatments is to expel the spirit causing harm, yet they can often result in additional harm to the patient. Findings suggest that while ougan are willing to collaborate with biomedical practitioners, significant barriers remain preventing cooperation between these two groups.
 
Article
Themes connected with mental illness and psychiatry frequently feature in the works of Alfred Hitchcock. Some critics believe it is a reflection of the director’s own mental health issues. Yet, it is more likely that Hitchcock was inspired by the Gothic tradition and the legacy of Edgar Allan Poe as well as the popularity of psychoanalysis in post war U.S. culture. This article looks at Hitchcock’s feature-length films in order to analyse the representation of psychopathic characters as perpetrators of crime and the disturbed mother–child relationships which may lead to mental aberrations. Furthermore, it presents the ways in which Hitchcock subtly undermines popular conceptions about the relationship between mental illness and crime, and the role of psychiatry in explaining unusual behaviour.
 
Article
For the past decade, within family medicine there has been a focus on cultivating doctors gut feelings as ‘a way of knowing’ in cancer diagnostics. In this paper, building on interviews with family doctors in Oxford shire, UK we explore the embodied and temporal dimensions of clinical reasoning and how the cultivation of doctors’ gut feelings is related to hierarchies of medical knowledge, professional training, and doctors’ fears of litigation. Also, we suggest that the introduction of gut feeling in clinical practice is an attempt to develop a theory of clinical reasoning that fits the biopolitics of our contemporary. The turn towards predictive medicine and the values introduced by accelerated diagnostic regimes, we conclude, introduce a need for situated and embodied modes of reading bodies. We contribute theoretically by framing our analysis within a sensorial anthropology approach.
 
Article
Due to limited professional mental health facilities in Indonesia, traditional and faith-based mental health care is essential to provide an alternative treatment. This study explored the therapeutic aspects of treatment at Pesantren Tetirah Dhikr (PTD), an Islamic-Sufi-based rehabilitation center for people with mental illness and drug addiction in Yogyakarta, Indonesia. We employed a case-study method to understand the process of therapy and the theoretical ideas behind the practice. We conducted interviews with the Kyai (head of PTD), his assistants, and sixteen patients (called santri). The results of a thematic analysis revealed that the practice of dhikr was the essential therapeutic component for improving the participants’ mental health. From an Islamic psychological perspective, the process of therapy at PTD was comparable with the process of purification of the soul in Sufism. This process comprised three stages: takhalli (purifying the soul from reprehensible attributes), tahalli (adorning the soul with noble and praiseworthy attributes), and tajalli (attaining of a pure soul). From a transpersonal psychology perspective, the effect of dhikr was comparable with the therapeutic benefits of meditation practice and other psychotherapy.
 
‘Tension:’ A grounded theory adaptation
An ethnopsychology of ‘tension’ and mental illness
Article
In low- and middle-income countries (LMIC) it is vital to understand acceptable, comprehensive, and culturally appropriate ways of communicating about mental distress. Diagnostic terminology is rarely used, may be stigmatizing, and is subject to misinterpretation. Local terms, such as idioms of distress, can improve mental health literacy and service delivery. Our objective was to examine lived experience and coping connected to distress and depression in an under-researched population: young men from LMIC urban slums. We conducted 60 qualitative interviews with men (ages 18–29) in Bhashantek slum, Bangladesh. Themes were generated using thematic analysis and grounded theory techniques. The heart-mind (mon), mentality (manoshikota), mood (mejaj), head (matha or “brain”), and body (shorir) comprised the self-concept, and were related to sadness, hopelessness, anger, worry, and mental illness. The English word “tension” was the central idiom of distress. “Tension” existed on a continuum, from mild distress or motivational anxiety, to moderate distress including rumination and somatic complaints, to severe psychopathology including anhedonia and suicidality. Respondents connected “tension” to burnout experiences and mental illness which was summarized in an ethnopsychological model. These findings can inform culturally sensitive measurement tools and interventions that are acceptable to the community, potentially increasing engagement and enhancing therapeutic outcomes.
 
Article
The original version of this article unfortunately contained an error. In the reference list the author name “Joanne Cacciatore” is incorrectly spelled as “Joanne Corriatore”.
 
Article
Mexicans living in the United States frequently rely upon popular healing to address a broad spectrum of physical, psychological, and spiritual ailments. They practice Mesoamerican healing ways including using herbal remedies, employing nutritional health promotion and illness remediation, over the counter pharmaceuticals, prayer and religion, and visiting expert healers. In this article, we utilize Brigitte Jordan’s theory of “authoritative knowledge,” to show how Mexican immigrants’ ancestral and ecological-based healing knowledge travels with them through migration. Based on original ethnographic research in the Southwest borderlands, we expand an understanding of the factors that support the continuity of authoritative knowledge spatially and temporally. Mexicans’ healing knowledge persisted north of the border because it (1) incorporated a wide array of healing techniques and materials that remained accessible post-migration, (2) enabled immigrants to heal according to Mesoamerican worldviews that privileged natural modalities and a holistic approach to body, mind, and spirit, and (3) remained relevant by allowing immigrants to remedy daily health stressors inherent to Mexican migration, including the border crossing, detention and deportation, and daily fear provoked by undocumented status. While lay practices have often been interpreted as problematic by medical professionals, we conclude that Mexicans’ authoritative healing knowledge serves as a survival mechanism during the challenging circumstances of binational migration.
 
Channeling, DID and DTPD comparison:
Article
Channeling experiences are often compared with Dissociative Trance/Possession Disorders and Dissociative Identity Disorders and more recent diagnostic criteria presented in the DSM 5 and ICD-11. From this comparison, it emerges quite clearly that, for most cases, channeling can either be considered an exceptional non-ordinary mental experience or a non-pathological Dissociative Trance/Possession experience. If this characterization is valid, the next step is to understand the origin of channeling experiences. Are they an expression of channeler’s unconscious or voluntary mental mechanisms, or real connections with “other discarnate entities”? Given their peculiar characteristics, channeling experiences offer a unique opportunity for a scientific investigation and in particular, the origin of the information received by the channelers.
 
Article
Based on 16 months of fieldwork conducted at drug addiction treatment facilities in Yunnan, Southwest China, this article examines how Chinese drug users invent moralist selves during the frequent occurrences of shifei incidents. Shìfēi, meaning literally right/wrong, is a crucial concept in Chinese society with two contradictory meanings: (1) moral norms/judgment that ought to be discerned and followed (SHI-FEI); (2) “troubles” or “quarrels” that are often morally undesirable (shifei). By delving into a typical incident of shifei, this article analyzes the logic, motivation, and interpretations of the drug users and addiction treatment facility staff who are involved in the local moral world. It argues that for drug users, the relationship between SHI-FEI and shifei is not oppositional, as often assumed. Instead, both are valuable moral experiences and useful cultural means in response to users’ moral demands and tensions. Negotiating SHI-FEI and shifei enables an ambiguous space in which drug users seek, claim, and practice their moralist selves. This article also argues that under various sociopolitical and moral constraints, drug users’ moral selves are characterized by an inward focus on claims of morality and legitimacy. This inward focus reflects a process of moral involution. This study contributes to understandings of moral self-making in stigmatized situations.
 
Article
Generations of scholars have debated hair’s significance as a symbol of womanhood, fertility, and spiritual morality in South India. For contemporary Indian women, hair is a site of concern, often expressed as an everyday preoccupation with hair loss or “hair fall,” as it is known in the subcontinent. This exploratory study investigated hair fall among Kannada-speaking Hindu women in the South Indian city of Mysuru, Karnataka. It used a series of focus group discussions to explore how women talk about the causes and consequences of hair fall, and how women cope with hair-related distress. Participants articulated clear, shared ideas about why hair falls and how it can be managed. They connected hair fall to broader stressors in their lives both directly and symbolically. Hair fall, therefore, appears to function idiomatically in this context, both as an idiom of distress in its own right, and as a symptom of other idioms and forms of distress. Additional research is needed to establish the importance of hair fall relative to other distress constructs, and to more directly assess its potential value in research and intervention.
 
Article
This article addresses conflicting concerns related to space for mourning in Norway. It draws on material from qualitative interviews with bereaved parents who have lost a child in stillbirth. Space for mourning, and the need for sick leave, arose as a crucial concern and complex issue in these interviews. Although initiatives have been developed to introduce grief as a valid category in diagnostic repertoires, it is not a legitimate basis for sick leave in the acute phase. Common alternatives have been referrals to psychic instability or depression. Both variations represent a medicalization of the normal with implications that need to be addressed, and which this article discusses from the bereaved parents’ point of view. Extended parental leave, and the introduction of grief allowance, are possible alternatives for the provision of space in normal but demanding times of grief. Despite not yet part of the repertoire for gatekeepers in the Norwegian welfare state, they are part of the public discourse. Besides a crucial acknowledgment of the grief of the parents, these options also represent possibilities for preventing a pathologization of what is a normal rite of passage.
 
Article
Physician-assisted death (PAD) for patients suffering from a mental illness is allowed in the Netherlands under certain conditions but is a very controversial topic, mainly discussed by ethicists and physicians. The voice of the patient is rarely included in the debate, so we know little about what their views on the topic are. We aim to understand the views of patients with mental illness and wish to die with regard to the possibility of PAD in the Netherlands. The data for this qualitative study were collected through 21 in-depth interviews with Dutch patients who have a wish for PAD as a result of suffering from a mental illness. We identified four themes in relation to the meaning of PAD for the patients suffering from mental illness and wish to die. These themes are (1) Autonomy and self-determination, (2) ending the suffering, (3) recognition, and (4) a dignified end-of-life. The option of PAD for patients suffering from mental illnesses was considered of great importance to the patients who have a wish to die. We highlight the importance of ‘recognition’ for the situation of the patient, as this could lead to new perspective. We argue that psychiatrists need to reflect on providing this recognition in earlier phases of treatment, taking seriously and discussing a wish for PAD in treatment is beneficial to patients. It provides space for the patient to discuss their wishes and could cause them not wanting to die anymore.
 
Characteristics of research participants Individual interviews (N = 26)
Article
This article presents an analysis of the lived experiences of youth mental health practitioners taking part in Transcultural Interinstitutional and Interdisciplinary Case Discussion Seminars (TIICDS), an intercultural training initiative developed in Montréal (Québec, Canada), while considering the current context of increasing social polarizations. Using insights from the community of practice (CoP) framework and drawing on the analysis of 21 seminar sessions and 26 semi-structured individual interviews, this article examines the relation between the local sociopolitical context, the participants’ verbalization about their identities, and the affect and cognition evoked by the training. Results indicate that TIICDSs present several features of a CoP and that intercultural training needs to build on both theoretical and experiential knowledge, while considering local contextual elements. These include historical and contemporary social representations and power differentials between groups, the cultural identities of trainees, and the institutions and sociopolitical structures in which clinical practices take place. These elements, we argue, are sensitive and potentially conflictual but can be addressed through supportive and reflexive group-based initiatives such as CoPs that bring together practitioners on a regular basis and provide them with a ‘culturally safe enough’ space in which they can learn to complexify their understanding of clinical situations.
 
Map of overarching themes and subthemes
Article
Ethnic minority females are less likely to receive a diagnosis or treatment for an eating disorder (ED). This study captured the experiences of therapists who have worked with ethnic minority females to improve outcomes for this group. Twelve therapists in the United Kingdom, London were recruited for semi-structured interviews and thematic analysis was used to analyse the data. Shame was cited as a barrier to accessing help. This influenced therapeutic work such as not challenging shame or linking this to a negative interpretation of parents. Emotional and interpersonal factors were thought to be more common risk factors for the ED. The minimising of weight and shape concern and non-fat-phobic anorexia was thought to lead to a complex and delayed route to accessing ED services. Therapists felt restricted by service management who they felt required them to deliver a narrow range of therapies that had not necessarily demonstrated therapeutic outcomes in ethnic minority females. Nevertheless, therapists reported using curiosity to guide their cultural adaptations when feeling uncertain. When working with ethnic minority females, therapists face challenges from the therapeutic and diagnostic framework that services are aligned to. Creative solutions to address this include adapting the patient care pathway, referral guides, cultural reflective practice, and the use of cultural genograms and scripts in therapeutic work to address unmet needs.
 
Number of psychologists mentioning the respective country of origin of their (migrant and/or refugee) patients
Categories of Suffering. Traumatic experiences are represented as transcending the CoO, the flight as well as the post-migration situation
Most frequently mentioned symptoms or states. The number indicates the total of psychologists who referred to the respective symptom or state
Article
Worldwide there are 79.5 million displaced people, many of which face war, violence, tragic flights and struggles in host countries. Research shows augmented prevalence rates of mental disorders among refugees internationally, but little is known about refugee mental health in Latin American countries. Furthermore, only a few studies have taken into consideration the knowledge of clinical psychologists who treat refugee patients. The present study examines the experiences of 32 psychologists in Brazil regarding their refugee patients’ psychological suffering and mental disorders. Semi-structured interviews were conducted in various locations in Brazil and analysed following a consensual qualitative research approach. Four clusters of refugee patients’ suffering were synthesised: post-migration stressors, traumatic experiences, flight as life rupture, and the current situation in the country of origin. The most frequently described conditions in patients were anxiety and depression. However, the results also show that the use of manuals for the classification of mental disorders is contested among psychologists in Brazil. Most psychologists stressed patients’ socio-political suffering and saw patients’ symptoms as normal reactions to their experiences. There is a need to acknowledge the socio-political suffering of refugees in Brazil and foster their mental health by tackling current post-migration stressors such as discrimination.
 
Article
Anorexia nervosa is a paradoxical disorder, regarded across disciplines as a body project and yet also an illness of disembodied subjectivity. This overlooks the role that material environments—including objects and spaces—play in producing embodied experiences of anorexia both within and outside treatment. To address this gap, this paper draws together two ethnographic studies of anorexia to explore the shared themes unearthed by research participants’ engagements with objects that move across boundaries between treatment spaces and everyday lives. Demonstrating how the anorexic body is at once both phenomenologically lived and socio-medically constituted, we argue that an attention to materiality is crucial to understanding lived experiences. A materialist account of anorexia extends the literature on treatment resistance in eating disorders and offers a reconceptualisation of ‘the body in treatment’, showing how objects and spaces shape, maintain, and even ‘trigger’ anorexia. Therefore, against the background of the high rates of relapse in eating disorders, this analysis calls for consideration of how interventions can better take account of eating disordered embodiment as shaped by material environments.
 
Article
For years, Common law and Civil Code have determined the legal age as majority which defines adulthood, giving a presumption of legal capacity to adults. At this age, all adults are presumed to be capable of making their own decisions, protecting their interests and exercising the rights they enjoy in the acts of their civil life. This legal presumption of capacity structures the life-course of adults and allows them to act and make decisions either in daily life or for exceptional civil acts, for instance, marriage. Domestic laws, including French laws, do provide for certain exceptions, especially for persons suffering from disease or disabilities. The use of substitutive decision-making, or “coercive legal” measures, is increasing. At the same time, these legal substitutive decision-making measures have encountered challenges. The cornerstone Article of International Convention on the Rights of Persons with Disabilities (CRPD) reaffirms the exigence of equal recognition of all persons before the law with equal capacity. The interpretation of this article 12 is subject to considerable controversy. The controversy around CRPD and the paradox between the normative evolution of fundamental rights and the increasing uses of legal substitutive decision-making measures in social practices raise questions about the place of this legal presumption of capacity. In this article, we wish to tackle this controversy by starting with situations where the daily capacity to exercise one’s rights becomes an issue for the professional or family circle. What happens when persons seem unable to understand the consequences of their actions or when they behave incomprehensibly according to their close ones? When should others around the person worry about the person’s ability to take care of oneself? What happens when a person’s ways of functioning change? Is it an indication that his or her state of health is experiencing changes? That the person’s needs have evolved? What does this imply for family and friends, especially in terms of actions or substitute decisions? Using the core notion of “capacity trajectory,” this article intends to empirically shed light on how rights and legal capacity are exercised in situations of vulnerability. We wish to demonstrate that the presumption of capacity requires certain “conditions of capacity” in practice.
 
Article
This article examines the self-concept of the person who experienced Notq -the Druze phenomenon of remembering and talking about previous life. We focus on ‘solved’ stories- ones in which the person identifies his/her previous incarnation. The central question of this study is: What is the phenomenological experience of a person who has had Notq? In-depth semi-structured interviews were conducted with twenty-three Israeli Druze adults. The findings expose the Notq’s experience and its manifestations throughout ‘Notq’s life career’. The findings also show that Notq provides psychological resources which create a symbolic type who represents the central ethos of the Druze. In the discussion we argue that Notq can be perceived as a cultural idiom providing unique psychological and cultural resources. This study contributes to the research of psychology and culture by examining the Druze belief in reincarnation, the interpretation of cultural idioms and cautions against treating them as idioms of distress.
 
Article
Drawing from ethnographic research with psychedelic therapists and researchers, this article explores political tensions between two sources of efficacy within psychedelic therapy: the self and the chemical. At times researchers and therapists emphasize the specificity of chemical effects in relationship to the neurobiology of particular diagnoses. And at other times they foreground the self as the true source of an experience which is not tied to that same biochemistry. Anthropologists have long emphasized that efficacy is a historically and socially embedded category and practice. Those conversations have new valence in light of recent theorization of the chemicals as material-semiotic structures shaped by their experimental contexts. This article argues that while the empirical claims embedded in these two efficacies can and do mutually include each other, a fundamental political tension remains between the efficacious ends envisioned by each. As clinical trials develop these drugs as therapeutic agents, they do so through linking the specific effects of the chemical to particular diagnostic populations, which may enfranchise these chemicals, but not all their efficacies.
 
Article
This paper explores how criticism surrounding the ethics and safety of biomedical technologies circulates and ‘converts’ through global–local religious encounters, producing new claims of moral opposition and rights to religious freedom. The paper is concerned with the question of what rhetorical devices make vaccine safety doubt relevant to religiously Orthodox settings and what implications arise? Based on an ethnographic study of vaccine decision-making and non-vaccination advocacy in Jerusalem, the paper examines how opposition is forged amidst evolving global–local encounters and relations. The data reveal how Christian activists attempt to engender ethical and moral opposition to vaccination among American Orthodox Jews in Jerusalem by ‘converting’ public criticism around safety into a religious discourse of bodily governance. Pinpointing how critiques of biomedical technologies discursively ‘convert’ offers a conceptual template in anthropology to chart how counter-positions are formed and transformed amidst evolving tensions between biomedical and religious cosmologies.
 
Article
Standardized assessment tools developed in western contexts may systematically miss certain problems that are considered important in non-western cultures. In this mixed-methods study, we used an open-ended assessment tool (the Top Problem Assessment; TPA) to identify culturally relevant concerns among low-income Kenyan youth. We then (a) applied thematic analysis to identify the most frequently reported problems and (b) examined the extent to which these problems were reflected in standardized mental health measures. Using the TPA, we identified common social, academic, and economic problems facing Kenyan youths. Specifically, 61% of the sample reported a social problem, 38% an academic problem, and 35% an economic problem. By contrast, the standardized assessments revealed that worrying and difficulty concentrating were the most commonly reported symptoms. However, the emotional and behavioral problems assessed via the standardized measures were only reported as top problems by 17% of the sample. Overall, our findings are consistent with the idea that standardized measures can miss certain culturally-salient concerns that can be acquired through open-ended assessments. We discuss how brief open-ended assessment tools could complement standardized measures, inform the development of culturally relevant standardized measures, and offer rich data about the experiences of people in understudied cultural contexts.
 
Article
In this piece, the authors present the case of a young Black American man who experienced symptoms of post-traumatic stress disorder after an episode of police violence. Through engagement with this case, the authors consider whether trauma-focused psychotherapies, particularly trauma-focused cognitive behavioral therapies (TF-CBT), are equipped to attend to contextual factors relevant to traumatic experiences of police violence. The authors suggest further research to determine for whom and in what contexts standard forms of psychotherapy as well as alternatives to TF-CBT are effective, and augmenting provider education to include advocacy strategies aimed at reducing police violence—advocacy that is relevant in the context of nationwide protests occurring after the officer-perpetrated killings of George Floyd, Breonna Taylor, and others.
 
Article
Recovery is now widely acknowledged as the dominant approach to the management of mental distress and illness in government, third-sector and some peer-support contexts across the United Kingdom and elsewhere in the Anglophone Global North. Although narrative has long been recognised in practice and in policy as a key “technology of recovery,” there has been little critical investigation of how recovery narratives are constituted and mobilised, and with what consequences. This paper offers an interdisciplinary, critical medical humanities analysis of the politics and possibilities of Recovery Narrative, drawing literary theoretical concepts of genre and philosophical approaches to the narrative self into conversation with the critiques of recovery advanced by survivor-researchers, sociologists and mad studies scholars. Our focus is not on the specific stories of individuals, but on the form, function and effects of Recovery Narrative as a highly circumscribed kind of storytelling. We identify the assumptions, lacunae and areas of tension which compel a more critical approach to the way this genre is operationalised in and beyond mental health services, and conclude by reflecting on the possibilities offered by other communicative formats, spaces and practices.
 
Article
This article aims at describing the tensions arising from working on and with someone in psychiatry, in order to make this person more “autonomous”. First, through the example of the recovery, it acknowledges, the normative horizon of what is considered today as “good care”: a negotiation between partners, aiming at increasing the possibilities for everyone to follow their own lifestyle. It then seeks to describe how this definition of good care is endorsed and applied in two institutions (in Belgium and in France) hosting people with severe mental health issues where the care teams are using three words (“contract”, “project” and “autonomy”). The article analyses the difficulties encountered while putting into practice these demanding ideals and shows how and to what end the care teams take action in defining the “good” projects and, in a more general way, what patients can or should expect from themselves and from their future.
 
Article
Mental disorders or altered psychological states are prevalent in all populations, regardless of race or ethnic origin, while at the same time culture also shapes the conceptions of mental disorders. Religion is deeply rooted in the daily life of the Muslim-majority countries, while Arab countries are affected by an ongoing modernization. Thus, how does the traditional religious conception of mental disorders interact with Western psychological conceptions in contemporary Arab-Muslim society? This study explores the conceptions of mental disorders and their causes among Muslims in contemporary Jordan. By employing cognitive anthropological method (free-listing) forty participants were asked to provide three lists of: (a) typical names of mental disorders, (b) causes of mental disorders, (c) determining features of mental disorders. Collected qualitative data have been quantitatively analyzed and interpreted in the context of relevant ethnographic and interview data. While Western terms of mental disorders are well known among young and educated Jordanians, the study demonstrates that Jordanians employ cultural and religious notions alongside. This coexistence of different conceptions confirms an importance of Islamic notion in the modern rendering of mental health. As a result, despite rapid modernization, mental health is still highly stigmatized.
 
Article
This article traces the case of Hala, a woman chronic patient of the Lebanon Hospital for Mental and Nervous Disorders (LHMND) in late 1950s Lebanon. Her story reveals a conglomeration of actors, expertise and technologies that regulated both her sexuality and mental illness, as she was moved, returned, then moved again, from the care of the family to the care of the psychiatric institution. By reconstructing an ethnographic case of the story of Hala, the article tackles an under-investigated area of research at the intersection of subjectivity, sexuality, psychiatry and family life. The case of Hala illustrates an on-going tension in defining and diagnosing mental illness for women between two forms of care: institutional psychiatry on one hand—promising a quick return of patients to society—and the family on the other, with its own understandings of what constitutes abnormality for women. Having lived at the hospital for more than twenty years, Hala’s voice and experience provide a powerful contribution to the ethnographic history of psychiatry in Lebanon. The article tackles questions on competing psychiatric and social authorities and the formation of psychiatric subjectivities. It also provides methodological and ethical reflections on the use of archives when conducting ethnographic research on psychiatry from the global peripheries. The case of Hala illustrates the patient’s own experience of LHMND’s policies of social rehabilitation in the late 1950s. It adds to a broader understanding of the processes that have led to the pathologizing of sexuality in under-studied societies such as Lebanon and the Middle East.
 
Article
Prolonged grief disorder (PGD) is a new mental health disorder, recently introduced in the International Classification of Diseases (ICD-11), World Health Organization Classification of Diseases (WHO). The new ICD-11 guidelines reflect an emerging wave of interest in the global applicability of mental disorders. However, the selection of diagnostic core features in different cultural contexts has yet to be determined. Currently, there is debate in the field over the global applicability of these guidelines. Using semi-structured interviews with 14 key informants, we explored the acceptability of ICD-11 guidelines for PGD according to Japanese health professionals as key informants. The interviews revealed symptoms of grief possibly missing in the ICD-11 PGD guidelines including somatization and concepts such as hole in the heart. Additionally, sociocultural barriers such as stigma and beliefs about the social desirability of emotions may challenge patients’ and clinicians’ acceptance of the new ICD-11 criteria.
 
Article
"Mothering while black" in Cleveland, Ohio is a radical act. This highly segregated, highly unequal urban environment is replete with the chronic stressors that degrade well-being and diminish survival for Black mothers and their infants; specifically, a maternal mortality rate two and a half times that of their white counterparts and an infant mortality rate nearly three times that of infants born to white mothers. In the midst of such tragedy and disadvantage, Black mothers strive to love and care for their children in ways that mitigate the toxicity of structural racism. The seventeen pregnant and postpartum Black women in this ethnographic study describe transformational experiences with what we label "betterment:" whereby they center their children's perspective and needs, reconsider their social networks, and focus on the future with an unflinching understanding of the constraints of structural racism. Locating betterment alongside other examples of maternal embodiment and through the rich theoretical lens of Black feminist scholars these participant narratives suggest that the toxic effects of racism and the means to resist them are embodied by Black mothers. A nuanced understanding of Black motherhood disrupts public discourses of blame and responsibility that obscure our collective duty to dismantle structural racism.
 
Article
Much has been written about the multifaceted significance of food and eating from an anthropological perspective; the same can be said about the role of food in collective identity construction and nation building. In contrast, the nexus of food, memory, psychological trauma, and disordered eating has been less explored. The aim of this interdisciplinary article is to synthesize available knowledge on this topic by engaging with research literature in fields such as food history, anthropology, sociology, and psychiatry as well as autobiographical works, cookbooks, etc. One main section of the article focuses on the role of food and cooking in exile and refuge. Another section deals with the role of food in the aftermath of historical trauma, whereas a final section discusses various works on disordered eating in the wake of traumatic experiences. In sum, the dual nature of food and cooking—at once concrete and abstract, material and symbolic—offers an arena in which ambivalent memories of trauma can take on tangible form. The concept of postmemory may be useful in understanding how food and cooking can function both as a vehicle and as a remedy for intergenerational trauma.
 
Pilesort data analyzed by nonmetric multidimensional scaling and cluster analysis
Correspondence analysis of categorization exercise
PROFIT Analysis of Chalsaenggyŏtta (Handsome), Kkonminam (Flower Boy), and Chimsŭngnam (Beastly Guy) Dimensions
Article
Men's body image is an issue of increasing importance as related illnesses continue to grow in prevalence around the world. However, cross-cultural attention to men's body image experiences has been relatively understudied. Based on data derived from cognitive anthropological methods of cultural domain analysis , I develop the concept of "muscularities" to more effectively examine the expectations inherent in multifarious models of body image men continuously navigate. Related to but distinct from "masculinities"-the recognition of culture-bound hierarchies of ways of doing-being a man-"muscularities" attends to the culturally particular ways in which muscles are conceived and evaluated as indices of socioeconomic status, intelligence, social skills, and professionalism, to name a few. Young South Korean men's experiences of chan'gŭnyuk ("small muscle") and manŭn kŭnyuk ("large muscle") challenge universalist assumptions about the kinds of muscles people value in global perspective, demonstrate the necessity of recognizing multiple muscularities in research, and encourage new directions of inquiry that attend to the consequences of variable embodiments of muscularities.
 
Article
This article reconstructs how Arab doctors, medical missionaries, British counterinsurgents, and Palestinian rebels negotiated and contested the legitimate role of medical workers and healthcare in times of colonial conflict. Drawing insight from a medical anthropological literature which challenges the notion of medical neutrality as normative, and setting mandate Palestine alongside other case studies of medicine in times of conflict from the interwar Middle East and North Africa, this article argues that while healthcare and medical authority could be put to work to support the colonial status quo, they could serve other, more radical ends too. To highlight the complexity of the political positioning of medical workers and healthcare, this article focuses on the town of Hebron during the great revolt which rocked the foundations of British rule in Palestine between 1936 and 1939, and relies on a range of colonial and missionary archival sources. The first part of the article uses the case study of an Egyptian medical doctor who took up political office in the town in moments of crisis to show how medical authority could be consciously transmuted into a force to uphold a besieged political order. The second part draws on the diary of a British mission doctor to reconstruct his efforts to assert medical neutrality during the great revolt, and—more strikingly still—how Palestinian insurgents participated actively in this attempt to transplant international legal protections to Hebron. The final part traces the incorporation of healthcare into the strategies of both British counterinsurgents and Palestinian rebels, with the British policy of collective punishment indirectly but appreciably degrading access to healthcare for Palestinians, and Palestinian counterstate ambitions extending to the establishment of insurgent medical services in the hills.
 
Observed distribution of social status in PKFC
Observed variance in social status based on race
Observed variance in social status based on poverty
Article
Children fathered and abandoned by United Nations peacekeepers are an unintended consequence of peacekeeping operations. Research suggests that the social identity of peacekeeper-fathered children (PKFC) is complex and contradictory. While economically disadvantaged, PKFC’s biracial background confers elements of racial privilege. Using the Democratic Republic of Congo as a case study, the present research evaluates the impact of racial differences on PKFC’s social standing. Drawing on in-depth interviews with a racially heterogeneous sample of 35 PKFC and 60 mothers, we analyse how race and poverty interact and cause PKFC’s conflicting social role. The data demonstrates that being of mixed race leads to the expectation of a higher living standard. Since most PKFC live in extreme economic deprivation, their anticipated privilege contrasts with reality. We found that the stigmatizing effects of poverty were amplified by biracial identification, leading to additional disadvantage, epitomised in the term “Muzungu aliye homba” [white child gone bankrupt]. The findings add to research on ‘children born of war’ and show the role of culture in shaping youth’s social identities. Based on PKFC’s intersecting burdens, we make policy recommendations that address the nexus of race and poverty.
 
Article
In France, women can be incarcerated during pregnancy and can keep their babies with them in prison up to the age of 18 months. The small number of nurseries in France and their unequal geographic distribution as well as the high percentage of foreign prisoners often result in women's isolation from their usual cultural environment. Family members and cultural community play a crucial role in the process of mothering. The aim of this study is to explore through these mothers’ narratives how they experience the cultural aspects of this process in the prison environment. We conducted semi-structured interviews to collect the experience of 25 mothers and 5 pregnant women in 13 different prison nurseries in France and used interpretative phenomenological analysis to explore the data. Four different themes emerged: prison: repression of cultural practices, prison: a culture of its own, loss of traditional culture, and cultural hybridization. The specific environmental architecture and operating rules in prison nurseries may induce acute repression regarding cultural ways of mothering. Considering both cultural permeability specific to the peripartum period during which women tend to more easily embrace cultural aspects from their environment, and family distance which restrains cultural transmission, these mothers gather multiple factors of vulnerability for full prisonization, as a form of forced assimilation to prison culture. But a sort of specific hybrid prison culture around motherhood seems to emerge instead, in a process similar to creolization.
 
Article
Touch is a fundamental sense and the most unexplored of the five senses, despite its significance for everything we do in relation to ourselves and others. Studies have shown that touch generates trust, care and comfort and is essential for constituting the body. Based on ethnographic fieldwork, this study explores the absence and presence of touch in interactions between people with mental illness and professionals, in health care encounters with general practitioners, neurologists and physiotherapists, as well as masseurs. We found that touch and physical examination of patients with mental illness is absent in health care encounters, leaving the patients with feelings of being out of place, misunderstood, less socially approved and less worthy of trust. Drawing on Honneth and Guenther, we conclude that touch and being touched is an essential dimension of recognition-both of the patients' bodily sensations and symptoms and of them as human beings, detached from the psychiatric label-as well as contributing to the constitution of self and personhood. These findings confirm that touch works as an existential hinge that affirms a connection between the patient, the body and others and gives a sense of time, space and existence.
 
Article
In India, where there is no centralized medical records system, biomedical care providers rely on families to explain their child’s illness and to carry records of any previous treatment the child may have received. Drawing on discussions of documentation, I argue that in the context of medical treatment for pediatric seizures, (1) families collect medical records to enable and shape their child’s medical treatment, and (2) such a merging of medical and familial care is necessitated by the nature of their child’s illness and the structure of the Indian healthcare system. Based on ethnographic fieldwork in Meerut and New Delhi, this paper attends to practices of record keeping to understand the demands biomedical institutions place on families for the treatment of their child’s seizures. I examine the creation, maintenance, and movement of medical records to suggest that documents are a point of intersection between medical and kinship practices. They are artifacts of care that can narrate parallel histories of a patient’s illness and family-clinician efforts to alleviate a child’s suffering.
 
Article
Susto is one of the most common disorders referenced in the medical anthropological and cultural psychiatric literature. This article questions if ''susto'' as understood in cultural psychiatric terms, especially in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM), is in fact a single ''cultural concept of distress.'' There is extensive cross-cultural and intracultural variability regarding fright-related disorders in the ethnographic literature. What is often labeled ''susto'' may be in reality a variety of distinct disorders, or lacking in the two signature components found in the cultural psychiatric literature: the existence of a ''fright,'' and subsequent soul loss. There has been significant pol-ysemic and geographical drift in the idiom label, the result of colonialism in Mesoamerica, which has overlayed but not necessarily supplanted local knowledge. Using data from fifteen years of research with Q'eqchi' (Maya) healers and their patients, we demonstrate how important variability in signs, symptoms, diagnosis, treatment, and prognosis of fright-related disorders renders any simple declaration that this is a singular ''susto'' problematic. We argue for a careful consideration of the knowledge of Indigenous medical specialists charged with treating fright-related disorders and against the inclination to view variability as insignificant. Such consideration suggests that Indigenous forms of fright-related disorder are not susto as presented commonly in the DSM and cultural psychiatric literature.
 
Top-cited authors
Devon Hinton
  • Harvard Medical School
Mark Nichter
  • The University of Arizona
Brandon A Kohrt
  • George Washington University
Roberto Lewis-Fernández
  • Columbia University
Laurence J. Kirmayer
  • McGill University