Thus a new secular remedy for the medieval sin of sloth evolved: the discipline of work. Soon idleness was virtually regarded as the primary crime against industry, and this was supported by influential members of the scientific and political community in Europe. During this era, a significant intellectual framework, the doctrine of materialism, developed the idea that the body was a source of energy capable of transforming universal natural energy into mechanical work.
This ability to generate energy and perform labour could then be harnessed by the state for the production of wealth and articulated in the form of a metaphor: the body as machine. By the turn of the century, the body was modelled on the thermodynamic engine and linked with physical forces in the cosmos through a unifying category: energy, the antithesis of fatigue.
This concept of energy also gained popularity among late nineteenth-century physiologists keen to understand bodily functions through principles of physics and chemistry leading to the development of terminology such as calories and muscle proteins to explain energy production within the body. The traditional western proscription of idleness, which spiritualized and consecrated labour, was displaced onto the working body or class and recast in scientific and medical language as a natural category. Several texts and monographs on fatigue were published and a state similar to the Elizabethan melancholic era had developed.
With the invention of the ergograph, aesthesiometer and algesiometer, attempts to measure the physical consequences of mental fatigue were balanced by others which tried to establish and develop a pure psychological category of fatigue. Among the most notable attempts was that of Emil Kraepelin who argued for devising sophisticated psychological techniques to measure fatigue. He measured and plotted graphs on fatigability in mental terms through monitoring psychological performances of factory workers in his laboratory. This term was then shared and reinforced by prominent physicians and social scientists, including Charcot, Simmel and Durkheim.
Nuances like chronic fatigue and myalgic encephalomyelitis ME reflect how their causes are contested by biological and psychological theories, while reified by an industry of sickness benefits and litigation. Although a cardinal feature of depressive disorder as low energy , it retains a separate identity as chronic fatigue disorder in contemporary western ethnopsychiatry American Psychiatric Association DSM IV Somatization followed as a logical continuation of this discourse on fatigue.
It is now enshrined within the DSM IV as a disorder in itself, considered resistant to treatment and continues to preoccupy researchers who either seek a biological substrate Goodwin and Potter or consider it prevalent among those who have a less differentiated psychological vocabulary Leff However, standard textbooks of psychiatry now describe it as a means of communicating affective distress through somatic language. It is not surprising that the concept of somatization originated in an era when eugenic theories dominated academic scientific thinking.
Its popular usage in current English began as a common overarching metaphor of a natural force principally in physics fourteenth to seventeenth century , that denoted a sense of weight, pressure, strain or a deformation upon a material object. Its introduction into psychiatric literature occurred at the end of the nineteenth century when it was first associated with neurasthenia Rabinbach and considered a general cause of mental disorders.
This diagnostic term is therefore a good example of an aetiologically and culturally based disorder trauma within a diagnostic system that claims to be atheoretical and culture free American Psychiatric Association DSM IV. As a generic equivalent of bacterial or viral infection of the disease model, its credibility relates to non-stigmatizing qualities such as an impersonal nature, location outside the body and a semantic distancing from other emotion related vocabulary.
If the cultural validity of depression can be taken as local experiences of the population that are clarified and validated on their own terms, then depression can be construed as a culturally valid concept for western settings. If this is the case, it is a fallacy to assume that depression is some real objective disease entity which can be found elsewhere or, for that matter, packaged and transported to a contrasting setting for ready use. As observed earlier, depression for the culture-free psychiatrist in India is no more than a consensus of psychiatric nosology among health professionals sharing a common western medical epistemology.
To proceed further entails the following: 1. A study of lived experiences of everyday suffering and recourse to help through local narratives and language that would identify key constructs and examine the cultural logic of constructing illness experience in both western and non-western settings. The semantic illness network is one such approach that revealed local distress models for the Punjabi community in Britain Krause and Shiite Muslims from Iran Good Such local models would generate popular and locally meaningful patterns of distress to validate local experience on its own terms.
These could then be operationalized and validated against western phenomenology and psychopathology for congruence or goodness of fit in form, content and quality. It is likely that some patterns of distress may not fit with western descriptions of psychopathology and disorders and may therefore need separate and distinct class category representation. Examples of these are the Japanese concept of taijin kyofusho in the official Japanese diagnostic system for mental disorders; the qi-gong excess of vital energy psychotic reaction and shenjing shuairuo neurasthenia as represented within the Chinese Classification of Mental Disorders, 2nd edn American Psychiatric Association DSM IV Alternatively, some patterns may well reveal common universals that would enrich the debate on cultural validity.
Development of instruments, both quantitative and qualitative, that would measure such distress patterns and contribute towards the development of higher order categories or syndromes. Only then can such categories be comparable with western psychiatric concepts for cross-cultural equivalence and validity. What are its relative perceived threats to marriage, kinship ties and integrity of the community on the one hand versus economic risks or unemployment on the other?
Would a western life events questionnaire be recalibrated by local members of the population who might choose to rearrange the hierarchy of events? Cultural validity apart, there is an additional reason that merits such an enquiry: mental health professionals, particularly from developing nations, have often expressed surprise at the manner in which scholarly discourses on medical anthropology remain confined to western academic institutions with little impact on changes in everyday clinical practice in their own settings. These include their subordinate status within health institutions across cultures, the lack of teaching and systematic research in this area leading to a poor impact on mainstream medical disciplines including psychiatry.
It is in this context that anthropologically informed methods of enquiry have potential to help establish clearer links between personal suffering and local politico- economic ideologies. Such methods can generate alternative canons of culturally valid psychiatric theory and practice and contextualize them in both time and space. Although ambitious in its aims, research that will critique western psychiatric theory and practice and reveal its ethnopsychiatric premise also broadens the debate on cultural validity of psychiatric disorders in general. Moreover, this process might generate local interest into indigenous taxonomies and provide a meaningful framework within which both professionals and patients from non-western cultures could reclaim their local cultural and political histories.
A comprehensive review of the literature Kleinman and Good suggests significant differences in guilt, self-esteem and somatic symptom between western developed and non-western developing societies. Various hospital psychiatric clinics of rural and urban Bombay —83 and Bangalore — This is a common reference point in clinics. Most recently, the anti-psychotic drug clozapine was introduced without the mandatory blood count monitoring personal communication, Professor R. Raguram, Bangalore. The author would like to clarify that this description of everyday clinical routine does not imply that such culture-free care and practice is deliberate, nor does he question professional competence.
On the contrary, great care is taken to provide consultations in a humane and competent manner that match with practices at internationally renowned clinics. But the issue here is about the criteria used. Thus the academic and folk metaphor for mood disturbances as feeling down or high, and the linear link with past memories illustrated by the association of childhood loss and current depression Littlewood For a more detailed discussion, see Elias and Macfarlane on how capitalist economic structures shaped the development of private vocabulary.
See also Johnson on how British housing architecture and domestic spaces articulated the distinction between private and public. While Cassian suggested eight sins, Gregory reduced the number to seven. Tristitia was thought to be synonymous with acedia Jackson Paracelsus — His given name was Theophrastus Bombastus von Hohenheim. He suggested that melancholic complexions drive the spiritus vitae up towards the brain, leading to an excess and thus cause melancholia. Thus melancholics are disturbed by their own nature Jackson He used the terms passions and affectations as synonyms for sorrow, which was a result of black bile affecting the mind.
His prescription included dietary restrictions, company of women, avoidance of darkness and keeping a busy mind. Timothy Bright — , another physician turned clergyman, postulated that black bile vapours rose from the spleen to obscure the clear mind and cause melancholia. This bears some resemblance to the current dichotomy of neurotic and endogenous depression. These were a combination of a range of astrological theories relating to the influence of Saturn , demonic attributions and moral transgression against the Church.
MacDonald suggests that traditional medieval and renaissance models of the universe 60 Thomas Willis — was one of the first to introduce chemical theories. There were several eighteenth-century theories that revolved around the brain and nerves. Influential concepts of well-known European physicians are summarized below: Friedrich Hoffman — postulated particles in body fluids that blocked the brain pores. Herman Boerhave — introduced a mechanical hydraulic circulatory physiology in which factors that slowed the blood circulation led to stasis around the hypochondriacal region causing melancholia.
In melancholia, primary mental images caused by prolonged thinking or brooding on a fixed idea led to secondary alteration in the blood. William Cullen — postulated that the brain was controlled by a system of Newtonian forces, which caused excitement and collapse in various disease conditions. The brains of melancholic patients were firmer and drier in texture, which were therefore vulnerable to higher degrees of excitement. The reader will find a detailed account in Jackson There were instances of pejorative terms used to describe variants of melancholia, such as Mopishness Richard Napier , to reflect the sullen inactivity of husbandmen and artisans, while the term melancholy was reserved for the dumpish mood of idle gentlefolk.
The foolish, weak and stupid people, heavy or dull souls were considered rarely troubled with low spirits Porter The term melancholy was recorded disproportionately among those of higher social rank with many merely adding the label to enhance themselves and give a dignified status to their conduct. Compare also with the popular northern Indian Hindi term Udaas Kabir, commonly reserved for the dishevelled appearance of young men, after being jilted by their lovers but one that is neither pathologized by the local culture nor related to social rank ; although the commonly accepted term for depression among clinic populations is Udasi.
This concept highlights a key western cultural preoccupation with the attainment of pleasurable states and unlimited happiness. Such affects and their accompanying epiphenomena, he argues, are rooted in Buddhist existential discourse and do not constitute an illness; although features of depressive disorder may well be elicited. The action of depressing, or condition of being depressed; that which is depressed: in various senses.
The digits in parenthesis italicised , denote the year when the term was first used. The act of putting down or bringing low, or the fact or condition of being brought low in stature, fortunes, etc Frith Wks, 5, Aduersitie, tribuation, worldly depression. Thus depressing others, it pride seeketh to raise it selfe, and by this depression angers them. Six Lessons Wks. Greece III. Flags, the Elevation whereof was a signal to joyn Battle, the Depression to desist.
Peace 57, The depression of public funds Great depression…has without doubt lately shewn itself in a very remarkable manner in the influenza. Scott in Gd. Words July Barometrical depressions or cyclones. Babb, L. East Lansing: Michigan University Press. Bhishagratna, K. Chowkhamba Sanskrit Studies Volume Varanasi: Chowkhanba. Bright, T. Thomas Vautrollier. Brill, A. New York: Random House. Carritt, E. London: Routledge and Kegan Paul. Clarke, B. Cardiff: University of Wales Press. Delumeau, J. Trans E. New York: St. Desjarlais, R. New York: Oxford University Press.
Doughty, O. Elias, N. E, Jephcott. New York: Pantheon Books. Gaines, A. Goldman, R. Good, B. Goodwin, F. Cole et al. New York: Plenum Press. Heelas, P. Hunter, R. Jackson, S. New Haven: Yale University Press. Jadhav, S. Unpublished MD Thesis. Editorial commentary. Johnson, M. London: University College London Press. Johnson, S. London: Longman. Kaplan, H.
Baltimore, Maryland: Williams and Wilkins. Kelly, G. New York: Norton. Kleinman, D. Krause, I. Lakoff, G. Legge, M. Legouis, E. Revised edition. London: Aldine Press. Lutz, C. Studies in Emotion and Social Interaction. Lynch, O. The Social Construction of Emotion in India. MacDonald, M.
Macfarlane, A. Marsella, A. Marx, K. Berlin: Springer-Verlag. Neill, J. Nicholson, S. Nichter, M. In Kleinman and Good Porter, R. London: Faber and Faber. Rabinbach, A. Rippere, V. Sartorius, N. Geneva: World Health Organisation. Shweder, R. Boston: Harvard University Press. Siegfried, W. Winokur, G. Journal of Nervous and Mental Diseases , 82— New Jersey: Princeton University Press. Yet apparently they can be located and identified by physicians. Personal misfortune is increasingly experienced through a medical lens which encourages us to understand and shape our troubles in a clinical way: as something like a disease which suddenly constrains us from outside our intentions, with its particular cause and characteristic pattern, and for which doctors possess potential treatments.
The impact of unemployment, incest or witnessing disaster? Is sexual dissatisfaction an illness? Our inclination to theft, violence or greed? In its attempt to become recognized as a purely naturalistic science, independent of the particular moral values in which it has developed, western medicine has played down the social relationship between patient and doctor and between the experience of suffering and the local understandings through which suffering occurs. Medicine seeks the laws and regularities of a physical world immune to changes in historical frames of reference or in human cognitions.
As the French anthropologist Pierre Bourdieu , p. When psychiatry developed as a medical speciality in late eighteenth-century Europe, physicians recognized that certain of the concerns which by analogy with physical disease they examined as sicknesses could appear more commonly in one country or group rather than in another. Britain was identified as a country particularly liable to the morbus anglicus despair and suicide as a consequence of its climate cold and wet , its diet beef and the pace of its commercial life fast , all contributing to the vulnerabilities of the national character melancholic Cheyne Illnesses like melancholia, spleen or neurasthenia were recognized as the cost of accepting new public responsibilities by men of the emerging middle classes in the period of early industrialization and extending political representation.
Other sicknesses — hysteria and moral retardation — were rather a distressing inability to accept such responsibility, an outward manifestation of the weaker bodily or moral constitution of European criminals and women, or of slaves and other subdominant or colonized subjects, when they were threatened with the possibility of similar obligations Brigham Donna Harraway has argued in a critique of anthropology , p. Culture was thus not only an historical process in time but, like nature, something which could be accumulated to be used and indeed commodified.
The more culture, the less significant was nature in human societies: and the converse. The actual relationship between nature and culture — modes of thought taken for concrete entities — was and remains problematic. Different professional disciplines developed to specialize in each: what in Germany became known as the natural and moral sciences. Form and content Clinical psychiatry developed in the nineteenth-century hospitals of Europe where industrial societies confined those recognized as insane, and the majority of hospitalized patients still remain diagnosed as psychotic — as demonstrating diseases which, if pathological changes in the brain cannot readily be demonstrated, are at least presumed to be present Schneider , and which reduce responsibility and thus legal accountability.
The scientific prestige of hospital medicine, and its identification of an illness which corresponded to what was popularly recognized as insanity and which in the early twentieth century came to be known as schizophrenia, tended to make the predominant understanding of mental illness the medical e. Gaskell Beard Not every person who was diagnosed as having a particular mental illness reported exactly the same experiences. To deal with variations in the symptoms between individuals, clinical psychiatry still makes a distinction between the essential pathogenic determinants of a mental disorder — those biological processes which are held to be necessary and sufficient to cause it — and the pathoplastic personal and cultural variations in the pattern.
These two are still distinguished in everyday clinical practice by the particularly nineteenth-century German distinction between form and content. To which we might add the modern imperative to naturalize experience; so thus hotness, translated into temperature, became something like a natural entity which, like the idea of manic-depression, could easily be rated as a linear scale Littlewood It seemed most applicable when abnormal experiences and actions were associated with a recognized and presumably ubiquitous disease such as brain or thyroid tumour, anaemia, or with traumatic and vascular damage to the brain.
The hallucinations which were experienced during the delirium of the brain-damaged alcoholic were taken directly to reflect the biological form which could only be expressed through an insignificant content which reflected their particular character and the preoccupations of their society. Thus, looking at persecutory ideas in the West Indies, one study in the s argued that for the local blacks, paranoid suspicions the form were directed against relatives and neighbours content , following local ideas of sorcery in an egalitarian village community, while for the white Creoles, preoccupied with retaining control as a precarious elite, the phantom poisoners were identified among the surrounding black population Weinstein If nature was form and culture content, treatment was to be directed to the underlying biological cause, relatively easy — at least in theory — if it was identified by neuropsychiatrists as an object like a tumour or a bacterium.
To take an example from the German psychiatrist Emil Kraepelin: that a patient said he was the Kaiser rather than Napoleon that is, the content was of little clinical value compared with his delusion of grandiose identification form. Now this left the shared social world fairly redundant in psychiatric illness as it was observed in the hospital; except inasmuch as a society might facilitate one or other physical cause, as patterns of drinking might encourage alcohol-induced dementia, or local conceptions of risk increased the likelihood of traumatic accidents, or in a less direct way through changes to the physical environment and thus to human biology through genetic selection as with sickle cell anaemia.
The form—content schema worked fairly smoothly in European mental hospitals where the scope of what counted as clinical observation was limited by the institutional context, but by the beginning of the twentieth century psychiatry began to extend its practice to the peoples of the colonial empires. Many local patterns which suggested novel types of mental illness had been previously recorded by travellers, missionaries and colonial administrators, sometimes indeed as illnesses but often as examples of the criminal perversity of native life or just as picturesque if rather troublesome oddities.
In one of the first discussions of the problems of comparing psychiatric illness across societies, Kraepelin , after a trip to Java during which he collected accounts of amoks and also observed hospitalized patients, suggested that the characteristic symptoms of a particular mental illness — those which one could find everywhere in the world — were the essential pathogenic ones which directly reflected its physical cause. This proved difficult given the variety of local patterns together with the intention, which Kraepelin enthusiastically shared, to fit them into the restricted number of categories already identified in European hospitals.
The medical observer was to focus on those symptoms which seem distinguishing and characteristic, and thus biologically determining: in fact such symptoms are notably elusive in psychiatry where anxiety, irritation, insomnia, anorexia, depression, self-doubt and suicidal preoccupations are common to virtually all identified illnesses, and which themselves shade into everyday experience. Common features have then tended to be ignored, more by an act of faith in the Kraepelin—Birnbaum model than through an empirical consideration of all the available evidence.
Thus the statistical attempt to define key features favoured by epidemiologists in the s results in circular and quite varied arguments about categorization and universality. Psychiatric illnesses have not been shown to form neatly bounded monothetic categories, so multivariate analysis of a multitude of possible symptoms produces rather different types of classification, depending on whether one includes or omits shared symptoms, and indeed on what is to count as a symptom. When faced with patients from a society or minority group with which they are unfamiliar, British and American psychiatrists still complain of the culturally exotic factors which obscure the elusive disease process.
Indeed, any differences within the shared social context of western patterns, say between women and men, have been ignored until recently in favour of biological or bio-psychological aetiologies to explain variation. These could be presumed to be worldwide patterns. Dysphoric moods and unusual actions were locally recognized in Africa or Asia, not necessarily as something recalling a physical illness but often as part of totally different patterns of social classification and order — as spirit possession or rituals of mourning, or in the course of initiation, sorcery and warfare.
Those patterns that recalled the psychoses of the west seemed generally recognized as unwelcome but not always as akin to sickness Rivers Yet, when colonial doctors turned to writing reports and academic communications, local understandings of self and illness which might now seem to us as analogous to psychiatric theories were described, not as self-contained, meaningful and functional conceptions in themselves, but rather as inadequate approximations to western scientific knowledge.
At times however, the understandings of small-scale rural societies, like the more recognizably medical practices of India and China, cut dramatically across European experience. Individuals locally regarded as amoks were thus really demonstrating epilepsy or perhaps catatonic schizophrenia Kraepelin If one looked, for instance, at a Malay patient who had a false belief that she was persecuted by her neighbours, then her delusion was the form, and the neighbours provided the content, but the persecution seemed variously one or the other. That she was deluded is important for arguing that she is mentally ill; the neighbours are of no diagnostic significance, but that her delusions were persecutory could be or not, depending on the selected illness.
The assumptions made by Kraepelin in his studies in Java remain the dominant paradigms in comparative psychiatry: how similar do patterns have to be before we can say that we are talking about the same pattern? How do we distinguish between those features which appear to be generally the same from those which vary? And what are our units of categorization going to be when deciding sameness and difference, normality and pathology? This equivalence has often been extraordinarily optimistic. Windigo was identified by psychiatrists confidently but variously with patterns as disparate as depression, schizophrenia, hysteria and anxiety.
Similarly, amok was explained not only as the local understanding of epilepsy or schizophrenia, but as malaria, syphilis, cannabis psychosis, sunstroke, mania, hysteria, depression, disinhibited aggression and anxiety Kiev Identifying symptoms rather than the local context meant that amok and latah have generally been regarded not as autonomous cultural institutions, but simply as erroneous Malay explanations which shaped of a single universal disease, although psychiatric observers disagreed radically as to which disease this might be.
The extent to which such patterns could be fitted into a universal schema depended on how far the medical observer was prepared to stretch a known psychiatric category, and thus on their preferred theoretical model. By the s, Weston La Barre and Georges Devereux, psychoanalysts who were much less attached to purely biomedical arguments, had gone further in including as instances of schizophrenia a wide variety of local institutions — possession states, shamanism, prophecy, millennial religions and indeed, for La Barre, social change in general.
They argued not just that schizophrenia might typically appear in these social institutions but that the institutions exemplified schizophrenic experiences Littlewood b : everyday culture in non-western societies — ideas of selfhood and agency, creativity, religious experience — could be understood, as it were, as insanity spread out thin. Culturally obscured, or simply a primitive form, in neither did culture determine anything but rather acted as a sort of indeterminant soup which passively filled in or distorted the biological matrix.
Categorizations of illness, medical or popular, are adjacent to other social classifications — to those of character, ethnicity, gender, the natural world and historical experience — on which they draw and which they plagiarize. Biology, the form of the illness, so far from being universal, was like culture, on a developmental spectrum: indeed on the same line for culture simply reflected underlying biology. This denial of the social sources of psychological illness, together with the assumption that symptoms observed in Europe were somehow more real and less obfuscated by local values, led to the common argument that depression did not yet occur in non-Europeans for its essential western characteristic of self-blame was not observed Carothers The absence of depression was sometimes directly attributed to a less evolved brain Vint , an idea which of course had implications when considering the possibility of independence for colonial Africa under African leadership Carothers Guilty self-accusations of the type found in clinical depression in the west were in fact identified in colonial Africa in the s, not by psychiatrists in the colonial hospitals but by an anthropologist looking at the distribution of shrines Field Is it something like the misery which we might identify in various situations of loss or bereavement, or the pattern of rather physical experiences such as loss of interest, waking up early and poor appetite, which are recognized as clinical depression, or else some more specific sentiment of Judaeo-Christian guilt and a wish to die?
Greater psychiatric familiarity with the experience of personal distress in the former colonies has suggested that depression may be a variant of widespread patterns of what we might term dysphoric mood which in depression is represented through a particularly western moral psychology which assumes an autonomous self as the invariant locus of experience, memory and agency. The recognition that many non-western illnesses could no longer be subsumed as primitive forms of real categories led comparative psychiatry or as it was now called, cultural psychiatry to propose a new category.
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They were usually episodic and dramatic reactions, limited to a particular society where they were locally identified as distinct patterns of action very different from those of everyday life; and which, we might now note, had been of colonial concern because they were bizarre, outrageous or frankly troublesome. There is a continuing debate as to what the category refers: usually restricted to a pattern found only in the society in question and which symbolizes and represents fundamental local concerns, on occasion it has been applied to apparently universal illnesses which are shaped, distinguished and treated in a local content on the changing ideas see Lee ; Littlewood and Lipsedge ; Ritenbaugh A locally recognized reaction in New Guinea, kuru, was however once regarded as a culture-bound syndrome akin to hysteria, but no longer, given the likely role of a slow virus identified in its aetiology which has made it even more exotic through recognition that it could be transmitted through cannibalism.
And anyway how could such illness be clearly distinguished from the social patterns in which it was embedded? A later question, reserved for the late s, was how to deal with illnesses such as eating disorders which were apparently only to be found in European societies Lee ; Littlewood , c. Cultural psychiatrists now generally held appointments in western university departments, away from the poorly funded and intellectually marginal concerns of colonial psychiatry which still remained close to popular western ideas of race. The affected person was now suffering less from something recalling a medical disease with culture tacked on so much as demonstrating in an exaggerated form those psychological conflicts established in the course of childhood socialization.
So windigo the Ojibwa cannibal compulsion psychosis was interpreted as a local preoccupation with food in a hostile environment, fuelled by residues of infantile resentment at the mother for the early weaning necessitated by the scarcity of food. After an indulgent childhood, the young boy was precipitated into early adulthood by brutal tests of self-reliance and encouraged to fast to attain ultrahuman powers. Dependence on his parents was replaced by a precarious dependence on spirits which encouraged solitary self-reliance in hunting.
The mother, feared and hated for her violent rejection of her son, returned to possess him in the form of the windigo Parker Symptoms, dreams, religious symbols and social institutions were all to be taken as aspects of the same conflicts Seligman Psychoanalysis, developed out of practical therapeutic concerns rather than a concern with diagnosis, still argued that one could distinguish problem, causation and treatment, but differed as to how to go about it.
Criticizing the historian Edwin Ackernecht , p. Like Devereux, he still regarded it as all distinctly unhealthy. Alternatively, Weston La Barre, Ari Kiev and Thomas Scheff took the cathartic expression of hidden desires as a resolution rather than an exacerbation of cultural conflicts — as something closer to healing. This all gets rather circular and, like hospital psychiatry, ignores local conceptions of healing in favour of western ideas of normality and illness. Paralleling the earlier idea of non-western pathologies as masked or incomplete forms, non-western healing was now taken as an incomplete form of psychoanalytical therapy Frank ; Kiev What remained constant in all of this was the conviction, however muted, that something approximating to medical categories was still the appropriate way to frame the question; and that these provided universal criteria by which one could agree that certain patterns were justifiably termed dysfunctional or maladaptive Doi Roheim Benedict ; Lambo Psychoanalysis still subscribed to those positivist ideals of the late nineteenth century which had sought an understanding of human society whose ultimate justification would be in science, not religion.
If they attempted a more value-free comparative approach and one based on fieldwork with informants rather than on hospitalized patients, psychoanalysts still placed a particular primacy on patterns described in their bourgeois European patients which, in frequent disregard of the ethnographic data, they then identified in other societies. Fanon ; Loudon ; Mannoni Or else, as Sargant had argued, personal conflicts are expressed in limited contravention of role-specific norms in fairly standardized situations, and that it is these contraventions which had been identified, correctly or otherwise, as pathologies.
Social anthropologists have objected that their error was to use a medical grid which inevitably objectifed social action as disease entity. Rather, one should start by simply describing a society in its own terms, for societies are not traditional residues of some nearly forgotten past which is passing away but always constitute themselves anew in their chosen memories and actions. Social scientists, however, are hardly immune from comparing one society with another to obtain regularities and general patterns, and in order to do that, they too define analogous domains in each — whether those of social structure, kinship, religion or sickness.
These domains derive from western experience. Each society easily comes to be read as aggregates of such areas of comparison which become reified as the components of a society with structured and causal relationship to each other Littlewood The comparative problem is hardly unique to medicine. The evolutionary schema did offer one sort of comparison by relating societies or illnesses as states of transformation along a historical spectrum driven by certain processes.
Few anthropologists, some sociobiologists, Freudians and Marxists perhaps excepted, would now subscribe to the idea of unilinear human development through which local institutions and actions are to be understood as determined by underlying processes, whether those of evolutionary selection or of the relations of production.
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The aim is to explore what we can learn from anthropology to achieve a contextual understanding of mental illness and health in contemporary society. The book contains a wide selection of ideas, and works well to bridge the gap between anthropology and psychiatry. Additional Product Features Place of Publication. Her most recent book The Testimony of Lives. He was a founder member of the Transcultural Psychiatry Society and published widely in the field of Perinatal Mental Health from a sociocultural perspective. He was elected President of the Royal College of Psychiatrists in and continues his link with the Department of Psychiatry at Makerere University, Uganda where he held his first lecturer post in Show more Show less.
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