Showing papers in "Culture, Medicine and Psychiatry in 1979"

Sociocultural stress and the american native in Alaska: An analysis of changing patterns of psychiatric illness and alcohol abuse among Alaska natives

Abstract: This paper presents selected morbidity and mortality statistics to outline developing trends and the current status of psychiatric illness and alcohol abuse among the Aleut, Athabascan, Yupik, Inupiat, Tlingit, Haida and Tsimpshian people of Alaska. Analysis of the records of the Indian Health Service, the Community Mental Health Centers and the Alaska Psychiatric Institute, the providers of care for Alaska Natives, shows that the number of individuals treated as inpatients and outpatients for psychiatric illness and alcohol abuse has been rising steadily. Accidental injury and suicidal behavior are common. The treated prevalence rates for these diagnoses exceed recorded rates for other American Native and non-Native groups. For each category of violent death, suicide, homicide, accidents and alcohol, rates for Alaska Natives are higher than rates for Alaska non-Natives, American Indians and the U.S. (all races) and are rising. The data suggest a public health problem in which the primary elements are behavioral disturbance and violent death.

Definitions and diagnoses: cultural implications of psychiatric help-seeking and psychiatrists' definitions of the situation in psychiatric emergencies.

Abstract: This paper explores lay and psychiatric actors' definitions of mental illness by focusing on several aspects of emergency psychiatric diagnosis. First, it considers psychiatric diagnosis as a social and cultural process in which mental illnesses are defined with increasing specificity as individuals move from lay to psychiatric contexts. Second, the paper considers variation in psychiatric residents' conceptions of mental illness, their role in emergency contexts, and lastly, their diagnostic styles. Diagnostic styles are shown to exist and to be grounded in residents' definitions of the situation. It is suggested that the variation in psychiatrists' definitions of the psychiatric situation, especially as regards etiology, plays a prominent, but as yet unnoted, role in producing variability in psychiatric diagnosis. It is also argued that actors' definitions are cultural, grounded in non-professional. lay ideology, and are not products of secondary professional socialization.

Taijin Kyofusho: diagnostic and cultural issues in Japanese psychiatry.

Abstract: Taijin Kyofusho or 'anthrophobia' is a Japanese culture-specific disgnostic label for the presenting problems of various fear reactions in interpersonal situations. The starting point of the present study was accumulating studies on Japanese cases of Taijin Kyofusho and the assertion in Japanese psychiatry that the symptom complex called Taijin kyofusho is Japanese culture-bound. In light of previous works on culture-bound disorders, the present study examines whether or not American mental health professionals could diagnose Japanese case descriptions of Taijin Kyofusho and what kinds of labels they applied to these Japanese cases. The results showed that American judges were able to diagnose Japanese cases nearly as well as American cases. However, there were considerable variability and inconsistency in their judgments of both the Japanese and American cases. The rate of disgnostic agreement dropped considerable as judges were asked to proceed from broad categories to specific categories. American judges grouped the Japanese cases of Taijin Kyofusho into a number of heterogeneous categories using labels such as paranoid schizophrenia, paranoid personality, phobic neurosis, and anxiety neurosis, among others. These results are discussed in terms of psychopathological diagnostic criteria and present conceptualization of culture-bound disorders, value judgments of mental health professionals, and the social contexts in which Taijin Kyofusho reactions occur.

Lexemic change and semantic shift in disease names.

Abstract: The lexicon of illness terms used by Mexican American women is affected by the practice of speaking both Spanish and English and by the coexistence of several health systems. When there is changing participation in various health systems, with increasing interference and code switching, linguistic evidence for these changes may be found. In some cases an English disease name is borrowed. In others, a cognate is coined from an English disease name. Some terms, now no longer useful, are dropped. Finally, some Spanish disease names which do not have equivalents in English or in scientific medical theory may be retained, but there is a shift in the meaning of the words themselves. The direction of the shift is towards semantic correspondence with the concepts of scientific medicine. In these ways the medical lexicon is changed, with the changes reflecting a new medical culture.

Stereotypes of mental illness: A comparison with ethnic stereotypes

Abstract: This paper draws on empirical and theoretical studies to argue that popular and professional conceptions of mental illness share specific traits with ethnic stereotypes: (1) they are exaggerated and serve to erect a qualitative boundary where none objectively exists: (2) they are maintained through selective perception, rationalization, and sanctions; (3) they help to erect the “thresholds,” i.e., the criteria, for crossing or recrossing the boundary; (4) they serve to define relations, including those of power, between groups; (5) because they perform these important cognitive and conative functions, they persist despite a flow of personnel across them and despite repeated demonstrations of their inaccuracy. They cannot be expected to change until the actual relations between groups change.

Spirit possession and spirit mediumship from the perspective of Tulu oral traditions.

Abstract: The phenomenon of spirit possession is looked at in relationship to the broad cultural context in which it is found to exist in a region of southern India. The author critically reviews various attempts to explain spirit possession as solely a psychological or sociological event. Instead, he turns to the region's spirit possession and mediumship cults, oral traditions and social ideology for an ethnographically relevant interpretation of spirit possession.

An explication of 'wind illness' in northern Thailand.

Abstract: ‘Wind illness’ is a very common complaint among the Northern Thai, yet is rarely recognized by Thai physicians trained in biomedicine. Persons most susceptible to ‘wind illness’ are adult women who have ever borne a child. Consequently, data were obtained from 415 everparous women, 43% of whom reported ever having had ‘wind illness’ and 57%, never having had it. In addition, 20 individuals who had ever had the syndrome were followed for case study, and 13 indigenous healers who traditionally treat clients suffering ‘wind illness’ were interviewed. Their perceptions of the etiology, symptomatology and treatment of ‘wind illness’ are reported in Part I. Part II is an attempt to define ‘wind illness’ in terms of biomedicine and as a consequence of fertility. Part III synthesizes the emic and etic accounts with explanations for the perdurance of ‘wind illness’ despite the advances of biomedicine and the recent fertility decline in Northern Thailand.

Folk concepts of mental disorder among the Lao: continuities with similar concepts in other cultures and in psychiatry.

Abstract: Folk concepts for mental disorder were studied among rural Lao people. While predominantly inferring etiology (e.g. spirit-caused disorder), certain terms also emphasized particular descriptive psychopathology or behavioral abnormality. Preventive strategies were stressed for insanity due to “excessive worry” or “broken taboo”.

Espanto: A dialogue with the Gods

Abstract: Espanto or susto has been analysed from various points of view in the last fifteen years. From a survey covering 109 case analyses collected in Nicolas Ruiz (Chiapas, Mexico), we reached the conclusion that this folk illness cannot be conceived of as a syndrome in the medical sense. A semiological analysis showed that espanto can be better described as an indigenous theory whose function is to relate illness events to other levels of reality. According to indigenous belief, the Holy Earth and the chtonian spirits of the underworld play an important role in the origin of the illness. This origin is associated with an opening of the earth as is illustrated in the earthquakes or the volcanic eruptions forming the prototype of a fright experience leading to espanto; or, it is attributed to agents who inhabit locations where the earth presents a fissure (river, ravine, cave). It is through these holes that the Holy Earth exerts her power. Concomitantly, the body of the victim is believed to open itself to the influences of the bad winds of espanto. Trembling is another aspect of the phenomenon which is observed at numerous levels: first, during the fright experience; second, when the victim falls ill (chills jumping in bed); and third, when the curandera takes the pulse of the patient to see if the blood is afraid. These multiple analogies lead to the assumption that there is a meaning shared by these separate manifestations.

Variations regarding susto causality among the Cakchiquel of Guatemala.

Abstract: George Foster's model of ‘personalistic’ and ‘naturalistic’ disease theories is employed in the present analysis of fright-sickness among Cakchiquel villagers in highland Guatemala. Field data from Panajachel and San Antonio Aguas Calientes suggest that pronounced intrasocietal competition favors personalistic interpretation, with sorcery cited as the ultimate source, rather than naturalistic interpretation, which emphasizes chance or destiny. Village differences in subsistence ecology and internal competition apparently underlie variations in both the social function and assumed etiology of fright-sickness.

A time to live, a time to grieve: patterns and processes of mourning among the Yolngu of Australia

Abstract: Anthropological studies of mortuary ceremonies have focused primarily on their social and structural correlates and functions. Little attention has been given to their role in facilitating the expression and resolution of grief by the bereaved. The elaborate and extended mortuary rites of the people of northeastern Arnhem Land, Australia (the "Murngin") have several characteristics which promote and structure the mourning process and facilitate the full reintegration of the bereaved into the social life of the community.

Self-care in rural areas of India and Nepal.

Abstract: Self-care during illness and pregnancies by individuals and their families is a ubiquitous and integral part of societies throughout the world. This paper reports findings about self-care practices identified during four studies carried out over a ten-year period involving about 14,000 interviews in 7,400 households comprising over 48,000 people in three Indian states and three districts of Nepal. The proportion of ill individuals using self-care over a two-week period in the different study areas ranged from 19 to 42 percent. This involved 5 to 9 percent of the total population in self-care activities during these two weeks. Much larger differences were found between India and Nepal in the use of self-care during pregnancies. Self-care or care by relatives and friends was the predominant source of maternity care in Nepal, including deliveries, while Indian maternal care was dominated by traditional birth attendants. Comparisons also were made between self-care and the use of professional healers or health care services during the same time period. Differences in the use of self-care by age, sex, caste, access to government or special project services, type of illness, and duration and severity of illness have also been shown. The need for similar, better standardized surveys in combination with intensive studies examining the details and rationale behind self-care practices in different societies has been stressed as an essential step in developing programs to expand or modify self-care practices of individuals and their families.

Potential and effective meaning in therapeutic ritual.

Abstract: Anthropologists who accept the functionalist dogma that everything in a culture is related to everything else can easily demonstrate from their own point of view that any ritual is richly meaningful. If, then, the healing power of therapeutic ritual depends on making illness meaningful, any ritual, if seen from this perspective, should be efficacious. We must distinguish, however, between potential and effective meaning, i.e. what a ritual might mean and what it does mean to participants in it who generally lack an anthropologist's global view of their culture. Effective meaning can be assessed by examining a ritual's relevance to the situation in which it occurs and factors which facilitate or hinder communication of what it might mean to particular persons. This argument is illustrated by analyzing the meaning of a Chinese healing ritual in two different situations in which it occurs.

Hutterite belief in evil eye: Beyond paranoia and towards a general theory of invidia

Abstract: Most studies of ‘evil eye’ link economic and political inequality to the fear of appropriation of property while tying envy (invidia) to paranoia. In both psychiatric and anthropological studies of evil eye, explanation of the phenomenon is problematic because the data are retroductive — involving a rationalization on the part of the patient or informant in terms of either delusions or world-view respectively. In this paper the connection between invidia and paranoia is questioned by grounding the analysis of Hutterian beliefs in evil eye in social interaction rather than retroductive explanation. In the case of the Hutterites it is envy itself which is feared and linked to high anxiety levels and sometimes to anxiety attacks or even depression.

Demonic explanations of disease among Moroccan Jews in Israel.

Abstract: Demonic explanations of disease preserved among Moroccan Jews living in two Israeli moshavim are described and amalyzed. Applied most often to sira, a traditional ailment involving somatic and anxiety symptoms, these explanations are construed as a two-level ordered sequence of steps including elements from both ordinary reality and the demonic world. Traditional patients are usually more aware of the manifest chain of precipitating events centering around emotional consequences of a real trauma. Their rabbi-healers, however, are predisposed towards molding these events into a covert-demonic pattern, the core of which involves a human injuring a jinn and the latter's retaliation. In the explanatory scheme the real-traumatic and the demonic plots are intermingled and this fusion lends the etiological sequence a meaningful rationale as exemplified by two case illustrations. Nevertheless, our analysis renders the demonic substratum quite vulnerable, since the manifest-traumatic plot may be singled out as an autonomous explanation under the impact of the mainstream of modern Israeli society. Reasons for the hitherto tenacious preservation of the demonic component among traditional segments in Israel are presented by comparing the explanatory status of demons and psychoanalytic concepts. Certain vulnerabilities of the denomic explanation which throw doubt upon its long-term survival in modern context are discussed as well.

Elementary systems of medicine.

Abstract: The beliefs about causes of disease, orientations to medical problems, and the treatment practices of relatively small and elementary societies are reviewed and analyzed. Selected published reports of this problem area of ethnomedicine serve as source material. An attempt is made to induce generalizations which will serve as a possible baseline for studies dealing with related material pertaining to more advanced societies.

Anthropology and mental health: reflections on interdisciplinary growth.

Abstract: The publication of Joseph Westermeyer, ed., Anthropology and Mental Health: Setting a New Course, is the departure point for taking stock of past and present links between anthropology and psychiatry. These reflections relate historical trends to the conference volume which contains examples of recent interdisciplinary research. The article critically reviews some of these and then suggests other recent or current work, not mentioned, which the author considers representative of some of the promising results of anthropological contributions to psychiatric interests. Questions are raised, but left unanswered, which might be further examined in attempts to continue long established interdisciplinary collaboration.