Showing papers in "Culture, Medicine and Psychiatry in 1990"

American oncology and the discourse on hope.

Abstract: From the perspective of medical anthropology and comparative research, American oncology appears as a unique variant of international biomedical culture, particularly when contrasted with oncological practice in societies such as Japan and Italy Based on interviews with 51 oncologists in Harvard teaching hospitals, this paper argues that American oncological practice draws on distinctive cultural meanings associated with "hope" and is infused with popular notions about the relationship between psyche and soma, the progressive efficacy of biotechnical interventions, truth-telling, and the nature of the physician-patient relationship

Facts and meaning in psychiatry. An anthropological approach to the lifeworld of schizophrenics.

Abstract: Dominant research paradigms in psychiatry appear broadly unequipped for explaining the diversity of outcome in schizophrenics The author builds on anthropological approaches to meaning construction and on European psychiatric phenomenological descriptions of forms of “being-in-the-world” to propose alternative research perspectives Data have been collected on schizophrenics contrasted on the base of hospitalization rate Statistical analysis has evidenced recurrent structural features in the stance-toward-the-world among non-rehospitalized patients Qualitative analysis of patients' narratives enlightens the meaning of these data from the patient's perspective It shows the centrality of a “positive withdrawal” position toward-the-world for schizophrenics in the sample and exemplifies the function of specific cultural signifiers for constructing one's experience In reference to Tellenbach's idea of endo-cosmo-genesis, the author hypothesizes that individual vulnerability associated with schizophrenia interacts with Western cultural values and enforces the “withdrawn” component of “positive withdrawal” in North American schizophrenics

The angry liver, the anxious heart and the melancholy spleen. The phenomenology of perceptions in Chinese culture.

Abstract: The purpose of this article is to advance a different approach to the phenomenology of the “lived-body.” To understand the role of the body in generating culture, traditional constraints influencing bodily perceptions are considered. The alternative is found in the phenomenological method of bodily perceptions. Numerous examples from traditional Chinese medicine, based on research in China, illustrate a wealth of symptoms, sensations, and their relation to the world of emotions. These examples provide arguments for collapsing the strict distinction between somatic changes and emotions as based in the dichotomized view of mind and body, subject and object. The analysis also includes the semantic dimensions of these bodily processes.

Embodying illness, embodying cancer.

Abstract: Individuals and societies embody illnesses in different ways, in part determined by the way a person knows and lives his or her diagnosis and prognosis. Based on research in Northern Italy, on the experiences and meanings of cancer and on the practice of nondisclosure of the diagnosis, we find nondisclosure reflects a world divided--life/death, good/bad, mind/body--with the unwanted converted to "other." The strong association of cancer with death, suffering, and hopelessness in much of Italy, coupled with the tremendous power attributed to naming and "sentencing" makes nondisclosure a major mechanism for keeping the "condemned" in this social world, and keeping death, decay, and suffering in the "other." It is the social reality that is dominant here, such that informing a patient of cancer can be tantamount to social death.

Explanatory models of major depression and implications for help-seeking among immigrant Chinese-American women

Abstract: This study explores the explanatory models of major depression in a group of 40 recently immigrated Chinese-American women, and demonstrates the significant relationship between problem conceptualization and help-seeking behavior. Respondents are presented a vignette depicting major depression, from which they are asked to conceptualize the problem described and answer questions regarding its cause, impact and potential sources for help-seeking. Those who provide a psychological conceptualization are likely not to suggest professional services, but to turn to themselves and family and friends for assistance. On the other hand, those who hold a physical conceptualization are likely to seek out medical services. Implications for effective mental health service delivery to this population are discussed.

Hwabyung: the construction of a Korean popular illness among Korean elderly immigrant women in the United States.

Abstract: The cultural construction of Hwabyung, a Korean culture-bound syndrome, is explored among a sample of 20 elderly Korean immigrant women in the United States. Hwabyung results when distressed emotions associated with the specifically Korean way of perceiving and reacting to intolerable and tragic life situations cause bodily symptoms by interfering with the harmony of "Ki" (vital energy). Korean elderly immigrants report a broad range of symptoms associated with Hwabyung; they less frequently report the epigastric mass, which had been considered the cardinal symptom by cosmopolitan and traditional medical writers. Hwabyung is treated holistically with psychosocial support from family, spiritual comfort, home and popular remedies, traditional Korean medicine, and biomedical treatments. Hwabyung provides a way of conceptualizing and resolving emotional distress through somatization among Korean elderly immigrant women.

On being ethnic: the politics of identity breaking and making in Canada, or, nevra on Sunday.

Abstract: The creation of ethnically sensitive health care is a major federal and provincial government concern in Canada at present. The concept of multiculturalism is used to reinforce the notion of rights for minority groups and the Canadian mozaic is explicitly contrasted with the American melting pot. In this paper, the lives of Greek immigrant women in Montreal are used to illustrate how class and gender are as relevant to the immigrant experience as is ethnicity. It is shown how values which were central to female identify in Greece can become a liability after immigration and how the notion of Greek identity in Canada is a fluid category which is subject to repeated transformations. It is suggested that medical anthropologists who ignore the complexity of social categories and whose focus is limited to the cultural construction of illness and the expression of distress are in danger of reinforcing a notion of the "quaint ethnic," a stereotype to which the concept of multiculturalism is often reduced.

Psychiatric case finding in Ethiopia: shortcomings of the Self Reporting Questionnaire.

Abstract: Attenders of health care facilities usually present somatic complaints. It is important to identify the psychiatric patients among them, especially the neurotic complainers. They are at risk for being exposed to expensive somatic investigations and being prescribed useless and sometimes harmful drug treatment. The World Health Organization designed the Self Reporting Questionnaire (SRQ), to be a universally applicable psychiatric case finding instrument, for use in medical clinics. A feasibility study with this instrument was carried out with 110 respondents in Ethiopia. A moderate criterion validity was found, limitations being partly due to the sensitivity of the SRQ to help-seeking behavior, even in the absence of any mental illness. This study also revealed problems in transcultural communication because many of the diagnostic concepts used in this instrument were too western to be transposed unchanged to the Ethiopian culture. Items need fairly extensive modification to be applicable there.

Boundaries inside the body: women's sufferings in southern peasant Italy.

Abstract: In a village of Southern Italy the secret world of women's emotions is fundamentally expressed through the body. The female body is open to events of the world and absorbs and feels their effect and defines a new identity, a minimal one. This gives rise to a symbolic anatomy, pathology, and physiology that serve to distinguish male and female worlds and to bridge inner and outer experience. These "traces" of external and extraordinary events, which in the past and in daily life have cut the secret and emotional world of women, are inscribed on the body. This body becomes a phenomenological memoir that opens a new way of interpreting distress and suffering and illness. This article represents a bridge from the interpretation of suffering and illness in Southern Italy via Gramsci and De Martino to a metacultural process of creating a polysemic and multilevel sense of self.

Discourse, knowledge and experience of cancer: A life story

Abstract: This paper proposes an exploration of interfaces between discourse, knowledge and experience of cancer within the life story of a patient suffering from cancer. This life story was collected in the context of a study in clinical anthropology on the cancer experience conducted within a French-speaking population of cancer patients in the province of Quebec, Canada. The theoretical model was based upon the cultural hermeneutic approach of Good and Good. Perspectives for clinical practice are suggested concerning the status of popular medical knowledge in modem clinical culture, and the gap between patient experience and the discourse about cancer.

Possessed and dispossessed youth: spirit possession of school children in northwest Madagascar.

Abstract: Spirit possession is a common experience shared by many women in northwest Madagascar. In the town of Ambanja, possession by volatile and dangerous Njarinintsy spirits is an affliction which strikes young, adolescent schoolgirls. When Njarinintsy is contrasted with tromba, another well-known class of spirits found in this region, it becomes clear that Njarinintsy possession is a relatively recent phenomenon, and its victims form a discrete and unusual group. These girls are, in essence, young migrants, who have moved alone to town in order to attend school. Close examination of their experiences reveals that these young girls must cope, on their own, with the conflicts and contradictions that plague the shift from rural to town life, and from youth to adulthood. Such problems are further complicated by those associated with educational policy in Madagascar. These children, more than any other members of this community, suffer from the contradictions of a fragmented world. Possession provides them with a means through which to express the chaos inherent in their daily lives.

Paradise regained: "miraculous healing" in an Israeli psychiatric clinic.

Abstract: The articulation of the experience of distress in terms of prevailing cultural idioms is deemed a crucially important factor in the effectiveness of healing devices across the globe. This curative factor, however, is not easily attainable in multicultural settings where therapist and patient do not share the same world view or explanatory models. In the following case presentation we report a culturally sensitive employment of strategic therapy with an ultra-orthodox psychiatric patient in Jerusalem. Despite the enormous cultural gap between the parties, the therapists were sufficiently sensitive to the patient's mythic world to enable him to recast his traumatic experiences in the mold of key idioms of his cultural background. These idioms were amplified by providing the patient with a myth-congruent metaphor and manipulated to afford a dramatic resolution of his emotional conflict. In what follows we discuss the setting of the therapy, the patient's background and diagnosis and the course of treatment. Following a verbatim account of the last therapeutic session, in which the patient's self-reconstitution had been completed, we discuss the cultural idioms synthesized in the text and the pertinence of hypnotic and metaphoric therapies to multicultural settings.

Ethnocentricity and the social construction of 'mass hysteria'.

Abstract: This study provides a critical historical review and analysis of the variety of human expressions which have been erroneously labeled under the grandiose category “mass hysteria.” It is argued that Western science reductionist approaches to the classification of “mass hysteria” treat it as an entity to be discovered transculturally, and in their self-fulfilling search for universals systematically exclude what does not fit within the autonomous parameters of its Western-biased culture model, exemplifying what Kleinman (1977) terms a “category fallacy.” As a result of objectivist methodologies, the etiology of actions labeled as “mass hysteria” is typically viewed as deviant, irrational or abnormal behavior resulting from a malfunctioning ‘proper’ social order. However, what constitutes ‘the’ correct social order is a function of a researcher's historical sociocultural and/or scientific milieu. This study reviews the problem, advocating Geertz's (1973) culturally relativistic approach to understanding various cross-cultural behavior that is sensitive to and tolerant of the unique context and milieu of participants. “Mass” or “epidemic hysteria” is viewed as an invention of Western psychiatry and should be abandoned and replaced with the term collective exaggerated emotions. Instead of attempting to ‘discover’ a neatly packaged, unitary external disease entity, the focus of a meaning-oriented approach emphasizes the deciphering of foreign realities, semantic networks and symbol systems.

Continuity and change: the interpretation of illness in an anishinaabe (ojibway) community

Abstract: Rich descriptions of Anishinaabe medical knowledge and the cultural meanings associated with illness are available in the anthropological literature, especially in the writings of A.I. Hallowell. Most of this work is based on fieldwork carried out prior to 1940 and was often motivated by a desire to reconstruct the pre-contact situation. Since that time, there have been numerous changes affecting health status and health care. This paper examines lay medical knowledge in a contemporary Canadian Anishinaabeg community, with particular attention to change and continuity in the way people explain and respond to the occurrence of illness.

Indignant suicide in the Pacific: an example from the Toraja Highlands of Indonesia.

Abstract: This paper describes and analyzes a type of Toraja (South Sulawesi, Indonesia) suicide in which a person kills him or herself after having been slighted or offended, usually by a close family member. Comparing and contrasting such suicides to similar types found elsewhere in Austronesia-speaking Oceania, the paper argues that self-inflicted deaths of this nature are not so much ‘anomic,’ as suggested by some analysts, as ‘indignant’; they are committed by persons who feel that they have been severely mistreated or abused according to traditional notions of reciprocity, mutual aid, and the dangers of frustrated desire. The paper concludes by suggesting that Durkheim may have underestimated the frequency and importance of ‘indignant’ suicide in ‘traditional’ societies and that, conversely, contemporary analysts may be underestimating the importance of traditional norms and values in accounting for the high rates of suicide found in many parts of the Pacific today.

The hall of dragon metamorphoses: A unique, indigenous asylum for chronic mental patients in Taiwan

Abstract: This paper describes the spontaneous rise of an indigenous asylum for the chronic mentally ill, called Lung Hwa Tang (The Hall of Dragon Metamorphoses), in contemporary Taiwan. Sociocultural factors relevant to the asylum, including the roles played by Chinese families and the current situation of mental health care in Taiwanese communities, are discussed. Despite its detrimental effect on patients, this asylum stands for an alternative mental health care system in the folk sector; it reflects a great demand from the communities for access to modern mental health services, the development of which have been very slow and inadequate in the past four decades in this rapidly developing country.

The therapist and the source of healing among the Yaka of Zaire

Abstract: The Yaka of southwestern Zaire and the capital, Kinshasa, practise some ten major healing cults with initiatory treatments. These follow the model of rites de passage and lead the patient to resituate him/herself in the group, while partially redramatizing the cosmology and the fundamental values of the society. The body-self is the source and scene of the healing. The therapeutic drama offers a space-time stage upon which metaphoric correspondents of organs, affects, energies and bodily functions are constituted and manipulated. Acting as the patient's maternal uncle, as trapper-hunter, and as demiurge and weaver, the healer aims at fighting the illness by turning it back against itself autodestructively. The initiate is ‘reborn’ thanks to the emergence of the vital flow, particularly through trance, leading her or him to take up a transformed presence in the world and the group: this is “the weaving of the vital flow.”

Zezuru turn of the screw. On children's exposure to evil.

Abstract: Zezuru adults and children take into account concepts of evil in directing their lives, especially in managing incidents of trauma and sickness Using the story The Turn of the Screw by Henry James to reflect on these notions, evil is traced in the expressions heard and treatment sessions witnessed during two years research with 60 traditional healers in Mashonaland, Zimbabwe Evil, particularly as evidenced in witchcraft and possession by aggrieved spirits, is part of a discourse on human suffering--illness, misfortune, death--within a specific community Healers' treatment of children and their conceptions of childhood form the base for a discussion of evil

How do societies and “corporate” groups delimit themselves? A puzzle common to social and medical anthropology

Abstract: Classic anthropological theories define the first but neglect the second condition of social life. When they assume that the universal effect of the incest taboo is the opening of the consanguinial groups to the others, to exchange, they do not explain the closure of their sphere of reciprocity, i.e., the delimitation of the society. Hence the question: How, by which means, are stateless societies delimited or do they delimit themselves? Among the Senoufo of Ivory Coast (Nafara), one of the main acts of male initiation ceremonies — to the Poro, which is the very basis of the Senoufo's ethnic identity — is a ritual intercourse between the neophytes and their symbolic mother who has just given birth to them. This rite materializes the initiatic axiom: Senoufo men reproduce themselves by incest. In this case, the prescription of ritual incest is a means by which the society “closes” the field of reciprocity “openend” by the prohibition of actual incest. The return of the forbidden — at the heart of the institution which reproduces its identity — is the basic principle of the ritual delimitation of this society. Despite appearances, the delimitation of the so-called “corporate groups” — for example, an African lineage — is neither more “natural” nor more jural than that of the society which contains them. The limits of these groups are traced and retraced notably in the course of traditional “therapies” and by means of etiological entities which share several common, distinctive properties. (1) They cannot operate outside of the group delimited by them. (2) They are polyvalent and their effects are permutable from one group-member to another. (3) They act periodically: they have to dismantle the group periodically from the inside in order to be able to delimit it constantly from the outside. This phenomenon of spatio-temporal inversion (inside-outside; periodic-continuous), observable in any process of ritual delimitation, deserves our attention insofar as its closer analysis could lead us to rethink our present theories of ritual.

Being affected by the other

Abstract: Against present trends towards the homogenization and the hegemony of one world intellectual "koine," the author underscores the richness contained in the plurality of intellectual styles, discursive paradigms and cultural configurations. He shows that all encounters encompass a tragic dimension, that of power and dependence, that cannot be neutralized by the most sensitive individual empathy. Seven rules are finally offered for guiding Western and non-Western scholars on the road towards the transnational and transcultural dialogue.