Culture, Mental Illness and the Body

ANTHROPOLOGY 245
CULTURE, MENTAL ILLNESS AND THE BODY

Prof. Byron J. Good
Depts. of Anthropology and Social Medicine
With Alistair Donald
Department of Social Medicine
Harvard Medical School

Fall Semester 2000
Wednesday 1-3
William James Hall 301

This seminar provides an opportunity to examine issues relevant to the study of mental illness in cross-cultural perspective. The course begins with three sessions which address basic orientations in the field — a clinical perspective as rendered by a recent ethnography of American psychiatric residency training, views from contemporary medicalized psychiatric research, and a classic psychological anthropology perspective. The course then examines how cross-cultural research and writing grounded in these perspectives influence our understanding of broad categories of mental illness: affective disorders and depression, schizophrenia and the major psychoses, and traumatic disorders. Discussions will focus on classic questions (eg. about the status of mental ‘illnesses’) and current research issues (with a special interest in the place of psychological, narrative and phenomenological analyses in ethnographic research). The course will also focus explicitly on the psychological interviewing and the psychological experience of the ethnographer in carrying out cross-cultural research. The course concludes with an examination of issues of state violence, the psychology of trauma, and the politics of experience.

All students are expected to participate actively in the discussions of the class and to take responsibility for leading the discussion one week. Those taking the class for credit will be asked to select four sessions and write a precis (2-4 pages) or reflections on the readings for the session (due the day before class). Each participant will be asked to carry out an interview project — to conduct four interviews with one person, focusing in part on psychological issues, and write a short analysis of the experience. And those taking the course for credit will be required to write a relatively short final paper, due the first day of exams in January.

 

Books ordered at the COOP:

Theresa O’Nell. 1996. Disciplined Hearts: History, Identity, and Depression in an American Indian Community. U of Cal Pr.

Barrett, Robert J. 1996. The Psychiatric Team and the Social Definition of Schizophrenia: An Anthropological Study of Person and Illness. Cambridge Un Press.

Foucault, Michel. 1979. Discipline and Punish. NY: Vintage Books.

Theodore Jacobs. 1990. The Use of the Self. International Universities.

Gill Straker. Faces in the Revolution: The Psychological Effects of Violence on Township Youth in South Africa.

Suggested books ordered:

Arthur Kleinman. 1988. Rethinking Psychiatry: From Cultural Category to Personal Experience. NY: Free Press.

Crapanzano, Vincent. 1980. Tuhami: Portrait of a Moroccan. Un of Chicago Pr.

American Psychiatric Assn. Diagnostic and Statiscal Manual, 4th edn. (DSM-IV)

Michel Foucault, Madness and Civilization: A History of Insanity in the Age of Reason.

Robert Levy, Tahitians.

 

COURSE SYLLABUS

 

Week 1, September 20: Introduction to the Course

Discussion of general themes in the course and of the history of the interactions of psychiatry and anthropology. Those who have not done so should read Arthur Kleinman, Rethinking Psychiatry: From Cultural Category to Personal Experience as an introduction to and overview of questions and literature relevant to this course. Chapter 2 of B. Good,Medicine, Rationality and Experience, also provides a historical and theoretical overview relevant to the course. And the world mental health report, developed and published by members of the Dept. of Social Medicine (Desjarlais et al, World Mental Health: Problems and Priorities in Low-Income Countries NY: Oxford University Press, 1995), provides an important overview of issues to be addressed.

 

Week 2 September 27 Orientation (1): Clinicians’ Perspectives on Psychopathology

We read Tanya Luhrmann’s ethnography of psychiatric residency training experiences, providing insights into the ways American physicians enter the world of psychiatry, how they come to experience and perceive mental illness, and the contradictions inherent in psychiatric knowledge structures.

Reading:

T. M. Luhrmann. 2000. Of Two Minds: The Growing Disorder in American Psychiatry. New York: Alfred A. Knopf.

 

Week 3 October 4 Orientations (2): Medicine, Social Psychiatry, and Epidemiology

Will read examples from the classic medical tradition of psychiatry, psychiatric research, and psychiatric nosologies (diagnostic schema). Will also review shifting paradigms of epidemiological research, and the emergence of a contemporary view of mental illness as a set of discrete, heterogenous disorders. Will review cross-cultural clinical and epidemiological research in psychiatry.

Readings:

Kraepelin, Emil. 1913. Lectures on Clinical Psychiatry. NY: William Wood and Co. Selections.

Murphy, H.B.M. 1982. Comparative Psychiatry: The International and Intercultural Distribution of Mental Illness.NY: Springer Verlag. (selections)

Corin, Ellen, and Gilles Bibeau. 1988. H.B.M. Murphy (1915-1987): A Key Figure in Transcultural Psychiatry. Culture, Medicine and Psychiatry 12:397-415.

Weissman, Myrna, and Gerald Klerman. 1978. The Epidemiology of Mental Disorders. J of Nervous and Mental Disorders 167:144-158.

American Psychiatric Association. 1994. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Washington, D.C.: American Psychiatric Assn. Read the introductory sections and Appendix I. Select one category (eg. Mood Disorders, Anxiety Disorders, Somatoform Disorders, Personality Disorders) and read quickly to understand nature of the document.

Desjarlais, Robert, et al. 1995. World Mental Health: Problems and Priorities in Low Income Countries. Oxford Un. Pr. Ch. 2 Mental Illness and Psychiatric Services

Good, Byron. 1992. Culture and Psychopathology: Directions for Psychiatric Anthropology. In New Directions in Psychological Anthropology. T Schwartz, G White, and C Lutz, eds. Pp. 181-205. Cambridge: Cambridge Un. Press.

Levy, Robert. 1992. A Prologue to a Psychiatric Anthropology. In New Directions in Psychological Anthropology. Pp. 206-230.

 

Week 4 October 11 Orientation (3): Culture, Psychology and Psychopathology

Begin a discussion of psychological approaches to cross-cultural studies of psychopathology. Review Devereux’s classic attempt to use psychoanalytic methods in an American Indian community, as well as Obeyesekere’s analysis of Sri Lankan ascetics. Examine role of attending to one’s own psychological response as a source of data. Freud’s Dora Case is a classic source for discussions of countertransference. Contrast with Sheweder’s view of ‘cultural psychology’.

Readings:

George Devereux. 1951. Reality and Dream. International Universities Press. Read Part II, pp. 117-310 (the case account).

Ganath Obeyesekere. 1981. Medusa’s Hair: An Essay on Personal Symbols and Religious Experience. Un of Chicago Pr. Read Introduction and Part One, pp. 1-51.

Richard A. Shweder. 1990. Cultural Psychology — What Is It? In Cultural Psychology: Essays on Comparative Human Development. James W. Stigler, Richard A Shweder, and Gilbert Herdt, eds. Cambridge Un Pr.

Suggested:

Freud, “Fragment of an Analysis of a Case of Hysteria” (1905) — Dora Case. Standard Edition of Freud, Vol. 7, pp. 15-122.

Bernheimer, Charles, and Claire Kahane, eds. 1985. In Dora’s Case: Freud-Hysteria-Feminism. NY: Columbia Un Press.

 

Week 5 October 18 Psychological Interviewing

Review approaches to psychological interviewing, attending to ‘uses of the self’ and ‘psychological listening’.

Discuss class assignment.

Readings:

Theodore Jacobs. 1990. The Use of the Self. International Universities.

Evelyn Schwaber. 1995. A Particular Perspective on Impasses in the Clinical Situation: Further Reflections on Psychoanalytic Listening. International Journal of Psychoanalysis 76:711-722.

Byron J. Good, Henry Herrera, Mary-Jo DelVecchio Good, and James Cooper. 1985.  Reflexivity, Countertransference and Clinical Ethnography:  A Case from a Psychiatric Cultural Consultation Clinic.  In Robert Hahn and Atwood Gaines (eds.), Physicians of Western Medicine, pp. 177-192.  Dordrecht, Holland:  D. Reidel Publishing Company.

Robert I. Levy. 1973. Tahitians. Mind and Experience in the Society Islands. Un of Chicago Pr. Required: Review Appendix 1, Check Sheet of Topics for Psychodynamic Interviews (pp 509-511). Suggested: pick out several chapters of interest to read, examine Levy’s method.

 

Week 6 October 25 Depression (1): Culture, Affect and Affective Disorders

Review approaches to the cross-cultural study of depression. Examine anthropological writing on ‘culture and the emotions’ as a context for studying depression as emotion and depression as illness.

Readings:

Michelle Rosaldo. 1983. The Shame of Headhunters and the Autonomy of Self. Ethos 11:135-151.

Renato Rosaldo. 1984. Grief and the Headhunter’s Rage: On the Cultural Force of Emotions. In E. Bruner (ed.), Text, Play, and Story: The Construction and Reconstruction of Self and Society, pp. 178-195. Washington, DC: Am. Ethnological Society.

Freud, Sigmund. [1917] Mourning and Melancholia.

DSM-IV. Section on Mood Disorders. Also review sections on Anxiety Disorders and Somatoform Disorders.

Kleinman, Arthur, and Byron Good. 1985. Culture and Depression. (Selections)

Sing Lee. 1999. Diagnosis Postponed: Shenjing Shuairuo and the Transformation of Psychiatry in Post-Mao China. Culture, Medicine and Psychiatry 23:349-380. Commentaries by Keh-Ming Lin, arthur Kleinman, Wenwei Yan, and Qijie Shen (pp. 381-399).

Suggested:

Bottero, Alain. 1991. Consumption by Semen Loss in India, and

Elsewhere. Culture, Medicine and Psychiatry 15:303-320.

Kraepelin, Lectures on Clinical Psychiatry, Lectures 1, 2, 7, 8

Kleinman, Arthur. 1986. Social Origins of Distress and Disease: Depression, Neurasthenia and Pain in Modern China. New Haven: Yale University Press.

Lin, Tsung-yi, ed. 1989. Neurasthenia in Asian Cultures. Special issue of Culture, Medicine and Psychiatry 13 (2).

Kirmayer, Laurence, ed. 1994. Special issue of Transcultural Psychiatric Research Review

(Vol 31, No 2) on Neurasthenia.

Styron, William. 1990. Darkness Visible. NY: Random House.

White, Geoffrey. 1993. Emotions Inside Out: The Anthropology of Affect. In Handbook of Emotions. M Lewis and J Haviland, eds. NY: Guilford Press.

White, Geoffrey. 1994. Affecting Culture: Emotion and Morality in Everyday Life. In Emotion and Culture. S Kitayama and H Markus, eds. Washington DC: Am Psycholog Assn.

 

Week 7 November 1 Depression (2): Historical Experience, Life Trajectories, and ‘Depression’ in an American Indian Community

Read key chapters of Terry O’Nell’s book, discuss issues it raises for ethnographic research on this topic and the viability of joining anthropological and psychiatric perspectives on ‘depression’. Compare analytic perspective here with O’Nell’s recent essay on PTSD among Indian Vietnam vets and the Good and Good essay on the state and emotions in Iran.

Readings:

O’Nell, Theresa. 1996. Disciplined Hearts: History, Identity and Depression in an American Indian Community. Berkeley: Un of Calif Press.

O’Nell, Theresa. 2000. “Coming Home” among Northern Plains Vietnam Veterans: Psychological Transformation in Pragmatic Perspective. Ethos 27:441-465.

Good, Mary-Jo DelVecchio, and Byron Good. 1988. Ritual, the State, and the Transformation of Emotional Discourse in Iranian Society. Culture, Medicine & Psychiatry 12:43-63.

Suggested:

Pandolfi, Mariella. 1990. Boundaries Inside the Body: Women’s Sufferings in Southern Peasant Italy. Culture, Medicine and Psychiatry 14:255-273.

Jack D. Maser and Norman Dinges, eds. 1992/93. The Co-Morbidity of Depression, Anxiety and Substance Abuse among American Indians and Alaska Natives. Special Issue of Culture, Medicine & Psychiatry 16 (4).

 

Week 8 November 8 Schizophrenia (1): Culture, Narrative, Experience

First, review basic definitions and theories of schizophrenia. Second, review anthropological studies of schizophrenia as subjective experience. Examine approaches based in narrative analysis, phenomenology, and studies of the ‘self’, as well as classic psychoanalytic statements about relating to psychotic persons. Examine hypothesis about resistance of psychosis to meaning.

Readings:

DSM-IV. Section on Schizophrenia and Other Psychotic Disorders.

Andreasan, Nancy, and William T. Carpenter. 1993. Diagnosis and Classification of Schizophrenia. Schizophrenia Bulletin 19:199-214.

Havens, Leston. 1989. A Safe Place: Laying the Groundwork of Psychotherapy. Harvard Un Press. Read Ch 7: Schizophrenia, pp 91-106.

Fabrega, Horacio. 1989. On the Significance of an Anthropological Approach to Schizophrenia. Psychiatry 52: 45-65.

Barrett, Rob. 1999. Kurt Schneider in Borneo: Do First-Rank Symptoms of Schizophrenia Apply to the Iban? Ms. To appear in Janis Jenkins and Robert Barrett, eds. Culture, Subjectivity and Schizophrenia. Cambridge University Press.

Barrett, Robert J. 1997. Cultural Formulation of Psychiatric Diagnosis. Sakit Gila in an Iban Longhouse: Chronic Schizophrenia. Culture, Medicine and Psychiatry 21:365-379.

Saris, A. Jamie. 1995. Telling Stories: Life Histories, Illness Narratives, and Institutional Landscapes. Culture, Medicine and Psychiatry 19(1): 39-72.

Corin, Ellen, and Gilles Lauzon. 1992. Positive Withdrawal and the Quest for Meaning: The Reconstruction of Experience among Schizophrenics. Psychiatry 55:266-278.

Corin, Ellen, R. Thara, and R. Padmavati. 1999. Living Through a Staggering World: The Play of Signifiers in Early Psychosis in South India. To appear in Janis Jenkins and Robert Barrett, eds. Culture, Subjectivity and Schizophrenia.Cambridge University Press.

Harrell, Stevan. 1991. Pluralism, Performance and Meaning in Taiwanese Healing: A Case Study. Cul, Med & Psychiatry 15:45-68.

Good, Byron, with Subandi. 1999. Experiences of Psychosis in Javanese Culture: Reflections on a Case of Acute, Recurrent Psychosis in Contemporary Yogyakarta, Indonesia. To appear in Janis Jenkins and Robert Barrett, eds. Culture, Subjectivity and Schizophrenia. Cambridge University Press.

 

Recommended:

Corin, Ellen E. 1990. Facts and Meaning in Psychiatry. An Anthropological Approach to the Lifeworld of Schizophrenics. Culture, Medicine and Psychiatry 14:153-188.

Kraepelin, Emil. 1913. Lectures on Clinical Psychiatry. Lectures III, XVI,XVII, XXI.

Strauss, John S., and Sue E. Estroff, eds. 1989. Subjective Experience of Schizophrenia and Related Disorders: Implications for Understanding and Treatment. Special Issue of Schizophrenia Bulletin, Vol 15 No 2. See especially Sue Estroff, Self, Identity, and Subjective Experiences of Schizophrenia: In Search of the Subject (pp. 189-196).

Searles, Harold F. 1988. Transference Psychosis in the Psychotherapy of Chronic Schizophrenia. In Peter Buckley, ed. Essential Papers on Psychosis. NYU Press. Ch 7, 177-232.

Haley, Jay. 1959. An Interactional Description of Schizophrenia. Psychiatry 22:321-332.

Ogden, Thomas H. 1980. On the Nature of Schizophrenic Conflict (I). Int J of Psychoanalysis 61:513-530.

Csordas, Thomas J. 1991. The Affliction of Martin: Religious, Clinical and Phenomenological Meaning in a Case of Demonic Oppression. In Gaines, Ethnopsychiatry, ch. 5.

Devereux, George. 1980. Schizophrenia: An Ethnic Psychosis, or Schizophrenia without Tears (1965). In Devereux, Basic Problems of Ethnopsychiatry, 214-236.

Littlewood, Roland. 1993. Pathology and Identity: The Work of Mother Earth in Trinidad. Cambridge Un Press.

Jenkins, Janis H. 1988. Ethnopsychiatric Interpretations of Schizophrenic Illness: The Problem of Nervios within Mexican-American Families. Culture, Medicine and Psychiatry 12:301-329.

Estroff, Sue, with William Lachicotte, Linda Illingworth, and Anna Johnston. 1991. Everybody’s Got a Little Mental Illness: Accounts of Illness and Self among People with Severe, Persistent Mental Illnesses. Medical Anthropology Quarterly 5:331-369.

 

NOVEMBER 15 — NO CLASS, AAA MEETINGS

Week 9 November 22 Schizophrenia (2): Onset, Course and Politics

Review data suggesting major cross-cultural differences in course and outcome of schizophrenia across cultures. Examine literature on onset and early stages of psychotic illness, and the effects of acute onset on course and outcome. Review hypothesis on culture, expressed emotion and illness course. And raise questions about culture, subjectivity and course of illness.

Readings:

Hopper, Kim. 1992. Some Old Questions for the New Cross-Cultural Psychiatry. Medical Anthropology Quarterly 5:299-330.

Good, Byron. 1997. Studying Mental Illness in Context: Local, Global, or Universal? Ethos 25: 230-248.

Sullivan, Harry Stack. 1927. The Onset of Schizophrenia. American Journal of Psychiatry 151:135-139 (Sesquicentennial Supplement).

Strauss, John. S. 1994. The Person with Schizophrenia as a Person II: Approaches to the Subjective and Complex. British Journal of Psychiatry 164 (suppl. 23): 103-107.

Docherty, John et al. 1978. Stages of Onset of Schizophrenic Psychosis. American Journal of Psychiatry 135:420-426.

Yung, Allison R., and Patrick D. McGorry. 1996. The Prodromal Phase of First-Episode Psychosis: Past and Current Conceptualizations. Schizophrenia Bulletin 22:353-370.

Moller, Paul, and Ragnhild Husby. 2000. The Initial Prodrome in Schizophrenia: Searching for Naturalistic Core Dimensions of Experience and Behavior. Schizophrenia Bulleting 26:217-232.

Susser, Ezra, Molly T. Finnerty and Nancy Sohler. 1996. Acute Psychoses: A Proposed Diagnosis for ICD-11 and DSM-V. Psychiatric Quarterly 67:165-176.

Jenkins, Janis H., and Marvin Karno. 1992. The Meaning of Expressed Emotion: Theoretical Issues Raised by Cross-Cultural Research. American Journal of Psychiatry 149:9-21.

Stephen, Michele, and Luh Ketut Suryani. 2000. Shamanism, Psychosis and Autonomous Imagination. Culture, Medicine and Psychiatry 24:5-40.

Good, Byron, with Subandi and Mary-Jo DelVecchio Good. 2001. The Subject of Mental Illness: Psychosis, Mad Violence and Subjectivity in Indonesia. Forth-coming in French translation in Alain Ehrenberg, Anne Lovell (eds). La pathologie mentale à la croisée des chemins. Sciences sociales, psychiatrie, biologie. Paris, Ed. Odile Jacob, January 2001.

 

Week 10 November 29 Schizophrenia (3): Historical and Institutional Analyses

Examine critical theory perspectives on the asylum and the place of the asylum in the constitution of psychiatric knowledge and schizophrenia.

Readings:

Barrett, Robert J. 1996. The Psychiatric Team and the Social Definition of Schizophrenia: An Anthropological Study of Person and Illness. Cambridge Un Press.

Foucault, Michel. 1979. Discipline and Punish. NY: Vintage Books. Read III (2) The means of correct training, III (3) Panopticism. pp. 170-228.

Suggested:

Barrett, Robert J. 1988. Clinical Writing and the Documentary Construction of Schizophrenia. Culture, Medicine and Psychiatry 12:265-299.

Foucault, Michel. 1965. Madness and Civilization: A History of Insanity in the Age of Reason.

 

Week 11 December 6 Violence, Trauma and Dissociation

This session will focus on psychological effects of violence and on the growing science of dissociation and dissociative disorders. In the background is an enormous literature on trauma and memory and on cross-cultural studies of dissociative disorders, with a particular emphasis on spirit possession.

 

Readings:

Gill Straker. Faces in the Revolution: The Psychological Effects of Violence on Township Youth in South Africa.

Brown, Dan. 1997. Memory, Trauma Treatment and the Law. Norton. Read chs. 1 & 2.

DSM-IV – section on Dissociative Disorders

Jenkins, Janis. 1991. The State Construction of Affect: Political Ethos and Mental Health among Salvadoran Refugees. Cul, Med & Psychiatry 15:139-165.

Suggested:

Young, Allan. 1995. The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. Princeton. Selections.

Richard J. Castillo. 1994. Spirit Possession in South Asia, Dissociation or Hysteria? Part 1: Theoretical Background; Part 2: Case Histories. Culture, Medicine and Psychiatry 18:1-21, 141-162.

Crapanzano, Vincent, and Vivian Garrison, eds. 1977. Case Studies in Spirit Possession. NY: Wiley. Required: Crapanzano, Introduction.

Eguchi, Shigeyuki. 1991. Between Folk Concepts of Illness and Psychiatric Diagnosis: Kitsune-Tsuki (Fox Possession) in a Mountain Village of Western Japan. Cul, Med & Psychiatry 15:421-452.

Kraepelin, Lectures on Clinical Psychiatry, Lecture VI Epileptic Insanity, and Lecture XXV Hysterical Insanity

Kirmayer, Laurence, ed. 1992. Taking Possession of Trance. Special issue of Transcultural Psychiatric Research Review(Vol 29 No 4) on Trance and Possession as Dissociative Disorders and a Proposed DSM-IV Trance and Possession Disorder Category.

Guarnaccia, Peter, Victor DeLaCancela, Emilio Carrillo. 1989. The Multiple Meanings of Ataques de Nervios in the Latino Community. Medical Anthropology 11:47-62.

Ellenberger, Henri F. 1970. The Discovery of the Unconscious. NY: Basic Books. Ch. 6 Pierre Janet and Psychological Analysis (pp. 331-417).

Guarnaccia, P, B Good, A Kleinman. 1990. A Critical Review of Epidemiological Studies of Puerto Rican Mental Health. Am J of Psychiatry 147:1449-1456.

Skultans, Vieda. 1991. Women and Affliction in Maharashtra: A Hydraulic Model of Health and Illness. Culture, Medicine and Psychiatry 15:321-359.

Ward, Colleen A. 1989. Altered States of Consciousness and Mental Health: A Cross-Cultural Perspective. Sage Publications.

Owen, A.R.G. 1971. Hysteria, Hypnosis and Healing in the Work of J-M. Charcot. NY: Garrett Pubs.

Week 12 December 13 Discussion Session

Final discussion of interviews, papers, course themes.

Copyright © 2000 Byron J. Good