Culture Medicine and Psychiatry最新文献

Emerging consensus among enactivist philosophers and embodied mind theorists suggests that seeking to understand mental illness we need to look out of our skulls at the ecology of the brain. Still, the complex links between materiality (in broadest sense of material objects, habits, practices and environments) and mental health remain little understood. This paper discusses the benefits of adopting a material engagement approach to embodied and enactive psychiatry. We propose that the material engagement approach can change the geography of the debate over the nature of mental disorders and through that help to develop theoretical and practical insights that could improve management and treatment for various psychiatric conditions. We investigate the potential role of Material Engagement Theory (MET) in psychiatry using examples of aetiologically different mental illnesses (schizophrenia and dementia) in respect of their shared phenomenological manifestations, focusing particularly on issues of memory, self-awareness, embodiment and temporality. The effective study of socio-material relations allows better understanding of the semiotic significance and agency of specific materials, environments and technical mediations. There is unrealised potential here for creating new approaches to treatment that can broaden, challenge or complement existing interventions and practices of care.

In Chile, a long and oppressive military regime (1973-1990) dismantled emergent initiatives for the deinstitutionalisation of psychiatric care, imposing a neoliberal constitution that opened public services to market forces and limited the state's role in health and social care. After being associated with communism and socialism, community-based mental health work was banned, and socialist psychiatrists were silenced through torture or exile. However, some therapeutic initiatives persisted, such as the "Protected Commune" (PC) initiative within the El Peral psychiatric asylum. The PC attempted to mimic a real town inside the asylum's gated perimeter. It featured an ecumenical chapel, a school, and various "council" departments like recreation, education, waste, economy, and health. Paths received names, wards became districts, and patients and workers were assigned new, democratic roles, all while the authoritarian regime entirely controlled the "outside" world. The initiative ceased with the return of democracy in 1990. Deemed an eccentric and negligible episode, the PC is often seen as an interruption to the radical community-based experiences of the pre-dictatorial era. Drawing on archival research and oral history interviews with participants, this paper examines how the PC harnessed the notion of community to navigate the complex socio-political landscape of the dictatorship. Differing from established accounts of the political uses of psychiatry under authoritarianism, the study positions the PC as a prism for understanding the contradictory ways in which the idea of 'community' has been able to transcend radically opposed social and political regimes, becoming a core feature in the vocabulary of mental health reform, despite its ambiguities.

Infertility, to those who are affected by it, is much more than whether one manages (or not) to have a child: it can be a traumatizing experience. Based on a clinical case study that involved one-to-one psychotherapy sessions and semi-structured interviews with six involuntarily childless women living in Norway, this article develops the argument that there is a need to treat infertility as trauma, both conceptually and from the perspective of therapeutic practice. The analysis contributes to our understanding of trauma as a disruptive event that erodes a person's moral agency. It does so by outlining conceptual and therapeutic tools that illuminate what happens in the psyche as a result of the trauma: they help explaining why the moral agency of different individuals is damaged to different extents, and how therapy can repair it. In relation to the issue of involuntary childlessness, the analysis shows where infertility fits within one's traumabiography-a map of the way adverse experiences over the life-course have affected one's psyche and behavior-both as traumatizing in itself and connected to previous traumas. This understanding enables more effective therapeutic support and better care for many individuals whose long-term suffering would otherwise remain unacknowledged and untreated.

Trans subjectivities continue to be included in major compendia of mental illness, despite recent moves to depathologize "cross-gender identification." Regardless, the inclusion of "gender dysphoria" is often framed as a formal mechanism to support access to gender affirming care as transgender subjectivities are re-conceptualized as part of sex/gender diversity and away from madness. The latter permits trans individuals to evade sanist oppressions. However, moves to disassociate from mad individuals also often serve to condone sanism. For instance, a contemporary policy landscape often sees transgender advocates arguing for the "medical necessity" of gender affirming care for gender dysphoria as a "recognized medical condition," thereby skirting the inclusion of gender dysphoria as a psychiatric condition and implying that gender dysphoria carries a special ontological status that separates it from madness (reified as "mental illness"). More though, this framework endorses material violences toward mad individuals that are often advanced via the workings of the state to consign marginalized constituents to death by withholding the means of life, i.e., necropolitics. In the following, I argue that trans disassociations from madness often endorses or assents to mad necropolitics. Drawing from Mbembe's (Necropolitics. Duke University Press, Durham, 2019) framework, I suggest that medicalizing trans narratives, despite being used to object to anti-trans laws in contemporary context, ideologically support mad "death worlds" organized through the U.S.A. welfare state and prison industrial complex. However, I also suggest alternative strategies, i.e., intersectional collaboration, that may uplift mad and/or trans communities.

This paper considers the development of new clinical and medical practices in the early 2000s in France, after the adoption of legal reforms aiming at the prevention of sexual infractions and the protection of minors. The paper explains how the reform led to the creation of a new form of punishment for sexual offenders, l'obligation de soin (therapeutic obligation), which can be described as long-term mandatory therapeutic monitoring. This paper offers an analysis of the implementation of this measure from the standpoint of the specialized mental health care unit which were entrusted the mission of caring for the new group of convicted patients, i.e., patients sentenced to undergo mandatory therapy, after this legal reform. In the new regime these mandatory therapies created, clinicians are tasked to combine their conventional mission of care for the patient in the present, with the judicial mandate of detecting and preventing the patient's relapse qua recidivism in the future. Mobilizing ethnographic examples that evidence the way clinical care comes to encompass a penal mandate of long-term surveillance of convicted patients, I argue that the dual injunction of procuring care while preventing relapse-recidivism constrains the psychodynamic forms of clinical intervention deployed by French clinicians, realigns both psychiatric and clinical interventions along penal lines, and revives interest in some of the diagnostic categories and aims of criminal psychiatry which were important for the development of psychiatry in France.

Advances in end-of-life technologies increasingly destabilize received notions of personhood, identity, and ethics. As notions of personhood and identity within such systems are made to conform to discrete, binary and less fluid categories, some in the West have sought guidance in the techniques and views related to the dying process cultivated in other cultures, particularly Tibetan Buddhism. This article considers such dynamics as they unfolded in research focused on the postmortem bodies of Tibetan Buddhist practitioners in India. This article introduces the term thanato-technics to highlight the temporalities, imaginary or otherwise, evoked, enabled, and invested through the use of technologies to ascertain or conjecture about the intrasubjectivity of the dead and dying.

Understanding local worldviews is a challenge during clinical encounters, especially when they involve cultural references without acceptance from the medical community. Gangstalking is a Western cultural notion which refers to systematic harassment, surveillance, and torture from unseen or covert assailants or networks. It is not a 'real phenomenon' compared with genuine stalking, but experients report worse depression, post-traumatic symptoms, suicidal ideation, and longer lasting encounters. They report physical pain and impossible feats of espionage technologically orchestrated by unknown malevolent actors. Using conversational data from targeted individual podcasts, I explore gangstalking as a cultural concept of distress (CCD) by highlighting associated explanations, idioms, and symptoms. Clinically, gangstalking is likely diagnosed as paranoid schizophrenia. However, its association with frightening events parallels Susto and Nervios. Physical symptoms parallel Open Mole and Brain Fag Syndrome. Like many CCDs, gangstalking is a multi-dimensional phenomenon not neatly mapped onto psychiatric categories. Misinterpreting gangstalking cases as unique or isolated is a likely outcome even when they fit within a well-known Western subculture and techno-science belief system. Moving past prior, outdated notions of folk illnesses and culture-bound syndromes, gangstalking as a CCD helps end the assumption that only the other has exotic or non-psychiatric categories of distress.

Amid patriarchal conditions that render one son necessary and multiple daughters burdensome, selective abortion of female fetuses has become pervasive in India. Public responses often cast sex selection as self-evidently ignorant, cruel, and misogynistic - an obvious evil meriting denunciation and eradication. Drawing on ethnographic fieldwork in Gujarat state, this article zooms out from ultrasound and abortion to survey the landscape of biomedical, herbal, and religious son production techniques surrounding them. Doing so clarifies the lived moral experience in which sex selection is embedded. Resort to multiple son production techniques is both an abstract moral indicator reflecting prevailing concerns and a pragmatic moral intervention aimed at harnessing every available means in response to those concerns. Fundamentally, people live out the multimodal quest that sometimes leads to selective abortion as aspiration - social, bodily, spiritual - toward an indispensable good, not as heartless rejection of daughters. Pluralistic son production illuminates the moral uses of medical pluralism for care-seekers, social scientists, and policymakers and practitioners. The case underscores that "complementary" therapies, rather than being just desperate behaviors, barriers to biomedical therapy, or curiosities to be integrated into care, may in fact be the clearest markers of the moral conditions in which public health problems unfold.

In this article, I present the individual ethnography of Amina, a Senegalese woman possessed by the spirits of her lineage. Amina's story shows the lacerations of a person who simultaneously inhabits two worlds: the traditional Lebou culture and the Western one. When her spirits manifest themselves, she is forced to choose between two different interpretations of her suffering: the traditional persecutory and the Western psychopathological. She chooses the former but refuses the healers imposed by the tradition and turns to a priest of her choice, who proves to be sensitive to her need to personally own the healing journey. Amina strategically manipulates the plasticity of the traditional belief system without abandoning it; she bends it to shake the boundaries of herself, and her group and lineage. She uses the disruptive potential of possession and the irruption of the invisible world in the visible to renegotiate her role and acquire a new status in her group. She uses the performative dispositive of possession to renegotiate and expand her spaces of agency and affirm her tenacious subjectivity of a permanently liminal person, one who inhabits, shakes and redraws the boundaries between different worlds of meaning.

This paper explores the intricate interplay between living with mental illness and the processes of identifying mental illness in Abeokuta, Nigeria. With a particular focus on the contextual understanding of personhood, this study reveals how sociocultural backgrounds modulate the understanding of mental illness and its treatments within the Yoruba context. Through nine months of ethnographic fieldwork and discursive narrative analysis, the research revealed that becoming a mentally ill person is deeply intertwined with the everyday social life in the study site. The analysis highlights the multifaceted nature of personhood, encompassing various aspects such as parenthood, friendship, employment, and financial freedom. These facets of personhood are shaped by specific social practices and embedded within complex webs of social relations, often becoming more pronounced when these relationships are disrupted, leading to certain behaviours being categorised as mental illness. This paper underscores the significance of recognising and acknowledging the contextual notion and understanding of mental illness to ensure the provision of acceptable and effective care and recovery strategies.