Culture Medicine and Psychiatry最新文献

Since the 1980s, French police forces have used less-lethal weapons (armes à létalité reduite)-meant to neutralize targets without killing them-to enforce order. At first mostly deployed against working-class and racialized citizens living in the margins of French cities, they have been used against wider sections of the population during recent demonstrations against neoliberal reform. These weapons can cause severe injury, with longstanding physical, social, and emotional consequences. Moreover, citizens who suffer these injuries endure a stigma of criminality, making widespread social recognition of their pain difficult, which motivates them to look for acknowledgement of their victimhood in court. Based on 22-months of ethnographic research amongst people who have been mutilated or wounded with these weapons during police operations, this article is divided in two parts. In the first part, I describe people's bodily sensations-anger, tension, pain, etc.-while awaiting trial and during court hearings. I show how, much like the initial police violence, the process of waiting for justice, the events in court, and the final verdicts also become a form of violence that is inscribed on their bodies. In the second part, I turn to my interlocutors' close networks of support and care. In contrast to official proceedings, these networks allow for the refusal of socially attributed criminality and the acknowledgement and validation of their pain. I argue that they create a form of reparation that could serve as a model for a liberation medicine, a core aspect of which is the recognition of socially inflicted pain.

The Coyolxauhqui Imperative offers a decolonial framework for reimagining trauma and healing in psychiatric practice by drawing on the Aztec myth of Coyolxauhqui's dismemberment and celestial transformation. Challenging Western biomedical assumptions of linear recovery and pathologization of fragmentation, this paradigm centers cultural epistemologies of nepantla (liminal space), conocimiento (embodied truth-telling), and mythic temporality (cyclical reintegration). Through critical analysis of Nahuatl cosmology, Gloria Anzaldúa's theoretical expansion, and contemporary ritual practices, the model reconceives psychological crises as sacred processes of disintegration and reassembly. We delineate theoretical foundations, clinical applications (including narrative pharmacology, ritual reassembly, and decolonial charting), and policy implications that foreground communal re-membering over individual symptom suppression. The Imperative advances an integrative praxis that honors fragmentation as generative, privileges cultural sovereignty, and undermines psychiatric coloniality. Our interdisciplinary synthesis establishes pathways for culturally resonant assessments, participatory methodologies, and land-based healing initiatives. By repositioning fragmentation as luminous, this work invites psychiatry to adopt borderlands healing practices that valorize ancestral wisdom, collective narrative sovereignty, and ritual space-holding.

Compared to the biomedical model of mental suffering, the increasingly influential trauma model has received little critical attention. We examine the discursive practices justifying and promoting the trauma-informed care: a set of assumptions and clinical recommendations presented as universal and uncontested guidelines for mental health practitioners. Critical review of two major guidelines for trauma-informed care - the SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach (2014) and A paradigm shift: relationships in trauma-informed mental health services by Sweeney et al. (2018) - was inspired by critical discourse analysis and the analysis of reification. Trauma-informed care is a diverse set of recommendations combining generally accepted standards with the notion of broadly defined trauma as the primary cause of mental suffering. We have identified mechanisms that (1) present the broad trauma model as an assumption-free description of reality, (2) portray it as superior to other models, and (3) elevate the authority of those who adopt the broad trauma model to interpret the suffering of others. The discursive procedures found in the trauma-informed manuals are similar to those documented in the biomedical-psychiatric literature. Potential risks include iatrogenic harm, politicization of mental health care, and reduction of its diversity and effectiveness. Evaluation of the guidelines from the perspectives of safety, cultural validity, ethics, and cost-effectiveness should precede their implementation into clinical practice.

Indigenous peoples in Colombia face an elevated risk of experiencing spiritual disharmonies, a term used by Indigenous communities to describe mental health challenges, due to a range of factors, including barriers to accessing care and recovery systems, extractivist policies, armed conflict, food insecurity, and the erosion of cultural identity, among others. These risks are more effectively addressed when elements of Indigenous cultural practices are integrated into biomedical care processes. This study aimed to analyze the role of cultural practices in the management of public mental health in two Indigenous communities from the Colombian Amazon and Pacific regions. Using a qualitative study design with an epistemological approach grounded in contextual constructivism, we conducted a thematic analysis and identified a central theme: "Culture as the foundation for managing public mental health." This theme encompassed categories such as "Structural Competence in the Biomedical Health System" and "Ancestral Practices for Recovery." The ancestral knowledge and practices of Colombia's Indigenous peoples can contribute to a deeper, culturally sensitive understanding of spiritual disharmonies, offering potential points of integration with biomedical health systems that are tailored to each community. This culturally informed perspective supports more effective approaches to expanding access to integrated care systems that not only address mental health concerns but also tackle the social determinants underlying these disharmonies.

The provision of care for suicidal and, perhaps especially, chronically suicidal people walks a fine line: between acknowledging a person's suffering and their desire to die, and trying to accompany them safely through their most difficult moments. In this article, we explore what it means to receive and provide "safe care," as traced through the words of people with lived experiences of suicide. Our data comes from 18 interviews with members of an Australian lived experience of suicide organization, which included people with lived experience of chronic suicidal ideation, the bereaved, peer workers, and Safe Space volunteers. Drawing on the anthropology of care and aligned psychoanalytic theory, particularly Emily Yates-Doerr's (Anthropol Human 45:233-244, 2020) consideration of the seed container and Donald Winnicott's notion of holding, we unpack how suicidality is experienced, what makes care safe, and how notions of holding space for people are becoming anchored in emerging "Safe Spaces." Interview participants called for a paradigmatic shift in suicide care: in contrast to "negative" conceptions (Baril, in: Disability Stud Q 40:1-41, 2020), what arose in their stories were appeals for present-focused and engaged support where emotion, turmoil, and sorrow could be weathered alongside the listener. Thus, safe care works within infrastructures of care to neutralize-not diminish, prevent, or fix-suicidality, and to hold it within a space of concern so that it may transform.

The horizon of critical theories and their target audience (i.e., the subjects exposed to social suffering) have drifted apart. While the former relies on its own set of diagnostic concepts (e.g., alienation), the actors are socialized within the frames of biomedical discourses. This creates a rupture between theory and praxis: the concepts of social suffering fail to orient collective action. To overcome this challenge, a translator category is elaborated, which can link the distinct biomedical and critical discourses, while reconnecting theory and praxis. Burnout is chosen as a translator category because it is located at the border of the psychological discourses (on depression) and the critical sociological discourses (on alienation). First, the birth of the concept is reconstructed in a genealogical fashion. Second, the psychological measurement tools and explanations are overviewed with a special emphasis on the failed attempt of discursive medicalization. Third, the sociological explanations are analyzed from the perspective of their potential of breaking the biomedical and psychological discursive hegemony. In the last section, it is discussed how burnout can link the discourses of alienation (as a cause of burnout) and depression (as a consequence of burnout), while remaining accessible to the biomedically socialized subjects.

In this article, we address the potential of mythological narratives to contribute to understanding meaning in life. Drawing on contemporary theories concerning meaning in life including the existential psychotherapeutic approach, discrepancy-based model and hierarchical meaning-making model, we highlight key principles of the meaning-making process that are reflected also in world mythological narratives. These common principles include encountering a profoundly impactful event, dissatisfaction with the current state, meaning-making attempts, and providing a vision of the desired state. Consequently, by integrating insights from psychology and anthropology, we propose that myths not only continue to hold enduring relevance in contemporary life but also possess considerable potential as frameworks for enriching knowledge on what makes life meaningful and pathways that help individuals experience meaning in their lives.

This study investigates the psychological and social impact of the ongoing colonial violence in Gaza, both on the local population and on distant witnesses. Drawing on 30 testimonies collected between November 2023 and June 2024, the research captures the lived experiences from two distinct groups: 15 Palestinian participants living in the Gaza Strip, and 15 mental health professionals (including psychotherapists and academics) based in Europe. Using phenomenological and thematic analysis, the findings reveal the profound effects of genocidal violence on mental health, emotional resilience, and meaning-making processes. For Palestinians, daily exposure of bombardment, displacement, and systemic dehumanization undermines personal and collective agency, resulting in emotional numbness, anger, and alienation. Witnesses from European contexts reported helplessness, disorientation, and moral injury, often struggling with their perceived complicity in global systems of oppression. The study challenges conventional trauma frameworks, emphasizing the need to conceptualize colonial trauma as continuous, collective, and politically rooted. It argues for integrating social and political dimensions into psychological approaches to trauma, and highlight the ethical and political importance of bearing witness. Ultimately, the paper calls for a transnational process of collective healing and solidarity, aimed at dismantling the structural foundations of violence and dehumanization.

Dominant cultural framings of recovery in psychosis describe a process of increasing social connection, community integration, identity reclamation, and hope. Drawing on 6 months of ethnographic fieldwork on a psychiatric rehabilitation ward for 'complex psychosis' in London, I consider what we might learn from recoveries that appear not to follow this trajectory. My primary case study, of a man diagnosed with treatment-resistant schizoaffective disorder who identifies with/as the famous ex-footballer Ronaldo, interrogates the social implications of his attempts to 'mask' his identity while on leave from the hospital to avoid "caus[ing] trouble"-strategically embodying, in effect, the fictitious 'ordinary' person denoted by the English idiom the man on the Clapham omnibus. I argue that his complex recovery, built on a trial-and-error process of retreat from social connection and caution towards hope, reflects a degree of clinical complexity seldom acknowledged outside psychiatric rehabilitation. Engaging with more nuanced anthropological theories of recovery in psychosis, my analysis illuminates how the time, space, and relative safety of a lengthy involuntary hospital admission proved necessary for his complex recovery to unfold. This insight contrasts with the dominant operationalisation of recovery in contemporary mental health systems, which seems to be fuelling disinvestment in such rehabilitative admissions.