Culture Medicine and Psychiatry最新文献

'Nostalgic environments' are increasingly being created in museums and institutional care settings for people with dementia, to support residents' capacities for memory and recognition. Drawing upon ethnography carried out in a public nursing home specialized in dementia care in Copenhagen, Denmark, this paper engages conceptually the employment of material heritage within dementia care environments, proposing dementia care as a 'curatorial' practice: caregivers act as 'curators' who re-establish and reorganize the 'meaning' of the residents by preserving their individual biographies and societal belonging. The analytical alignment of dementia care with the curating of cultural valuables reveals that the human is not only the subject within-and the creator of-cultural heritage, but also the object: the person with dementia is simultaneously an acting subject in care and an object for performances of the category of the human. As the curatorial care performed in nursing homes preserves not only individual, but also collective memories of what it takes to be human and belong in society, these institutions should be recognized as significant sites within society concerned with the production of meaning, value and cultural heritage.

I argue that the emergence of ICBT (Internet Cognitive Behavioral Therapy), a novel computerized psychotherapeutic intervention, heralds a shift in the status of psychotherapy from craft to labor. Psychotherapy, as is practiced commonly today, retains its status as craft; therapists in managed settings still work within what I term an opaque bubble, their work invisible and uninterrupted, even by their immediate supervisors and managers. The therapists participating in the Israeli Ministry of Health's course training the first cohort of 'online therapists' find themselves in uncharted territory: The automation of psychotherapy in the form of ICBT constitutes the profession's first major 'division of labor,' not only minimizing the role of the human therapists, but rendering their craft transparent and controllable in ways previously unimaginable. This shift is theorized as a transition from a workmanship of risk, to a workmanship of certainty, and the potential degradation of therapists' skills and status is explored.

In this article, I address the experiences of family members of people with dementia, as they expressed the sensation of gradually losing the person with dementia. Based on ethnographic fieldwork in nursing homes in the Netherlands, and contributing to the anthropology of grief, I explore the co-existence of experiences of anticipatory grief and manifestations of care to maintain meaningful relations. I show how my interlocutors adapted to changing circumstances as the disease progressed, and in so doing found new ways to relate, as well as prepared for future losses and the expected end of life. I argue that anticipatory grief is temporal and relational, encompassing both present and future losses, and involving a continuous negotiation between the loss and the continuing relationship. I underscore the entanglement of loss and connection, showing how both exist parallel to, and may emerge from one another, and demonstrating how an anthropological approach to anticipatory grief can reveal the nuanced and equivocal character of experiences of illness and at the end of life.

The notion of 'mental health literacy' has been proposed as a way of improving mental health problem recognition, service utilisation and reducing stigma. Yet, the idea embodies a number of medical-model assumptions which are often at odds with diverse communities' spiritual traditions and local belief systems. Twenty participants were recruited to this study consisting of mental health service users (N = 7), family carers (N = 8) and community members (N = 5) in a temple town in Kerala, South India participated in semi-structured interviews exploring the variety of beliefs and practices relating to mental health. Our findings indicate that the issue may be better understood in terms of multiple mental health literacies which people deploy in different circumstances. Even those sceptical of traditional and spiritual approaches are knowledgeable about them, and the traditional practices themselves often involve detailed regimes of activities aimed at effecting an improvement in the person's mood or condition. Therefore, we argue it is appropriate to consider mental health literacy not as a unitary universal phenomenon but instead as a mosaic of different literacies which may be deployed in different settings and in line with different experiences and which may operate in synergy with each other to enable treatment but also facilitate a sense of meaning and purpose in life.

It is commonplace to state that dementia is a complex condition. Such complexity involves the limits between pathological and normal aging, diagnosis with no simple organic causation, and the use of psychiatric medication that does not cure but generates hope to alleviate symptoms such as forgetfulness and delirium. Based on an ethnography of one year and a half (2017-2018) in a Brazilian metropolis, within a Public Geriatric center and the households of three families, I argue that dementia, more than a complex condition, is a generator of drug complexity. Following Stefan Ecks' reflections on multimorbidity and polyiatrogenesis and Karen Barad's understanding of intra-action, I discuss the polypharmacy present in most cases of dementia that I have known. Considering the complicated relations of medications with themselves and with time and places, I conclude that dementia should be seen a polypharmaceutical phenomenon.

Building on 12 months of ethnographic fieldwork among people with Alzheimer's disease living in Denmark, I argue that the loss of a sense of time caused by Alzheimer's is not a subjective loss, but rather an intersubjective one. Alzheimer's disease entails living with desynchronized rhythms, time that can be made painfully explicit, and numbers becoming increasingly tricky to manage. Drawing on Thomas Fuchs' theory of how individuals live in "basic contemporality," I explore moments of temporal rupture, and how people with Alzheimer's challenge their social relations due to their different sense of time. The article contributes to ongoing discussions about belonging. Taking inspiration from Tine Gammeltoft's description of how belonging entails fragile attempts at being part of something larger, and is thus a joint social practice, I show how one dimension of belonging's fragility is the inability to be in synch with social time. By proposing the notion of temporal belonging, I suggest that sustaining a sense of belonging is also about being able to participate in the rhythms and tempo of social life.

This study assesses the perspectives and experiences of Vodou priests (ougan) in the treatment of mental illness in northern Haiti. Our goal is to explore the etiology and popular nosologies of mental illness in the context of Haitian Vodou, through understandings of illness and misfortune which are often viewed as a result of sent spirits-or spirits sent supernaturally by others with the intent to cause harm. Using a qualitative approach, this study conducted semi-structured in-depth interviews with 20 ougan living near the city of Cap-Haïtien. Interviews highlight a sample of healers with little formal training who maintain beliefs and practices that differ significantly from current biomedical models. Ougan treat mental illness through a variety of means including prayer and conjuring of spirits, leaves for teas and baths, as well as combinations of perfumes, rum, human remains, and other powdered concoctions that are either imbibed or rubbed on the skin. The primary purpose of these treatments is to expel the spirit causing harm, yet they can often result in additional harm to the patient. Findings suggest that while ougan are willing to collaborate with biomedical practitioners, significant barriers remain preventing cooperation between these two groups.

Autscape is an autistic-led conference, organised annually in varying locations around England. Governed by a strict set of rules and regulations, Autscape is a social and spatial setup explicitly devised to accommodate the tendencies, sensitivities, and preferences of people on the autism spectrum. It is a design, in other words-as organisers and participants alike often profess-for an altogether autistic space. The uniqueness of the event, and consequently its value to anthropological theory, lies in the shared imagination of the setting by those who inhabit it as one in which neurotypical masks, otherwise worn daily in keeping with hegemonic society's expectation of conformity, can finally be removed. I introduce the concept of un-festival as a means of depicting this event, similar to festival in its goals of defiance and inversion, but different from-and in important ways, opposite to-festival in its style and architecture, in the dispositions it encourages and mobilises, and in its potential implications. The un-festival offers a powerful comment on this moment in history, whereby masks are no longer seen as an item that affords freedom, but as one that stifles it. While Autscape participants remain doubtful as to the actual effect of this event on neurotypical society, they do nevertheless express a desire that this project will have some longstanding effects. That once a space has been designed for autistic people that considers their specific needs and tendencies, autism may then finally cease to be interpreted through a neuro-normative prism and freed to be understood in autistic people's own terms.

The field of medical action extends beyond the clinical encounter. Rather, clinical encounters are organized by wider regimes of governance and expertise, and broader geographies of care, abandonment and violence. Clinical encounters in penal institutions condense and render visible the fundamental situatedness of all clinical care. This article considers the complexity of clinical action in carceral institutions and their wider geographies through an examination of the crisis of mental health care in jails, an issue of significant public concern in the United States and much of the world. We present findings from our engaged, collaborative clinical ethnography, which was informed by and seeking to inform already existing collective struggles. Revisiting the concept of "pragmatic solidarity" (Farmer in Partner to the poor: a Paul Farmer reader, University of California Press, Berkeley, 2010) in an era of "carceral humanitarianism" (Gilmore in Futures of Black Radicalism, Verso, New York, 2017, see also Kilgore in Repackaging mass incarceration, Counterpunch, June 6-8, http://www.counterpunch.org/2014/06/06/repackaging-mass-incarceration/ , 2014), we draw on theorists who consider prisons to be institutions of "organized violence" (Gilmore and Gilmore in: Heatherton and Camp (eds) Policing the planet: why the policing crisis led to Black lives matter, Verso, New York, 2016). We argue that clinicians may have an important role in joining struggles for "organized care" that can counter institutions of organized violence.

The literature suggests long-term consequences and lack of support for birthmothers following relinquishment of their child for adoption (Memarnia in Listening to the experience of birth mothers whose children have been taken into care or adopted, 2014). But there was not any work done to study in-depth experiences of birthmothers after giving away their child in Pakistan. So, the purpose of the present study was to explore the experiences of mothers who relinquished their child for adoption. As the present study was intended to explore lived experiences of a particular group, the phenomenological research design was used to conduct this qualitative study. An interview protocol was devised to explore the experiences of birthmothers. The sample was comprised of five birthmothers who relinquished their child for adoption and fulfilled the criteria. Semi-structured interviews were conducted with the birthmothers, and all the interviews were audio-recorded and transcribed before analysis. Interpretive Phenomenological Analysis (IPA) was used to interpret the transcripts of interviews. Further, data verification was done through peer scrutiny, by debriefing sessions with the supervisor, and enriches the description of the phenomenon. Four main themes were emerged: Reasons to Relinquish, Psychological Distress, Coping Strategies, and Disenfranchised Grief. The study present that the experience of relinquishment has a negative impact on birthmother and highlights the need for proper measures to regulate the process of adoption and involvement of psychologists during the process of adoption. Moreover, it stresses the need for acknowledgment of the experience and psychological services for birthmothers who relinquish their child.