A very exciting special issue of Transcultural Psychiatry has just been published: Practical Anthropology for a Global Public Psychiatry: Provocations and Future Directions is edited by Neely Myers, Rebecca Lester, and Kim Hopper. Here are the abstracts!
Reflections on the anthropology of public psychiatry: The potential and limitations of transdisciplinary work
Neely Myers, Rebecca Lester, and Kim Hopper
Transcultural psychiatry and anthropology have long championed the comparative study of emotional distress to better understand how people experience, interpret, and manage extraordinary mental events and emotional quandaries around the globe. This special issue brings together practitioners, scholars, and experts from both disciplines working at the intersections of the community and the clinic, the personal and the social, the local and the global, to ask: where does this effort currently stand? We hope this collection of articles will serve as a bellwether selection of provocations and future directions for transdisciplinary research in psychiatric anthropology.
Much research on the mental health system in the US, at least, skirts the sprawling, fragmented, poorly mapped terrain of “de facto” services—a motley array of institutional arrangements claiming to offer custody and care, such as jails, prisons, detention facilities, residential institutions for teenagers, homeless shelters, and a variety of quasi-institutions for the deaf, blind, and elderly. Rather than avoiding these settings, the researchers contributing to this issue reflect on the challenging work of engaging intimately with interlocutors living with these conditions. We use the term “public psychiatry” to refer to this ad hoc, patch-worked, and ill-monitored system. Unlike “public health,” as we use the term here, public psychiatry encompasses not populations but structures: state, private, and informal configurations of care, the surrogates of care and the default options offered when care is unavailing. Understood in this way, we can reflect on both public psychiatry in the US and the global variations of public psychiatry familiar to readers of this journal.
Recovery stories: An anthropological exploration of moral agency in stories of mental health recovery
Neely Anne Laurenzo Myers
Moral agency has been loosely defined as the freedom to aspire to a “good life” that makes possible intimate relationships with others. This article uses ethnographic research to further the discussion of the role of moral agency in mental health recovery. This article attends to the ebb and flow of moral agency in the life stories of three people diagnosed with a serious psychiatric disability at different stages in their individual recoveries to illustrate particular aspects of moral agency relevant for recovery. From these, a more complex notion of moral agency emerges as the freedom not only to aspire to a “good life,” but also to achieve a “good” life through having both the intention to aspire and access to resources that help bring one’s life plans to fruition. Each storyteller describes an initial Aristotelian peripeteia, or “breach” of life plan, followed by an erosion of moral agency and sense of connection to others. The stories then diverge: some have the resources needed to preserve moral agency, and others attempt to replenish moral agency that has been eroded. In these stories, the resources for preserving and nourishing moral agency include the ability to cultivate the social bases of self-respect, autobiographical power, and peopled opportunities. These stories cumulatively suggest that without such resources one’s attempts to preserve or nourish the moral agency needed for recovery after the peripeteia, which is often perpetuated by the onset and experience of serious mental illness, may fall short.
Violence, addiction, recovery: An anthropological study of Mexico’s anexos
Angela Garcia and Brian Anderson
Informal, coercive residential centers for the treatment of addiction are widespread and growing throughout Latin America. In Mexico these centers are called “anexos” and they are run and utilized by low-income individuals and families with problems related to drugs and alcohol. This article draws on findings from a 3-year anthropological study of anexos in Mexico City. Participant observation and in-depth interviews were used to describe and analyze anexos, their therapeutic practices, and residents’ own accounts of addiction and recovery. Our findings indicate that poverty, addiction, and drug-related violence have fueled the proliferation of anexos. They also suggest that anexos offer valuable health, social, and practical support, but risk exacerbating the suffering of residents through coercive rehabilitation techniques. Emphasizing this tension, this article considers the complex relationship between coercion and care, and poses fundamental questions about what drug recovery consists of in settings of poverty and violence.
Shifting blame: Buprenorphine prescribers, addiction treatment, and prescription monitoring in middle-class America
Sonia Mendoza, Allyssa S. Rivera-Cabrero, and Helena Hansen
Growing nonmedical prescription opioid analgesic use among suburban and rural Whites has changed the public’s perception of the nature of opioid addiction, and of appropriate interventions. Opioid addiction has been recast as a biological disorder in which patients are victims of their neurotransmitters and opioid prescribers are irresponsible purveyors of dangerous substances requiring controls. This framing has led to a different set of policy responses than the “War on Drugs” that has focused on heroin trade in poor urban communities; in response to prescription opioid addiction, prescription drug monitoring programs and tamper-resistant opioid formulations have arisen as primary interventions in place of law enforcement. Through the analysis of preliminary findings from interviews with physicians who are certified to manage opioid addiction with the opioid pharmaceutical buprenorphine, we argue that an increase in prescriber monitoring has shifted the focus from addicted people to prescribers as a threat, paradoxically driving users to illicit markets and constricting their access to pharmaceutical treatment for opioid addiction. Prescriber monitoring is also altering clinical cultures of care, as general physicians respond to heightened surveillance and the psychosocial complexities of treating addiction with either rejection of opioid dependent patients, or with resourceful attempts to create support systems for their treatment where none exists.
God in the brain: Experiencing psychosis in the postsecular United States
Nev Jones, Timothy Kelly, and Mona Shattell
There is a growing literature on what contemporary cultural theorists have broadly termed the “postsecular”: the abandonment of clear-cut boundaries between the secular and nonsecular in the industrialized West and an embrace of a complex understanding of what is real that neither accepts nor rejects the supernatural. These new cultural currents may affect not only philosophers and theologians, but also the ways in which individuals with psychosis make sense of their experiences. This paper reports on the key findings of an in-depth qualitative analysis of 19 interviews of individuals diagnosed with psychotic disorders. The majority of participants described ongoing and self-conscious struggles to demarcate their experiences as the products of the real world or a “crazy” mind. With equal frequency, participants weighed and debated competing secular and supernatural explanations, often juxtaposing and blending different explanatory frameworks. We found that this syncretic process affected not only the content of psychotic experiences—what delusions or hallucinations are about—but also the type of arguments or logics used to justify particular interpretations. We discuss the implications of these observations with respect to clinical practice and the broader phenomenology of psychosis, challenging often oversimplified discourse on “insight” and suggesting that polarization(s) between “biomedical” and “psychosocial” explanations may be of less relevance to patients’ real-world experiences than is often assumed.
Signing on for dirty work: Taking stock of a public psychiatry project from the inside
Leah G. Pope, Lauren Cubellis, and Kim Hopper
As applied anthropologists used to working at arm’s length from public psychiatry, we step out of the daily grind to take stock of the challenges of taking on ethnography entrained–harnessed to the implementation of a new program. These include the loss of critical distance, the struggles to negotiate locally viable forms of authority and relevance, the necessity of sustaining a Janus-faced relation with principal players, the urgency of seeing time-sensitive information converted into corrective feedback, and the undeniable attraction of being part of “committed work” with game-changing potential. In so doing, we rework the terms of witnessing and revive an old alternative: that documentary dirty work be reclaimed as a variant of public anthropology, one that transforms the work of application from mere afterthought to integral part of the original inquiry.
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