Medical Anthropology Quarterly has published a special issue, edited by Dominique P. Béhague and Kenneth MacLeish, featuring articles that “examine diverse incarnations of what might be called the global psyche,” asking how the global and the psyche “appear…as mutually constituting descriptors and objects of intervention, but hailed into existence, actively produced, struggled over, and made into sites of new possibility.”
The Global Psyche: Experiments in the Ethics and Politics of Mental Life
Dominique P. Béhague, Kenneth T. MacLeish
Across hemispheres, nations, and domains of social life, the language of psychiatry and mental health constitutes an increasingly universal frame for suffering while also expressing a human condition ever more liberated from and ever more alienated by medical knowledge. The use of psychiatric labels and discourses as tools of governance in the face of violence and disorder and as means of grievance and redress for social and political movements are not particularly new. But the present moment presents a particular density, ubiquity, and fluidity to both of these deployments. The affective dimensions of large‐scale political projects, from humanitarianism to environmentalism, electoral processes to ever‐expanding (self‐) surveillance practices, rest on objectifying interior states and generating master narratives of collective stress (Masco 2017). Psychiatric symptoms and diagnostic categories become sites of threat, governance, care, resistance, mobilization, and knowledge creation in domains ranging from health care access, borders and immigration, police violence, nuclear conflict, and control and funding of scientific research to white nationalism, post‐industrial precariousness, neoliberal managerialism, hate crime, and liberal apocalypticism. In the process, conceptions of mental life become sites of moral and political reckoning and ethical speculation and reconfiguration, birthing novel experiments in justice, rights, survival, personhood, and the good life.
Toxic Environments and the Embedded Psyche
A discussion of the recent transition to a new geological epoch, the Anthropocene, opens this article. The need to declare a new era has been declared necessary by geologists, together with other scientists and critical commentators due to the inordinate amount of human-made destruction being imposed on the globe and its inhabitants. This destruction disproportionally effects those who are economically deprived and experience discrimination. An account of the recognition and routinization of epi- genetics follows, in which an unexamined assumption of genetic determinism is debunked. A move to recognize human existence everywhere as contextualized in environments that impinge on body functioning throughout life opens up a discussion of the embodiment of trauma followed by six illustrative examples from the newly recognized field of environmental epigenetics.
In 2006, the United States Department of Defense developed for the first time official criteria for the use of psychopharmaceuticals “in theater”—in the physical and tactical spaces of military operations including active combat. Based on fieldwork with Army soldiers and veterans, this article explores the transnational and global dimensions of military psychopharmaceutical use in the post‐9/11 wars. I consider the spatial, material, and symbolic dimensions of what I call “pharmaceutical creep”—the slow drift of psychopharmaceuticals from the civilian world into theater and into the military corporate body. While pharmaceutical creep is managed by the U.S. military as a problem of gatekeeping and of supply and provisioning, medications can appear as the solution to recruitment and performance problems once in theater. Drawing on soldiers’ accounts of medication use, I illuminate the possibilities, but also the frictions, that arise when routine psychopharmaceuticals are remade into technologies of global counterinsurgency.
Postwar development contexts are increasingly sites of mental health and psychosocial interventions in which local health providers are trained by foreign experts in evidence‐based diagnostic and treatment strategies. Underlying this course of action is a well‐accepted biomedical logic that assumes symptoms can be identified and translated into mental disorders, and disorders into forms of treatment. I question this logic by investigating how patients are actually “made” in postwar and resource‐scarce settings. Specifically, I focus on the tensions and ethical dilemmas with which practitioners in Kosovo grapple as they navigate requirements of international standards, their own perception of good care, and the limited resources at their disposal. The resultant practice of “making patients” to fit diagnostic repertoires is a product of health practitioners’ structural power, but also an ethical response to the materially untenable conditions that practitioners and their patients are confronting.
Exceeding Crisis. The Psychic Life of Drawings
Since 2015, an unprecedented number of people from Middle Eastern and African countries have crossed borders into and within Europe. Media and political actors describe this time as an “emergency” and a “crisis” that challenges the core of European values and human rights principles. Calling this a crisis implies responding to it, on the one hand, with humanitarian gestures of saving lives, and, on the other, with stricter border control. I reflect on the grammar of crisis and the forms of care that it simultaneously enables and disables. I am inspired by the relationship between two painters—from Tunisia and Nigeria—and their forms of therapeutic and ethical explorations through art. I propose to attend to practices that bear witness to other grammars, or the lack thereof. These practices are the expression of a denial, or, better, of an interruption in the language of the crisis and pathology.
Psychoanalysis has produced an ensemble of institutions, expertise, procedures, and practices for rendering the psychoanalytic subject legible and, through this, psychic life as an actionable site of intervention, dislocation, and struggle. This article examines how diverse psychoanalytic communities in Buenos Aires have produced unique grammars that influence how individuals articulate ideas about health and well‐being. Descriptive, culturally specific, historically informed, and always provisional, this grammar is empirically grounded in lived experience. Through presenting several case studies, I flesh out how this grammar, as a deictic expression of/for the unconscious is deployed, reworked, and embodied in everyday interactions. I demonstrate how psychic life is enmeshed within social and political experience. In doing so, I consider how interpersonal, existential, environmental, social, and political contingencies shape divergent notions of well‐being and structure desires of what it means to live “a good life.”
Living in the world’s leading superaging society, Japanese are confronted with a tsunami of dementia that has generated fear of becoming mentally incommensurable to oneself and to others. Based on three years of fieldwork in various clinical settings, including a memory clinic in Tokyo, I show how people with dementia (dementia tojishas) and doctors have employed three approaches to overcoming incommensurability: psychotherapeutic, neurobiological, and ecological. With a primary focus on the neurobiological, I show how tojishas and doctors try to cultivate what I call “neurobiological empathy,” asking people to imagine not just how to be together with those with dementia but also what it is to be (in the mind of someone) with dementia. Investigating both the effects and limits of the neurobiologization of dementia, I ask how the dementia tojisha movement can work toward diminishing the preexisting fear about dementia and supplementing incommensurability with understanding and empathy.
Commentary: Animating the Psyche
Anne M. Lovell
For global metrics to have purchase, they must be imbued by more than what Reubi (2018) terms, with a nod to Weber, the “quantificational spirit” of the new epidemiology. They must be animated, brought to life (“animate” derives from the Latin anima, “soul”). Friction is produced in the animation of these categories, without which local encounters of these tools of global mental health do not find a foothold. This is one sense in which we might understand the spirit of global “psyche” (from the Greek: “breath,” “life,” “soul”). The French term esprit captures well the polysemy; it translates as both spirit and mind; as in the spirit (esprit) of capitalism and philosophy of the mind (esprit). In on‐the‐ground encounters between psyche and concrete practices and practical categories, practitioners and patients (patient taken here in its classical meaning, as that on whom an agent acts, whether agency resides within the subject or not), each animates the other. But this is not the only incarnation of psyche possible.
A Medical Anthropology of the “Global Psyche”
A medical anthropology of the “global psyche” may sound like an odd project. Is there one psyche that pervades the whole globe? In their introduction to this special issue, Dominique Béhague and Kenneth MacLeish dissuade any suggestion of either the global or the psyche as entities that could be examined like substances. Neither the psyche nor the globe are stable points of reference. They are not names of entities. Instead, the global psyche is “a concept, era, program, and episteme that rewards careful analysis” (this issue). There are “multitudinous labors” and “novel forces—political, technological, neurobiological, ecological” that are redefining what either the global or the psyche could be.