Anthropological Approaches to Psychological Medicine: Crossing Bridges

305 Pages·2000·1.04 MB·English

by  Vieda Skultans

Anthropological Approaches

to Psychological Medicine
of related interest
Confidentiality and Mental Health
Edited by Christopher Cordess
ISBN 1 85302 860 6 pb
ISBN 1 85302 859 2 hb
Race, Culture and Ethnicity in Psychiatric Practice
Working with Difference
Edited by Charles Kaye and Tony Lingiah
ISBN 1 85302 696 4 pb
ISBN 1 85302 695 6 pb
Emotional Expression Among the Cree Indians
The Role of Pictorial Representations in the Assessment
of Psychological Mindedness
Nadia Ferrara
ISBN 1 85302 656 5 pb
ISBN 1 85302 655 7 hb
Therapeutic Communities
Past, Present and Future
Edited by Penelope Campling and Rex Haigh
ISBN 1 85302 626 3 pb
ISBN 1 85302 614 X hb
Therapeutic Communities 2
Bion, Rickman, Foulkes and the Northfield Experiments
Advancing on a Different Front
Tom Harrison
ISBN 1 85302 837 1
Therapeutic Communities 5
Remorse and Reparation
Edited by Murray Cox
ISBN 1 85302 452 X pb
ISBN 1 85302 451 1 hb
Forensic Focus 7
Anthropological Approaches
to Psychological Medicine
Crossing Bridges
Edited by Vieda Skultans and John Cox
Jessica Kingsley Publishers
London and Philadelphia
Chapter 2 was originally published in the International Journal of Social Psychiatry
(1996), volume 42, pp.245–265, and is reproduced with the kind permission of The
Avenue Publishing Co.
All rights reserved. No paragraph of this publication may be reproduced, copied or
transmitted save with written permission of the Copyright Act 1956 (as amended), or
under the terms of any licence permitting limited copying issued by the Copyright
Licensing Agency, 33–34 Alfred Place, London WC1E 7DP. Any person who does
any unauthorised act in relation to this publication may be liable to prosecution and
civil claims for damages.
The right of the contributors to be identified as authors of this work has been
asserted by them in accordance with the Copyright, Designs and Patents Act 1988.
First published in the United Kingdom in 2000 by
Jessica Kingsley Publishers Ltd,
116 Pentonville Road, London
N1 9JB, England
and

325 Chestnut Street,

Philadelphia PA 19106, USA.

www.jkp.com
© Copyright 2000 Jessica Kingsley Publishers
Library of Congress Cataloging in Publication Data
A CIP catalog record for this book is available from the Library of Congress
British Library Cataloguing in Publication Data
Anthropological approaches to psychological medicine
1. Cultural psychiatry 2. Psychiatry – Social aspects
3. Medical anthropology
I. Skultans, Vieda II. Cox, John, 1939–

616.8’9

ISBN 1 85302 708 1 pb
ISBN 1 85302 707 3 hb
Printed and Bound in Great Britain by
Athenaeum Press, Gateshead, Tyne and Wear
Contents

Introduction 7
Vieda Skultans and John Cox
Part 1 Theoretical Approaches
1 The Cultural Construction of Western Depression 41
Sushrut Jadhav, University College, London
2 Psychiatry’s Culture 66
Roland Littlewood, University College, London
3 Remembering and Forgetting: Anthropology and Psychiatry:
The Changing Relationship 94
Vieda Skultans, University of Bristol
4 Narrative and Method in the Anthropology of Medicine 105
John Campbell, University of Wales, Swansea
5 Anthropology and Psychiatry: Two of a Kind but Where is
the Other? 123
Els van Dongen, University of Amsterdam
Part 2 Clinical Approaches
6 Social Anthropology and the Practice of Public Health
Medicine 145
Jane Jackson
7 The Implications of an Anthropology of Religion for
Psychiatric Practice 172
Simon Dein, Princess Alexandra Hospital, Harlow
8 Establishing Cultural Competency for Mental Health
Professionals 184
Maureen H. Fitzgerald, University of Sydney
9 Cambodian Concepts of Perinatal Mental Disorder:

Relevance to Understanding Western Approaches to

Perinatal Mental Health 201

Maurice Eisenbruch, University of New South Wales
10 Social Anthropology and Stigma: The Importance for

Psychiatry 233

Gerard Hutchinson, Institute of Psychiatry, London

and Dinesh Bhugra, Institute of Psychiatry, London

11 Structures of Medical Thought:

Professional Dispositions in Practice 258

Simon Sinclair, University of Durham
12 Lessons from Anthropology 271

Maurice Lipsedge, South London and the Maudsley NHS Trust
List of Contributors 290

Subject Index 292

Author Index 299
Introduction
Vieda Skultans and John Cox
The energy to cross the bridge between anthropology and psychiatry was
part of our autobiographical narratives. One of us (VS) had worked as a
medical anthropologist in a Department of Psychiatry at Bristol University
and was therefore immersed in the ways of thought of doctors, and
psychiatrists in particular. The other (JC) was trained in general adult
psychiatry and had worked in East Africa for two years as part of his higher
training. This experience of being translated from a Department of
Psychiatry in London to a lecturer post at Makerere University, Kampala was
a formative culture ‘shock’ which encouraged a cautious move from the safe
training in British psychiatry to an environment where it was fundamentally
essential to grasp the relevance of social and anthropological dimensions
necessary to understand the causes and management strategies of mental
disorder. For us ‘crossing the bridge’ was a part of daily work routines. We
hope these readings will encourage others to cross this bridge from either
direction and so enlarge their professional practice and research routines.
OUTLINING THE FIELD
Yet before bridges can be crossed we need to know what lies either side of the
bridge and how strong the bridge: we need a map. Yet the conceptual terrain
on either side of our bridge resists easy classification. The Oxford Shorter
Dictionary offers us an older, etymological and all-embracing view of
anthropology as the study of man which the anthropologist Leach would no
doubt reject as ‘a monstrous universal form of enquiry’ (1982, p.13). These
days we should at least add the supplement attributed to Malinowski that it is
the study of man embracing woman while learning the language with the
help of a sleeping dictionary.1 Psychiatry was defined as the medical
treatment of diseases of the mind. Inadequate as these definitions are, posing
more questions than giving answers, we will rest with them for the time
being. These definitions clearly suggest that anthropology – with the
7
8 ANTHROPOLOGICAL APPROACHES TO PSYCHOLOGICAL MEDICINE
sweeping scope of its interests – might have something to contribute
towards the understanding of the mind and its vicissitudes. Thus as the
boundaries and nature of anthropology have become more firmly
delineated, so the specific contribution of anthropology to general medicine
and psychiatry can be more rigorously specified.
Histories of anthropology remind us of its colonial roots.2 As the colonial
impetus of anthropology has diminished, the emphasis on other cultures has
disappeared.3 Instead local cultural difference has emerged as the focus of
anthropological interest. Perhaps less tangible and easy to grasp than ‘other
cultures’, it is however an enormously fruitful concept which puts both the
observer and the observed under the microscope.4 Difference is, of course, a
relative concept. One cannot be different in the way that one can perhaps be
beautiful; difference is always ‘difference from’, thus a simultaneously
holding in attention as two contrasting concepts.5In this way an awareness of
different cultural practices can lead in turn to a questioning awareness of
one’s own practices: hence the specific relevance of anthropology to the
development of mental health services in a multicultural society.
Participant observation is central to the identity of anthropology and is
characterized as akin to the experience of immersion in a bath.6
Anthropological knowledge is, above all, knowledge grounded in the highly
personal encounter between the anthropologist and the strange culture.7
Through learning cultural norms and practices through trial and error –
much as a child would–anthropologists acquire the insider’s view of another
culture. But to become accessible to others it cannot remain an insider’s view
only, it must be communicated. The participant therefore must also be an
observer who is able to translate indigenous concepts and practices into
another language using anthropological concepts. The etymology of the
term ethnography gives us a clue to this important element in the
anthropological enterprise: the writing or description of cultural otherness or
difference.8
ANTHROPOLOGY AND SOCIOLOGY
In its insistence, some would say over-insistence, on the role played by culture
and society in enabling human beings to establish their true identity,
anthropology clearly shares much common ground with sociology.9 Both
disciplines see the individual as shaped and shaping their environment
through an ongoing process of mutual influence. So what common ground
do these disciplines share and wherein lies their distinctiveness? The
sociologist Mills puts this well when he writes: ‘The sociological imagination
enables us to grasp history and biography and the relations between the two
in society. That is its task and its promise’ (1973, p.6). The anthropologist
Leach eschews a definition but the concern of his kind of anthropology is
INTRODUCTION 9
clearly with the ways in which different societies chop up reality or perceive
the world in terms of simplified binary categories, i.e. through difference.
Although he sees anthropology as an empiricist discipline, he is also
committed to the idealist potential within anthropology. For example, the
structuralist perspective offers considerable leverage for making sense of
belief systems.
THE HISTORICAL LEGACY
Both disciplines emerged at roughly the same point in history and share
many intellectual ancestors. It is often said that anthropology and sociology
are children of the Enlightenment. We could rephrase this more precisely by
saying that the intellectual framework provided by the Enlightenment made
possible the growth of specifically anthropological and sociological bodies
of knowledge. What do we mean by this? Enlightenment thinkers such as
Locke and Hume in England and Rousseau in France drew a distinction
between nature and society, recognizing the power of enculturation but still
emphasizing the underlying psychological sameness of mankind, its psychic
unity if you like. Difference was thus a property of cultures and sameness of
individuals and their bodies insofar as they are embedded in nature. A
common rationality and a separation from nature enabled men to stand back
and observe their own and other cultures: it facilitated the growth both of
sociology and of anthropology. ‘Society could not be studied in anything
resembling a scientific manner until the idea of society as in some sense an
object to be studied had been established’ (Pocock 1961, p.5). Conversely,
the study of other societies and cultures became central to the construction of
a universal human nature: ‘One needs to look near at hand if one wants to
study men: but to study man one must learn to look from afar: one must first
observe differences in order to discover attributes’ (Rousseau, quoted by
Lewis 1976, p.16). We shall come back to this text of Rousseau’s when
discussing the development of transcultural psychiatry. We might add,
however, that belief in the essential sameness of mankind did not preclude
the idea of men having a greater, or lesser, share in a common rationality. For
example, the nineteenth-century anthropologist Tylor saw cultures in terms
of an evolutionary hierarchy: cultures were ranked in terms of how
developed they were (1958). Thus the essential tasks of anthropology and
sociology were made possible by the Enlightenment. Namely, a belief in a
shared human rationality made comparison and explanation possible and the
objectification of society provided the emerging social sciences with an
object of study. Together sociology and anthropology sought to undermine
our taken for granted assumptions about own and other cultures. Sociology
has been characterized as the discipline which renders the familiar or taken