Ethnopsychiatry

Ethnopsychiatry is that branch of medical anthropology focally concerned with mental health and illness. Historically, ethnopsychiatry studied the theories and practices of “primitive” or folk psychiatries. Such work generally involved the application of then current western “psychiatric” (unmarked) “knowledge” and practice to the ethnopsychiatries of other cultures. The field of ethnopsychiatry was first delineated by Hungarian-born, French-educated and U.S.-trained psychoanalytic anthropologist and classicist George Devereux (ne György Dobo) (1908-1985). His colleague, Dr. Louis Mars, a Haitian psychiatrist, coined the term.

In Devereux’s original conception, ethnopsychiatry is double sided. First, it is ” the systematic study of the psychiatric theories and practices of a primitive [sic] tribe. Its primary focus is, thus, the exploration of (a) culture that pertains to mental derangements, as (locally) understood” (Devereux, 1961, p. 1). Second, the field is the study of “culture and the abnormal.”

The ethnopsychiatric rubric now subsumes a wide variety of studies. They include works from the history and philosophy of medicine and psychiatry as well as from anthropology and allied social sciences. The merging of once distinct disciplines has been occasioned by the interpretive turn in the social sciences. The semantic or hermeneutic and cultural constructivist positions have served to deconstruct dominant discourses of Western medicines and open them to far-ranging analyses that expose the reality of the variety of professional psychiatries and their respective cultural cores. Early on, colonialist psychological projections could be seen as the bases of ethnopsychiatric investigations serving to (re)create notions of otherness of the externally and internally colonized.

Psychiatrists have assumed that Western nosologies and disease entities are universal. Whereas traditionally, ethnopsychiatry focused on folk systems almost exclusively, the “New Ethnopsychiatry” took as its subject all forms of ethnopsychiatric theory and practice, whether folk or professional, in the East or West. It further redefined the clinical encounter as an engagement between healer and sociocultural, historical representative rather than patient-as-biological-unit. This perspective represented an updating and a localizing of Devereux’s original conception and sees professional systems of medicine as equally culturally constructed and situated in local cultural historical and moral contexts.

Ethnopsychiatric research now includes the application, as well as study of Western psychological, psychiatric, and psychoanalytic theories themselves in the investigation of psychic lives. Ethnopsychiatry today recognizes that a cultural, rather than a universal, psychology underlies specific folk or professional psychiatries. In anthropology and in professional ethnopsychiatries, the terms cross-cultural or cultural psychiatry are often used to refer to work at the interface of culture and mental illness and health.

In the New Ethnopsychiatry, the application of German, U.S., or French psychiatric knowledge to another culture provides insight and data both on the psychiatric system from whose perspective the study is conducted as well as that system or systems serving as the object of study. The distinction between folk and professional ethnopsychiatries is now seen as one of degree, not of kind. The former term applies to an informal system that concerns an abnormal ethnopsychology and its treatment, while the latter refers to a formal such system that evidences licensing, educational institutions, written texts, and so on.

The New Ethnopsychiatry, unlike the old, has direct relevance to the theory and practice of professional ethnopsychiatry as well as to anthropology. Increasingly, from within psychiatry, there is recognition of the central role of culture and cultural identity. One here notes the ethno- (or cultural) psychiatry clinics established in Montréal, Paris, Cambridge, Massachusetts, and San Francisco.

In the fourth edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (1994) and its text revision (2000), there appears an “Outline for Cultural Formulation and Glossary of Culture-Bound Syndromes.” The American Psychiatry Association has published a manual on culture assessment that covers individual cultural identity, etiological theories, culture-specific stressors and supports, cultural features of the patient/physician relationship, and a section on overall cultural assessment for therapy and planning.

However, there is yet the tendency in professional U.S. ethnopsychiatry, in line with its “biological essentialism,” one of its two main orientations, among others, to biologize and, therefrom, to create notions of fundamental differences among social categories. With respect to ethnic populations, the biological essentialism reproduces cultural notions of “race” to the detriment of these populations. Gender also plays a role, often negative, in biomedical and psychiatric practice, as does age and social standing. These cultural features demonstrate the validity of the conception of psychiatry as ethnopsychiatry.

A key focus, past and present, has been on local cultural understandings of mental disorder and signs thereof. Such considerations focus on all ethnopsychiatries.

The personal meanings embodied in and the experience of such disorders, illness narratives, more recently have become foci of research. Also of interest are diagnostic and therapeutic practices, including psychopharmacology. Pharmacology studies now include constructions of ethnicities that are allegedly biologically distinct (i.e., like “races”), which “may benefit” from different dosages or different agents.

The study of illness course and outcomes has been important for demonstrating the cultural and social bases of even the major psychiatric illnesses. Work also demonstrates that institutions reflect cultural values and in turn influence the experience and behavior of those living in them, whether hospitals or today’s prisons.

The New Ethnopsychiatry incorporates into the clinical setting and psychiatric thinking previously excluded domains of experience. These include the suffering of those subjected to illness and violence and marginal social status (for example, refugees, immigrants).

The New Ethnopsychiatry engages ethnopsychology because of the intimate relationship of the medical/psychiatric with nonmedical notions of self and person, identity, gender, emotion, and cultural history from which notions of affliction derive. Central conceptions of person continue to attract attention in folk psychiatries, as they have in professional psychiatries since its introduction into that literature.

A new area of interest is that of psychiatric bioethics and geropsychiatric bioethics incorporating studies of bioethics.

Chronic ethnopsychiatric conditions, some new to the gaze (and how these are endured and managed by self and others) differ from our usual focus on acute problems. Increasingly, we see interest in geropsychiatry, especially the dementias, such as Alzheimer’s disease (AD). This research brings aging into ethno-psychiatry’s gaze. The interest in dementia entails the study of the sciences involved in the construction of AD as a disease (and not brain aging).

A stock-in-trade of ethnopsychiatry has been the study of culturebound syndromes. Now, however, researchers often consider Western disorders as culturebound. This perspective actually began in the work of this field’s founder, George Devereux, and his analysis of schizophrenia as a culturebound syndrome, in 1963.

References:

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2. Devereux, G. (1961). Mohave ethnopsychiatry. Washington, DC: Smithsonian Institution, Government Printing Office.
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