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Culture, mental health and psychiatry (CHDV 23301, 33301; ANTH 35115) Eugene Raikhel Comparative Human Development eraikhel@uchicago.edu SUMMARY This course examines mental health and illness as a set of subjective experiences, social processes and objects of knowledge and intervention. On a conceptual level, the course will invite students to think through the complex relationships between categories of knowledge and clinical technologies (in this case, mainly psychiatric ones) and the subjectivities of persons living with mental illness. Put in slightly different terms, we will look at the multiple links between psychiatrists’ professional accounts of mental illness and patients' experiences of it. Readings are drawn primarily from medical and psychological anthropology, cultural psychiatry, and science studies. They have been chosen to reflect a range of perspectives and disciplinary frameworks, both in the social sciences and in psychiatry itself. Students will be expected to pay close attention to the relationships between various texts, as well as their underlying assumptions, the evidence they employ, the historical and social context of their production and the positionality of their authors. PREREQUISITES This course is intended for 3rd and 4th year undergraduates and graduate students with some background in the social sciences. COURSE FORMAT The course meets on Mondays and Wednesdays. On Mondays I will lecture for most of the session, and on Wednesdays we will typically have a discussion for most of the session. My Monday lectures will not necessarily cover the readings per se. Instead, I

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will provide a background and framework for our discussions of the texts on Wednesdays. ASSIGNMENTS AND EVALUATION Students will be evaluated on the basis of the following requirements and assignments:

1) Participation in weekly discussions. (20% of grade) 2) Two short (1,500 - 2,000 word) assignments which will be described in

detail once the course is underway. (30% of grade) 3) A 4,000 - 5,000 word final paper, which either A) develops an argument

based on a number of readings drawn from multiple units in the course, B) explores one of the thematic units in greater depth, drawing on additional literature, or C) draws upon the course readings to interpret and analyze preliminary fieldwork which the student has already carried out. D) Graduate students have the option of completing a detailed annotated bibliography for all of the course readings in lieu of a final paper. Students should prepare a one paragraph abstract proposing their topic by October 27. The paper (or bibliography) is due on December 8 – one week after the last day of class. (50% of grade)

A number of required books will be available for purchase at the Seminary Co-op Bookstore and on reserve at Regenstein:

Tanya M. Luhrmann, 2000, Of two minds: the growing disorder in American psychiatry, Knopf: New York. Ian Hacking, Mad travelers: reflections on the reality of transient mental illnesses (Charlottesville, Va.: University Press of Virginia, 1998). Lorna A. Rhodes, Emptying Beds: The Work of an Emergency Psychiatric Unit (University of California Press, 1995). Angela Garcia, The Pastoral Clinic: Addiction and Dispossession along the Rio Grande, (University of California Press, 2010).

All other texts will be available in the “Course Documents” folder on Chalk.

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Schedule of course sessions, readings and lecture topics:

1. MENTAL ILLNESS AND PSYCHIATRY: CONCEPTUAL FRAMEWORKS

Tanya Luhrmann. Of Two Minds – Introduction and Chapter One (pp. 3-83).

Ian Hacking. 1999. "Madness: Biological or Constructed?" In I. Hacking, The

Social Construction of What? (pp. 100-124). Cambridge, MA: Harvard University Press.

Arthur Kleinman. 1988. The Illness Narratives: Suffering, Healing & the Human

Condition. New York: Basic Books, pp. 3-55. Frantz Fanon. 1963. “Colonial Wars and Mental Disorders.” The Wretched of the

Earth. New York: Grove Press, pp. 249-316. Sept 27 – Introduction to the course Sept 29 – Lecture and discussion Normal/pathological distinction – Symptom, disease, disorder –Major classifications of mental disorders – Harmful dysfunction – Culture and the category fallacy – Hermeneutics of symptoms.

2. PSYCHIATRIC POWER AND INSTITUTIONAL LIFE

Lorna A. Rhodes, Emptying Beds: The Work of an Emergency Psychiatric Unit (University of California Press, 1995). Entire book.

David Rosenhan, 1973. “On Being Sane in Insane Places,” Science, 179, pp.

250-8. Oct 4 - Lecture Anti-psychiatry and critiques of asylum psychiatry – Goffman, Scheff and labeling theory – Pathogenic institutions – Rosenhan experiment – Foucault on confinement and psychiatric power – Deinstitutionalization and its outcomes Oct 6 – Discussion

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3. THE EPISTEMIC CULTURES OF PSYCHIATRY

Tanya Luhrmann. Of Two Minds -- Chapters Four and Five - skim (pp. 158-238).

Charles Rosenberg, 2007. Chapter 2 “The Tyranny of Diagnosis: Specific

Entities and Individual Experience” and “Contested Boundaries: Psychiatry, Disease and Diagnosis,” Chapter 3 of Our Present Complaint: American Medicine, Then and Now. Baltimore: Johns Hopkins University Press, pp. 13-59.

Allan Young. 1995. “The DSM-III Revolution.” Ch. 3 (pp. 89-117) in The

Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. Princeton: Princeton University Press.

Rebecca J. Lester, “Brokering Authenticity: Borderline Personality Disorder

and the Ethics of Care in an American Eating Disorder Clinic,” Current Anthropology 50, no. 3 (2009): 281-302.

Oct 11 - Lecture Psychodynamic and biological ways of knowing and managing mental illness – Disease specificity and diagnosis – The DSM – Dualism, monism and emergent properties in the mind/brain – Psychiatry as clinical neuroscience – Varieties of reduction – Clinical styles of reasoning Oct 13 - Discussion

4. THE SOCIAL LIFE OF THERAPEUTICS

Allan Young. 1995. “Everyday Life in a Psychiatric Unit.” Ch. 6 (pp. 176-223)

in The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. Princeton: Princeton University Press.

Eva Illouz, “Triumphant Suffering,” in Saving the modern soul: Therapy, emotions,

and the culture of self-help (Univ of California Pr, 2008), pp. 152-196. Andrew Lakoff, “The Lacan Ward: Pharmacology and Subjectivity in Buenos

Aires,” Social Analysis 47 (2003): 82-101. Kelly A. McKinney and Brian G. Greenfield, “Self-compliance at ‘Prozac

campus’,” Anthropology & Medicine 17, no. 2 (2010): 173-185. Oct 18 – Lecture

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Psychotherapy and personhood – Consequences for clinical encounter, treatment, outcome – Liberalism, risk and selfhood – Techniques of the self – Psy disciplines and self-governance. Oct 20 – Discussion

5. FROM CULTURE-BOUND SYNDROMES TO IDIOMS OF DISTRESS

Gananath Obeyesekere. 1985. “Depression, Buddhism, and the work of culture in Sri Lanka.” In A. M. Kleinman & B. Good (Eds.), Culture and Depression, (pp. 134-152). Berkeley: University of California Press.

Arthur Kleinman and Joan Kleinman. 1985. “Somatization: The

Interconnections in Chinese Society Among Culture, Depressive Experiences, and the Meanings of Pain.” In Beyond the body proper: Reading the anthropology of material life. Lock, Margaret M and Judith Farquhar. Eds. Duke University Press, 2007. pp. 468-474.

Robert A. Hahn, “Culture-bound syndromes unbound,” Social science & medicine

21, no. 2 (1985): 165. Rebecca Seligman and Laurence J. Kirmayer, “Dissociative Experience and

Cultural Neuroscience: Narrative, Metaphor and Mechanism,” Culture, Medicine and Psychiatry 32, no. 1 (1, 2008): 31-64.

Oct 25 – Lecture Colonial psychiatry – A genealogy of cultural psychiatry – Culture-bound syndromes – Somatization, psychologization – Migration and mental illness – Depression and anxiety – Forms of somatization and meanings of somatic symptoms – Idioms of distress – Biolooping – Cultural biology and ecological approaches to mental illness – Culture in the DSM – The cultural formulation and “cultural competence”. Oct 27 – Discussion Assignment #1 due

6. THE EXPERIENCE OF PSYCHOSIS AND PRODUCTION OF CHRONICITY

Robert Desjarlais. 1994. Struggling Along: The Possibilities for Experience among the Homeless Mentally Ill. American Anthropologist 96: 886-901.

Ellen Corin, and Lauzon, G. 1992, Positive withdrawal and the quest for

meaning: the reconstruction of experience among schizophrenics. Psychiatry 55(3), pp. 266-81.

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Tanya M. Luhrmann, 2007. “Social defeat and the culture of chronicity: or,

why schizophrenia does so well over there and so badly here,” Culture, medicine and psychiatry, 31(2), pp. 135-72.

Sue Estroff. 1989. Self, identity, and subjective experiences of schizophrenia: in

search of the subject. Schizophrenia Bulletin 15 (2): 189-96. Nov 1 – Lecture Narrative, experience and psychosis – self and identity in schizophrenia – Phenomenological approaches to psychosis – Jaspers, Binswanger – Differences in outcome for schizophrenia in “developed” and “developing” countries – “Positive withdrawal” -- Social etiologies of mental illness and their effects – Diagnostic differences – Double bind and psychoanalytic models – Biological models – Stigma – Urbanicity – Stress-diathesis – Expressed emotion. Nov 3 – Discussion Topic for final paper due

7. POST-PSYCHIATRY, EMPOWERMENT AND RECOVERY

Anne M. Lovell, and Sandra Cohn (1998) The elaboration of "choice" in a program for homeless persons labeled psychiatrically disabled. Human Organization 57(1):8-20.

Summerson Carr, “Anticipating and inhabiting institutional identities,”

American Ethnologist 36, no. 2 (2009): 317-336. Nick Crossley, “Not being mentally ill,” Anthropology & Medicine 11, no. 2

(2004): 161-180. Francisco Ortega, “The Cerebral Subject and the Challenge of Neurodiversity,”

BioSocieties 4, no. 04 (2009): 425-445. Nov 8 – Lecture Patient advocacy groups and recovery movements – Communication technologies and biosociality – “Neurodiversity” Nov 10 – Discussion

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8. ADDICTION CIRCUITS

Angela Garcia, The Pastoral Clinic: Addiction and Dispossession along the Rio Grande, (University of California Press, 2010).

Nov 15 – Lecture Disease models of addiction – Medicalization, morality and responsibility – Addiction as brain disease – Structural violence and critical medical anthropology – Mutual help and recovery – Identification and denial – Drug treatments – Harm reduction – Blurring distinctions – Addiction and subjectivity. Nov 17 – Discussion Nov 19

9. MENTAL ILLNESS AS SOCIAL FACT

Ian Hacking, Mad travelers: reflections on the reality of transient mental illnesses (Charlottesville, Va.: University Press of Virginia, 1998). pp. 1-102.

Alain Ehrenberg, 2010. The Weariness of the Self: Diagnosing the History of

Depression in the Contemporary Age. McGill-Queen's University Press. Introduction, Chapter 7, Conclusion, pp. 1-14, 190-233.

Nov 22 – Lecture From labeling to looping – Making up people -- Transient mental illness – Contested illnesses – Mass psychogenic illness. Nov 23 – Discussion Assignment #2 due

10. ENTERING THE 21ST CENTURY: NETWORKS, NEUROBIOLOGY AND NEOLIBERALISM

Tanya Luhrmann. Of Two Minds – Chapters Six and Seven (pp. 239-293). Chikako Ozawa-de Silva, 2010. “Shared Death: Self, Sociality and Internet

Group Suicide in Japan.” Transcultural Psychiatry 47(3): 392-418. Joao Biehl, 2010. “Human Pharmakon: Symptoms, Technologies,

Subjectivities,” In: A Reader in Medical Anthropology: Theoretical Trajectories, Emergent Realities. pp. 213-231

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Nikolas Rose, “‘Screen and intervene’: governing risky brains,” History of the Human Sciences 23, no. 1 (February 1, 2010): 79 -105.

Nov 29 – Biological psychiatry – Mental illness as brain disease – Folk notions of personhood and neurobiological reductionism – the somatic self argument – psychiatry and the political economy of the pharmaceutical industry – “disease mongering” – globalization of biopsychiatry – transforming local idioms of distress – social efficacy and placebo effects – “side-effects” and personality – pharmacological enhancement Dec 1 – Discussion Dec 8 Final paper due