Exporting American mental illness

The New York Times Magazine has a great discussion of the effects of the exportation of American ideas about mental illness, titled appropriately, The Americanization of Mental Illness by Ethan Watters, based on his forthcoming book, Crazy Like Us: The Globalization of the American Psyche, coming out this month from Free Press. The article is quite good, offering some intriguing cases, such as the rise of virulent, American-style anorexia nervosa in Hong Kong, the effect of possession beliefs on communities’ reactions to schizophrenia, and how the narrative of mental illness as ‘brain disease’ might actually lead to great stigma as it spreads and replaces local understandings. The article is well worth a read, and I’m looking forward to the book.

graphic by Alex Trochut, NYTimes

The ethnographic record is full of conditions that didn’t make it into the most recent edition of the DSM — amok, nervios, koro, zar — you can check out Wikipedia or some other source on ‘culture bound syndromes,’ such as Introduction to Culture-Bound Syndromes in Psychiatric Times, to get a fuller discussion of some of these conditions. The Psychiatric Times piece suggests that there are at least 200 culture-bound syndromes.

One thing I really liked about the New York Times Magazine article, however (and by extension, Watters’ book, I suspect), is that the discussion of ‘culture-bound syndromes’ usually tends to treat other people’s syndromes as ‘culture-bound,’ Western psychological illnesses as not ‘culture-bound.’ Watters’ work points out that Western mental illness is both itself culture-bound and that persuading people to believe in Western-style mental illness can affect the way that psychic disorders manifest.

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Gravlee et al: Race, Genetics, Social Inequality, and Health

Clarence Gravlee, Amy Non and Connie Mulligan have just published an outstanding article in PLoS ONE, Genetic Ancestry, Social Classification, and Racial Inequalities in Blood Pressure in Southeastern Puerto Rico. The abstract opens:

The role of race in human genetics and biomedical research is among the most contested issues in science. Much debate centers on the relative importance of genetic versus sociocultural factors in explaining racial inequalities in health. However, few studies integrate genetic and sociocultural data to test competing explanations directly.

Note how that fits so well into the points just made in Nature/Nurture: Slash to the Rescue. But Gravlee, Non and Mulligan don’t just say we need to overcome the nature vs. nurture dichotomy, they do research that bridges it and even better, test ideas on both sides: “We draw on ethnographic, epidemiologic, and genetic data collected in southeastern Puerto Rico to isolate two distinct variables for which race is often used as a proxy: genetic ancestry versus social classification.”

This type of collaborative research can be crucial to getting the data to answer complicated questions. Connie Mulligan and Lance Gravlee deserve credit for taking the time to discuss how to bring together their respective approaches before going out to do research. In this case, the data come down more on the nurture (or social) side. As they write:

Our preliminary results provide the most direct evidence to date that previously reported associations between genetic ancestry and health may be attributable to sociocultural factors related to race and racism, rather than to functional genetic differences between racially defined groups.

Before someone gets all hot and bothered, Lance has also shown how to bring nurture back to nature. In Gravlee’s recent paper, How Race Becomes Biology: Embodiment of Social Inequality (pdf), he gives us following: “Drawing on recent developments in neighboring disciplines, I present a model for explaining how racial inequality becomes embodied – literally – in the biological well-being of racialized groups and individuals. This model requires a shift in the way we articulate the critique of race as bad biology.”

In the PLoS paper, Lance, Amy and Connie are aiming squarely at the use of race in medicine, where it has become common in some circles to use racial classification as a proxy for genetics. Basically this research destroys the proxy notion, since social classification turns out to be a better predictor of blood pressure than genetic ancestry.

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Funerals and Food Coping in Rural Lesotho

Lesotho Funeral Home
By Brandon Sparks

Imagine you are hungry. You have been hungry for weeks, with no end in sight due to a heavy drought that severely diminished your land’s production. Your gravely ill sister lives with you, as do her two young children, further straining your limited food supply. Then your neighbor dies. You do mourn, but you also feel relief – relief because you will be able to take your family to the funeral. There they will be able to eat.

This post examines food crises in Lesotho and the role funerals play in coping with these food shortages within a rural town and neighboring villages. In my senior thesis written on the costly funerals in Lesotho and the impact of HIV/AIDS on their practice, I found that the local Basotho people use funerals as a food coping mechanism. Lesotho often suffers from periods of drought that place a burden on food resources and force people to look for methods to supplement their daily food.

Lesotho VillageI will begin with a brief look at the factors behind the food shortages, followed by a description of funeral practices and how families are able to use them to for food coping. Lesotho is a small country in southern Africa. Through a quirk in British rule, it remained independent from South Africa and is now the only country to have its entire border completely surrounded by another country. The terrain is mountainous and has earned Lesotho the nickname of “the roof of Africa.” Less than eleven percent of the land is arable and farmers are at the peril of periodic droughts.

Lesotho also has one of the highest HIV/AIDS prevalence rates in the world, with some estimates as high as thirty-one percent of its over two million population carrying the virus (Brummer 2002). The high percentage stems from Lesotho’s history of labor migration to the gold and diamond mines of South Africa, where Basotho men would contract the disease and then bring it home to their families in Lesotho.

The attraction of mining employment to Basotho (from Lesotho) men comes partially from the lack of opportunities at home. Agriculture production has dropped in the past fifty years due to deterioration of the land through erosion, mono-cropping, and overgrazing, insecurities in the system of land tenure that inhibited farmers from securing their holdings, population pressure that increased exploitation of arable land, and environmental factors like hail, frost, and drought (Murray 1981). These factors, coupled with population growth, mean that the frequency and severity of food crises has increased in the last century.

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Paul Farmer: This I Believe

Paul Farmer is a doctor and an anthropologist, and spoke as part of NPR’s series This I Believe. Farmer co-founded Partners in Health, a non-profit organization dedicated to improving health care for the poor around the world. He helped develop DOTS (directly observed therapy), a way to provide care for HIV/AIDS that works in resource-poor settings, as well as community-based approaches to treating multi-drug resistant TB in developing countries.

As an anthropologist he has emphasized the importance of structural violence, the negative impact that systems of power can have on people through racism, gender inequality and political violence, with significant articles in both Current Anthropology and PLoS Medicine.

His most recent book is Pathologies of Power: Health, Human Rights, and the New War on the Poor. You can also read about his lifework in Tracy Kidder’s biography, Mountains beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would Cure the World.

Hat-tip (and thanks) to Ryan Anderson over at Ethnografix and his anthropological list of inspiring people and work.

Link to full text of Paul Farmer’s This I Believe NPR recording.

Community-Based Work and the Importance of Being Integrative – The Ganey Award and Video

In April I had the honor of receiving the Rodney F. Ganey, Ph.D., Faculty Community-Based Research Award. Given by the Center for Social Concerns at the University of Notre Dame, the Ganey Award goes to a Notre Dame faculty who has done collaborative work in the local community. For those interested in the details of that work, here is the press release – Daniel Lende Wins 2009 Ganey Award.

Neuroanthropology.net has played a central role in the community-based research I have done with my students. These include posts on using humor in recovery from breast cancer, a support group for women with HIV/AIDS, research to help redesign a local hospital waiting room, and the stories that US war veterans wanted to share about their everyday battles with post-traumatic stress disorder.

Two peer-reviewed articles have come out of the community-based research with my students: Embodiment and Breast Cancer among African American Women, and Community Approaches to Preventing Mother-to-Child HIV Transmission: Perspectives from Rural Lesotho. A great community guide, Underneath It All: Humor in Breast Cancer, was put together by the students, community members and myself, and is now used in a local hospital.

One of the best things about the award was that the Center for Social Concerns made this wonderful video with my community partners and my students. Here’s the YouTube link, but I also present it below as it captures why I do this sort of work.

I also want to share a written version of what I said at the CSC award dinner. No, no, not all the thank yous (there were plenty and all richly deserved), but a reflection on my own approach to my work.

I want to close by speaking to why the work I have done has meshed so well with the Center for Social Concerns.

At its core my work is integrative. Notre Dame had encouraged that integrative spirit. These five factors make that spirit a reality.

First is listening, listening to the person across the table. That is the start to doing community-based work and the start to understanding other ideas.

Second is the synthesis of intellectual and social problems. These are human problems, where compassion and involvement can matter as much as intellectual analysis or abstract policy.

Third is a push to make our research international and interdisciplinary, and not just local and field specific. Integration only happens by crossing boundaries.

Fourth is the combination of traditional publishing with other forms of scholarship, such as a community guidebook and electronic publishing. These forms of scholarship can reach many, many more people than a typical peer-reviewed article.

Fifth, being community-oriented, with an insistence that what we do is relevant to more than just the university. Some of the most challenging questions and even our best answers and outcomes can come from those people across the table, the people with whom we are lucky enough to work.

These five factors – listening to others, the synthesis of intellectual and social problems, making our work interdisciplinary, combining traditional publishing with other forms of scholarship, and having a community orientation – all matter. Together they make a tremendous difference in our lives as academics, students, and community partners.

Vidéothèque: Videos on Cross-Cultural Health, Sickness and Healing

The Vidéothèque : Santé, Maladie, Malheur is an absolutely incredible video archive on medical anthropology, with a particular focus on sub-Saharan Africa. I started exploring it when it was mentioned as part of the trance video links, but it’s so rich it deserves its own post – well over 100 video clips that are freely available in Real Media packaging.

Alain Epelboin
Alain Epelboin

The collection has been put together by Alain Epelboin, who has also contributed the lion’s share of footage. Other film makers include Beatriz Soengas, Sylvie Heslot, Susanne Fürniss and Claire Lussiaa-Berdou. The collection is hosted through Réseau Académique Parisien.

Alain Epelboin is a doctor and anthropologist who runs the Labotoire Eco-anthropologie et Ethnobiologie, which is part of the Centre National de la Recherche Scientifique. You can see a video of Alain discussing his work, as well as this informative article – both in French, as are most of the videos.

Some of the videos you can see include Ebola in Congo, this narrated documentary on the Aka of the Central African Republic and the Congo, Traditional Medicine, Culture and AIDS, and Mort et naissance de Masiki.

And here’s the entire list of the Santé, Maladie, Malheur videos.