"Mind Games": A Session Presented at the SMA at Yale

Presentations at the Society for Medical Anthropology Conference at Yale (September 24-27, 2009) offered a cross section of work being done in many separate fields of interest. In keeping with my interests in pharmaceuticals, Japan, and mental health, I attended three excellent sessions that I would like to briefly summarize for people who could not attend. Here’s an outline of some of the papers presented on Friday, September 25, in a session entitled “Mind Games: The Intersections of Globalizing Biopsychiatry, Politics and Social Movements.”

Jonathan Metzl shared some themes from his forthcoming book, The Protest Psychosis: How Schizophrenia Became a Black Disease (Beacon Press 2010). Metzl’s presentation offered stark surprises in the cultural history of schizophrenia in the US. He balanced hard data from the Ionia State Hospital for the Criminally Insane in Ionia, Michigan, with advertising images from professional medical and popular cultural literature and even from Hip Hop to limn the evolution of the image and diagnosis of schizophrenia from a tame, white person’s disease through the early part of the 20th century, to an African American male disorder with specific linkages to civil rights protests during the 1960s and 1970s.

Junko Kitanaka presented “Too Depressed to Work: The Emerging Science of the Psychopathology of Work Stress in Japan.” Psychiatry and mental illness are co-evolving in Japan, exposing many areas in need of clinical ethnographic investigation. The rising suicide rate is a good place to start. Kitanaka analyzed the phenomenon known in Japan as “suicide through overwork”. These cases engage long-standing public debates surrounding workloads and workplace relations, as well as psychiatric debates over the etiology of suicide (is the ultimate cause biological or environmental?) and growing popular awareness of clinical depression and the social suffering caused by a persistent economic recession. She recounted the Ministry of Health Labor and Welfare’s surprising invention of a quantified measure of social stress. A longer version of this superb paper, entitled “Questioning the suicide of resolve: Disputes regarding ‘overwork suicide’ in 20th century Japan,” can be found in Weaver, John & David Wright (eds.), A History of Suicide in the Modern World: International Perspectives (Toronto 2009).

The context-specific issues surrounding the professional, popular and political conceptions of mental illness—the three being, in the realm of psychiatry, peculiarly inseparable—that Metzl and Kitanaka brought out in their papers, was evident also in Dominique Behague’s study, “Community-based psychotherapy and transformations in politicization amongst youth in Southern Brazil.” Behague points out that while resistance to biopsychiatric reductionism is manifest in Brazil, the DSM diagnoses of ADHD and conduct disorder have nevertheless entered the local therapeutic lexicon. Moreover, in her sample, behavioral disorders are being systematically applied to lower class youth. Behague seeks the solution to this paradoxical trend not (in this paper) by evaluating therapist’s way of engaging the subject, but in how youth patients themselves react to diagnostic categories and therapies. She shows that the “politicizing effects of medicalization” must be understood beyond the therapist and the doctor-patient relationship, but in class relations and other aspects of the youths’ own experience and use of behavioral diagnoses. Behague’s study (the detailed version of which will be printed in Medical Anthropology Quarterly this year) ups the ethnographic stakes on the question of how biopsychiatric models are integrated in given locales; it is not, she observes, a simple matter of identifying ambiguities or declaiming syncretism.

Elizabeth Davis gave a paper entitled “‘By Reason of Danger’: Rights, Refuge and Responsibility in Greek Psychiatry.” Nissim Mizrachi presented “Psychological Technologies and the Creation of the ‘New Jew’ in Israel.”

The discussant, Stefan Ecks, pointed out the shared political focus of all of the papers, and specifically their crystallization around the themes of autonomy, self-reliance, emancipation, and responsibility. How do psychiatrists confront the political embeddedness of their work? Where might this discussion might lead if the authors were to cast it in terms of the classical political theoretical concepts of liberal democratic ideals, Enlightenment, and so on? As an immediate topic for debate, Ecks suggested that psychiatry might experience the most trouble justifying its practices in the context of democratic regimes that stress equality and self-determination. The authors of the panel might well agree with Ecks’s insight that not just politics in the everyday but the political ideological cultures in which a globalizing psychiatric profession takes root, is indeed subject for productive reflection.