How to deal with “mental illness"? Are people who are labelled ill actually ill? Is it ok that psychologists call “adolescent rebellion” for “Oppositional Defiant Disorder”? What is anthropologists’ role here? Eugenia Tsao discusses these questions in an article in Counterpunch and in a paper in the open access anthropology journal Alterities.
The extent to which our lives and livelihoods have been “colonized by the reductive logic of pharmaceutical intervention” is breathtaking, she writes. Drugs are touted with increasing regularity as a treatment of choice for entirely natural responses to conditions of unnatural stress - although medical textbooks and even drug advertisements have admitted uncertainties in psychiatric research (“While the cause [of depression] is unknown, Zoloft can help”):
How have we been persuaded to equate such things as recalcitrant despair (“Dysthymic Disorder,” DSM-IV-TR 300.4), adolescent rebellion (“Oppositional Defiant Disorder,” DSM-IV-TR 313.81) and social apathy (“Schizoid Personality Disorder,” DSM-IV-TR 301.20) with aberrant brain chemistry and innate genetic susceptibilities rather than with the societal circumstances in which they arise? What does it mean when increasing numbers of people feel as though they have no choice but to self-medicate with dubious chemical substances in order to stay in school, stay motivated, stay employed, and stay financially solvent?
As Laurence Kirmayer of McGill University has suggested, the millennial rise of a “cosmetic” psychopharmaceutical industry, wherein drugs are “applied like make-up to make us look and feel good, while our existential predicaments go unanswered,” raises disturbing questions about the consequences of our willingness to use chemicals to treat forms of distress that would seem to signal not biological but social maladies.
When psychiatrists lament that over half of depressed people are “treatment-resistant,” Tsao stresses, they do not consider that it is a strenuous aversion to being told that one’s existential grievances are irrational, a mere result of a pathological neurochemical imbalance, that discourages many people from seeking medical help.
Anthropologists have an important role to play here, Tsao explains:
(A)nthropologists who seek to honor their informants’ narratives and confute clinical meta-narratives may find it useful to illuminate the perils of overliteralization: to explain why it is that those who are sick and suffering will so often thumb their noses at those who presume to offer help; to highlight the tragicomedy in the seemingly bottomless capacity of highly educated MDs and PhDs to overlook simple things like the anaesthetizing comforts to be found in a bottle or at the edge of a razor blade, or why a person might choose to act out of anguish rather than economic rationalism.
I ultimately argue that an efficacious anthropology of psychiatry must adopt as its point of departure the candidly transformative objective of repoliticizing mental illnesses as historical rather than congenital events. Anthropologists must, in short, develop ethnographic, historiographic, and rhetorical strategies for destabilizing the biological with the biographic.
(A)nthropologists should pay careful attention to regional histories, local processes of identity formation, and other kinds of social transactions paradigmatically excluded from biomedical narratives in order to distinguish necessary etiological agents from sufficient ones. While certain congenital factors may precondition an individual’s susceptibility to, for example, schizophrenia, the cultural factors that activate the disorder will in most cases determine whether or not an individual ultimately develops the condition – as corroborated by numerous studies on identical twins (Levy 1992:215-216).
Tsao presents theories by Robert Levy, Hans A. Baer, Merrill Singer, Ida Susser, and Nick Crossley. From them, she extracts “four fundamental methodological criteria that a robust anthropology of psychiatry must be equipped to meet":
• An adequate means of distinguishing proximate and ultimate causes of specific mental illnesses.
• An explicit aim of recontextualizing, repoliticizing, and rehistoricizing mental health issues through elucidations of pathogenic conditions.
• Methods for critiquing the specific ways in which hegemonic texts (e.g. the DSM, clinical scripts, standardized questionnaires) systematically delegitimize and obscure social etiologies.
• Methods for reinserting alternative etiological narratives into mainstream medical conversations and, ultimately, into lay discourse.
Anthropologists challenge is according Tsao twofold: (1) to sharpen our interdisciplinary literacy with biomedicine and its cognates, but in a critical rather than deferential manner; and, in so doing (2) to elucidate the emergent, rather than immanent, character of illness experiences.
>> Eugenia Tsao: Inside the DSM. The Drug Barons’ Campaign to Make Us All Crazy (Counterpunch 20.8.09)
For more articles by Eugenia Tsao, see her website
The blog Neuroanthropology has more information on anthropology and mental illness.
The next issue of the journal Alterities is about women, see the call for papers
Check out the film “Afflictions: Culture and Mental Illness in Indonesia” it is a 6-part series of ethnographic films on severe mental illness in Indonesia and explores the relationship between culture, mental illness, and first-person experience.
Learn more at www.afflictionsfilmseries.com