Clinically applied ethnopsychiatry
The work of Bateson and Turner has had a direct influence on family therapy and the newer 'expressive' European therapies. Psychiatric anthropologists increasingly work on health and development projects, refining epidemiological measures, evaluating community reception of mental illness, the attribution of responsibility, doctor-patient communications, the pathways into psychiatric care, networks of care and such Western 'cults of affliction' as Alcoholics Anonymous, the consequences of stigma, and the daily life of psychiatric institutions and patients, and have recently turned to record personal narratives of illness and mental handicap (Goffman, Estroff, Skultans, Janzen, Kleinman, Langness and Levine). A particular concern for European anthropologists has been the psychiatric care provided for ethnic minorities and, following the work of Mannoni and Fanon, the psychological consequences of racism, and how Western ideals of health and maturity replicate entrepreneurial values of the self-sufficient individual (Littlewood and Lipsedge 1989).
In the last decade ethnopsychiatry has been profoundly influenced by critical theory, the feminist health movement and by the studies in the epistemology and politics of psychiatry initiated by fFoucault. Against the North American 'critical medical anthropologists' (Singer, Scheper-Hughes, Taussig, M.Lock, Young) who have argued that much of ethnopsychiatry's interest in 'meaning' and 'communication' is intended to accommodate patients to medical treatment through co-opting their own beliefs, Gaines (1992) had objected that these Marxist theorists assert an empirical reality for mental illness more than they admit. He proposes to restrict the term 'ethnopsychiatry' to the study of local meanings alone, arguing that Western science is as much an ethnoscience as any other, and that its various national schools can be examined like other social institutions. How do ethnopsychiatrists deal currently with the naturalistic-personalistic dichotomy? The Nouvelle Revue d'Ethnopsychiatrie (France and Quebec) follows Devereux with an eclectic mix of psychoanalysis, biology and romantic ethnography. The interests of the United States and Kleinman's journal Culture, Medicine and Psychiatry have remained individualistic and psychological, always more 'cultural' than 'social', and now semantically focused and not easily distinguished from medical anthropology; the Canadians retain an interest in the psychobiology of trance and hypnosis, psychoactive substance use, and other altered states of consciousness; the British and Dutch remain theoretically close to general social anthropology but with a strong emphasis on conflict and on the mental health of minority groups. Increasing numbers of psychiatrists in other countries (Norway, Japan, South Africa, Australia, India, Brazil) and in the World Health Organization now incorporate anthropological critiques into their cultural and epidemiological studies. Psychoanalytical influences on ethnopsychiatry are increasingly marginal but remain significant in Latin American medical ethnography and in the 'cultural and media' studies inspired by Lacan and Kristeva.
ROLAND LITTLEWOOD
See also: culture and personality, emic and etic, medical anthropology, psychoanalysis, psychological anthropology, body, possession
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