Origins and history
From its origins in the late eighteenth century, clinical psychiatry recognized that mental illness might be influenced, sometimes even caused, by a society's mores, roles and sentiments. Generally, the patterns of severe illness (psychosis) identified in European hospitals were taken as universal, whilst it was accepted that wide variations existed in everyday psychological functioning which could be attributed to *'race', *religion, *gender and *class. In the first explicitly cross-cultural comparison, the German hospital psychiatrist Emile Kraepelin (1904) concluded after a trip to Java that the illnesses which were found universally probably had a biological origin which determined their general form whilst local culture simply provided the variable content through which they manifested. He noted that local understandings could allocate the illness to categories quite different from those of Western medicine such as spirit *possession or a call to a *shamanic role; yet, like the military doctors of the European colonies (Littlewood and Lipsedge 1989), he was confident he could distinguish the universal from the particular when attributing atypical illness to 'a lower stage of evolutionary development'.
Locally recognized patterns which recalled mental illness but could not easily be fitted into Western nosologies were described as f'culture-bound syndromes' which represented a society's character: the dhat syndrome being the exaggeration of *Hindu preoccupations with purity; amok as a relic of precolonial patterns of redistributive justice; witiko as a *cannibalistic impulse consequent on scarcity of food and abrupt weaning of the Ojibwa child; the kayak angst of the Arctic solitude; malignant anxiety as the individual manifestation of Yoruba sorcery preoccupations; the perennially interesting voodoo death ('death by sorcery'); rarely, as with pibloktoq ('Arctic hysteria'), as a biological disease such as avitaminosis. Extensive lists of these syndromes were compiled, many now recognized as *folkloric curiosities whose actual behavioural occurrence seems doubtful, but which provided some variety to leaven the mundane tasks of colonial asylum administration. Between World War I and the 1950s, anthropological interest in mental illness was largely restricted to the American *culture and personality school which, following fFreud, emphasized variation in adult character and culture as originating in childrearing practices, and which had little interest in insanity. The standard procedure was to use psychoanalytical measures of personality across societies and relate the findings to levels of anxiety and sorcery accusations. Psychotic individuals occasionally appeared in the classic ethnographies (e.g. Nuer Religion) but with little comment, and those European anthropologists trained in clinical psychiatry or psychology (fRivers, fC.G.Seligman, fFortes, Carstairs, Field) generally followed psychoanalytical models in examining neurotic illness as an exaggerated form of cultural preoccupations: the cognitive and neurosociological interests of fMauss excepted. The term 'ethnopsychiatry', coined by the Haitian psychiatrist Louis Mars in 1946 to refer to the local presentation of psychiatric illness, was popularized in the 1950s by f Georges Devereux in his psychoanalytical study of the Mohave. Devereux, a Hungarian-French anthropologist (1961:1-2), like Mars uses the term to refer to the medical study of illness in a particular community through looking at its 'social and cultural' setting, but he adds a new emphasis on 'the systematic study of the psychiatric theories and practices [of] an aboriginal group', comparing this to the then established procedures of fethnobotany (see *ethnoscience). It is in this second sense that the term is now generally recognized. In some hundred papers and books Devereux examined such conventional culture and personality interests as the mental health of the shaman, homosexuality and *millenialism and *dreams, together with studies of suicide and abortion among the Plains Indians and classical Greeks.
In an extended debate with the medical historian Erwin Ackernecht, who objected to the psychoanalytic 'pathologisation of whole cultures' and preferred rather a simple comparison between local and Western ideas of illness, Devereux (1970) firmly privileged an etic (psychoanalytical) analysis, declaring shamans to be 'surrogate schizophrenics' on behalf of their community, insane in what he termed their 'ethnic unconscious' yet able to generate new ideas for their stressed fellows; he warned however that such solutions could only be irrational and lead to further 'catastrophic behaviour'. He later developed his theory of complementarity: whereby any cultural pattern could be understood simultaneously from both psychoanalytical and sociological directions, but in practice he reduced sociology to psychology. Devereux's ideas were taken to full development by La Barre who argued that all cultural innovators, successful or otherwise, have been schizophrenic. Psychiatric anthropology now favours Ackernecht's more modest approach: whilst shamans and other inspirational healers and leaders may on occasion be psychotic by Western criteria (at least when they experience their initial 'call), practising shamans are rarely psychotic. Our etic (psychoanalytic or psychiatric) formulation may fit variously with *emic (local) categorizations of illness.
Devereux focused interest on the problem of etic/emic and normal/abnormal distinctions in psychiatry where, in contrast to *medical anthropology's more evident distinction between disease and illness, its analytical construct—mental illness —was less evidently an object of observation in nature and indeed on examination appeared closely related to the ideological concerns of Western medicine. His associate Roger Bastide (1965:9-12) restricted the term 'ethnopsychiatry' to the study of local conceptualizations which recalled those of Western psychiatry, and distinguished it from social psychiatry (the social context of a mentally ill person) and from the sociology of mental illness (its epidemiology and social causes). The latter two are now generally elided. It would be appropriate to see the various overlapping sub-disciplines as ranging from medical to anthro pological interests, each marked by fluctuating popularity and influence: starting from the medical end with epidemiology and social psychiatry, through comparative psychiatry, transcultural and cross-cultural psychiatry, cultural psychiatry, and anthropology and psyckiatry, ethnopsychiatry and fcognitive anthropology. This closely parallels the spectrum (and recent shift) from empirical cross-cultural psychology to interpretive psychological anthropology, psychoanalytical and evolutionary interest being replaced by ethnoscience with more detailed studies of the context and local meaning of the phenomena. The key issues, though, remain the same.
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