ASA Decennial Conference - Anthropology and Science

Social anthropology and psychiatry

Contact Convenor: Roland Littlewood

Department of Anthropology, University College London
Gower Street
London WC1E 6BT

Tel: 0020 7679 2445

r.littlewood@ucl.ac.uk 

Panel abstract

As with any social fact, one can interpret an illness as somehow characteristic of the particular society in which it is found: whether as demonstrating shared sentiments refracted in individual situations, or as some expression of what observers recognise as the 'tensions'; between constituent groups.  Such specificity has been a continuing problem for comparative studies in psychiatry.  Can those patterns recognised by doctors as 'culture-bound syndromes' be fully explained through an understanding of one particular society?  Or should these patterns be subsumed under more universal categories?; or, more modestly, be placed in groups whose members demonstrate some family resemblances to each other?  Can we argue both - local specification and superordinate category - when a 'behaviour syndrome appearing in widely differing cultures takes on local meaning so completely that it appears uniquely suited to articulate important dimensions of each local culture, as though it had sprung naturally from that environment' (Good)?

Whether some general category adequately subsumes a characteristic local experience is fundamental for any human science.  The case of clinical psychiatry is complicated by its claim to demonstrate biological reality - so that individual illnesses can be identified as instances of some natural category which exists 'out there' independently of any local interests in which it appears embedded, our own included.  The question recalls anthropology's debates, less as to whether mana or segmentary alliance categories which transcend local particularities, than whether sexual avoidance of close kin by non-human primates is homologous to incest prohibition or whether it is merely analogous primate 'avoidance' then being an inappropriate extrapolation from our human concerns.

Apocalyptic suicide: Towards an interpretation

Simon Dein, University College London

How do we understand apocalyptic suicide? Interpretations must take into account factors both internal and external to the groups.  These factors include: a strong dualistic philosophy, a leader with total control over the movement, relative isolation in the presence of apocalyptic teachings.  The role of mental health professionals in dealing with these groups is discussed.  After discussing the characteristics of members and charismatic leadership the point is made that religious violence may be precipitated in a dialectic interaction between group members and their perceived outside opponents.  Following the realisation that the forces of evil cannot be overcome, the group commits suicide rather than face the tribulations of end time. The similarities of these groups in relation to suicide bombings and the recent atrocities in the USA are discussed.

Goodness of fit: local forms of suffering in India and scientific vocabulary of mental health

Sushrut Jadhav, University College London

In contrast to the rigours of personal analysis, seminars and training over extended periods that characterise western psychotherapeutic training, psychiatric training in India continues within the framework of a guru-chela apprenticeship but that has over the years added to it a watered down version of western psychotherapy.  The process of deliberately filtering off cultural components of patients' narratives to yield symptoms and signs, including defence mechanisms that devalue projections onto mythical characters, is considered credible and meritorious.  The paper argues this relates to an effort on the part of alienated health professionals attempting to approximate their patients' stories as stories to western therapeutic narratives to arrive at some sort of goodness of fit with the latter.  This appears to be an easier way to resolve their dilemma: being accepted by their western counterparts, which in turn translates into merit amongst local colleagues.  Once a cultural cleansing is achieved, therapy, or for that matter any other health intervention, can proceed as outlined in the eagerly awaited journals and books that arrive by post or through the philanthropic gesture of western colleagues. Through this process of collusion, local suffering is invalidated.

Pathologising love as culture bound disorder: the ramifications of scientific identification in Tonga.

Michael Poltorak, University of Sussex

How did a Tongan descriptive term for a relationship of 'ofa (love) between a person and tevolo (ghost) come to be naturalised and pathologised as a 'culture bound disorder' in biomedical terms? This paper examines how attention to speaking or writing as acts that constitute relationship both reveal this process and demonstrates the value of using a Tongan epistemology to qualify anthropological interpretations.

In Tonga the dramatic phenomenon of girls and women being affected by tevolo- inadequately glossed as ghost, spirit, devil or demon-is known by a variety of terms. In the anthropological and ethnographic literature, however, it has generally come to be known as 'avanga. Through the work of researchers, the term 'avanga has taken on a quality of culture bound disorder, described as indigenous to Tonga, as an acute spirit possession, and as a disease which mostly occurs among adolescent females.

Such definitions of 'avanga in the literature comes despite the absence of any united recognition by healers of 'avanga representing more than a symptom, a kind of fascination, a description of behaviour, an illness in a very ill-defined form or the provenance of sickness. The specificity with which 'avanga is represented in the literature, contrasts dramatically with the multiple, often contradictory understandings, and lack of understandings, and uses healers and local people profess. It is curious that of all the terms 'avanga is possibly the most personalistic in aetiology and implication and yet it is the term which researchers have chosen to naturalise and pathologise.

How then did a variably understood and often ambiguous term become a culture bound disorder in anthropological and biomedical terms? What is lost in the process of identification, categorisation and naturalisation? What are the implications on the lives of sufferers of more psychiatric understandings? One can examine the nature of the context in which the many behaviours that are named as 'avanga arises, but not point to causes. They are beyond any sense of objective knowledge, they lie in experiences, whether of tevolo or not, and cannot be severed from the acts of speaking (or writing) that implicitly or explicitly constitute relationship through claiming to represent them. This paper argues that we cannot claim to understand what 'avanga is without asking the concomitant question of how our spoken or written acts of interpretation constitute relationship and reflect the focus of our 'love'?

“I know I’m not the same as before”: the emergence of Gulf War Syndrome as a medical diagnosis

Susie Kilshaw, University College London

This paper looks at the social and economic circumstances of the formation of a new medical movement/diagnoses: Gulf War Syndrome.  I will show that Gulf War Syndrome (GWS) is a conduit for the expression of social ills and social concerns. This research traces such underlying issues as: gender roles, confidence in authority, notions of trust and ideas of conspiracy and cover-up that shape these beliefs. Questions on how narratives about Gulf War Syndrome are being accommodated and resisted, ignored or embraced within medical and non-medical setting is central to this research. 

Medicalization is often thought of in terms of the appropriation of social problems by the “medical profession” which establishes standards of normality as well as acceptable parameters of deviance. However, medicalization is not just of medical profession and not just about social control, but it is used by people for a variety of reasons.  The medicalization of disorder “may be self-initiated, engaged prior to medical confirmation or contrary to the opinion of doctors.  Health-care seeking may be undertaken to legitimize and validate a sick role already assumed and enacted” (Nichter 1998:327).  GWS is the first time a diagnosis was entirely led by the sufferers with no (initial) support from the medical profession- thus it was the sufferers themselves who were pushing the medicalization of their condition.

Veterans and their advocates place a high degree of importance on the claims of physical, biological explanation, rather than one that may integrate social or psychological aspects.  It is the very lack of a discrete and definable set of physical symptoms, and rejection of any psychological factors, that continues to lie at the centre of the debate concerning GWS.

Remarks on the ‘New Age’, science, and anthropology

Mr Bill Redwood, University College London

Due to the assumed unfamiliarity of the audience with the data in question, this paper commences with some brief ‘snap shots’ from the field. Previous scholarship will then be surveyed, the popular term ‘New Age’ and the dated sociological term ‘New Religious Movement’ rejected in favour of ‘alternative spirituality’ (after Bowman and Sutcliffe 2000), and a definition of alternative spirituality will be established.

The argument begins with a relatively uncontroversial examination of science and alternative spirituality. This section of the paper establishes that far from seeing a process of secularisation as predicted by modernist thinkers, religion or spirituality is alive, well, and increasingly prevalent. A postmodern condition, it will be argued, has engendered a situation in which religion and science have reconverged in the form of alternative spirituality and the closely-related discourse and practice of alternative medicine. It will be suggested that the epistemological and ontological uncertainty inherent in the postmodern condition readily explain the form and the popular appeal of alternative spirituality, and that we may ‘read’ alternative spirituality as therapeutic, as a culturally-specific attempt at addressing (a) culture-bound syndrome(s).

This paper then focuses on the observation that the current anthropological reaction to alternative spirituality is markedly polarised. On the one hand, there are those who regard alternative spirituality as ‘mad’ or ‘bad’, and its proponents as either foolish or evil. Despite the prevailing rhetoric of cultural relativism and political awareness in contemporary anthropology, commonly-voiced attitudes to alternative spirituality would be unthinkable or at least inexpressible were they to be displayed towards other religious or spiritual discourses and practices. That said, this paper shows how on the other hand, ideas which clearly stem from alternative spiritual discourse are manifested in the work of a number of respected anthropologists, all of whom have in different ways failed to eliminate western alternative spirituality from their writings and thinkings of Other cultures. This paper acknowledges that the line between emic and etic is perhaps never to be a clear or uncontroversial one, but concludes that nevertheless, contemporary social anthropology must approach alternative spirituality with both greater understanding and increased critical awareness, wherever it may be encountered.

'Modernity' and multiple personality

Professor Roland Littlewood, University College London

Whilst 'multiple personality disorder' (MPD) has certain affinities with nineteenth century hysteria, for anthropologists its obvious affinities are with spirit possessions.  MPD may be said to have emerged particularly in the 1980s as a coalescence of interest between certain psychotherapists, psychologists and their patients: the whole pattern run through with post-modern concepts of multiplicity, post-feminist and Christian right responses to the sexual abuse of children and with a return to the 'realities' of trauma and of satanic abuse, and with cyberspace and science fiction themes of alien penetration.

The emergence (and eventual nosological acceptance) of MPD illustrates both how emergent pathologies and their professionals respond to certain media current and social panics, as well as the more conventional idea that social dramas reflect a variety of cultural themes.