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  Subjects -> ANTHROPOLOGY (Total: 398 journals)
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Culture, Medicine and Psychiatry
Journal Prestige (SJR): 0.375
Citation Impact (citeScore): 1
Number of Followers: 16  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0165-005X - ISSN (Online) 1573-076X
Published by Springer-Verlag Homepage  [2467 journals]
  • Correction to: “Women as Troublemakers”: The Hard Sociopolitical
           Context of Soft Bipolar Disorder in Iran

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      PubDate: 2022-12-01
       
  • Correction to: A Cross-cultural Perspective on Intrathecal Opioid Therapy
           Between German and Iranian Patients

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      PubDate: 2022-12-01
       
  • Cognitive Optimisation and Schizophrenia: Assembling Heterogeneity,
           Overcoming the Precariousness of Life, and Challenging Public Health
           Policies in Psychiatry in France

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      Abstract: Abstract Cognitive remediation therapy (CRT) aims to optimise cognitive abilities of people who suffer from schizophrenia in order to improve their social adaptation. This therapeutic orientation was developed in psychiatry in the 1980s and 1990s, at a time when the disorder was being redefined as a neurocognitive deficit disorder. In this article, I describe CRT as an assemblage that lies at the intersection of multiple, overlapping theories and spaces of mental disorders and psychiatric care. To do so, I draw on 18 months of ethnographic research conducted in a French hospital unit dedicated to the development of CRT. I argue that the focus on cognitive health and cognitive abilities (or deficits) is not only redefining the logics of care and reshaping medical conceptualisations of schizophrenia, but it is also opening up to a new understanding of people’s precarious life conditions, where emotional, biological, and cognitive fragility is intertwined with social and economic uncertainty. I then examine the extent to which psychiatrists have extended the goals of CRT to include psychosocial rehabilitation in order to mitigate not only the effects of cognitive deficits, but also the effects of limited social and professional integration encountered by patients. Finally, I conclude with a consideration of how CRT has become, for its proponents in France, a means to develop a policy and organisational project for French psychiatry.
      PubDate: 2022-12-01
       
  • Interrupting Patients in Healthcare Settings: What is Being
           Interrupted'

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      Abstract: Abstract Scientific literature since the 1980s examines the phenomenon of healthcare professionals interrupting patients: at which second patients opening expositions are interrupted and how long they take if unrestrained. Although the goal of this literature is strictly numerical—determining interventions’ length—, it reveals a number of its authors’ views and preferences. Our discourse analysis reveals, first, that, often in between the lines, this literature suggests reasons for letting patients speak freely and tries to dismantle the myth of the overly-loquacious patient. Second, by turning to some philosophical inquiries into the notion of “interruption,” we explore how, within this literature, the ultimate reason for interrupting patients and silencing several of their concerns is often the fear of a certain medical logic being interrupted—a logic that dates back to Vesalius and Bichat, and that informs nowadays biomedicine: patients’ speech is valuable as long as it contributes to a diagnosis in the form of the identification of an underlying tissue damage. That is, this literature presents the interruption of patients as a device of claiming power on the part of an eminently biomedical approach to illness. The paper provides further reasons for not interrupting patients proposed by the biopsychosocial model, “narrative medicine,” and anthropologists who study the functions of illness narratives.
      PubDate: 2022-12-01
       
  • “Women as Troublemakers”: The Hard Sociopolitical Context of Soft
           Bipolar Disorder in Iran

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      Abstract: Abstract Gender differences in the prevalence of psychiatric disorders, with higher prevalence of mood and anxiety disorders among women, have been the focus of much debate. In Iran, the adoption of the construct of Bipolar Spectrum Disorder (BSD) and of the concept of “soft bipolarity” has been associated with a large gender difference in rates of diagnosis. This paper discusses the gendered meanings of the diagnosis of BSD in Iran. In this qualitative study, we conducted 25 in-depth semi-structured interviews with prominent psychiatrists and university professors (7 female and 18 male) at six different universities in Iran and 37 in-depth semi-structured interviews with patients (23 female and 14 male, 18–55 years of age) who had received bipolar spectrum disorder diagnosis and treatment, excluding Bipolar I. Findings suggest that the high rate of diagnosis of bipolar spectrum disorder (i.e., subthreshold or soft bipolar disorder) among women in Iran is influenced by gender, sociocultural, political, and economic factors, as well as the diagnostic practices of biomedical psychiatry. The dominant biological psychiatry system in Iran has led many psychiatrists to frame sociopolitically and culturally rooted forms of distress in terms of biomedical categories like soft bipolarity and to limit their interventions to medication. This bioreductionist approach silences the voices of vulnerable groups, including those of women, and marginalizes discussions of problematic institutional and social power. To understand the preference for biomedical explanations, we need to consider not only the economic interests at play in the remaking of human identity in terms of biological being and the globalization of biological psychiatry, but also the resistance to addressing the sociocultural, political, and economic determinants of women’s mental suffering in particular contexts.
      PubDate: 2022-12-01
       
  • “Breaking Down”: Afflictions and Treatments During Times of
           Crisis in Buenos Aires

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      Abstract: Abstract Based on the ethnographic research carried out on speech-based therapies at health centers in marginalized areas of the Buenos Aires Metropolitan Area, this article problematizes the “breaking down” or “being broken” as a local language of afflictions that emerges from the rapidly deteriorating material living conditions related to downward social mobility. Specifically, I analyze how these discomforts turn into narrative in terms of economic and political subjective and collective crises, which combine and hybridize personal experiences with mainstream discourses of the country’s recent history. Based on a brief analysis of the changing relationships between psychoanalysis and poverty in the Buenos Aires area, I also examine how speech-based approaches classify these afflictions as “social issues,” external to their logic, as they resist to be entirely subdued to current psychological knowledge, categories, and techniques.
      PubDate: 2022-12-01
       
  • ‘I am Dying a Slow Death of White Guilt’: Spiritual Carers in a South
           African Hospice Navigate Issues of Race and Cultural Diversity

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      Abstract: Abstract Culturally appropriate spiritual care is increasingly recognised as a crucial component of spiritual care. As part of a larger study, we were interested in cultural and racial issues as experienced by spiritual carers in a hospice in Cape Town, South Africa. We conducted one-on-one interviews and focus group discussions with a cohort of spiritual care workers, who, being volunteers and relatively privileged South Africans, discussed their sensitivity to cultural issues, but also mentioned a host of political, racial and identity issues which profoundly affect their work. The data suggest that the concept of culturally appropriate care must be understood and acted on contextually. We note that the work of transformation of care cannot be separated from broader questions of social inequality and change.
      PubDate: 2022-12-01
       
  • SymptomSpeak: Women’s Struggle for History and Health in Kosovo

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      Abstract: Abstract What are the linguistic dimensions of pain, and what kind of articulations arise from these painful experiences' How does the language of pain circulate, connect, and reach across histories, gendered realities, and social politics' In what ways might the language of pain act on and transform the world by shaping and changing socio-political agendas' I explored these questions among women in Kosovo and discovered a unique symptomatic language which I call SymptomSpeak. SymptomSpeak is a powerful language evoked, shared, and exchanged by women to articulate political, social, and economic grievances, to challenge societal norms, and to demand justice. The language itself consists of a detailed symptom vocabulary which is variously assembled into meaning complexes. Such assemblages shift depending on the social context in which they are conveyed and are referred to as nervoz (nervousness), mërzitna (worried, sad), mzysh (evil eye), and t’bone (spell). I describe in detail how women variously combine and exchange components of SymptomSpeak and, thereby, question dominant framings of reality. Thereby, my intention is to contribute to a new understanding of pain as language which straddles the fine line between socio-political commentary and illness; produces gendered political realities; and challenges the status quo through its communicative power.
      PubDate: 2022-12-01
       
  • Visualizing a Calculus of Recovery: Calibrating Relations in an Opioid
           Epicenter

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      Abstract: Abstract This article uses participatory photography to explore the relationships animating efforts towards recovery from opioid use disorder (OUD) in the Dayton, Ohio area, an epicenter of illicit opioid use and overdose death. A photo-elicitation project was conducted with thirteen people who met the DSM-5 criteria for OUD. Photographs were used as prompts during qualitative interviews, which were thematically analyzed. Analysis of both visual and textual data demonstrated the ways in which recovery became an unfolding process of calculation as participants made strategic choices to navigate relations and encounters with things, people, and places. Relationships across each of these domains could, under some circumstances, serve as supports or motivators in the recovery process, but, in alternate settings, be experienced as “triggers” prompting a resumption of problematic drug use or, at the very least, a reckoning with the feelings and emotions associated with painful or problematic aspects of personal histories and drug use experiences. Findings highlight the importance of understanding recovery as a calibration of the ambiguous relations animating experiences of everyday life. We argue for continued emphasis on recovery as an active performance and ongoing practice of calculation—of risks and benefits, of supports and triggers, of gratification and heartbreak—rather than a goal or static state.
      PubDate: 2022-12-01
       
  • Ancient Roots of Today’s Emerging Renaissance in Psychedelic
           Medicine

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      Abstract: Abstract An international ban on psychedelics initiated by the United Nations’ Convention on Psychotropic Substances in 1971 restricted the clinical use of these ancient psychoactive substances. Yet, in an era marked by rising mental health concerns and a growing “Deaths of Despair” epidemic (i.e., excess mortality and morbidity from suicide, drug overdose, and alcoholism), the structured psychedelic use that has long been a part of ritual healing experiences for human societies is slowly regaining credibility in Western medicine for its potential to treat various mental health conditions. We use a historical lens to examine the use of psychedelic therapies over time, translate ancient lessons to contemporary clinical and research practice, and interrogate the practical and ethical questions researchers must grapple with before they can enter mainstream medicine. Given the COVID-19 pandemic and its contributions to the global mental health burden, we also reflect on how psychedelic therapy might serve as a tool for medicine in the aftermath of collective trauma. Ultimately, it is argued that a “psychedelic renaissance” anchored in the lessons of antiquity can potentially help shift healthcare systems—and perhaps the broader society—towards practices that are more humane, attentive to underlying causes of distress, and supportive of human flourishing.
      PubDate: 2022-12-01
       
  • The Harm Inflicted by Polite Concern: Language, Fat, and Stigma

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      Abstract: Abstract Understanding language as a social action draws attention to the ways in which fat stigmatizing discourses do social harm. Drawing on interviews and experiences situated in Osaka, Japan and north Georgia, US, this paper looks closely at the ways in which fat stigma is expressed across the two sites, both blatantly and through more subtle language use. We identified four key themes in people’s narratives around localized ideas about fatness. These themes are: (1) expressed pity or concern for fat people; (2) reported experiences of indirect stigma in public settings; (3) reported experiences of direct stigma in private settings; and (4) robust and repeated associations between fat and other conditions that had locally relevant negative connotations in each site. We further identify the expressed concern and pity articulated in the first theme as a form of cloaked, “dressed up” stigma and as such, we argue that it enacts social harm, especially when it co-occurs with more blatant forms of stigma. Linguistic niceties around caring actually, at least in these contexts, reify symbolic connections between fat bodies and their social failure.
      PubDate: 2022-12-01
       
  • Could the DSM-5 Cultural Formulation Interview Hold Therapeutic
           Potential' Suggestions for Further Exploration and Adaptation Within a
           Framework of Therapeutic Assessment

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      Abstract: Abstract The Cultural Formulation Interview (CFI), included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, is a person-centered instrument for systematically appraising the impact of cultural factors in psychiatric assessment. A number of key areas in the future development of the CFI have been identified in order to ensure further clinical uptake. In this paper, we suggest that applying a Therapeutic Assessment (TA) approach in using the CFI—i.e., framing the interview in a way that gives primacy to its self-transformative potential by explicitly focusing on those issues that are seen as the most urgent, relevant, and meaningful by the patient—could prove helpful in alleviating patients’ suffering beyond what is achieved by merely collecting relevant cultural information that may inform diagnosis and subsequent treatment interventions. The TA methodology has been designed as a collaborative approach to psychological assessment in which the assessment procedure itself is meant to induce therapeutic change. This is achieved by explicitly focusing on the particular questions and queries that patients have about themselves with respect to their mental health problems or psychosocial well-being; these questions are then allowed to guide the assessment process and the interpretation of the findings. We suggest a number of potential modifications to the related Outline for Cultural Formulation and to the CFI content that could strengthen a TA-inspired focus. With this paper, we do not claim to offer a definitive integration of the TA approach in using the CFI but hope to further the discussion of a therapeutic potential of the instrument.
      PubDate: 2022-12-01
       
  • Violence at Rikers Island: Does the Doctor Make It Worse' A Clinician
           Ethnographer’s Work Amidst Carceral Structural Violence

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      Abstract: Abstract In this article, I describe the dilemmas of working as a physician-ethnographer within the Rikers Island jail healthcare system before and at the beginning of the COVID-19 epidemic in April 2020. The Rikers Island jail system in New York City has been in the national spotlight as a space of violence, trauma, and death amidst calls to decarcerate by community members and abolition advocates. This article is a personal reflection on the labor and subjectivity of healthcare providers and their positionality to multiple axes of structural and interpersonal violence while attempting to provide care in carceral institutions. I observe how COVID-19 functioned as an additional form of structural violence for incarcerated people. Clinical ethnography remains an essential tool for understanding complex social phenomena such as violence. However, physician-ethnographers working in these spaces of structural violence can have unique and conflicting constraints: tasked with providing evidence-based medicine but also simultaneously participating in an unusual form of labor that is an amalgamation of care, social suffering, and punishment. Despite and across at-times conflicting roles and obligations, I propose that these fragmented subjectivities can foment social criticism, propel advocacy toward decarceration, and produce a critically engaged dialogue between fields of anthropology and medicine toward a goal of health justice.
      PubDate: 2022-11-29
       
  • Intimacy, Anonymity, and “Care with Nothing in the Way” on an
           Abortion Hotline

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      Abstract: Abstract This essay is an ethnographic account of a volunteer, anonymous hotline of physicians and advanced practice providers who offer medical advice and guidance to those who are taking medications on their own to end their pregnancies. Attending to the phenomenology of caring on the Hotline reveals a new form of medical expertise at play, which we call “care with nothing in the way.” By operating outside the State’s scrutiny of abortion provision, the Hotline offers its volunteers a way to practice abortion care that aligns with their professional and political commitments and that distances them from the direct harm they see caused by the political, financial, and bureaucratic constraints of their clinical work. By delineating the structure of this new regime of care, these providers call into question the notion of the “good doctor.” They radically re-frame widely shared assumptions about the tenets of the ideal patient–doctor relationship and engender a new form of intimacy–one based, ironically, out of anonymity and not the familiarity that is often idealized in the caregiving relationship. We suggest the implications of “care with nothing in the way” are urgent, not only in the context of increasing hostility to abortion rights, but also for a culture of medicine plagued by physician burnout.
      PubDate: 2022-11-28
       
  • Recalibrating the Scales: Enhancing Ethnographic Uses of Standardized
           Mental Health Instruments

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      Abstract: Abstract This article reflects on the narrative data that can emerge through the use of standardized mental health scales, drawing from two studies related to emotional distress among immigrant populations in Texas. In both studies, standardized scales complemented in-depth interviews. The initial goal in using scales was to collect quantifiable data, yet through the research process, the scales also served to elicit complementary narratives that enhanced interview data, forcing the researchers to reconsider the potential uses of scales. In thinking about the ethnographic potential of standardized scales, the goal of this article is twofold. First, based on our findings, it presents methodological considerations for how to use scales in a way that can facilitate the emergence of in-depth responses that complement other ethnographic methods. Second, although the scope of data collected and analyzed utilizing scales is most often limited to quantitative data, this research demonstrates a need to more fully consider other forms of data that may emerge from using scales. Thus, this article reflects on three inter-related areas where scales provided ethnographic data, using examples from two studies. Overall, this research shows that scales have more ethnographic potential than what has typically been recognized.
      PubDate: 2022-11-12
       
  • Discourses of Involuntary Care in the South African Psy-Complex

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      Abstract: Abstract In 2014, the United Nations Convention on the Rights of Disabilities adopted recommendations advising the replacement of involuntary care with supported care. This has polarised many about how best to provide for People living with Mental Conditions (PLPCs). Notwithstanding the contentions of this debate, we find on a personal discursive level that involuntary care is concealed as a self-evident and unquestionable response to the treatment of PLPCs. This can mean that policy-makers and professionals reproduce approaches to PLPCs uncritically. Considering these complexities, we used Critical Discourse Analysis (CDA) to examine what current norms surround involuntary care in the South African psy-complex, and how these are reproduced. We interviewed nine members of the South African psy-complex, including review board members, psychologists, and psychiatrists, and found several discourses maintaining current psychiatric norms. These include biomedical and techno-disciplinary discourses of treatment, clinico-legal disciplinary and danger discourses, and paternalistic discourses of institutional care. Each of these uniquely highlights the ways in which involuntary care is maintained and normalised, revealing that careful consideration is required to prevent potential human rights violations on behalf of professionals and policy-makers, regardless of whether in involuntary or support paradigms.
      PubDate: 2022-11-08
       
  • Complicity Consciousness: The Dual Practice of Ethnography and Clinical
           Caregiving in Carceral Settings

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      Abstract: Abstract Anthropologist-clinicians who engage in both ethnographic inquiry and clinical practice confront methodological, ethical, and epistemological predicaments that can challenge and enhance the moral practice and ethics of care inherent both to healing and to ethnography. Clinician-ethnographers often find themselves practicing within harmful systems that they also critique, such as hospitals or carceral institutions. This paper analyzes the dual practice of obstetrical care and ethnography in a county jail and a county hospital. These intertwined roles involve wrestling with sometimes conflicting vocational and ethical obligations to heal, to protect privacy, to address bodily consequences of systemic oppressions, and to critique the systems that mete human suffering. Developing a consciousness of clinical-ethnographers’ complicity, rather than disavowing it, can be aligned with approaches of abolition medicine to reimagine more just forms of healing.
      PubDate: 2022-10-28
       
  • Harm Reduction Principles in a Street Medicine Program: A Qualitative
           Study

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      Abstract: Abstract There is ample evidence that homelessness is associated with high rates of morbidity and mortality. Street Medicine seeks to eliminate these disparities by providing healthcare on the streets to people who are unsheltered. While extant research describes health disparities for the unsheltered and programmatic approaches to addressing housing instability, there are few published studies describing how healthcare providers build and maintain relationships with patients on the street. This insight is central to specifying how street medicine differs from traditional forms of care and defining aspects of street medicine that contribute to successful patient engagement. Through a collaboration between Operation Safety Net (OSN), a street medicine provider in Pittsburgh, Pennsylvania, and [name redacted], an exploratory qualitative study was designed and implemented using harm reduction principles as a guiding framework. Qualitative interviews were conducted with eleven OSN street medicine providers and a thematic analysis using a deductive approach was used to analyze the data. Findings identified the ways that relational harm reduction was central to all aspects of patient care provided through this program. Major themes included: (1) individualism, or meeting patients where they are figuratively and literally; (2) humanism, which refers to valuing and holding true regard for patients; and (3) nonjudgmental care, in which providers do not hold negative attitudes toward patients and their decisions. These themes are consistent with relational principles of harm reduction. Challenges that were discussed also aligned with these principles and included frustration with systems providing care that did not meet patients’ individualized needs, and pain and trauma experienced by providers upon losing patients for whom they genuinely cared. Understanding these relational principles of harm reduction may help providers operationalize ways to effectively engage and maintain homeless patients in care and subsequently bridge the gap to traditional models of care. This study may provide valuable insights to expand the street medicine field in research and applied clinical and community settings.
      PubDate: 2022-10-13
       
  • Beyond Competence: Efficiency in American Biomedicine

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      Abstract: Abstract “Competence” is a longstanding value of American biomedicine. One underidentified corollary of competence is efficiency: at once a manifestation of competence, a challenge to competence, and a virtue in its own right. We will explore the social construction of efficiency in US undergraduate medical education through an analysis of its sociocultural and technological landscapes. We present qualitative data from two allopathic medical school field sites in the Midwestern United States, where medical students’ careful selection of certain learning resources and overall perspectives on the curriculum underscore their focus on efficiency and pragmatic approaches to knowledge. In the discussion, we consider the ethical implications of physician efficiency, as well as future trajectories for the study of efficiency in the medical social sciences, bioethics, and medical education. We posit that efficiency is at the theoretical heart of US medical practice and education: a finding that has wide-reaching implications for how researchers conceptualize the enterprise of biomedicine across cultural contexts and interpret the lived experiences of physicians, medical students, and other clinicians.
      PubDate: 2022-09-30
       
  • The Politicised Child, Transcultural Constructions of Childhood,
           Psychological Trauma, and the Mind in the Modern World: Afterword

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      PubDate: 2022-08-13
      DOI: 10.1007/s11013-022-09804-2
       
 
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