21A.460 – Medicine, Religion, and Politics in Africa and the African Diaspora May 5, 2005 • Roles of stereotypes in ethnography • Could have had more ethnographic material • What happens when countries are in distress? How to address trauma across cultural boundaries in times of upheaval? • How can we address structural effects on a person’s consciousness? How to assess the state of an individual in disordered societies? Discussion of Reading • Manga (case in reading) – unwed mother, causing problems in family. Shot by family during apartheid. Did psychological analysis postmortem, family did not receive aid because she was considered unstable. • Consider how to think about mental health in wider scope • In diagnostic actions, people relive traumatic events • Clinicians were faced with a challenge in determining what is relevant in biomedical framework. • With diagnosis of PTSD, patients are relieved of responsibility for actions o Only thing considered outside person is cause o Everything else is located inside o How external events affect person internally o PTSD is still controversial, and not all agree to its designation • Biomedicine was deeply involved in supporting apartheid policies • In this context, what relevance does psychiatry have? • In situations of war and violence, should health professionals stay neutral? o In facing people with disorders, hard to stay neutral o What happens if clinicians are guided by stereotypes? o If so, then are clinicians replicating and reproducing stereotypes? o How conscious are clinicians of the extent to which they are influenced by stereotypes? How aware are they of what is going on in their heads? • In Haiti: clinicians secretly helped poor supporters of democracy during the 1991-1994 coup period, although they could have been attacked • Traumatic events were seen to cause disorders • After end of conflict, nation needed healing from biomedical as well as indigenous healing practices o Sometimes are in conflict, but sometimes necessary to resolve conflicts and effects Chapter 2: • Deals with issue of medical pluralism • John (case study): psychotic, biomedicine did not work to treat, mother believed the spirits were angry that he did not become a healer. Believed he was possessed. • How to accommodate different medical viewpoints in biomedical science? 121A.460 – Medicine, Religion, and Politics in Africa and the African Diaspora May 5, 2005 • None of the health officials used mom’s knowledge about situation. Why wasn’t the mother’s expertise about the situation used in determining the problem and treatment? • Cross-cultural look at schizophrenia: o 2 different studies o Developing countries have more cases than developed (why?) o Unsure whether it is from bias in definitions of schizophrenia, or actually that there are more cases o Quicker onset in developing countries o Outcomes are better in developing countries o In developing world, people can be mentally ill and still be productive and fulfill social role, which can control course of illness. o Role of economy in mental illness o Easier to get back into society in the long-term in developing world • Schwartz wants more ethnographic experience, more lived experience rooted in certain ideologies o Lived experience can give more knowledge about patterns of social suffering o Lack of knowledge about the ‘Other’ in clinical settings can reinforce notions of status quo unconsciously, reinforce common notions of ‘normal’ and ‘Other’ Chapter 10 • Transient psychoses. Psychosis and possession states often similar. How to determine difference, treat? • Biological and psychosocial interlinked, can’t separate. • There are other influences that make possession/psychosis difficult to study. For example, difficult in situations where alcohol or drugs are used • Transient disorders, dissociation, on larger scale are linked to ‘primitive’ societies • ‘Modern’ world also causes fragmentation of mind o Multiple personalities increasingly common o Becoming a first-world disease o This is becoming a convergence point between 1st and 3rd world o To what extent do clinicians want to pathologize these experiences? Should it these be considered on a continuum between socially acceptable and pathological, rather than strict discrete units of separation? • Explores how certain behaviors are seen as pathological • African/African-American men in developed settings are diagnosed with schizophrenia in much greater numbers than in any other racial group • There are more complex ways to engage these issues that are not rooted in Western context • Questions notion of the autonomous individual. Is this a valid model? • Flexible self and boundaries between individual and environment/social world are malleable 221A.460 – Medicine, Religion, and Politics in Africa and the African Diaspora May 5, 2005 • Schwartz can point out similarities to Western model, but still recalls questions of power, since Western world still defines notions of person, normal, and pathological • Western world still holds power to construct knowledge about other • Malleability of person – described in O.Butler book (to be read next week) Movie: The Return of Sara Baartman • Georges Cuvier: French scientist who dissected Saartje Baartman (Hottentot Venus). o Baartman’s callipygean character likened to monkeys. o Physiognomy repeatedly likened to orangutans. • Baartman elevated French and medicine: she became part of French medical heritage • She was a symbol of black women’s sexuality. • Represented missing link to many people. She was used to establish link between animal kingdom and human. • Her skeleton remained on public display until 1967. • Brain size same as Descartes, establishing that brain size cannot be used as a marker for intelligence, etc. • Ironically, she was born in 1789, the same year that supposedly marked the end of sexism, racism, and restored respect for women in France • After years of negotiation, French government gave up her remains. • Her remains were taken to South Africa, buried on South Africa’s day of women • Issues brought up in transferring her, determining her burial site and historical memorial: o Who has the right to speak for her? Tribe? Country? o Why can decide for