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Andrew Scull, J. Geoffrey Golson (eds.

), Cultural Sociology of Mental Illness, London, Sage,


2014 (work in progress)

Samuel.leze@ens-lyon.fr

First draft before submission

Anthropology of mental illness,


Madness is a major disorder of social ties and a universal problem for all societies. The
formation and transformation of local treatments of madness are therefore a major area
of study within social and cultural anthropology. In this perspective, “treatment” should
be understood on three different levels. First, as treatment of the problem that madness
poses to social order; Second, as treatment of an ailment on the basis of a therapeutic
system that can call upon specialist knowledge or not (e.g. a classification, an etiology,
a pharmacopoeia, etc.) in order to identify the disorder or to determine its nature and to
then provide the appropriate intervention; Finally, as moral treatment of people
experiencing madness and trying to find a solution to their state of disorder.
This definition of the anthropology of madness does not confer special status
upon psychiatry, psychology or psychoanalysis in the approach to these elementary
forms of otherness and irrationality. Rather, these are all possible areas of
anthropological inquiry as illustrated by a number of studies which have become
classics in the field, such as Tanya Luhrmann’s work on two opposing conceptions of
personhood in American psychiatry, Robert Barrett’s study on the hospital management
of schizophrenia and Lorna Rhodes’ research on psychiatric treatment in a maximum
security prison.

The cultural analysis of personhood


Far from being a narrow and specialized field of research in medical
anthropology, the theoretical goal of the anthropology of madness is instead to
contribute to the wider cultural analysis of moral conceptions of personhood and of the
contemporary making of ethical subjectivities. Indeed, the moral language that we use
to speak of ourselves and of relationships to others establishes a specific form of life in
which boundaries have been negotiated between the normal and the pathological, the
tolerable and the intolerable, between monstrosity and humanity, responsibility and
irresponsibility, between what is moral and what is immoral, etc. All these boundaries
come together to define the framework of what is thinkable and feasible in a particular
time and place. In other words, they define the self-evident facts that are embodied in
common understanding.
However, this cultural analysis also takes the specific problems, methods and
results of social and cultural anthropology and feeds them back into more specialized
and applied debates that are part of the medical field of mental health. The key
difficulty is obviously to avoid being reduced to the role of a specialist of "culture",
understood in a somewhat flat sense as interference to filter out or an obstacle to
overcome, whether as an expert in public health or as a critic of the medicalization of
the experience of human suffering. Similarly, it is important to avoid being caught up in
certain disputes, for example regarding the nature of madness, as they give rise to
contradictory anthropological theories either seeking to explain one form or other of
madness (as evidenced by Grégory Bateson or Jules Henry’s work) or on the contrary
looking to show the metaphorical or mythological status of madness, as sometimes
propagated by a naïve constructionism still in vogue today.
Thus, in this interdisciplinary area that can sometimes seem confusing due to the
proliferation of different labels in circulation (Cultural psychiatry, ethnopsychiatry,
ethnopsychoanalysis, primitive or folk psychiatry, transcultural or comparative
psychiatry or psychology, etc.) the issues that arise are mainly professional questions
approached from a clinical and/or epidemiological perspective. It is a question of
applying psychiatric knowledge to populations, such as migrants or members of a
different society, who exhibit expressions and conceptions of madness that are far from
self-evident to the ordinary clinical gaze. In these studies, which are not without
interest, it is nevertheless important to constantly bear in mind the theoretical and
methodological problem inherent in the fact of applying psychological concepts of a
theory of personality (i.e. psychiatric, psychoanalytic, psychological etc.) to cultural
analysis rather than to the cultural analysis of personhood.

Methods of Cultural Analysis


It is also important to recall that social anthropology inherits issues and representations
deriving from a long social history of madness that also permeates current common
understanding. The accounts of travellers, evangelists or military doctors from antiquity
to the present day, have continued to perpetuate conflicting representations about
madness or the irrationality of members of exotic cultures so as to better emphasize
their Otherness. These can serve either to enhance the conservative idea of a
harmonious community living without stress in opposition to the pathogenic modern
society of individuals, or else to promote the racist and reductive identification of entire
societies with forms of madness. This can be seen in many literary accounts concerning
the emotions conducive to madness in Africans in general or, more specifically in
colonial psychiatry, concerning types of pathology that are supposedly characteristic of
a given group and the presumed existence of negative personality traits.
In order to take the facts of common understanding beyond their fixed and
limited dimension and allow a complete picture to be formed, anthropologists retrace
the path that leads from the formation of a concept to the moment when it is taken up in
clinical practice, in patient experiences and in popular culture. Three methodological
approaches can be identified, while keeping in mind that in the absence of an overriding
and defining key anthropological research issue, there is a clear risk of studies
becoming fragmented into areas focusing on specific societies or psychopathologies:
When a concept has a long history and displays changes in value over time, the
“genealogical” method is often used, in the manner of Fredriech Nietzsche and Michel
Foucault, as illustrated by the work carried out by Allan Young or Didier Fassin and
Richard Rechtman on the cultural success of the category of trauma.
When there is wide circulation of a given cultural object (like the popular image
of Freud and the proliferation of images of depressive or schizophrenic brains in the
mass media), then the method employed is that of the "social life of things", in the
manner of anthropologist Arjun Appadurai. This is illustrated by the work of Joseph
Dumitt on the neurobiology of depression, Andrew Lakoff on the impact of American
psychiatry in Argentina and, in part, Junko Kitanaka on the social and political success
of the category of depression in Japan.
Anthropologists usually complete this approach by conducting local or multi-site
field-work in psychiatric institutions, in close proximity to professionals and patients.
They can also choose to focus solely on the moral and emotional experience of persons
affected by a disorder of social ties. It is then individual narratives that can give rise to
different types of insight for cultural analysis according to the theoretical problem under
consideration: the strategic uses of theories of mental health (Didier Fassin and Richard
Rechtman); the cultural production of a type of subjectivity (Emily Martin); the impact
and footprint of mechanisms of domination in the expression of social suffering (Arthur
Kleinman, Veena Das, Margaret Lock); the phenomenological structure of the
experience of a mental disorder (Janis Jenkins, Els Van Dongen).

Samuel Lézé
ENS de Lyon (France)

See Also: Diagnosis and Culture; Epidemiology (Culturally considered); Ethnopsychiatry;


Mental illness defined (Historical Perspectives); Mental illness defined (Sociological
Perspectives)

Further Readings
Barrett, Robert J. The Psychiatric Team and the Social Definition of Schizophrenia: An
Anthropological Study of Person and Illness, Cambridge: Cambridge University Press, 1996
Brodwin, Paul. Everyday Ethics: Voices from the Front Line of Community Psychiatry,
Berkeley: University of California Press, 2013
Davis, Elizabeth Anne. Bad Souls: Madness and Responsibility in Modern Greece. Durham:
Duke University Press, 2012
Desjarlais, Robert R. 1997 Shelter Blues: Homelessness and Sanity in a Boston Shelter.
Philadelphia: University of Pennsylvania Press.
Dongen, Els Van. Worlds of Psychotic People: Wanderers, ‘Bricoleurs’ and Strategists. New
York: Routledge, 2004
Dumit, Joseph. Picturing Personhood. Brain Scans and Biomedical Identity, Princeton:
Princeton University Press, 2004
Estroff, Sue E. Making It Crazy: An Ethnography of Psychiatric Clients in an American
Community, Berkeley: University of California Press, 1981
Gaines, Atwood D. Ethnopsychiatry: The Cultural Construction of Professional and Folk
Psychiatries, Albany, NY : State University of New York : SUNY Press, 1992
Fassin, Didier, Rechtman, Richard. The Empire of Trauma. An Inquiry into the Condition
of Victimhood, Princeton: Princeton University Press, 2009.
Hinton, Devon E. and Good, Byron, J. (ed.) Culture and Panic disorder, Stanford, Stanford
University Press, 2009
Jenkins, Janis and Barrett, Robert. Schizophrenia, Culture and Subjectivity: The Edge of
Experience, Cambridge: Cambridge University Press, 2004
Kitanaka, Junko. Depression in Japan: Psychiatric Cures for a Society in Distress. Princeton:
Princeton University Press 2011
Kleinman, Arthur. Patients and Healers in the Context of Culture: an Exploration of the
Borderland between Anthropology, Medicine, and Psychiatry. Berkeley, CA: University of
California Press, 1980
Kleinman, Arthur and Good, Byron, eds. Culture and Depression: Studies in the
Anthropology and Cross-cultural Psychology of Affect and Disorder. Berkeley / Los Angeles:
University of California Press, 1985
Arthur Kleinman, Das, Veena, Lock, Margaret. (eds) Social Suffering, Berkeley-Los Angeles-
London: University of California Press, 1997
Lakoff, Andrew. Pharmaceutical Reason: Knowledge and Value in Global Psychiatry, New
York: Cambridge University Press, 2006
Leibing, Anne and Cohen, Lawrence. (eds), Thinking about Dementia - Culture, Loss, and the
Anthropology of Senility. New Brunswick; Rutgers University Press, 2002
Littlewood, Roland & Dean, Simon. (ed.) Cultural Psychiatry & Medical Anthropology: An
Introduction and Reader, London: Athlone Press, 2000
Littlewood, Roland. Pathologies of the West: An Anthropology of Mental Illness in Europe
and America, Ithaca, NY: Cornell University Press, 2001
Luhrmann, Tanya. Of Two Minds: The Growing Disorder in American Psychiatry, New
York: Alfred A. Knopf, 2000
Martin, Emily. Bipolar Expeditions: Mania and Depression in American Culture, Princeton:
Princeton University Press, 2007
Rhodes, Lorna A. Emptying Beds: The Work of an Emergency Psychiatric Unit, Berkeley:
University of California Press, 1991
Rhodes, Lorna. Total Confinement: Madness and Reason in the Maximum Security Prison,
Berkeley: University of California Press, 2004
Shepers-Hughes, Nancy. Saints, Scholars and Schizophrenics. Berkeley: University of
California Press, 2001 (1979)
Waldram, James. Revenge of the Windigo: The Construction of the Mind and Mental Health
of North American Aboriginal Peoples, Toronto: University of Toronto Press, 2004
Young, Allan. The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder,
Princeton, N.J.: Princeton University Press, 1995