No coin nor oath required. For personal study only.
Cultural essentialism" seems almost inevitable for cross-cultural scientists and medical anthropologists. Culture provides shared meanings and sentiments that organize illness experience, symptoms and their presentation, and psychiatric syndromes or disorders. A central claim of our discipline has been that diagnostic criteria, illness behavior, modes of expressing affect, and therapeutic strategies all vary from society to society. But this view has always been problematic. Anthropologists have long resisted the embarrassing stereotypes implicit in clinicians' requests for rules about how to alter their practices to provide culturally appropriate treatment for members of particular ethnic minorities. Nonetheless, members of such groups have often accused anthropologists of being more interested in "folk illnesses" than in the social and political sources of suffering and the inadequacy of care for the disadvantaged, a claim resisted by many who work in this field. One is drawn up short, then, by Leslie Swartz's account in this volume of the contradictions facing the committed mental health worker in South Africa. To advocate the importance of recognizing cultural differences among South African psychiatric patients is to help reproduce the racist ideology of apartheid.
We have drawn together the papers in this volume because they suggest new directions for the study of culture and psychiatry in the contemporary world. State violence, racism, gender conflicts, and struggles between the nation state and local aspirations are the focus of attention of these papers, rather than the primordial cultural characteristics of patients and their conflicts with a cosmopolitan, medicalized psychiatry. The image of coherent cultures and ordered societies gives way in the face of state violence, both chaotic and repressive. E1 Salvador and South Africa, along with Cambodia and Lebanon, replace the Tahitians as a source of theorizing. Culture and identity are cast as resources both for domination and resistance in national struggles and the micro-politics of the hospital ward. And these are all shown to be central features of everyday mental health care in many parts of the world today. Clearly, new ways of thinking and writing are necessary to comprehend the role of "culture" in shaping psychopathology and therapies in this context.
The papers by Janis Jenkins and Pablo Farias describe research with Salvadoran refugees who have fled the violence and profound torment of their homeland. Jenkins extends recent writing on the "state construction of emotions" to provide an account of affect as politicized and social, rather than as
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