How do medical anthropologists approach mental health in other cultures?
Answers
If the general characterization of the fundamental problems in the psychiatrist’s and anthropologist’s work and thinking on mental illness is at least crudely correct, then, it is hardly surprising that at the point of contact between the two disciplines, despite the increasing collaboration, there still remains uneasiness sharpened, in no small measure, by their different methods. The psychiatrist’s method subscribes to positivism, in turn expressive of the epistemological enterprise of establishing objective knowledge represented as regularities, even laws (Polkinghorne 1983). The entity being researched is treated as an ‘object’ that can be universalised. The psychiatrist develops instruments and looks for reliable data. The instruments are the standard procedural means by which information on the subjects is collected. The instrument becomes a reliable one if results generated remain constant on repeated examination of the same phenomenon. But for the anthropologist, research is derived from various phenomenological, pragmatic, hermeneutic, critical and postmodernist traditions and the tendency is to stress the particulars of human experience and social life while taking history, language and culture into account. The anthropologist seeks to describe the world of others as it appears to him/her, striving as much as possible not to impose his/her own view. In other words, the anthropologist tries to understand and represent the experience and actions of people as he/she encounters, engages and lives through situations. To achieve this, questionnaires are seldom used because “questionnaires presume that what is relevant to ask about setting can be known in advance” (Hahn 1995: 103). Rather, attempt is made to understand the phenomena under study based as much as possible on the perspectives of those being studied. Anthropologists believe that their self-reflective attempts to ‘bracket’ existing theory and their own values allow them to understand and represent their informants’ experience and actions more adequately than would otherwise be possible.
With this substantial divergence in the methods of psychiatry and anthropology, the discomfort of the anthropology students on the interdisciplinary project would seem clear. They have been trained in generating material for analysis that was not pre-structured according to a model of supposed ‘objectivity’. However, the interview schedule that they were supposed to work with, requires that they administer it in homes, with the subject alone, and following specified rules. For them, materials to be generated must allow for the documentation of multiplicity, variability and indeed contradictions within accounts. They highlighted a number of ambiguities in reading the questionnaire, which was drafted by the project leader, a psychiatrist, during the first of a series of research meetings before the pilot study. For example, there was a question on how often respondents have headache, which the students find unclear because headaches in Xhosa - the language of the respondents - have several meanings. Attempts were made to resolve such ambiguities by the research team, but at the level of text rather than in relation to a broader context, the social setting of the respondents circumscribed by cultural boundary. What this highlights is the uneasiness of the anthropologist when psychiatry ‘meets’ anthropology. Yet, it has been through this ‘meeting’ that anthropology has proved itself to be a creative discipline and has been able to provide psychiatry with additional understanding. This understanding is set out in the section that follows.
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