Culture, Medicine, and Psychiatry

The previous issue of Culture, Medicine and Psychiatry (Vol. 5, N. 4) included my article “When Rational Men Fall Sick: An Inquiry into Some Assumptions Made by Medical Anthropologists” together with a series of comments. This paper consists of my replies to some of the commentators and a case study illustrating my points.

Psychiatric practice involves writing as much as it involves talking. This study examines the interpretive processes of reading, writing and interviewing which are central to the clinical interaction. It is part of a broader ethnographic study of an Australian psychiatric hospital (which specializes in the treatment of patients with a diagnosis of schizophrenia). The paper examines two major types of written assessment of patients — the admission assessment and the ‘complete work-up.’ Writing is analyzed as performance, thereby focusing on the transformations that are effected in patients, their perceptions of their schizophrenia, and their total identity. One crucial transformation is from ‘person suffering from schizophrenia’ to ‘schizophrenic.’ The paper aims to show that as much as psychiatry is a ‘talking cure’ it is also a ‘writing cure.’

In this article, I address the experiences of family members of people with dementia, as they expressed the sensation of gradually losing the person with dementia. Based on ethnographic fieldwork in nursing homes in the Netherlands, and contributing to the anthropology of grief, I explore the co-existence of experiences of anticipatory grief and manifestations of care to maintain meaningful relations. I show how my interlocutors adapted to changing circumstances as the disease progressed, and in so doing found new ways to relate, as well as prepared for future losses and the expected end of life. I argue that anticipatory grief is temporal and relational, encompassing both present and future losses, and involving a continuous negotiation between the loss and the continuing relationship. I underscore the entanglement of loss and connection, showing how both exist parallel to, and may emerge from one another, and demonstrating how an anthropological approach to anticipatory grief can reveal the nuanced and equivocal character of experiences of illness and at the end of life.

A health diary study was conducted to examine the incidence and nature of health problems and illness behavior among rural residents in Japan. Attention was paid in particular to the utilization of folk medicine or alternative practitioners in the context of illness behavior. One hundred and sixty-one health problems were recorded over a 4-week diary period by 28 housewives aged 35–64 years. Headache, tiredness and gastrointestinal problems were among the most common problems. Emotional/psychological problems, the most frequently recorded problems in the health diary studies conducted in the United States or England, were recorded by only 3 participants. Only 6 problems (3.7 percent) resulted in consulting a doctor. Three women utilized an acupuncturist, shinkyūshi, during the diary period. Self-care, such as resting by lying down, using home remedies and self-medication including household drugs, Toyama kusuri and folk medicine, was practiced for 101 problems (62.7 percent). Folk medicine or alternative practitioners played important roles in the health seeking process. The health diary method was shown to be suitable not only to Western communities but also in a rural Japanese context.

This paper draws on ethnographic material to challenge the taken-for-granted relationship between anorexia and fear of fat. While popular understandings assume anorexia to be an extension of everyday dietary guidelines and a fear of weight gain from foods high in fats and calories, I argue that it is fear of contamination rather than fear of fat per se that is at issue. Through a critique and extension of Mary Douglas' structuralist typology and Julia Kristeva's embodied theory of abjection, I demonstrate that it is the qualities of certain foods, and in particular their amorphous natures, that render them contaminating. Saturating fats and invisible calories are considered dangerous by people with anorexia because they have the ability to move, seep, and infiltrate the body through the interplay of senses. Foods that transgress conceptual and bodily boundaries are thus to be avoided at all costs, for they have the potential to defile and pollute. In light of the low recovery rates for those with anorexia within Australia (and internationally), the findings of this paper have significant implications for the understanding and treatment of this disorder.