13 décembre 2016
Extraordinary Conditions: Challenges for Global Mental Health
Séminaire "Santé mondiale : savoir, dispositifs, politiques" de la chaire Anthropologie et santé mondiale avec Janis Jenkins, Université de Californie San Diego, Etats-Unis
My presentation is an anthropological appraisal of life on the edge of experience based on studies that I have carried out over the past three decades. A useful rubric for such an undertaking is “extraordinary conditions,” which carries double meanings. On the one hand, it refers to conditions, disorders, or syndromes that are culturally and historically defined as mental illness. On the other hand, I also mean conditions characterized by institutional and situational adversity, such as warfare, gender violence, and political economic structures of scarcity and neglect. People existing under extraordinary conditions are usually described as vulnerable individuals or populations, whereas in fact they are often actively confronting precarity under the press of extreme and life-threatening circumstances. In this respect, my ethnographic studies lead me to think less in terms of symptoms manifested and more in terms of struggle across an array of extraordinary conditions: the hearing of unrelenting voices, flight from political violence, or coming to terms with psychotropic medication.
Psychiatric medications in particular are entangled in a mélange of magic, science, and religion, and in addition are embedded in a structure of pharmaceutical markets and global capitalism. How does unequal distribution and access to these drugs reproduce social inequalities marked by distress and suffering? Currently, a significant gap exists between Psychiatric Anthropology and the field of Global Mental Health (GMH) with its call to "scale up" services worldwide. This gap is between virtually exclusive use of psychopharmaceuticals and the development of psychosocial therapeutic approaches, cultural knowledge, or community engagement. The anthropological imperative is to take into account both first-person accounts of affliction and structural/ecological constraints as matters integral to both therapeutic efficacy and ethical practice.