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Read the chapters in this book and feel, carry, resist, fight the weight, the heavy yoke of tragedy. Mass violence has been part of the human experience for as long as recorded history and weighs us down to this day. In the American Civil War 750,000 soldiers on both sides lost their lives, and the subsequent decades were dominated by national preoccupation with suffering, loss, and grief (Faust, 2008). Colonialism introduced mass violence to all the continents, with slavery accounting for a huge toll of human misery and death. In the meat grinder of trench warfare during World War I, millions of British, French, and German soldiers were killed and millions more wounded. The Battle of the Somme alone cost the British 450,000 casualties, 50,000 on the first day. That war ended with European societies expressing revulsion against all forms of mass violence, and yet just twenty years later a Second World War killed more than 50 million men and women (most of whom were noncombatants) and displaced hundreds of million more. The war embedded the Holocaust, still the symbol of mass violence as an institutional product of evil. Historians claim that the former Soviet Union may have killed even more people than the Nazis. And this outline of mass violence is only a preliminary to the many and different more recent forms of mass killing described in the chapters that follow.
Whatever the human cost of such immense and continuing destruction it must be staggering. China’s Great Leap Forward famine, which killed 30 million rural Chinese, was the unintended consequence of one of the most destructive social policies in human history, but no one knows its toll on families and networks in Chinese villages. The same can be said for the Cultural Revolution (Kleinman et al., 2011). And that is true of much of mass violence. We simply do not know what effect, especially over the long term, it has had on society, on interpersonal bonds, on local moral worlds, and on subjectivity.
Academic psychiatry is in trouble, becoming the narrowest of biological research approaches of decreasing relevance to clinical practice and global health. What is required is a rebalancing of the psychiatric academy to include greater support for researchers conducting social, clinical and community studies within a broad, more humanistic biosocial framework.
Over the past several decades, political conflicts, economic volatility and large-scale cultural and social changes have strongly influenced not only global health problem and solution frameworks, but the very way we conceive of global health as a public good. As politicians, business people and cultural elites employ the language of global health to shape discourse and policies focused on displaced and migratory peoples, they have perhaps unwittingly broadened the classic public health agenda. As a consequence, that agenda now includes violence and its traumatic consequences, the health (and mental health) impact of natural and social catastrophes, other health-related problems from obesity to substance abuse, and the effect of pharmaceutical and digital technology innovations not previously considered to be core public health issues. They expand and reformulate the traditional spheres of public health, and challenge classic public health values.
As a result, debates shaping global health research, ethics, policy and programs have developed along two parallel tracks. One can be characterized as a neo-liberal approach combining economics (liberalization of trade and financing; new mechanisms for product development for diseases of poverty involving public–private partnerships; cost-effectiveness analysis), disease-specific and biotechnology programs and security concerns. The other has focused on human rights, social justice and equity frameworks with a broader, more inclusive model of the determinants of health. This perspective calls for a transformation of the current fractured system of global health governance into a transparent and accountable system, better equipped to address the world's global health agendas.
Many factors, including the increasing commercialization of biomedicine, have caused medical practice to be increasingly divorced from the practice of caregiving. In this article, the authors argue that the two must be reunited in multiple ways if we are to have a just and compassionate healthcare and medical practice.
Background. Most mental health research tools are developed in Western, urban contexts. Few studies have evaluated the applicability of these research tools in rural populations of non-Western countries. We examined the cultural acceptance and psychometric performance of the 12-item General Health Questionnaire (GHQ) in China's rural villages.
Method. Ethnographic investigations were conducted to assess the cultural applicability of self-report rating scales among villagers. This was followed by a survey of 1401 rural residents, randomly selected from 48 villages of Shandong province using stratified multistage cluster sampling. The respondents were administered the GHQ and the Composite International Diagnostic Interview (CIDI).
Results. The GHQ, when administered by trained interviewers, was culturally acceptable to rural residents. The scale had good psychometric properties in the study population. The area under the curve was 0·86. At a cut-off of 1/2, the sensitivity and specificity were 80·6% and 79·3% respectively.
Conclusions. The ethno-psychometric evaluation showed that the GHQ was both culturally valid and psychometrically sound in the Chinese rural context.
Research on stigma often focuses on general public attitudes and overlooks patients' subjective experiences of everyday stigma arising from significant others.
To document and compare the interpersonal experiences of stigma in patients with schizophrenia and patients with diabetes mellitus in Hong Kong.
Four focus groups were conducted to generate a self-report questionnaire. Data were collected from out-patients with schizophrenia (n=320) and diabetes (n=160).
Significantly more patients with schizophrenia (>40%) than diabetes (average 15%) experienced stigma from family members, partners, friends and colleagues. Over 50% anticipated stigma and about 55% concealed their illness. Dysphoria occurred in over half.
Interpersonal (especially intrafamilial) stigma was pervasive, hard to avoid and devastating to patients with schizophrenia. Family support had to be realised rather than assumed, despite the emphasis on relationship bonds in Chinese society Programmes that build the family as a rehabilitative resource should start early to reduce the development and adverse impacts of stigma.
Schizophrenia is the defining problem for psychiatry. In the nineteenth century, American psychiatry first projected onto schizophrenia the images of treatment that it inherited from European medicine: strait-jackets, hydrotherapy, bloodletting, herbal compounds, and, of course, the asylum. Then it was moral therapy, which held up until the ethnic mix of American society changed so significantly that America could no longer project a single moral world, and contesting multicultural influences that challenged the presumptions of this “our crowd” therapeutic approach. Latterly, social Darwinism, eugenics, and social science reinvigorated a fin de siecle organic image of the deranged mind based in the brain tainted by degeneracy.
The twentieth century was the hothouse of psychological models, with Freudianism coming to dominate the image of what mental illness was. Side by side with psychodynamic projections, somatic treatments evolved – if we can call such a stop-and-go, recursive, and controversial process by this term – from insulin shock and electroconvulsive therapies through psychosurgery to what we now think of as modern psychopharmacology. The broken brain has become the dominant professional (and popular) image in America. Today's world of biological psychiatry claims schizophrenia as its own, even though the genetic contribution to the transmission of schizophrenia has gotten more and more complex and uncertain, and there is still no biological marker in everyday clinical practice that can be used to diagnose and follow the course of the disorder.
When William James launched into the Gifford Lectures of 1901, he admitted to his Edinburgh audience a certain feeling of trepidation. Those lectures, which he would later publish as The Varieties of Religious Experience, evoked in James a sense of consternation because, as he remarked on the occasion, he was neither a theologian, nor a historian of religion, nor an anthropologist. “Psychology is the only branch of learning in which I am particularly versed,” James pleaded.
To illustrate the contribution anthropology can make to cross-cultural and international research in psychiatry, four questions have been put to the cross-cultural research literature and discussed from an anthropological point of view: ‘To what extent do psychiatric disorders differ in different societies?’ ‘Does the tacit model of pathogenicity/pathoplasticity exaggerate the biological aspects of cross-cultural findings and blur their cultural dimensions?’ ‘What is the place of translation in cross-cultural studies?’ and ‘Does the standard format for conducting cross-cultural studies in psychiatry create a category fallacy?’ Anthropology contributes to each of these concerns an insistence that the problem of cross-cultural validity be given the same attention as the question of reliability, that the concept of culture be operationalised as a research variable, and that cultural analysis be applied to psychiatry's own taxonomies and methods rather than just to indigenous illness beliefs of native populations.