DSM-5 on Culture: A Significant Advance

[A]ll forms of distress are locally shaped, including the DSM disorders.

– DSM-5 (APA, 2013, p. 758) 

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders  (DSM-5; APA, 2013) was finally presented on May 18th at the American Psychiatric Association’s annual meeting in San Francisco. Much ink has been spilled in the media about the ten-year process leading up to last month’s unveiling. But there has been virtually no mention of the fact the DSM-5 is a vast improvement in its treatment of culture. It reflects a much more inclusive description of the range of psychopathology across the globe, not just the particular constructs or exemplars most commonly encountered in the US, Western Europe, and Canada. I think the cultural component of DSM-5 has the makings of a model on which subsequent versions of the manual should be based.

What follows is a summary of a few talks that were given at the annual meeting of the Society for the Study of Psychiatry and Culture on May 3–5 in Toronto outlining the changes.

According to cultural psychiatrist Roberto Lewis-Fernández (Columbia University), “including information on cultural concepts of distress in DSM-5 will enhance the validity and clinical usefulness of diagnostic practice” across the board. Lewis-Fernández began his talk by briefly describing the limitations of DSM-IV-TR, which listed twenty-five “culture-bound syndromes” in an appendix. The use of the term “culture-bound” made these conditions appear highly localized and confined, a cabinet of curiosities. The list was also heterogeneous, Lewis-Fernández continued, some “syndromes,” including nervios, seemed to represent specific situational predicaments, or variations in the way people express their distress, rather than coherent collections of symptoms. Other expressions, such as ataque de nervios, are syndromic, but do not always represent psychopathology. Still others (like shenjing shuairuo or ‘neurasthenia’) appeared to be a cover term for several common, but seemingly unrelated, human ailments (e.g., fatigue, dizziness, headache, GI problems, sexual dysfunction, excitability); another group of conditions simply defied DSM categorization, such as mal de ojo (‘evil eye’).

Under the direction of Kimberly Yonkers and Lewis-Fernández, chair and co-chair respectively of the Gender and Cross-Cultural Issues Study Group, DSM-5 is a vast improvement. The new volume is divided into three sections – Section 1: Introduction (“DSM-5 Basics”); Section II: “Diagnostic Criteria and Codes”; Section III: “Emerging Measures and Models” – and an Appendix, which includes a “Glossary of Cultural Concepts of Distress.” Section III includes a chapter on cultural formulation, featuring an updated version of the outline introduced in DSM-IV as well as an approach to assessment, using the Cultural Formulation Interview (CFI). The chapter also includes a section discussing “Cultural Concepts of Distress” (pp. 758–759).

As Lewis-Fernández explained, the notion of “culture-bound syndromes” has been replaced by three concepts: (1) cultural syndromes: “clusters of symptoms and attributions that tend to co-occur among individuals in specific cultural groups, communities, or contexts . . . that are recognized locally as coherent patterns of experience” (p. 758); (2) cultural idioms of distress: “ways of expressing distress that may not involve specific symptoms or syndromes, but that provide collective, shared ways of experiencing and talking about personal or social concerns” (p. 758); and (3) cultural explanations of distress or perceived causes: “labels, attributions, or features of an explanatory model that indicate culturally recognized meaning or etiology for symptoms, illness, or distress” (p. 758).

Lewis-Fernández used depression as an example of a cultural concept. For western clinicians, major depressive disorder (MDD) can be considered a “syndrome,” or cluster of symptoms that appear to “hang together.” But depression can also be considered an “idiom of distress,” in the sense that westerners commonly talk of feeling depressed in everyday life. Finally, the label depression can imbue a set of behaviors with a particular meaning. No single concept maps onto a specific psychiatric disorder, and, conversely, no single psychiatric disorder (e.g., MDD) maps onto a cultural concept (e.g., nervios). In all, the glossary lists nine of  “the best-studied concepts of distress around the world” – ataque de nervios (‘attack of nerves’), dhat syndrome (‘semen loss’), khyâl cap (‘wind attack’), kufingisisa (‘thinking too much’), maladi moun (lit. ‘human caused illness’), nervios (‘nerves’), shenjing shuairuo (re-glossed as ‘weakness of the nervous system’), susto (‘fright’), and taijin kyofusho (‘interpersonal fear disorder’).

In practice, according to Lewis-Fernández, “each illness has to be assessed in its own right” and both the practitioner’s expertise and epistemological assumptions and the individual’s understanding of the illness should apply. That is, the clinician must not only draw from diagnostic experience, available categories of illness, and the various dimensions along which aspects of the illness may range, but also recognize and try to understand each individual’s anomalous experience. Furthermore, he said that nosology “has to be constantly evolving” due to “cultural variation over time in the way that psychopathological experiences are constructed.” But the information provided throughout DSM-5, and particularly in the cultural formulation chapter should help practitioners avoid misdiagnosis, obtain clinically useful information, improve clinical rapport and therapeutic efficacy, guide research, and clarify cultural epidemiology.

Lewis-Fernández sketched the structure of the Cultural Formulation Interview (CFI), which is also included in Section III. The CFI is a semi-structured interview composed of 16 questions that focuses on individual experience and social context (the objective is to assess cultural factors using a person-centered approach). The text is divided into two columns, with questions on the right and instructions on the left. Two versions are available, one for the individual and one for an informant, such as a family member or caregiver. (The interviews are available online at psychiatry.org/dsm5.) There are also 12 Supplementary Modules to the CFI, which provide additional questions to flesh out domains assessed briefly in the 16-item CFI (e.g., cultural identity) as well as questions that can be used during the cultural assessment of particular groups, such as children and adolescents, older adults, immigrants and refugees, and caregivers.

Lewis-Fernández also described how the glossary works using ataque de nervios as an example. Briefly, ataque is a syndrome characterized by “intense emotional upset, including acute anxiety, anger, or grief; screaming and shouting uncontrollably; attacks of crying; trembling; heat in the chest rising into the head; and becoming verbally and physically aggressive,” or otherwise feeling out of control (p. 833). (Ataque, like depression, also qualifies as an idiom of distress and an explanation.) The entry in the glossary cross-references related conditions in other cultural contexts and in the main text of DSM-5 (e.g., panic disorder). Conversely, a section in the entry under “panic disorder” in Section II of the volume (“Culture-Related Diagnostic Issues,” pp. 211–212) describes ataque and refers the reader to the glossary. In this way, clinicians are alerted to culture-related features of DSM prototypes in the main text and in more detail in the glossary. The cross-referencing, absent in DSM-IV, should enhance the ability of the clinician to diagnose syndromes in an appropriate cultural context.

In closing, Lewis-Fernández said that further research must continue to improve the international applicability of DSM by exploring the range of cultural variation (such as the nine examples provided in the glossary) and making revisions. The objective is that DSM-5 and subsequent versions reflect a more inclusive description of the range of psychopathology across the globe, not just the particular constructs or exemplars most commonly encountered in the US, Western Europe, and Canada.

In the next talk, psychiatrist-anthropologist Devon Hinton (Harvard Medical School) discussed the glossary in more detail, using khyâl cup (‘wind attack’) as an example. He began by saying that the purpose of the “thick, more detailed” descriptions in the glossary is to increase the effectiveness of assessment by encouraging greater consideration of cultural concepts of distress and their role in understanding how something akin to, e.g., “panic disorder” might be expressed, understood, and treated in particular settings. For instance, he continued, work on khyâl indicates that an episode can generate catastrophic cognitions about panic attack symptoms that create pernicious feedback loops, which have to be addressed. (Similarly, the dissociation frequently experienced during an initial ataque may lead to more dissociative episodes in response to stress.) The entries in the glossary “are not just distractions but key parts of local ontologies that need to be evaluated.” In other words, thinking through the three concepts or dimensions (cultural syndrome, cultural idiom of distress, and cultural explanation) is clinically useful for a “rich” diagnosis (Parnas & Gallagher, forthcoming).

A khyâl attack is a syndrome found among Cambodians. Symptoms include palpitations, dizziness, shortness of breath, and neck soreness, the triggers for which might be worry, fright, standing up, riding in a car, or going into a crowded area. The attack also includes catastrophic cognitions related to the symptoms that create pernicious loops (fear of the symptoms amplifies the symptoms and consequently the fear). The point, according to Hinton, is that khyâl attacks are not just labels; more generally, cultural syndromes are “key ways in which realities (the body, social worlds) are experienced, and they profoundly shape how anxiety and other disorders play out in particular contexts.”

It is important to note that these attacks include other co-occurring symptoms that “you don’t usually see in Americans with panic attacks, or we don’t ask about at least, such as soreness of the joints, neck soreness, tinnitus, and also headache and a feeling of being out of energy.” In part this is because, according to the Cambodian understanding of the physiology underlying an attack, khyâl (a windlike substance that flows along with blood throughout the body) is suddenly flowing up toward the heart, lungs, and neck. The lack of downward flow of khyâl and blood causes hands and feet to grow cold, and possibly stroke; and as the khyâl and blood flow upward, they may potentially stop the heart or burst the neck vessels before the khyâl exits from ears or eyes (which causes the related tinnitus or blurry vision). A khyâl attack can be mild, moderate, or severe. Degree of severity is determined during the course of treatment, typically coining (the streaks can range from light red to a more serious dark purple). The coining is also a way to remove blockages and restore the flow of khyâl and blood; it can create a warming effect, which is considered curative because it means khyâl is travelling out through the streaks left by the edge of the coin on the skin.

Hinton’s final point was that every symptom that clinicians might associate with an anxiety attack is “read according to the local ethnophysiology of khyâl.” As one example, fear of khyâl overload makes Cambodians hyper-vigilant to any sensation they may feel on standing, especially if they haven’t slept at night or haven’t been eating well, he added, “so you can see how these panic cycles can happen.”

******

One comment at the close of the session by cultural psychiatrist Laurence Kirmayer particularly resonates: The DSM-5’s cultural revisions challenge “the fundamental logic of psychiatric nosology”– i.e., “describing problems located inside peoples’ heads” – which is at odds not only with the fact that “when we start talking about languages and suffering . . . we are embedded in social networks and interpersonal relations and local worlds,” but with new work in social and cultural neuroscience and social genomics that illuminates how social factors, like childhood adversity, social isolation, migration, and stigma, affect mental health and illness.

The cultural aspect of DSM-5 signifies a richer diagnosis for people “living under the description of” a psychiatric disorder, in the words of Emily Martin. And, as Roberto Lewis-Fernández and Devon Hinton’s work on ataque de nervios and khyâl has shown, identifying the right cluster has major implications in terms of helping to elucidate the complex interactions of mechanisms  – physiological, psychological, and social – and their various feedback loops.

3×5: Culture, Neuroscience, and Psychiatry Schizophrenia Roundup

Many thanks (seriously) to Nev Jones for sending so many great suggestions my way.

Culture/Environment
1. Variation – among individuals, geographically,  and across cultures – in the incidence, precedence, and course of schizophrenia is more complex than previously suggested by three WHO studies (on a putatively better outcome in “developing” vs. “developed” countries). For example, regional data from the Worldwide-Schizophrenia Outpatient Health Outcomes or W-SOHO study suggest a better clinical outcome but a worse functional outcome in regions other than “North Europe” (See, e.g., Haro et al’s “Cross-national clinical and functional remission rates.”)

Studies also continue to support variation within geographical region, e.g., Kirkbride et al’s PLOS One systematic review, “Incidence of schizophrenia and other psychoses in England, 1950–2009,” which describes, in particular, higher rates among “migrants and their descendants of black Caribbean and black African origin” and among those of “mixed ethnicity,” which the authors suggest may be a possible marker of “third-generation descendants.” Urban birth/upbringing also remains a significant risk factor, “independent of differences in the age, sex and ethnic population structure of different geographical areas, and correlated to a number of socio-environmental factors including ethnic density, social cohesion, social fragmentation, deprivation, and inequality.”

2. Early Adversity: A 3/29/12 meta-analysis published online by Jim van Os et al. supports the link between childhood adversity and risk of psychosis.  “Childhood adversities increase the risk of psychosis: A meta-analysis of patient-control, prospective- and cross-sectional cohort studies.” The addition of cannabis use appears to increase risk even further (Konings et al., 2012). But see also Susser and Widom’s July 2012 critique of such studies, “Still searching for lost truths about the bitter sorrows of childhood.

3. Diagnosis and Social Abandonment: In “Psychosis and the fog of reality,” Vaughan Bell of Mind Hacks has provided pdfs of two articles by journalist Rachel Aviv: “God knows where I am: What should happen when patients reject their diagnosis?” in the 5/30/11 New Yorker and “Which way madness lies: Can psychosis be prevented?” in the 12/10 issue of Harper’s. See also David Dobbs’s post, “What’s it like to be schizophrenic” and Jocelyn Marrow and Tanya Luhrmann’s recent paper for Culture, Medicine, and Psychiatry (CMP) on social abandonment in India and the US. And finally, Schomerus et al’s (2012) bleak conclusion of their meta-analysis that “Increasing public understanding of the biological correlates of mental illness seems not to result in better social acceptance of persons with mental illness.”

4. Cognition/Anthropology of Neuroscience: Elizabeth Bromley, Gail Fox Adams, and John Brekke’s “A video ethnography approach for linking naturalistic behaviors to research constructs of neurocognition in schizophrenia” in The Journal of Neuropsychiatry and Clinical Neuroscience (3/1/12). See also Bromley’s exploration of researchers’ understanding of the concept of “cognition” as it applies to schizophrenia in “The Texture of the Real” (CMP, 2012).

5. First-person Experience: The blog Ruminations on Madness, provides, as always, some much-need insight on philosophy, psychiatry, and first-person experience. In “Excerpts from the journals of E” the author provides us with the fragments of a brilliant philosophy student’s trajectory following his first episode of  psychosis.

The blog itself testifies to the more complex view that “schizophrenia” covers a range of conditions, capacities, and behaviors, that outcomes are as diverse as the people to whom the label is attached, and that living with the disorder offers in itself an important research perspective. The blog is an opportunity for significant advocacy, in regard to which, addressing anthropologists, psychiatrists, psychologists, and others in the mental health field in Berlin last year, Arthur Kleinman said,

We have all failed in a way that our brothers and sisters and cousins in the AIDS community have not failed. If you went back twenty years, you would see that everything I’ve said about the chronically mentally ill you could say about AIDS patients. And in twenty years the situation for AIDS patients has radically changed. There has been enormous efficacy from advocacy in the AIDS field. We have failed in the area of advocacy. And what I want to suggest is that in the future those of who who build your careers here: Advocacy will be part of your careers. Rather than seeing advocacy as a threat to academic life, you’re going to come to see advocacy as central to the new academy in the future.”

Neuroscience

See also Ford & Mathalon’s (2012) review, “Neurobiology of schizophrenia: Search for the elusive correlation with symptoms” in Frontiers.

1. Epigenetics: Steven Hyman, “Target practice: HDAC inhibitors for schizophrenia,” in News and Views / Nature Neuroscience published online 8/28/12 re Kurita et al. on targeting epigenetic changes that occur with the use of antipsychotics.

2. Vulnerability: Jim van Os and Richard Linscott’s introduction to a special issue of Schizophrenia Bulletin,The extended psychosis phenotype – Relationship with schizophrenia and with ultrahigh risk status for psychosis.

3. More Gene x Environment: Book review of The Origins of Schizophrenia, edited by Alan Brown and Paul Patterson. (Reviewed by Michael Owen, MRC Centre for Neuropsychiatric Genetics and Genomics, and Neuroscience and Mental Health Research Institute, Cardiff University.)

4. Schizophrenia and Autism: Kong et al’s 8/23/11 Nature paper, “Rate of de novo mutations and the importance of father’s age to disease risk.

5. Auditory Hallucinations: A series of related papers featured in July 2012 Schizophrenia Bulletin prepared by members of the International Consortium on Hallucination Research [InCoHR] working groups.

Psychiatry/DSM-5

1. DSM-5: Randy Tanon and William Carpenter’s, DSM-5 Status of Psychotic Disorders: 1 Year Prepublication” dd. 4/13/12 in Schizophrenia Bulletin provides a “snapshot of current status of potential changes” in DSM-5 regarding psychotic disorders. The proposed revisions include a “schizophrenia spectrum concept (which would include the attenuated psychosis syndrome listed in Section III – see [4] below). Also, the subtypes of SZ will be dropped in favor of eight or nine possible “dimensional ratings of different psychopathology domains,” including hallucinations, delusions, disorganized speech, abnormal psychomotor behavior, negative symptoms, impaired cognition, depression, and mana. (NB: “Catatonia, formerly a subtype, will now be listed as a “specifier for psychotic disorders, mood disorders, and general medical disorders.”) The authors note that “the issue of how many dimensions are useful, reliably assessed, necessary, and practical remains an open question.”

2. Diagnostic labels: Ruminations on Madness (“In defense of the schizophrenia construct (?)” ) argues that labels can obscure differences between persons and kinds of experiences, but is

less sure … that the advantages of more dimensional or non-label-based approaches outweigh the potential benefits—benefits, specifically, in the domain of identity. Like most sociopolitical minority group labels (Latino or Autistic, for example), “schizophrenic” cuts an arguably over-wide swathe and yet clearly marks something that, for cultural, historical and individual reasons, is shared between individuals and provides a (potentially vital) sense of collective ‘being’ and cohesion. [To make this a little more personal, and to repeat something that I believe I’ve said many times in earlier posts,  I do not think I would be alive today were it not for the deep and sustaining sense of recognition and belonging I found early on in Louis Sass’ brilliant work on schizophrenia.]

3.  Attenuated Psychosis Syndrome (Proposed for Section III of the DSM-5) (Revised April 27, 2012): Because of reliability issues (according to Tanon and Carpenter validity is “fairly established), “this condition is being recommended for further study in Section III, which is the section of the DSM-5 text in which conditions that require further research will be included.”

4. A good prior discussion/debate by Carpenter and Jim van Os, “Should attenuated psychosis syndrome be a DSM-5 diagnosis?” in  Am J Psychiatry 2011, and also a recent review, “A Rose is a Rose is a Rose,” But At-Risk Criteria Differ” by Schultze-Lutter et al. of University Hospital of Child and Adolescence Psychiatry (Bern) and Department of Psychiatry and Psychotherapy (Cologne).

5. William Carpenter’s “The future of schizophrenia pharmacotherapeutics: Not so bleak” in response to Chattaranjan Andrade, Rajiv Radhakrishnan, and Praveen Fernandes, “Psychopharmacology of schizophrenia: The future looks bleak,” in Mens Sana (2012). One question he raises is how reconceptualization of schizophrenia as a multi-dimensional construct will affect drug development?

See also the following (non-psychosis specific):

3×5: Culture, Neuroscience, and Psychiatry Weekly Roundup: Empathy (August 6)

UPDATE: New links from Lori Hogenkamp via Facebook at end of post.

Brief note: I’ve come to realize that empathy (and its putative component processes – mirror neuron networks, affect sharing, mentalizing) brings out almost everything that’s problematic in social neuroscience research: problems of a conceptually vague cover term, problems with extrapolating from animal models (e.g., monkeys don’t imitate); problems with fMRI/ROI, problems with science writing for the public (e.g., this publisher blurb for Marco Iacoboni’s Mirroring People: “From imitation to morality, from learning to addiction, from political affiliations to consumer choices, mirror neurons seem to have properties that are relevant to all these aspects of social cognition”), problems with a too-powerful metaphor (err, the mirror) that’s hard to repack in the box after that last quote :( problems with extrapolating in other ways (see Emily Willingham’s post on what she describes as the “no empathy in autism meme” – as Ian Hacking said, “The history of late 20th century medicine will … also [be] a history of advocacy groups”), etc., etc.

On second thought, there are many positive implications that hover over all this work – for theory of mind, radical embodied cognition, network science approaches to the brain’s structural and functional connectivity  . . .

Many thanks to the Neuroanthropology Interest Group on Facebook for suggestions and Center for Building a Culture of Empathy and Compassion for inspiration! 

Culture

1. “Empathy as cultural process: Insights from the cultural neuroscience of empathy” by Bobby Cheon, Vani Mathur, and Joan Chiao (WCPRR, 2010).

2. Via Eugene Raikhel (Neuroanthropology Interest Group): See the just-published special issue of “Science in Context” on “The Varieties of Empathy in Science, Art, and History.” It includes an article by Shaun Gallagher (“Empathy, Simulation, and Narrative“), one by Allan Young (“The Social Brain and the Myth of Empathy“) and a number of others.

3. Roundup on “Anthropology, Teaching, and Empathy” in early 2012 by Jason Antrosio of Anthropology Report and a related post by Rex on Savage Minds, “Empathy, or, seeing from within.”

4. Hollan, D. C., & Throop, C. J. (2011). The anthropology of empathy: Experiencing the lives of others in Pacific societies. New York: Berghahn.

5. Blog post by Emily Willingham (Dec 2011): “Autistic people: Insensitive to social reputation, sure, but what about empathy?” on the website Autism and Empathy.

Neuroscience

1. Bernhardt, B. C., & Singer, T. (2012). The neural basis of empathy. Annual Review of Neuroscience, 35, 1–23.

2. Decety, J. Norman, G. J., Berntson, G. G., & Cacioppo, J. T. (2012). A neurobehavioral evolutionary perspective on the mechanisms underlying empathy. Progress in Neurobiology, 98(1), 38–48. See also, Decety, J. (2011b). The neuroevolution of empathyAnnals of the New York Academy of Sciences, 1231, 35–45.

3. Zaki, J., & Ochsner, K. N. (2012). The neuroscience of empathy: Progress, pitfalls and promiseNature Neuroscience: Focus on Social Neuroscience [Perspective], 15(5), 675–680.

4. Decety, J. (2011a). Dissecting the neural mechanisms mediating empathy. Emotion Review, 3,92–108. See also, Decety, J. (2010). To what extent is the experience of empathy mediated by shared neural circuits? Emotion Review, 2(3), 204–207.

5. “Empathy and pro-social behavior in rats” Inbal Ben-Ami Bartal, Jean Decety, and Peggy Mason. See also 2011 Science paper by same group.

 

Psychiatry

1. Cheng, Y., Hung, A., & Decety, J. (2012). Dissociation between affective sharing and emotion understanding in juvenile psychopathsDevelopment and Psychopathology, 24, 623–636.

[From Abstract]. . . youth with HCU [high callous-unemotional traits] exhibit atypical neural dynamics of pain empathy processing in the early stage of affective arousal, which is coupled with their relative insensitivity to actual pain. Their capacity to understand intentionality, however, was not affected. Such uncoupling between affective arousal and emotion understanding may contribute to instigating aggressive behaviors in juvenile psychopaths.

[From the paper] It is  important that the affective arousal deficit . . . cannot be explained by a lack of sensorimotor resonance [i.e., mirror neurons], as measured by mu wave suppression [this was an ERP study], which was present in a ll participants. This finding indicates that affective arousal is not mediated by the mirror neuron system.

2. “Empathy and alterity in cultural psychiatry” by Laurence Kirmayer (Ethos, 2008).

3. “Empathy and otherness: Humanistic and phenomenological approaches to psychotherapy of severe mental illness” by Elizabeth Pienkos and Louis Sass (Pragmatic Case Studies in Psychotherapy, 2012).

4. Empathy in mental illness edited by Tom Farrow and Peter Woodruff (CUP, 2007).

5. “Zero degrees of empathy” by Simon Baron-Cohen, covering disorders of empathy (borderline personality disorder, psychopathy, narcissism) and genetic, endocrine, and social influences.

UPDATE:

Toward an Anthropological Theory of Mind (AToM): Selves (Part 2)

Last month a small, international gathering of twenty-seven anthropologists and psychologists took place at the Stanford Humanities Center, organized by Stanford anthropology professor Tanya Luhrmann and Culture and Mind postdoctoral fellows Julia Cassaniti, and Jocelyn Marrow, with financial support from the Robert Lemelson Foundation. (See end of post for full list of participants; a summary of the session on “interiority and boundedness available here.)

The session on “selves” in many ways revisited some classic questions in psychological anthropology: “To what extent are selves culturally constituted? If selves are only partially constituted by culture, what other factors play a part in their makeup? Are those other factors – social, biopsychological, etc. – universal in nature?”

The difference is that the questions Doug Hollan (1992) and others before him asked may not have been answerable then. But new work emerging from anthropology, psychology, and the social cognitive, cultural, and critical neuroscience research programs is beginning to elucidate the different perceptions and mechanisms underlying the self, both stable individual differences as well as the idea of self as a (neuro-)cultural “product and process,” in either case, with the beneficial effect of “markedly expanding the range of the normal” (Markus & Kitayama, 2010).

In the first talk, Stanford social psychologist Hazel Markus whose work often focuses on comparisons of people living in North America and East Asia, discussed cultures and selves. She defined the self as “a person’s ongoing sense of himself or herself. It’s the “me” at the center of experience, and it’s a continually developing sense of awareness and agency that guides action and takes shape as the individual, both brain and body, becomes attuned to the various environments [he or she] inhabits.” She described selves as “implicitly and explicitly at work in all aspects of behavior – perception, cognition, emotion, motivation, relationships, group processes.”

We don’t have “one self,” but multiple selves attuned to different social and cultural contexts (some of which cultural neuroscientists like Daphne Oyserman have found can be easily “primed” or elicited in experimental settings). The one that is “on” operates as the foundational schema, she said, “which organizes more specific schemas.” Since at least Geertz (1974/1984), we’ve known that the particular, western conception of the self as “bounded, unique” is “a rather peculiar idea within the context of the world’s cultures,” but despite our best efforts, she continued, “I would say that the social sciences as a whole have made virtually no progress” in trying to “animate any other conception of mind” because the current, bounded, interior one, a product of our particular philosophy and history, “is so built into our cultures and science.” Behavioral neuroscience, in particular, has focused on an unrepresentative sample of “WEIRD” (i.e., western, educated, industrialized, rich, democratic) subjects (Henrich, 2010). The project for psychologists and anthropologists is to minimize our differences, with the understanding that “minds can be and are differently formed, and when they are . . . those different theories . . . matter for everything a person does.”

Hazel also mentioned that neuroscientists across subdisciplines (interested in, e.g., the effects of stress) share the same names for common units of analysis, like the HPA axis, suggesting a similar kind of agreement might help our theorizing about what is a self in socio-cultural contexts. For a start, she described the different theories of agency that come up in different contexts – e.g., the independent vs. interdependent model of self. (This model has been robustly supported by experimental evidence in cultural neuroscience with respect to even basic processes like visual perception; see Goh & Park, 2010.) She suggested focusing on identifying some key dimensions of the non-western models of mind, such as how interior or bounded the self is, which would go hand in hand with the independent vs. interdependent model of agency.

For example, feelings predict physical and mental health in cultures like the US that are organized around an independent model, whereas among the Japanese, who have significantly more negative feelings about themselves than Americans do, feelings are not predictive of health and wellbeing (but, interestingly, “level of relational harmony” is; see Kitayama, Karasawa, Curhan, Ryff, & Markus, 2010). This is not just an East/West dichotomy; Hazel said she’s seen very similar patterns of data – such as more holistic processing – among working-class Americans and more independent patterns among people living in northern Japan.

In the discussion that followed, Allen Tran was reminded of Heather Spector Hallman’s research on Japanese friendship among adolescents, for whom good friends are those who point out one’s faults (Hallman, 2011). The purpose of self and other criticism is to point out ways to improve, Hazel said. Allen asked Hazel to describe the differences in how negative affect is internalized in Japan vs. the West, which led to some interesting questions regarding feelings and health and wellbeing, at some (physiological) level does negative affect appear the same for both American and Japanese populations?

The next talk by Stanford Culture and Mind postdoctoral fellow Jocelyn Marrow, which was based on her 2001–2004 ethnographic research in Varanasi (North India) on emotional and psychiatric distress, discussed “how the specific theory of mind and self changes the appropriateness of emotional expressiveness throughout the life course.” Previous work on hierarchy, self and interpersonal relationships in India has found that, as persons become elder and more socially powerful, they experience themselves as more independent.  Jocelyn was particularly interested in the perceptions of women (and other family members) living with mental disorder regarding their experience of psychosocial interventions at public Indian psychiatric clinics. Patients and family members described the professionals’ psychosocial interventions at the clinic as “being made to understand” or exhorted regarding how to manage difficult family situations. Jocelyn said that “she quickly learned that samjhaana (‘making others understand’) was a cultural trope pertaining to many aspects of life. She said that samjhaana was a lifelong process of “empathy socialization undertaken by persons in positions of authority on behalf of their dependents and subordinates.” Those higher up in family, work, religious, and social hierarchies, who are perceived as embodying the best qualities (more wise, more perfect, closer to God than those below, which according to Indian ethnopsychology can permeate to others via touch, speech, glances, gestures,etc.) have a duty to socialize junior members “to attend to the demands, instructions, inclinations, and desires” of their seniors. (This most often concerns making juniors aware of their own impact on others’ wellbeing.)

Jocelyn then described an interesting asymmetry: “Hierarchical juniors were expected to shoulder the labor of understanding the minds and hearts of their superiors, while seniors had no equivalent responsibility to interpret the minds and hearts of their juniors from the immediate context” of juniors’ words and deeds. The different temporal dimensions were particularly interesting, i.e., although seniors bear “heavy responsibility” for juniors’ wellbeing in a general sense over the latters’ life courses, they privilege their own sense of what is best for juniors, rather than focusing on fulfilling juniors’ expressed wishes.   Ideally, seniors behave benevolently paternalistic towards their charges. Juniors’ transgressions, on the other hand, may be perceived as the fault of their elders.

In response to a question from Joel Robbins (“What happen when the junior has more knowledge or experience than the elder?”) Jocelyn clarified that her model related more to moral behavior than to expertise in certain areas (like driving or computers). Julia Cassaniti wondered what happened if elders gave bad advice. Tanya mentioned the work of Bambi Chapin who suggested that “the seniors failure to understand, failure to respond to the demands of the juniors” may have contributed to the civil war in Sri Lanka. Jocelyn said bad advice might lead to anger that an elder misled them or failed to take care of them. Another participant wondered if family therapy was much more prevalent than individual therapy. Jocelyn said yes, but she also said – and this may not be typical for other parts of India – there was a strong sense among the therapists that certain patients were being mistreated and that the therapists needed to modify things in the family environment. Another common intervention was to bring in an outside senior to make a senior in the family understand what they were doing was wrong.

Tanya asked Jocelyn if the general situation she described represented an asymmetry of mind reading? Jocelyn said, yes, a close mind reading of one’s elders helps juniors become better people. Tanya asked if the asymmetry resonated with any other features of social life. Jocelyn said the psychiatrists in psychosocial interventions “sort of insert themselves as an über-family elder.” The same asymmetry is prevalent in work environments: the boss’s personality comes to pervade the organization. A participant wondered if there were another piece to the dialogue. If a father criticized a son, for example, the son might (appropriately) respond to the father that he hadn’t been guided properly. Joel suggested the son can say or think that, but he would also bear the responsibility of following his father’s guidance. Hazel Markus felt social scientists, who may automatically assume an independent view of self, “haven’t taken seriously how important hierarchy is in organizing so much of the world, in organizing so much of (people’s) thinking, feeling, acting, and perceiving.”  She felt that Jocelyn’s data and observations, showing the positive consequences of hierarchical arrangements, are “really powerful.” (Jocelyn’s talk also reminded me of an interesting, recent face-processing study on the “boss effect” in American and Chinese graduate students by Liew, Ma, Han, & Aziz-Zadeh [2011], which offers some initial evidence for how deeply ingrained our perceptions of social hierarchy and social status are.)

In the final talk of the session, University of Chicago linguistic anthropologist John Lucy discussed his research on the relation between language and thought from a developmental perspective, particularly how individual languages might affect speaking and thinking in distinctive ways (which happens around middle childhood starting around age 8). The language patterns that we see in very young children are in place long before the associated cognitive patterns develop during middle childhood, i.e., overall this is a lengthy process. There are interesting costs and gains in middle childhood, he said. The costs are “that we begin to lock in our accent,” for example, another higher order feature (vis-à-vis the previous discussion) that is “quite durable and resistant to transformation.”  There is also a “deeper . . . engagement with the surrounding reality. It’s as if the language code has had a certain amount of autonomy and now begins to systematically connect to the presuppositions of a culture” as part of a process that is more a reorganization of the system than the incorporation of something new. He said that there are substantial gains at this time: the ability to narrate or to interact discursively in an appropriate manner with other people in the community, for example. He also said that some of the constructs  – language, culture, mind, self – are actually products of middle childhood, that is, “they are formal developments around which some of this reorganization is taking place.” (Thus, ToM means different things at different ages.)

The rest of the talk focused on where some of this reorganization is occurring, which he suggested can be located in the deictic system, which, through the use of pronouns, tense markers, demonstratives this, that, etc., maps the speaker’s utterance onto the external world and which develops over childhood in order to handle a more abstract perspective about oneself in relation to others as well as to cross-link to other contexts. He described four broad types: (1) deictic forms that tell us something about the participants in the interaction; (2) a set that tells us about events, (3) a set that tells us about the speaker’s stance on what’s happening, and (4) a set that tells us about the relation of this event to other events. Referring to a handout of a story about a schoolyard fight narrated by a ten-year-old girl, he pointed out elements in the somewhat chaotic nature of the storytelling that were typical for that age. He then pointed out all the features that don’t occur in younger children’s narratives, including how the narrator was able to embed dialogue in the story, as well as many culturally shaped ideas about social status, rights and privileges, etc. By simply watching how children talk about things in nonexperimental settings, he said, it’s possible to see how narrative skills, interaction skills, and cultural knowledge, and self are built into the apparatus, in one way or another. In view of all this, one final point he made in his position paper is the ease with which we project intentional mental states onto animals or children and, at the same time, the difficulty we have attributing mental states, “or at least good ones, to those from other cultures, who speak other languages [especially those that are structurally quite different, e.g., no overt tense markers], or who suffer from some communicative incapacity.” “[N]otice again,” he wrote, “how essentially social differences are construed psychologically, as deficiencies of self.”

Regarding John’s method of focusing on children’s speech in naturalistic settings (how grammatical and linguistic information is “interpenetrated” with pragmatic conventions related to the perceived needs of a specific listener, or “recipient design”), NYU linguistic anthropologist Bambi Schieffelin suggested also looking at things like clarifications, self repair, other-initiated repair, etc. Strategies for those instances in which something is not making sense to the listener may reveal significant cultural differences. John agreed that somewhere between experiments designed to reveal some feature that’s hidden and metatheories about where mind is located in the body, “there’s this other sphere which is both public and visible on the one hand and yet not necessarily consciously reflective. . . . And I think it would be a useful place to tie the two traditions together. ”

A question about translation turned the focus of the discussion to the more general issue of how minds interact on a nonverbal as well as verbal basis. In general, as one participant observed, very little is known about the mechanisms that mediate social interaction. Hazel Markus related the lack of theorizing about intersubjectivity to our cultural ideas of self and mind (independent, interior, bounded). John Lucy said our (over-psychologized) ToM is a solution to a problem of social coordination that tries to solve it without reference to social coordination. Tanya noted a possible generalization: in some cultures oriented toward an interdependent view of self (like Japan), social coordination is achieved via heightened mind-reading, whereas in other cultures, like that of the Urapmin, coordination is achieved via nonverbal acts like the social exchange of objects. Joel said that what counts as social coordination differs in different places. The Urapmin will put up with all kinds of misfires, even across hierarchies; despite the gift exchange, there is a lot of tolerance for lack of or less coordination without dissecting the underlying intention (the same verb means “to lie” and “to be wrong”). Social coordination includes the different ways in which we physically interact with each other, as Julia pointed out. (People may be less verbally attuned to one another.) Another participant asked Joel whether conversations among the Urapmin ever look chaotic, particularly when – Joel continued the thought – you can’t ask a speaker what she means? Another question, do we (especially “WEIRD” Americans with an independent view of self [Henrich, 2010]) misrepresent in the other direction, by focusing on the capacity for mind-reading? Aparecida Vilaça (Museu Nacional/Universidade Federal do Rio de Janeiro), with reference to Roy Wagner (1975/1981), observed that it depends on what the culture “creates as innate.” For westerners, “the innate is individualities” and action is focused on what one needs to coordinate or regulate. For other cultures, the “innate” is relationships and action is focused on differentiating, on improvisation.

Turning to John’s suggestion that ToM is a solution to a problem of social coordination, Julia asked what happens if it is not culturally expected that communication should always work, then the definition of the problem should also be different. The theories of mind that develop in different cultures may be solutions to the different ways in which we create sociality. Even our tacit concepts of time and the strength of our attachment to controlling understanding differ, another participant observed, which brings me back to the Markus and Kitayama paper: the mutual constitution of cultures and selves is as much a biological as a social (and psychological) issue. This is particularly evident in the direction of work by Hazel Markus, Shinobu Kitayama, Georg Northoff, Shihui Han, Joan Chiao, and others (see, e.g., Markus & Kitayama, 2010; Northoff, Qin, & Feinbert, 2011; Chiao , 2010, and Han & Northoff, 2008), presaging more collaboration incorporating the critical insights that anthropologists bring to bear on the culture–biology interface in the not-too-distant future

References

Chiao, J., Harada, T., Komeda, H., Li, Z., Mano, Y. Saito, D., . . . Iidaka, T. (2010). Dynamic cultural influences on neural representations of the self. Journal of Cognitive Neuroscience, 22(1), 1–11. doi: 10.1162/jocn.2009.21192

ABSTRACT: People living in multicultural environments often encounter situations which require them to acquire different cultural schemas and to switch between these cultural schemas depending on their immediate sociocultural context. Prior behavioral studies show that priming cultural schemas reliably impacts mental processes and behavior underlying self-concept. However, less well understood is whether or not cultural priming affects neurobiological mechanisms underlying the self. Here we examined whether priming cultural values of individualism and collectivism in bicultural individuals affects neural activity in cortical midline structures underlying self-relevant processes using functional magnetic resonance imaging. Biculturals primed with individualistic values showed increased activation within medial prefrontal cortex (MPFC) and posterior cingulate cortex (PCC) during general relative to contextual self-judgments, whereas biculturals primed with collectivistic values showed increased response within MPFC and PCC during contextual relative to general self-judgments. Moreover, degree of cultural priming was positively correlated with degree of MPFC and PCC activity during culturally congruent self-judgments. These findings illustrate the dynamic influence of culture on neural representations underlying the self and, more broadly, suggest a neurobiological basis by which people acculturate to novel environments.

Geertz, C. (1984). “From the native’s point of view”: On the nature of anthropological understanding. In R. A. Shweder & R. A. LeVine (Eds.), Culture theory: Essays on mind, self, and emotion (pp. 123–136). New York: Cambridge University Press. Original work published 1974.

Hallman, H. (2011). Lure of the intimate: Power practices in Japanese adolescent friendship (Doctoral dissertation). Retrieved October 19, 2011, from Dissertations & Theses @ University of California. (Publication No. AAT 3465785).

Goh, J. O, & Park, D. C. (2009). Culture sculpts the perceptual brain. Progress in Brain Research, 178, 95–111. doi:10.1016/S0079-6123(09)17807-X

ABSTRACT: Cultural differences in the way Westerners and East Asians perceive and attend to visual objects and contexts have now been shown across many behavioral studies. Westerners display more attention to objects and their features, in line with an analytic processing style, whereas East Asians attend more to contextual relationship, reflecting holistic processing. In this article, we review these behavioral differences and relate them to neuroimaging studies that show the impact of cultural differences even on ventral visual processing of objects and contexts. We additionally consider the evidence showing how extended experience within a culture via aging affects ventral visual function. We conclude that the brain findings are in agreement with the analytic/holistic dichotomy of Western and East Asian visual processing styles. Westerners engage greater object-processing activity while East Asians engage more context-processing activity in the ventral visual areas of the brain. Although such cultural imaging studies are still few, they provide important early evidence supporting the importance of cultural experiences in sculpting visual processing at the neural level.

Han, S., & Northoff, G.  (2008). Culture-sensitive neural substrates of human cognition: A transcultural neuroimaging approach. Nature Reviews Neuroscience, 9, 646–654.

ABSTRACT: Our brains and minds are shaped by our experiences, which mainly occur in the context of the culture in which we develop and live. Although psychologists have provided abundant evidence for diversity of human cognition and behaviour across cultures, the question of whether the neural correlates of human cognition are also culture-dependent is often not considered by neuroscientists. However, recent transcultural neuroimaging studies have demonstrated that one’s cultural background can influence the neural activity that underlies both high- and low-level cognitive functions. The findings provide a novel approach by which to distinguish culture-sensitive from culture-invariant neural mechanisms of human cognition.

Henrich, J., Heine, S.J., Norenzayan, A. (2010). The weirdest people in the world? Behavioral and Brain Sciences, 33(2–3), 61–83. doi:10.1017/S0140525X0999152X

ABSTRACT: Behavioral scientists routinely publish broad claims about human psychology and behavior in the world’s top journals based on samples drawn entirely from Western, Educated, Industrialized, Rich, and Democratic (WEIRD) societies. Researchers – often implicitly – assume that either there is little variation across human populations, or that these “standard subjects” are as representative of the species as any other population. Are these assumptions justified? Here, our review of the comparative database from across the behavioral sciences suggests both that there is substantial variability in experimental results across populations and that WEIRD subjects are particularly unusual compared with the rest of the species – frequent outliers. The domains reviewed include visual perception, fairness, cooperation, spatial reasoning, categorization and inferential induction, moral reasoning, reasoning styles, self-concepts and related motivations, and the heritability of IQ. The findings suggest that members of WEIRD societies, including young children, are among the least representative populations one could find for generalizing about humans. Many of these findings involve domains that are associated with fundamental aspects of psychology, motivation, and behavior – hence, there are no obvious a priori grounds for claiming that a particular behavioral phenomenon is universal based on sampling from a single subpopulation. Overall, these empirical patterns suggests that we need to be less cavalier in addressing questions of human nature on the basis of data drawn from this particularly thin, and rather unusual, slice of humanity. We close by proposing ways to structurally re-organize the behavioral sciences to best tackle these challenges.

Hollan, D. (1992). Cross-cultural differences in the self. Journal of Anthropological Research, 48(4), 283–300.

Kitayama, S., Karasawa, M., Curhan K. B., Ryff, C. D., & Markus, H. R. (DEC 02, 2010) Independence and interdependence predict health and wellbeing: Divergent patterns in the United States and Japan. Frontiers in Cultural Psychology, 1(163). doi: 10.3389/fpsyg.2010.00163

ABSTRACT: A cross-cultural survey was used to examine two hypotheses designed to link culture to wellbeing and health. The first hypothesis states that people are motivated toward prevalent cultural mandates of either independence (personal control) in the United States or interdependence (relational harmony) in Japan. As predicted, Americans with compromised personal control and Japanese with strained relationships reported high perceived constraint. The second hypothesis holds that people achieve wellbeing and health through actualizing the respective cultural mandates in their modes of being. As predicted, the strongest predictor of wellbeing and health was personal control in the United States, but the absence of relational strain in Japan. All analyses controlled for age, gender, educational attainment, and personality traits. The overall pattern of findings underscores culturally distinct pathways (independent versus interdependent) in achieving the positive life outcomes.

Liew, S. L., Ma, Y., Han, S., Aziz-Zadeh, L. (2011). Who’s afraid of the boss: Cultural differences in social hierarchies modulate self-face recognition in Chinese and Americans. PLoS ONE, 6, e16901. doi:10.1371/journal.pone.0016901

ABSTRACT: Human adults typically respond faster to their own face than to the faces of others. However, in Chinese participants, this self-face advantage is lost in the presence of one’s supervisor, and they respond faster to their supervisor’s face than to their own. While this “boss effect” suggests a strong modulation of self-processing in the presence of influential social superiors, the current study examined whether this effect was true across cultures. Given the wealth of literature on cultural differences between collectivist, interdependent versus individualistic, independent self-construals, we hypothesized that the boss effect might be weaker in independent than interdependent cultures. Twenty European American college students were asked to identify orientations of their own face or their supervisors’ face. We found that European Americans, unlike Chinese participants, did not show a “boss effect” and maintained the self-face advantage even in the presence of their supervisor’s face. Interestingly, however, their self-face advantage decreased as their ratings of their boss’s perceived social status increased, suggesting that self-processing in Americans is influenced more by one’s social status than by one’s hierarchical position as a social superior. In addition, when their boss’s face was presented with a labmate’s face, American participants responded faster to the boss’s face, indicating that the boss may represent general social dominance rather than a direct negative threat to oneself, in more independent cultures. Altogether, these results demonstrate a strong cultural modulation of self-processing in social contexts and suggest that the very concept of social positions, such as a boss, may hold markedly different meanings to the self across Western and East Asian cultures.

Markus, H. R., & Kitayama, S. (2010). Cultures and selves: A cycle of mutual constitution. Perspectives on Psychological Science, 5(4), 420–430. doi:10.1177/1745691610375557

ABSTRACT: The study of culture and self casts psychology’s understanding of the self, identity, or agency as central to the analysis and interpretation of behavior and demonstrates that cultures and selves define and build upon each other in an ongoing cycle of mutual constitution. In a selective review of theoretical and empirical work, we define self and what the self does, define culture and how it constitutes the self (and vice versa), define independence and interdependence and determine how they shape psychological functioning, and examine the continuing challenges and controversies in the study of culture and self. We propose that a self is the “me” at the center of experience—a continually developing sense of awareness and agency that guides actions and takes shape as the individual, both brain and body, becomes attuned to various environments. Selves incorporate the patterning of their various environments and thus confer particular and culture-specific form and function to the psychological processes they organize (e.g., attention, perception, cognition, emotion, motivation, interpersonal relationship, group). In turn, as selves engage with their sociocultural contexts, they reinforce and sometimes change the ideas, practices, and institutions of these environments.

Northoff, G., Qin, P., & Feinbert, T. E. (2011). Brain imaging of the self – Conceptual, anatomical and methodological issues. Consciousness and Cognition, 20(1), 52–63. doi:10.1016/j.concog.2010.09.011

ABSTRACT: In this paper we consider two major issues: conceptual-experimental approaches to the self, and the neuroanatomical substrate of the self. We distinguish content- and processed-based concepts of the self that entail different experimental strategies, and anatomically, we investigate the concept of midline structures in further detail and present a novel view on the anatomy of an integrated subcortical-cortical midline system. Presenting meta-analytic evidence, we show that the anterior paralimbic, e.g. midline, regions do indeed seem to be specific for self-specific stimuli. We conclude that future investigation of the self need to develop novel concepts that are more empirically plausible than those currently in use. Different concepts of self will require novel experimental designs that include, for example, the brain’s resting state activity as an independent variable. Modifications of both conceptual and anatomical dimensions will allow an empirically more plausible account of the relationship between brain and self.

Wagner, R. (1981).  The invention of culture (Rev. ed.). Chicago: University of Chicago Press.

List of Participants

Rita Astuti, Professor, Department of Anthropology, London School of Economics

Lera Boroditsky, Assistant Professor, Department of Psychology, Stanford University

Luke Butler, Graduate student, Psychology, Stanford University

Julia Cassaniti, Culture and Mind Postdoctoral Fellow, Anthropology, Stanford University

Eve Danziger, Associate Professor in Anthropology, University of Virginia

Suzanne Gaskins, Associate Professor of Psychology, Northeastern Illinois University

Dedre Gentner, Alice Gabrielle Twight Professor, Department of Psychology, Northwestern University

Kathyrn Geurts, Associate Professor of Anthropology, Hamline College

Alexa Hagerty, Graduate student, Anthropology, Stanford University

Douglas Hollan, Professor of Anthropology, University of California, Los Angeles

Graham Jones, Assistant Professor of Anthropology, Massachusetts Institute of Technology

Michelle Karnes, Assistant Professor in the Department of English, Stanford University

John Lucy, William Benton Professor Department of Comparative Human Development, Department of Psychology, University of Chicago

Tanya Luhrmann, Watkins University Professor in Anthropology (and Psychology, by courtesy) Stanford University

Ellen Markman, Lewis M. Terman Professor of Psychology, Stanford University

Hazel Markus, Davis-Brack Professor in the Behavioral Sciences, Stanford University, Department of Psychology

Giulia Mazza, Graduate student, Anthropology, Stanford University

Jocelyn Marrow, Culture and Mind Postdoctoral Fellow, Anthropology, Stanford University

Joel Robbins, Professor of Anthropology, University of California, San Diego

Barbara Rogoff, University of California, Santa Cruz Foundation Distinguished Professor of Psychology

Sonya Pritzker, Assistant Researcher and Clinical Specialist at the UCLA Center for East-West Medicine

Danilyn Rutherford, Associate Professor in Anthropology, University of California, Santa Cruz

Bambi Schieffelin, Collegiate Professor; Professor of Anthropology, New York University

Rupert Stasch, Associate Professor, University of California, San Diego

Allen Tran, Graduate Student, Anthropology, University of  California, San Diego

Jason Throop, Associate Professor of Anthropology, University of California, Los Angeles

Aparecida Vilaça, Associate Professor in the Postgraduate Program in Social Anthropology, Museu Nacional/Universidade Federal do Rio de Janeiro

Toward an Anthropological Theory of Mind (AToM) – Stanford Workshop Summary

This is the first in a series of posts covering cross-disciplinary research on theory of mind.

Last weekend a small, international gathering of twenty-seven anthropologists and psychologists took place at the Stanford Humanities Center, organized by Stanford anthropology professor Tanya Luhrmann  and Culture and Mind postdoctoral fellows Julia Cassaniti, and Jocelyn Marrow. The meeting was made possible by a gift from the Robert Lemelson Foundation.

Nestled under the dappled shade of oak trees, the center provided a beautiful setting for a relaxed yet animated discussion on the concept of theory of mind, including the possibility of cross-cultural, comparative research program. (See end of post for full list of participants.

This slideshow requires JavaScript.

According to the hypothesis on which the meeting was based “there are cultural variations in the way minds are imagined, and . . . these variations have consequences for mental experience (broadly defined) and the nature of social interaction.” Invited speakers briefly summarized their work (papers were circulated in advance) but most of each session and many lively coffee-break conversations were devoted to exploring related questions and research opportunities.

The workshop opened on Thursday evening with a talk by anthropologist Rita Astuti (London School of Economics) covering the history of ToM and the challenges of cross-cultural, interdisciplinary work. Below is a summary of the Friday morning session on “interiority and boundedness,” featuring talks by anthropologists Joel Robbins (UC San Diego), Julia, and Tanya.

Theory of Mind

Theory of mind (ToM) was coined by primatologists David Premack and Guy Woodruff to refer to the ability of an individual to “impute mental states to himself and to others” (Premack & Woodruff, 1978; Call & Tomasello, 2008). The concept subsequently carried over to developmental psychology and neuroscience. Psychologists were interested in the emergence in young children of a capacity to attribute false beliefs to other persons (Wimmer & Perner, 1983; also referred to as the Sally-Anne test or S-AT). Neuroscientists began to explore some possible neural mechanisms of ToM (which critically “enables us to predict what others are going to do” [U. Frith & C. Frith, 2010] ) like imitation (eventually bolstered by the discovery of mirror neurons in macaques, which fired when observing an object-directed gesture, with the mirror neuron “system” thus appearing to mediate an understanding of others’ actions), as well as “precursor” mechanisms, like face processing, gaze monitoring, or detection of animacy and their dysfunctions (Hurley & Chater, 2005; Rizzolatti & Craighero, 2004; Iacoboni & Dapretto, 2006). A particularly influential 1985 paper for both research programs by Simon Baron-Cohen, Alan Leslie, and Uta Frith argued that children with autism lacked a theory of mind based on their difficulties with the false belief test (Baron-Cohen, Leslie, & Frith, 1985). (Links to research cited available at end of post.)

Currently, the mainstream definition in the psychiatric neuroscience literature  characterizes ToM as the cognitive (or “high level”) capacity to “mind read,” that is, “to attribute mental states like thoughts, beliefs, intentions, and feelings to oneself and others,” (Montag et al., 2011). But, as several attendees noted, some assumptions implicit in this sort of definition – e.g., the extent to which ToM is based on explicit inferences of internally held propositions – presume an understanding of mind which is western.  Anthropologists have long been aware that the western model of mind is not shared by all people. Those at the meeting had assembled to explore what they knew about the consequences of different models of mind for mental experience, developmental process, psychiatric illness, and the adults experience of inferring intentions.

AToM: Interiority and Boundedness

In the first talk of Friday’s session, anthropologist Joel Robbins (UC San Diego) discussed his research on the Urapmin of Papua New Guinea, who, although generally described as sociocentric or relational, have a very strong sense of a core self that is virtually unknowable to others. For the Urapmin, the heart is the seat of thoughts, feelings, and intentions, and it is believed “one cannot know what goes on in the heart of another person.” The Urapmin appear not to use speech as a vehicle for expressing thoughts, feelings, or intentions, so much so that the language lacks verbs like thank, apologize, promise, and lie, and they are distrustful of others’ speech. (Although persons’ mental states are opaque to one another, Joel was quick to distinguish this form of “innate” opacity – a core self doubly wrapped within the heart/body  – from the communicative opacity and non-expressivity cultivated by the Yap that Jason Throop would go on to describe in the afternoon session.) At the same time, according to Joel, the Urapmin regularly say that people “do what they want to do,” or “are driven by their hearts,” and they have a rich vocabulary for different kinds of emotions and thoughts that arise in the heart. This means that in the Urapmin case the belief that people cannot know what others are thinking and feeling does not, as some have predicted, correlate with a general lack of cultural elaboration of ideas about the contents of the mind and their importance in motivating action. Joel also said that in the 1970s all adults in the community converted to charismatic Christianity and consequently face conflicting demands from, on the one hand, a religion that requires sincerity in speech and honesty in the confession of one’s sins to God and, on the other, from a traditional belief in the impossibility of such kinds of communication.

After giving a brief summary, Joel provided two basic claims/research questions: (1) Assuming theories of mind shape the mental experience of those who hold them, how do we test the possibility that people are not reading the minds of others in interpreting what they say or how they act? (2) Just as cultural ideas about language connect to morality, sociality, ideas about selves, etc., we should explore the ways in which cultural theories of mind are connected in important ways to ideas in other domains. Joel felt he was on firmer ground with the second research program in terms of exploring the ramifications of an Urapminian theory of mind. For example, most people in Urapmin assume they are “innately” related to many others, rather than expecting relationships to built out of shared feelings and thoughts, and the unpredictability of speech is moderated by everyday gift exchanges, which “almost have the rhythm of conversations” (a promise, for example, is made via the bestowal of a small gift rather than conveyed verbally.)

After Tanya opened up the session to questions and comments, one of the attendees mentioned Vygotsky’s work on the connection between language development and thought, particularly how inner speech develops from hearing external speech followed by a stage of talking (or thinking) out loud – i.e., a process of internalizing what is heard – which is eventually inhibited. Children and adults continue to hear subvocalizations which are unintelligible to others, however, and which serve as a vehicle for thought. She wondered about the extent to which the Urapmin subvocalize, and “how they are construing subvocalization in inner speech, if it’s not thought.”

Joel was intrigued by the suggestion, but also noted the complexity of an investigation into subvocalization. Interestingly, he mentioned that when people “hear God,” when the Holy Spirit tells them something, they do not “hear a voice,” but rather they experience the Holy Spirit “as a certainty in my heart,” although Joel also said this was common for charismatics generally.

Linguistic anthropologist Bambi Schieffelin (New York University), who conducted research among the Bosavi of Papa New Guinea and said they share many of the same orientations and preferences, commented that when her 4-year-old son talked to himself, the Bosavi found it very peculiar, even “creepy.” She thought there was an interesting cultural possibility that speech among the Bosavi (as part of a particular language ideology) always requires an addressee. Cultural psychologist Hazel Markus (Stanford University) said that in East Asia – Japan Korea and Taiwan, specifically – the idea that speech is appropriate only in certain situations or that the mouth is the source of misfortune (or meaningless prattle in the case of a chatterbox) is very common. In Japan, if something really matters “you won’t say it”; in other words, thoughts and speech are not necessarily always closely aligned. Also, “you have to have another person before the self is “on,” she said. (This isn’t to say there isn’t a very clear sense of an interior “something,” which is important and a source of great, emotionally expressive literature in Japan, she said.)

The second talk by Julia Cassaniti, based on her research in a small community in Thailand, explored how Buddhist ideas are lived in everyday life. She described three key concepts: mindfulness, kwan, and karma. According to her position paper, “the concentration and focus of the mind [mindfulness] is both a goal and a representation of healthy minds and bodies.” When the mind is distracted, the implication is that our “souls” or “ghosts” (kwan) are scattered. Julia likened kwan to our understanding of “wits.” Keeping our minds (or wits) balanced and permeable in the sense of open to experiences and aware of (and wary of ) our own and others’ intentions (“out in the air”) keeps our mind/wits together. Karmic energy (“the energy of intentionality”), which is destabilizing, arises when the mind becomes fixed on particular ideas, desires, or goals that “shoot out from us.” Consequently, people are reluctant to hazard a guess about what another person might be thinking or feeling, because this presumes the other is possessed of a single, bounded, autonomous mind that is wholly separate from one’s own.

A participant wondered what the relationship was between what people tell you in an interview and what they may be doing in everyday life. Julia said her informants seemed to actively practice what they believed, when, say, they were confronted with a predicament like the loss of money. Referring to soul-calling ceremonies, in which a white string bracelet used to “keep one’s kwan together,” is attached to the wrist, Aparecida Vilaça (Museu Nacional/Universidade Federal do Rio de Janeiro) recalled a similar practice in Amazonia in which an object – a necklace of beads – is considered “outside but also inside.” If the necklace breaks apart, so does one’s identity or personality (the wearer “goes crazy”). Julia said the white-string bracelets weren’t necessarily used to hold something inside; they’re not permanent and when the string wears out, the bracelet is put in a river and floats away. Another participant, who was familiar with a different Buddhist practice, said that in that context the intentions of the practitioners are very strong, but the point is to not get too attached to them or too obsessed with moving in a particular direction. Julia seemed to feel that the idea of having intentions but just not becoming too attached to them might have a deleterious looping effect, but concerns with attachment resonated (she described a festival in which lanterns or little boats are set afloat as a reminder not to become too attached to worries or intentions). Regarding the different perceptions of the mind that can be gleaned from the many varieties of religious practice in Thailand, China, and the US, Hazel Markus noted how, in the West, the mind is perceived as influencing or making things happen in the world. But “effortfully striving for something may not always be the best way to make things happen, in fact it’s often problematic, “ she said, “and that’s what’s so difficult for Westerners to grasp.” Another participant wondered if kwan stays in one piece or disintegrates into separate pieces when it “wanders off.” Julia said it appeared to stay in one piece. But she also said kwan is sometimes referred to in the singular, sometimes in the plural in the literature. The lack of noun/verb inflection in the language makes it difficult to determine. She felt, however, kwan was a concept best understood in the plural.

The theme of the final talk of the session by Tanya Luhrmann was how theory of mind changes mental experience. The talk focused on American experientially oriented evangelical Christians, who live in a world dominated by a “Westernized, Christianized, secularized theory of mind.” Three important features of this model are: (1) a wall between mind and world, which spirits cannot cross; (2) the interior word is important (i.e., “emotions and feelings count for something, they have causal consequences, and can make you sick”; (3) what’s in the mind is not real “in the way that tables and chairs are real.” Evangelical Christians hold a different theory of mind, in which God can cross the boundaries of the mind, and in which what is in the mind is real—but in a different manner than tables and chairs. These Christians must learn to adopt this new theory of mind. They cultivate a personal, interactive relationship with God, who is perceived as a person very much like oneself. The churches essentially teach a theory of mind in which individuals attend to the everyday flow of stream of consciousness and learn to “cherry pick out” particular thoughts, mental images, and feelings. Those that feel different, spontaneous, or “not me,” are identified as potentially emanating from God. Learning to orient to certain kinds of internal sensory information, asking for guidance from God on the most mundane matters of everyday life, and “daydreaming” about God as a continuous, warm, supportive presence (and conversation partner) is a kind of attention training paradigm for learning to respond to life’s bigger questions/challenges according to what God tells you to do. Tanya said a conflict arises in terms of being taught to orient to inner experience and cultivate an everyday relationship with God while, at the same time, not considering what occurs in the mind real. The result, Tanya said, is a kind of oscillating back and forth between the (fictional) mind/(real/fictional) world and the emergence of “a third (ontological) domain of reality” (“real but different”).

Tanya then described an experiment in which she randomized people into different prayer practices; those engaged in an imaginative prayer practice, which included daydreaming about God (vs. a control group engaged in Bible study) improved their mental imagery vividness and salience and their ability to use mental imagery and increased the likeliness of unusual sensory experiences. Many participants in this group also said “God became more real to them.” Based on these results, Tanya said she was interested in the idea of a cross-cultural research program that would look at dimensions of the mind like interiority, boundedness, whether the content of the mind is real, etc., in order to ask the following questions:  What is the significance given to inner thought? What is the inner-voice dialogue? What is the significance given to inner sensory experience, what kinds of experience count, what about unusual sensory experiences? Do dreams matter, if so, how? And what are the consequences of these different emphases on mental experience? Tanya also felt Aparecida’s comment about the idea of objects containing the mind would make an important research query.

In response to a participant’s question about the purpose of appealing to God on mundane matters Tanya said it was a way to make what you imagine God to be real (in terms of a real voice coming from outside your head). Evangelicals have “to get God across the boundary of the mind.” They have to get “God outside and real,” she said. (Tanya also described another set of practices by evangelicals, an effort to map emotional experiences onto God or to map God onto themselves so that they become more able to experience a sense of being loved by God.) Regarding Tanya’s idea for a cross-cultural study, another participant suggested not just asking about effects, in some secondary sense, but exploring the conflict among, e.g., the Urapmin, between their ToM and a Christian God whose intentions are knowable and can be expressed verbally. (“Why do you trust God’s words?”)

Tanya also commented that the American evangelical movement is a representation of God based on a specific representation of the American mind. She said there was a “buyer’s market” in God concepts designed for the secular mind because there is an acute awareness that people don’t necessarily believe in God. Hazel Markus felt an under-explored areas was the role of Protestant Christianity in giving life to an independent self, or form of agency, “that really underlies most of our theorizing.” Hazel thought this model of self wasn’t working for evangelical Christians, who may be seeking a more relational model (“the other was too harsh and too interior”). Tanya agreed, saying the evangelical movement (particularly the emphasis on personal experience) was a direct response to secularism.

Regarding the idea of a “buyer’s market,” Doug Hollan (UCLA) wondered how we can distinguish between a process of self selection (where a person has a certain set of proclivities, like hearing voices, and shops around for accommodating churches) vs. the argument of being socialized into certain practices that focus on “hearing” God. Tanya mentioned previous work using the Tellegen Absorption Scale in which she found a close relationship between a proclivity for absorption (according to the scale) and reporting an unusual sensory experience. Interestingly, referring to the randomized prayer practice trial she described earlier, absorption did not predict whether you experienced God as a person (being assigned to the imaginative prayer practice did) or whether you heard God, although it did predict lifetime report of hearing God. Another participant suggested keeping in mind the significance of individual differences in terms of temperament (or different attentional capacities or differences on the absorption scale).

Several questions emerged during the general discussion. One participant again brought up the question of how to explore what really happens in everyday life (vs. what the interviewee reports) in the sense of trying to understand what kinds of moments in life these cultural philosophies of mind are for (e.g., just those instances in which intentions are thwarted?) How can this be explored more systematically, that is, other than, say, looking at examples of reported speech? Also, in communities that follow different practices, how much of a difference is there in terms of the way an individual thinks, or theorizes, about his/her own and others’ mental states and anticipate others’ actions? Joel suggested that, at least among the Urapmin, their particular ToM operates constantly, it’s not just an explanatory model. Taking the Urapmin as an example, John Lucy suggested looking at ToM in terms of an overall system of social behavior rather than as a localized set of practices. How the culture acknowledges interior states (or doesn’t), would be a component. As the session drew to a close, the conversation continued to flow around these and other intriguing questions.

References

Call, J., & Tomasello, M. (2008). Does the chimpanzee have a theory of mind? 30 years later. Trends in Cognitive Sciences, 121(5), 187–192. doi:10.1016/j.tics.2008.02.010

On the 30th anniversary of Premack and Woodruff’s seminal paper asking whether chimpanzees have a theory of mind, we review recent evidence that suggests in many respects they do, whereas in other respects they might not. Specifically, there is solid evidence from several different experimental paradigms that chimpan- zees understand the goals and intentions of others, as well as the perception and knowledge of others. Never- theless, despite several seemingly valid attempts, there is currently no evidence that chimpanzees understand false beliefs. Our conclusion for the moment is, thus, that chimpanzees understand others in terms of a percep- tion–goal psychology, as opposed to a full-fledged, human-like belief–desire psychology.

Frith, U., & Frith, C. (2010). The social brain: Allowing humans to boldly go where no other species has been. Philosophical Transactions of the Royal Society B: Biological Sciences, 365(1537),165–176.

The biological basis of complex human social interaction and communication has been illuminated through a coming together of various methods and disciplines. Among these are comparative studies of other species, studies of disorders of social cognition and developmental psychology. The use of neuroimaging and computational models has given weight to speculations about the evolution of social behaviour and culture in human societies. We highlight some networks of the social brain relevant to two-person interactions and consider the social signals between interacting partners that activate these networks. We make a case for distinguishing between signals that automatically trigger interaction and cooperation and ostensive signals that are used deliberately. We suggest that this ostensive signalling is needed for ‘closing the loop’ in two-person interactions, where the partners each know that they have the intention to communicate. The use of deliberate social signals can serve to increase reputation and trust and facilitates teaching. This is likely to be a critical factor in the steep cultural ascent of mankind.

Hurly, S., & Chater, N. Eds. (2005). Perspectives on imitation. (Vols. 1–2). Cambridge, MA: MIT Press.

Iacoboni, M., & Dapretto, M. (2006). The mirror neuron system and the consequences of its dysfunction. Nature Reviews Neuroscience, 7, 942–951. doi:10.1038/nrn2024

The discovery of premotor and parietal cells known as mirror neurons in the macaque brain that fire not only when the animal is in action, but also when it observes others carrying out the same actions provides a plausible neurophysiological mechanism for a variety of important social behaviours, from imitation to empathy. Recent data also show that dysfunction of the mirror neuron system in humans might be a core deficit in autism, a socially isolating condition. Here, we review the neurophysiology of the mirror neuron system and its role in social cognition and discuss the clinical implications of mirror neuron dysfunction.

Montag, C., Neuhaus, K., Lehmann, A., Krüger, K., Dziobek, I., Heekeren, J. R., Heinz, A., & Gallinat, J.  (9/2011). Subtle deficits of cognitive theory of mind in unaffected first-degree relatives of schizophrenia patients. European Archives of Psychiatry and Clinical Neuroscience. Advance online publication. doi 10.1007/s00406-011-0250-2

Alterations of theory of mind (ToM) and empathy were implicated in the formation of psychotic experiences, and deficits in psychosocial functioning of schizophrenia patients. Inspired by concepts of neurocognitive endophenotypes, the existence of a distinct, potentially neurobiologically based social-cognitive vulnerability marker for schizophrenia is a matter of ongoing debate. The fact that previous research on social-cognitive deficits in individuals at risk yielded contradictory results may partly be due to an insufficient differentiation between qualitative aspects of ToM. Thirty-four unaffected first-degree relatives of schizophrenia patients (21 parents, 8 siblings, 5 children; f/m: 30/4; mean age: 48.1 ± 12.7 years) and 34 controls subjects (f/m: 25/9; mean age: 45.9 ± 10.9 years) completed the ‘Movie for the Assessment of Social Cognition’-a video-based ToM test-and an empathy questionnaire (Interpersonal Reactivity Index, IRI). Outcome parameters comprised (1) ‘cognitive’ versus ‘emotional’ ToM, (2) error counts representing ‘undermentalizing’ versus ‘overmentalizing’, (3) empathic abilities and (4) non-social neurocognition. MANCOVA showed impairments in cognitive but not emotional ToM in the relatives’ group, when age, gender and neurocognition were controlled for. Relatives showed elevated error counts for ‘undermentalizing’ but not for ‘overmentalizing’. No alterations were detected in self-rated dimensions of empathy. Of all measures of ToM and empathy, only the IRI subscale ‘fantasy’ was associated with measures of psychotic risk, i.e. a history of subclinical delusional ideation. The present study confirmed subtle deficits in cognitive, but not emotional ToM in first-degree relatives of schizophrenia patients, which were not explained by global cognitive deficits. Findings corroborate the assumption of distinct social-cognitive abilities as an intermediate phenotype for schizophrenia.

Rizzolatti, G., &  Craighero, L.  (2004). The mirror-neuron system. Annual Review of Neuroscience, 27, 169–192. doi:10.1146/annurev.neuro.27.070203.144230.PMID 15217330

A category of stimuli of great importance for primates, humans in particular, is that formed by actions done by other individuals. If we want to survive, we must understand the actions of others. Furthermore, without action understanding, social organization is impossible. In the case of humans, there is another faculty that depends on the observation of others’ actions: imitation learning. Unlike most species, we are able to learn by imitation, and this faculty is at the basis of human culture. In this review we present data on a neurophysiological mechanism—the mirror-neuron mechanism—that appears to play a fundamental role in both action understanding and imitation. We describe first the functional properties of mirror neurons in monkeys. We review next the characteristics of the mirror-neuron system in humans. We stress, in particular, those properties specific to the human mirror-neuron system that might explain the human capacity to learn by imitation. We conclude by discussing the relationship between the mirror-neuron system and language.

Premack, D. G., &  Woodruff, G. (1978). Does the chimpanzee have a theory of mind? Behavioral and Brain Sciences, 1, 515–526.

An individual has a theory of mind if he imputes mental states to himself and others. A system of inferences of this kind is properly viewed as a theory because such states are not directly observable, and the system can be used to make predictions about the behavior of others. As to the mental states the chimpanzee may infer, consider those inferred by our own species, for example, purpose or intention, as well as knowledge, belief, thinking, doubt, guessing, pretending, liking, and so forth. To determine whether or not the chimpanzee infers states of this kind, we showed an adult chimpanzee a series of videotaped scenes of a human actor struggling with a variety of problems. Some problems were simple, involving inaccessible food bananas vertically or horizontally out of reach, behind a box, and so forth as in the original Kohler problems; others were more complex, involving an actor unable to extricate himself from a locked cage, shivering because of a malfunctioning heater, or unable to play a phonograph because it was unplugged. With each videotape the chimpanzee was given several photographs, one a solution to the problem, such as a stick for the inaccessible bananas, a key for the locked up actor, a lit wick for the malfunctioning heater. The chimpanzee’s consistent choice of the correct photographs can be understood by assuming that the animal recognized the videotape as representing a problem, understood the actor’s purpose, and chose alternatives compatible with that purpose.

Wimmer, H. & Perner, J. (1983). Beliefs about beliefs: Representation and constraining function of wrong beliefs in young children’s understanding of deception. Cognition, 13, 41–68.

Understanding of another person’s wrong belief requires explicit representation of the wrongness of this person’s belief in relation to one’s own knowledge. Three to nine year old children’s understanding of two sketches was tested. In each sketch subjects observed how a protagonist put an object into a location x and then witnessed that in the absence of the protagonist the object was transferred from x to location y. Since this transfer came as a surprise they had to assume that the protagonist still believed that the object was in x. Subjects had to indicate where the protagonist will look for the object at his return. None of the 3–4-year old, 57% of 4–6-year old, and 86% of 6–9-year old children pointed correctly to location x in both sketches. Of the many cases where 4–6-year olds made an error they failed in only about 20% to remember the initial location correctly. As a test of the stability of children’s representation of the protagonist’s wrong belief the sketches continued with a statement about the protagonist’s intention to either deceive an antagonist or truthfully inform a friend about the object’s location. Independent of age, of those children who correctly thought that the protagonist would search in x, 85% of the time they also correctly thought that he would direct his antagonist to location y and his friend to location x. This shows that once children can represent a person’s beliefs they can constrain their interpretation of this person’s stated intentions to the person’s beliefs. In a more story-like situation another group of children had to infer a deceptive plan from the depiction of a goal conflict between two story characters and one character’s expedient utterance. At the age of 4–5 years children correctly judged this utterance as a lie only 28% of the time while 5–6-year olds did so 94% of the time. These results suggest that around the ages of 4 to 6 years the ability to represent the relationship between two or more person’s epistemic states emerges and becomes firmly established.

List of Participants

Rita Astuti, Professor, Department of Anthropology, London School of Economics

Lera Boroditsky, Assistant Professor, Department of Psychology, Stanford University

Luke Butler, Graduate student, Psychology, Stanford University

Julia Cassaniti, Culture and Mind Postdoctoral Fellow, Anthropology, Stanford University

Eve Danzinger, Associate Professor in Anthropology, University of Virginia

Suzanne Gaskins, Associate Professor of Psychology, Northeastern Illinois University

Dedre Gentner, Alice Gabrielle Twight Professor, Department of Psychology, Northwestern University

Kathyrn Geurts, Associate Professor of Anthropology, Hamline College

Alexa Hagerty, Graduate student, Anthropology, Stanford University

Douglas Hollan, Professor of Anthropology, University of California, Los Angeles

Graham Jones, Assistant Professor of Anthropology, Massachusetts Institute of Technology

Michelle Karnes, Assistant Professor in the Department of English, Stanford University

John Lucy, William Benton Professor Department of Comparative Human Development, Department of Psychology, University of Chicago

Tanya Luhrmann, Watkins University Professor in Anthropology (and Psychology, by courtesy) Stanford University

Ellen Markman, Lewis M. Terman Professor of Psychology, Stanford University

Hazel Markus, Davis-Brack Professor in the Behavioral Sciences, Stanford University, Department of Psychology

Giulia Mazza, Graduate student, Anthropology, Stanford University

Jocelyn Marrow, Culture and Mind Postdoctoral Fellow, Anthropology, Stanford University

Joel Robbins, Professor of Anthropology, University of California, San Diego

Barbara Rogoff, University of California, Santa Cruz Foundation Distinguished Professor of Psychology

Sonya Pritzker, Assistant Researcher and Clinical Specialist at the UCLA Center for East-West Medicine

Danilyn Rutherford, Associate Professor in Anthropology, University of California, Santa Cruz

Bambi Schieffelin, Collegiate Professor; Professor of Anthropology, New York University

Rupert Stasch, Associate Professor, University of California, San Diego

Allen Tran, Graduate Student, Anthropology, University of  California, San Diego

Jason Throop, Associate Professor of Anthropology, University of California, Los Angeles

Aparecida Vilaça, Associate Professor in the Postgraduate Program in Social Anthropology, Museu Nacional/Universidade Federal do Rio de Janeiro