Anthropologist–Psychiatrist Elizabeth Bromley’s “The texture of the real: Experimentation and experience in schizophrenia”

Anthropologist–psychiatrist  Elizabeth Bromley of UCLA writes from an insider’s perspective on neuroscientists’ understanding of cognition (and its deficits) in people living with schizophrenia. Below is the abstract with a link to the paper at Culture, Medicine and Psychiatry.

Elizabeth Bromley

Published online: 20 December 2011

Abstract

The dominance of the neurosciences in psychiatric research raises questions about the relationship between research practices and the lived experience of mental illness. Here, I use data from a group of researchers focusing on neurocognition in schizophrenia to explore the problem of representation in psychiatric research and the forms that neuroscientific evidence assumes for those who produce it. These researchers grappled with the complexity of schizophrenia not by narrowing disease concepts to biological facts but by referencing measurement techniques to generate new versions of schizophrenia. By linking experimental findings to inchoate concepts of personhood and social experience, I found that they reframed and reinforced cultural values, including that those with schizophrenia are destined to a debased and deficient existence. I argue that cognition has emerged as an essential feature of schizophrenia not only because of its representational utility but also because of the ontological work the concept performs. In closing, I present some implications for the neurobiological and social sciences
.

Psychiatry in 2012: Embracing complexity?

I’ve been reading through the descriptions and preliminary programs for various conferences scheduled for next year. Below are a few links to events of interest that seem to testify to the unruliness underlying the definition of mental illness and the “variety of ways” in which we try to understand the concept (Perring, 2010) – not only over developmental and evolutionary time, but in terms of immediate context  (social, biological) and local variations.

Conf Abstract: We are at the start of a new era of research on psychopathology, in which we will be tracing mental disorders and their earliest antecedents across multiple generations. Since World War II, population-based pregnancy and birth cohorts have gradually illuminated the evolution of psychopathology over the life course, and have identified very early antecedents of mental disorders which later emerge in youth and adults. Yet, almost none of these cohorts has systematically studied the prenatal experience and early mental development of both the children and grandchildren of the cohort members. Recently, this has changed: a few cohorts have multigenerational studies in progress, and many others are planning to initiate them. At the same time, our understanding of how genetic and contextual (societal, family, cultural) causes of psychopathology and resilience are transmitted across generations is being transformed. This conference brings together investigators at the forefront of multigenerational studies with investigators at the forefront of related developments.

  • New Approaches in Depression,” which takes place March 22–23, 2012, in Barcelona, features talks on dimensions vs. categories by German Berrios (historical perspective) and Cornelius Katona (DSM-5), as well as one by Mario Maj on a “resilient” topic for 2012 and beyond:
  • The annual meeting of the Society for Biological Psychiatry, which takes place May 3–5, 2012, in Philadelphia, casts a very wide net.  The conference theme focuses on social and systems neuroscience  (link to program). Featured speakers include Larry Young (affiliative behavior), Sarah-Jayne Blackemore (adolescent brain), Elizabeth Phelps (race and ethnicity), and Allison Doupe (songbirds), Marcus Raichle (default mode network), Cameron Carter (circuits/schizophrenia), and Leslie Ungerleider (circuits/attention).

The emerging field of global mental health aims to address the enormous disparities in mental health outcomes that beset low and middle-income countries. A growing body of research has established mental health as a priority for global health research and intervention. Significant advances have been made in identifying targets and strategies for intervention. However, there continues to be controversy and debate about the appropriate methods for establishing priorities, research themes and approaches, and modes of developing and/or adapting interventions in global mental health. In particular, there are tensions between a public health approach grounded in current evidence-based practices (which are still largely produced in high-income countries) and a culturally-based approach that emphasizes starting with local priorities, problem definitions, community resources and solutions. The cultural critique of global mental health has raised basic issues that will be explored in this workshop and conference: (1) the priorities of global mental health have been largely framed by mental health professionals and their institutional partners located in wealthy countries, and therefore reflect the dominant interests of psychiatry and may give insufficient attention to local priorities; (2) global mental health tends to assume that the major psychiatric disorders are biologically determined and therefore universal; (3) in focusing on existing evidence-based treatments, global mental health assumes that standard treatments can be readily applied across cultures with minimal adaptation; and (4) global mental health tends to emphasize mental health interventions and may marginalize indigenous forms of helping, healing, and social integration that can contribute to positive outcomes and recovery. This workshop will bring together experts in cultural psychiatry and global mental health to consider ways of bridging these perspectives. Sessions will address four broad themes: (1) setting the agenda in global mental health; (2) understanding the relationship between local and universal aspects of mental health problems; (3) developing culturally and community-based interventions; and (4) implementing and evaluating culturally and community-based interventions to foster resilience and recovery. The aim of the workshop is to develop some consensus on a research program that integrates social, cultural, primary care and public health perspectives. The one-day conference will focus on ways to generate an ongoing constructive critique of the global mental health movement to insure its goals and methods are responsive to diverse cultural contexts and communities.