Counterplay: FPR Interviews Anthropologist Robert Desjarlais

Science writer Karen A. Frenkel interviews anthropologist Robert R. Desjarlais for the FPR.

Robert R. Desjarlais is Professor of Anthropology, and recently held the Alice Stone Ilchman Chair in Comparative and International Studies, at Sarah Lawrence College, in Bronxville, NY. His interests include the cultural construction of experience, subjectivity and intersubjectivity, death and mourning, and the political economy of illness and healing. He has conducted ethnographic fieldwork in the Nepal Himalayas, with the residents of a homeless shelter in Boston, and among competitive chess players. He is the author of Body and Emotion: The Aesthetics of Illness and Healing in the Nepal Himalayas (University of Pennsylvania Press, 1992); Shelter Blues: Sanity and Selfhood Among the Homeless (University of Pennsylvania Press, 1997); Sensory Biographies: Lives and Deaths Among Nepal’s Yolmo Buddhists (University of California Press, 2003); and Counterplay: an Anthropologist at the Chessboard (University of California Press, 2011). He is currently writing his fifth book, titled Subject to Death: Yolmo Buddhist Engagements with Life, Loss, and Mourning.

KAF: You get into the heads of your sources in a very intimate way and write sensitively about them. Let’s talk about your interviewing and observation methods and how you developed them.

RD: The main conceptual framework I have in mind when I’m doing research is to see how peoples’ lives are put together, and to understand how they experience their lives and the worlds they live in. The fancy word for that in phenomenology is the “lifeworld.” What is the lifeworld of a person or a group of people I’m trying to understand? My methods are geared toward that kind of interpretative work – to delve into their lifeworlds, and to ask what are the different dimensions that contribute to them, from cultural dynamics to history to language to psychological processes to biology. My aim is to tap into a lifeworld, and when it comes to writing, to consider how to convey that to readers in interesting and accurate and fair ways.

KAF: Whatever works in the moment, depending on the temperament of your interlocutor, right?

RD: Exactly. I’m trying to attend to what their concerns are, as well as  the practical aspects of the interview. I much prefer to do interviews face-to-face and make people comfortable with our work together. If they have a certain energy, it’s good for me to have a sense about that. Often I come in with a template of questions to draw from and see where the conversation goes. Often I’ll go back to these same people, to talk some more, and fill in the blanks. Then, through working with different people, I’ll get a sense of the different perspectives that are involved here. I also spend a lot of time hanging out with people, living alongside them, and participating in what they’re involved with.

The term in anthropology for this is “participant observation,” where you participate in peoples’ lives, but you are observing all along, taking notes, mental or written, about what’s going on. Right now, I’m working on a section of a new book on death and funeral rites in Nepal called Subject to Death. For this section I’m drawing on my understanding of these rituals, based on ones I attended myself, dating back to the late 1980s. I’ve done a lot of research talking with people, and I’ve been considering how Buddhist perspectives tie into all this, so that I have a good sense of  the logic and history behind the rites.

KAF: Is there an anthropologist whose work and methodology you particularly admire?

RD: When I was in graduate school, the key one was Clifford Geertz. He taught at the University of Chicago and then Princeton University’s Institute of Advanced Studies. He did what he came to call “interpretive anthropology” – where one tries to understand cultures on their own terms, through interpretive methods. Geertz argued that an anthropologist should work to comprehend cultures in much the same way that a literary critic does in trying  to analyze and understand a literary  text. That was the guiding framework for me as I developed as a cultural anthropologist. People have moved beyond that because they’ve concluded that cultures are not like texts; they’re much more fluid, much more politically charged, to the point where the concept of distinct and bounded “culture” has come into question. Also, Geertz’s writing style was rich, humanistic, and he had a literary sensibility in trying to explain how these worlds work. That has shaped my work as well. More recently, I’ve been interested in the writings of the French philosophers Gilles Deleuze and Felix Guattari, as well as other contemporary anthropologists, including Michael D. Jackson, who has been advocating what he calls existential anthropology, wherein one tries to ascertain the existential imperatives and challenges that human beings often face in their lives. I have also been influenced by a lot of novelists.

Right now, I’m reading Moby Dick and love it. In effect, it’s an ethnography of the whaling industry and what it’s like to be on the ship. It’s quite inspiring to see how Melville laid it out. It’s a portrait of the lifeworld on the Pequod and a character analysis of Captain Ahab and other personalities.

KAF: In your most recent work, Counterplay, your approach is different from the Buddhists of Nepal in Sensory Biographies, in that you are playing games with your sources or interlocutors. It’s a very personal work, about your journey and about wanting to get away from thinking about death. Do you think that in being in the chess world, which is a world unto itself, and playing with your interlocutors, that you were doing anthropology in a different way?

RJ: Yes. At first I didn’t think of doing anthropology. I was just playing chess. I felt I had moved away from anthropology after I finished Sensory Biographies. Chess was so much more interesting to me at the time. I had in back of my mind that perhaps I could write about it, and I would tell my anthropology colleagues that I might do so. But for a couple of years I was just playing chess. It seems that this was a good way to do fieldwork because I was observing a world while actively engaged within  it. But my main priority was to get better at chess and enjoy playing with other people. Then slowly I realized I could start writing about it. It was then that I started to  put my thoughts on paper. But it was a different kind of engagement, both in terms of topic and the activities involved. When I was in Nepal, I was clearly doing research to gather information. When I was at the chessboard, I was trying to figure our how I could get better at the game.

I also wanted to write a book that was less scholarly and more accessible for a general audience. That shaped how I wrote it, too.

KAF: How does playing with your chess interlocutors inform the way you’re going about writing your new book?

RD: There are several dimensions. Something about chess and the elements of play came to the fore for me. Play is a very fascinating concept, in part because there are so many dimensions to it. Whether it’s simulation, fantasy, engagement with other people, or any creative activity and production – these all have elements of play. Play has a lot of affinities with ritual too, and that has added to my understanding of how these things work. At the same time, what I learned a lot from writing Counterplay  is how to write about peoples’ lives from a narrative, non-fiction approach – creating portraits of people and telling stories.

That’s in Sensory Biographies as well, but Counterplay suggests  a different way of going about it.

I like the ludic element in Counterplay, ludic in the sense of “play,” something playful. But the word ludic is  also associated etymologically with illusion and creating, with playful fantasy. Writing often embodies that. We see the ludic element in Moby Dick where Melville plays with the reader and these forms that he’s writing about. He’s playing with language and the way the characters  speak. We can sense the influence of Shakespeare there. A Buddhist world is very sympathetic to that because it very much understands the world as one of play, that themes are constantly coming and going, that what you see is not fully real, in the way that you see it. Things are ever shifting. If you think about it, the physics of a chessboard is similar to the physics of a Buddhist world. There are force fields of energy coming into play and out of play in different ways.

KAF: Would you please give an example?

RD: With any chess position you have arrangements of forces – the Queen, the King, the Bishops, rooks, the pawns. They’re all really bundles of energy moving in time and space. When advanced players look at a chess position, they will not see the material objects on the board so much as they will forces of energy in relation to one another. A Buddhist monk would probably say their take on the world is similar to that. From a Buddhist perspective, a person  is not  a stable, permanent self, or a concrete materiality, but a forcefield of energy.

KAF: Is there much chess playing among the Yolmo?

RD: Not really. I played games now and then in Kathmandu but it’s not a main tradition. A Buddhist practitioner once told me that chess is very Buddhist in spirit. I would agree with that.

KAF: You write about the effects of globalization on chess in cyberspace. Could you comment on the effects of cyberspace? It seems to me that a lot of what goes on in chess in cyberspace happens in cyberspace in general. Do you agree?

RD: Yes. Much of what is happening in the world of chess just now, with the advent of computer technologies – faster games, an endless and ever-growing mass of information and databases, computational analyses, remote, anonymous interactions between people – is taking form in our lives more generally.

KAF: I wonder what you think about the influence of cyberspace on the peoples of the world and their cultures. Will cyberspace make cultures more similar, or are cultures going to express themselves differently in cyberspace? Are we heading towards a world culture?

RD: Probably a little of both. We’re heading into a cyberculture where information is being constantly exchanged – there’s a fluid, fast-paced exchange of images and information shaping our lives. This will take on different manifestations in different parts of the world, given what’s already there culturally, and how people understand information and simulation.  For instance, I can imagine that simulation and virtual realities in a Tibetan Buddhist world would be perceived differently than they would  in a Christian fundamentalist society – the nature of truth, the nature of imagery, would be known and perceived differently.

I do see the nature of communication as different than it was just a few years before. Last night, for example, I was trying to learn more about digital photography and wanted to know what kind of tripod to get for my camera. So I asked questions through Google like, “What’s the best tripod?” and immediately got some decent answers. Fifteen years ago that was unthinkable. And I see this with my students. The use of text messaging and social networking sites are shaping, in a fundamental way, the nature of self and how they represent themselves to others. It’s shaping the nature of communication, the nature of time, how information and relations work through time. One of my students wrote a nice paper about anxiety in the age of text messaging and how, if you don’t hear back from someone within a few hours after sending them a text, that can be anxiety-provoking. All of this is playing into the nature of selfhood and relationships.

I see similar forces involved with the people I work with in Nepal. Yolmo people are setting up websites to represent their culture. I may be contributing to that this summer, as I’m thinking of taking photographs of people in the Yolmo region, the villages they live in, and the material aspects of their lives, and then create an on-line archive of sorts with these images. I’ll talk with people and see what they think. The website could be a collaborative effort with the people of Nepal.

It would be good to create some kind of documentation of Yolmo culture, because it’s changing quickly. Generations are changing as well. But there are cultural concerns about whether people want their pictures on the Internet. If I photograph a farmer, does he have an understanding of what’s going to happen with that image? Does he understand what the Internet is, and how his image will circulate? There’s also the consideration of when people die, you’re not supposed to say the name of the deceased, in part because the dead don’t have need for names, and invoking the name of a deceased person can bring up bad memories, so I have to think through what is involved in creating lasting visual representations of people on the Internet.

KAF: You comment that chess grandmasters are arrogant and less-than-whole persons. Some are two-dimensional and only come alive through chess. You also describe the danger and addiction to chess. The obsession that can envelope a person. Do you think cyberchess is making that worse?

RD: Yes, at least to an extent. For some people it is. Some are getting so caught up with the informational possibilities of the game. I saw that with myself. I often found myself thinking that I needed to know everything about a particular variation of a chess opening, and I would devote hours to learning about it .This has happened with my friends, too – this informational obsession. The cyberworld contributes to that. And there are online chess servers where people can play for hours on end, and that, too, can quickly become a compulsion.  It’s different from a few years ago when people just came to play chess at a chess club one evening a week, and it was a rather social experience, with people chatting in a back room.

KAF: Have you learned anything from chess that’s applicable to mental illness?

RD: Yes, this theme of obsession. I didn’t think of it that way, but these themes get played out in society as a whole. Obsession. Paranoia. Suspicion. Anxiety. These themes get played out in chess in terms of peoples’ lives when it comes to questions of mental illness or madness. If you look at any domain in life, you would see themes of madness, how things can go mad or wrong, in intensive ways So in Moby Dick you see how Ahab becomes obsessed with vanquishing a certain whale and how it has lasting reverberations with other people.

KAF: Are there obsessions like that in Nepal?

RD: That’s a good question. One key thing there is how much to withdraw from the world, because there is a very strong focus on detachment from loved ones at the end of life. The intensity there is not really obsession, but obsession is a kind of intensity. How much to remove oneself from the world is a kind of intensity – an  amplification, a sensibility, a certain desire. Then there is the sadness and nervousness that people  have at the end of life, and concerns about what will happen when they die and leave others, as well. In Nepal, a key theme is connection with other people and so the inverse dimension of that is disconnection with others.

KAF: I’m puzzled. I would think they would be more at peace with dying because they know it’s temporary, but I guess they’re not because of the 49-day transition.

RD: Most do understand that it’s temporary and that they’ll move on to another life. But once you die, you will never see the people you’ve been living with your whole life. You will never see them again, and you don’t know where you’ll be going. There is also the question of where you will get reborn and in what kind of lifeform. Karma is a determinant of that, but one cannot be sure how it will take form. Along with all that, the 49-day transitional period between one life and the next is very bewildering. You enter this dream-like, in-between state, where a lot of phantasmagoric images come at you. It can be very discombobulating to know that’s coming. In a larger sense there is reassurance that there is continuity, but things end at the same time, too.

KAF: You write, “words and gestures often converge with utterances sounding in time with the assertive placement of pieces and the pounding of chess clocks.” And then you quote anthropologist Thierry Wendling, who writes, “the gesture, the blow on the chessboard, or on the clock, dramatizes the expressivity of speech; the body serves as a technique of language.” What resonated for you in that?

RD: People often see chess as just a mental phenomenon – that chess is very disembodied. I don’t think that’s the case at all. Chess is very interactive. You can hear your opponent’s breath, and you can sense his gasp if you make a move that surprises him or takes him off guard. You sense your opponent’s bodily presence. You hear the ticking of the clock.

So one of the things I wanted to convey is that chess is multi-dimensional. There is so much going on at any moment – from interactions between people to biology, to the brain, and cultural history. All these factors weigh in.

KAF: And you lose all that with cyberchess.

RJ: Yes, that’s one of the disconcerting things. Some people say they don’t like playing chess online because they like the tactile feel of chess pieces and the face-to-face presence of someone sitting across from them. I was surprised that they put it so tangibly. I tend to play a couple of games online each day. It’s a weird feeling, because when you’re playing against these random, anonymous human opponents, there is very little  social interaction to speak of, no language or looks exchanged. People are anonymous. You play a game and then disconnect. It’s almost like a phantom social interaction. It’s sort of like Chat Roulette. You have a similarly brief interaction. It’s also close to Internet dating. If you meet someone at a party and make plans to get together at some point later on, there’s usually some accountability; people keep to their word. But if you make plans on the Internet with someone, that person might not show up, and not give it a second thought. The sense of morality is different online.

KAF: Is there an analogy in the real world?

RD: There’s something about the lack of face-to-face interaction on the Internet that is like driving on the highway and giving someone the finger.

KAF: You discuss the concept of counterempathy on p. 69 of Counterplay:

These days, players often adopt “counterempathy” measures by mixing up their opening strategies and chess-playing styles so that their prospective rivals cannot pin down their inclinations. Some players are concerned about their opponents “reading their minds” while playing, and they try not to let on too much about what they’re thinking. One grandmaster from Russia told me he advises his students that if they discover an effective sequence of moves, they shouldn’t think too hard or long on it, as their opponents might be able to intuit that sequence themselves. These concerns are in line with what anthropologists have gathered through their cross-cultural studies: instead of empathic alignment always being a welcome phenomenon in human societies, it’s often the case that “too accurate an understanding of the inner states of another may actually be experienced as an impingement or violation,” as anthropologist Kevin Groark puts it. Empathic insight can be a dangerous weapon.

The counterempathy guards tend to come down once a game is over. Opponents often meet up after a contest and go over the game just completed, in a collaborative fashion. They do so in part to gain a better sense of what their counterparts were thinking during the game, as well as to share their own thoughts, prompting moments of mutual understanding.

While these efforts at agonic and mutual empathy are an integral part of chess culture, it’s also understood that if a player has too much caring concern for an opponent, to the point of feeling sorry for him if he loses, that feeling can get in the way of being a strong player.

What do you think about this tension between playing someone and they’re an opponent, but then afterwards you have this chance to team up and understand what happened in the game and share your mutual love for the game. But that might weaken you somehow.

RD: Yes, it’s very double-edged – what you know and what you want to share with the other person. It’s woven into how people interact. Once I came across that, it surprised me because we tend to think of empathy as a social good, it’s good to have empathy and be involved with people who are empathically attuned. But sometimes too much empathy  into another person can be dangerous, or perceived as such in certain circumstances. You want to know what’s going on in the other person’s world, but you don’t want them to know too much about your own. So chess players can be rather cagey. I remember once a friend and I were studying variations of a chess position one afternoon. The next Monday night at a chess club I played one of those variations against another person, in a casual, friendly game. My friend got annoyed with me, and said, “Don’t show what we’ve been studying to other people. We have to keep it secret.” So it’s sorcery in a way. You don’t want to spread around what you know because it can come back to haunt you.

KAF: Your three books seem to me to be quite different. Do you agree?

RD: The running theme is that I’m mostly interested in understanding distinct lifeworlds. Some anthropologists are more interested in developing theory on various topics. I’m mostly interested, more like a novelist would be, in portraying a particular world, in much the same way Jane Austen and Fyodor Dostoyevsky did. That’s what I’m most interested in, and the conceptual frameworks at hand get woven in to that. Each book is an exploration of a world, the world of the homeless shelter, of chess players, the world of dying and death. After I finish the book I’m writing now, I might write a book about friendship.

KAF: How long was Sensory Biographies in the works, from conception to field work to publishing? Because I wonder if you were decompressing from it.

RD: I think that’s right. I started research in 1997, and I made several trips to Nepal – in the summer of ’97, spring ’98, the summer and fall of 2000 and the fall of 2001. The book was published in 2003. I finished writing it in the spring of 2002, so it was a five-year project. Most of my books are like that. They take several years to complete, especially while I’m busy with teaching, as well. To complete a decent draft of a book manuscript, one has to write for a good full year – about a chapter a month.

KAF: You couldn’t do your work with the same kind of continuity as with chess, right? Because you could be immersed in that world.

RD: With my work in Nepal, there’s always a sense of toing and froing, going to Nepal and getting a sense of what I’m trying to understand, and then returning home and writing it up for months and even years at a time. Then going back and trying it out my ideas and understandings on people. There’s very much that sense of back and forth, of being close and far away. But in the chess world it was a complete immersion for several years. The other major difference is that the chess world comes out of my culture. I grew up playing chess, too. It was very much an auto-ethnography – writing about my own world. And Nepal is always different, always other, and I never feel I have a fully-realized, intuitive feel for the culture. It evolves from understandings that develop through time, and it can be jolting when I’m writing. There’s always a sense of newness and otherness. I never really feel I know that world completely.

KAF: How did you develop your focus on attitudes towards death in Nepal? Why did you focus on that?

RD: I’m asking myself that these days. When I was doing the life histories for Sensory Biographies, I decided to work with elderly people. They, themselves, spoke about their time of dying. The two people I worked with most  were both in their mid-80s, and they would talk about how they had only a few more years to live, which turned out to be the case. So they talked about what it was to be at the end of their life and what they could anticipate after they died. I picked up on those concerns and they were comfortable talking about them. I also became further intrigued with these very interesting ritual processes that kick in after a person dies – from the cremation rites to the funeral rites – they’re very interesting not just because of the seriousness of the subject matter, but what they say about the nature of consciousness, culture, and transformation in rituals, and life and death. It held my interest and I felt there was a story to be told there. Even when I during the chess book I would dream about these themes. I wasn’t sure, when I was writing the book on chess, if I would come back to this material. But I had written half of Subject to Death already – and I had put so much into it that I felt I should come back and finish it.

KAF: And in the end of your “Prelude to Subject to Death” you say that the book is really about life.

RD: Yes. I’m realizing that it’s really about the vitality and continuity of life. When I first started, I saw termination everywhere. Now I see vast swirls of continuity. For several years now, I’ve taught a course called “Engagements with Death and Mourning.” But this fall I’m teaching a new course called “The Anthropology of Life Itself.” That might lead to work on this topic down the road.

KAF: Do you feel that anthropology, more than any other discipline, gives a sense of complexity of culture and its influences on individuals?

RD: I think so, but I’m biased. There is a multi-dimensional perspective inherent in anthropology that is very important. There are so many factors weighing into a situation. An anthropological sensibility trains one to see the world in that way. I see that in teaching my students, for they soon become aware of all the factors that need to be taken into account to make sense of how peoples’ lives are put together.

KAF: There is a concern that when you embed yourself in another culture and observe and take photos, maybe you impinge on that culture, in an analog to the Heisenberg Uncertainty Principle, where you affect what you’re studying. How do you get around that?

RD: It’s  tricky. I’m not sure you can completely get around it. I often think an anthropologist’s presence is not as influential as people feel, especially these days. I think I’ve had a small impact on peoples’ lives, compared to the effects of globalization, migration, and the advent of technologies. An image I once thought of is that I’m on a surfboard on top of a wave of change. But I’m not the one generating the wave. People I talk with would agree, I think

One has to keep a lot in mind when doing fieldwork. The best way for me is to develop a collaborative approach. I write books and there’s an agreement with the people about what I should be writing about, that a kind of support and a good can come out of that. The people I work with are very concerned with promoting their ethnic identity. It’s important for them to solidify and to publicize who they are within the Nepali world and  beyond. So they see my work as helping to do that. It can also help to create a record of who they are both now and who they were in the past. I see it as mutually beneficial rather than exploitative. Some feel anthropology is inherently associated with colonialism, but I don’t agree. There is something to the  idea that Westerners are going to other places and studying and observing and defining them in a certain way. But anthropology doesn’t have to be exploitative.

KAF: What do you think of the relatively new field of cultural neuroscience? Do you think brain anatomy differs across cultures and is shaped by it?

RD: That’s a good question. I can’t say I’m up-to-date on current research. There is also the question of what is anatomy as opposed to processing. I see things in terms of complex interactions of forces and factors. The brain is clearly an important dimension of it. It’s great to develop a field like cultural neurology, but the danger is to make things too brain-centered – to see it as the locus and driver or the “house” where everything is happening. Neuroprocessing is just one component of a very complex system of interactions. You have language, material objects, consciousness, relationships between bodies, cultural histories – and all of that weighs in together. So if we look at these funeral rites that I’m attempting to understand, for instance, the brain is clearly a part of that – how the rituals are interacting with the brain – but there is so much more going on. There are relationships between people, associations between memories, material objects, dreams, imagination. The brain is of course woven into that, but it’s only one element of a larger system of interactions.

KAF: What can anthropologists learn from cultural neuroscientists, if anything? Given their different approaches, can they collaborate?

RD: Definitely. What anthropologists can learn is a greater understanding of how the brain works, how it perceives information, and the subtleties of neural processing, thinking, imagining, sensing, and remembering. That’s a kind of black box in anthropology now. We’re writing about consciousness, emotions, and empathy, but we don’t have a fine-tuned understanding of how the brain is working with these things. So what one needs is a unified theory, in much the same way that people are looking for that in physics. That would interest anthropologists, too – looking at a phenomenon and knowing all that’s going into it. So for instance, I’m learning about digital photography. I was reading about how light works and how the brain perceives light and color that kind of perception is very different from a camera recognizes light and color. This is important to know, and the knowledge from this can be highly generative of insight and understanding. I would similarly be interested in how the brain perceives music and ritual practices and how these practices  have an effect on the brain. These are all fertile questions to explore, but anthropologists are cautioning against getting too reductionistic about it – just saying the brain is doing everything and that it all comes back to the brain.

KAF: Professor Desjarlais, thank you so much for your time.

Links

Interview, Israeli Public Radio

“Homo Ludens,” Jonathan Rowson, New in Chess

“For Love of the Game,” Chronicle of Higher Education

Foreword Reviews, March/April 2011

“Counterplay: An Interview with Robert Desjarlais,” ChessLife Online, United States Chess Federation


Defining Mental Illness in Children: The SSI “Safety Net”

Quote

Excerpt from forthcoming New York Review of Books (“The Illusions of Psychiatry” by Marcia Angell dd. 7/14/11 ):

One would be hard pressed to find a two-year-old who is not sometimes irritable, a boy in fifth grade who is not sometimes inattentive, or a girl in middle school who is not anxious. (Imagine what taking a drug that causes obesity would do to such a girl.) Whether such children are labeled as having a mental disorder and treated with prescription drugs depends a lot on who they are and the pressures their parents face.[1]  As low-income families experience growing economic hardship, many are finding that applying for Supplemental Security Income (SSI) payments on the basis of mental disability is the only way to survive. It is more generous than welfare, and it virtually ensures that the family will also qualify for Medicaid. According to MIT economics professor David Autor, “This has become the new welfare.” Hospitals and state welfare agencies also have incentives to encourage uninsured families to apply for SSI payments, since hospitals will get paid and states will save money by shifting welfare costs to the federal government.

Growing numbers of for-profit firms specialize in helping poor families apply for SSI benefits. But to qualify nearly always requires that applicants, including children, be taking psychoactive drugs. According to a New York Times story, a Rutgers University study found that children from low-income families are four times as likely as privately insured children to receive antipsychotic medicines.

[1] Duff Wilson, “Child’s Ordeal Reveals Risks of Psychiatric Drugs in Young,” The New York Times , September 2, 2010.

The Hard Problem of Schizophrenia: BPS Response to DSM-5

Aside

Today the Society for Humanistic Psychology blog posted an excerpt of the British Psychological Society “Response to the American Psychiatric Association DSM-5 Development”  (they also provide a link to pdf). Regarding schizophrenia, on the positive side the BPS supports the use of a severity scale in the DSM-5 for the following dimensions: hallucinations, delusions, disorganization, abnormal psychomotor behavior, restricted emotional expression, avolition, impaired cognition, depression, and mania, “not only because it focuses on specific problems . . . but because it introduces the concept of variability more fully into the system.” But the BPS has significant concerns about the validity and utility of the diagnosis more generally (“it is entirely possible for two individuals with the diagnosis to share no characteristics or symptoms”). They also recognize the “hard problem” for DSM-5 (and beyond), the need to consider “the relational context of problems and the undeniable social causation of many such problems.” As Kwame McKenzie and others (Morgan, McKenzie, & Fearon, 2008) have recently argued social risk factors (e.g., the stress of being an immigrant) interacting with genetic and epigenetic processes may play a significant role in etiology.

Imagining the Future: A 10-Year Plan for Neuroscience

Harvard Provost and neuroscientist Steven Hyman summary vision of roadmap (introduced by Garen Staglin at One Mind for Research Forum May 23–25, 2011). Additional videos from conference on genetics, emotion, learning and memory, the connectome, translational neuroscience, as well as interview with Karl Deisseroth (optogenetics, Stanford) via TheScienceNetwork.Org.

Vodpod videos no longer available.

Link

Recent NYT article (“A schizophrenic, a slain worker, troubling questions”) underscores the need for systems of care: “If we don’t get funding, we’re either on the street, in prison, dead or rather be dead.”

Comment (links added) by Mark Zanger, Boston, MA (June 18, 2011):

A brilliant article with an unfortunate headline. We try to describe people with illness as “person with” rather have them a walking label: a schizophrenic, a cancerous, a diabetic, an autistic. Rather we can say, a person with schizophrenia, or a man with cancer, or a woman with diabetes, or a child with an autism disorder. This reminds us that people with issues, even alleged murderers, are people first and dealing with illness from a position of person-hood. An issue that might have been explored in the article is the right to refuse treatment versus measures of civil commitment used on persons with paranoid schizophrenia and a history of violence, such as “Kendra’s Law” in New York. Massachusetts does not have a measure of this kind, and is unlikely to pass one even in the wake of this horrible and not entirely isolated incident. The New Yorker has just run a very moving article on the price of “right to refuse” for one woman with schizophrenia; the New York Review of Books is in the middle of a two-part review of three books questioning the validity of existing medical treatment for mental illness. Let’s not leave civil commitment to the Post or the Wall Street Journal, eh?

Planning Underway for Next FPR-UCLA Interdisciplinary Conference (2012)

The tentative title for our next interdisciplinary conference is “The Emerging Neuroscience of Culture: Prospects and Challenges,” which is planned for 2012. Below is a brief description (comments are warmly welcomed!):

Over the next decade, many aspects of human behavior and emotions will become increasingly understood using the research and techniques of neuroscience, in conjunction with anthropology, sociology, economics, and psychology.  Combining a brain-based perspective with the critical significance of non-neuro-centric aspects of culture – systems of discourse, institutions, and belief – will lead to major advances in how we understand the different ways in which people live, organize, govern, and create meaning in global, national, and local contexts. The aim of this conference is to bring together anthropologists, psychologists, neuroscientists, and those in related fields in a relaxed and collegial setting (formal talks and lab and field case studies alternating with roundtable discussions)  to inform one another about the latest studies; discuss and debate different concepts, theories, and methodologies; and propose ideas for collaborative research projects. We are specially interested in teams that are developing multidisciplinary strategies, methodologies, and approaches and invite them to do joint presentations that include discussions or feature insights on the dynamics of these kinds of studies. We are also interested in presentations that consider the history and social implications of neuroscience.

“What is Mental Illness?” Psychiatry in a State of Flux

UPDATE: Skeptically Speaking interviews Richard McNally (6/12/11)

An untidy stack of new books on psychiatry has sprouted in my office since our last conference on cultural and biological contexts of psychiatric disorder in January 2010. At the top is a slim volume by Harvard clinical psychologist, experimental psychopathologist, and DSM-IV (PTSD and specific phobia) committee member Richard McNally entitled What is Mental Illness? (Belknap Press, 2011) that promises to cut through “both professional jargon and polemical hot air, to describe the intense political and intellectual struggles over what counts as a ‘real’ disorder, and what goes into the DSM.” (McNally is also advisor to the DSM-V Anxiety Disorders Sub-Workgroup.) The book, which was written for an academic/trade audience and can be read through in a single evening, is an impressive synthesis of research and scholarship interwoven with insights.

Like Arthur Kleinman’s Rethinking Psychiatry: From Cultural Category to Personal Experience (save for another evening),  the titles of McNally’s chapters are phrased in the form of questions: “An Epidemic of Mental Illness?”; “Are We Pathologizing Everyday Life?”; “Can Evolutionary Psychology Make Sense of Mental Disorder?”; “Psychopathology as Adaptation?”; “Does Society Create (Some) Mental Disorders?”; Is It in Our Genes?”; “Do Mental Disorders Differ by Kind or Degree?”; “So What is Mental Illness Anyway?” The “gift” of this book is McNally’s ability to  survey and evaluate a broad swath of psychiatric, evolutionary, philosophical, anthropological, historical, and neuroscientific literature, with the biological, classificatory, pharmacological, social, and narrative aspects of mental illness given equal play.

Although nearly half of all Americans suffer from some form of mental illness according to a recent study, McNally argues that we shouldn’t be surprised at the high rates. Just as “physical illness runs from the common cold to cancer,” he writes, so mental illnesses can range from mild phobias to severe psychoses. The real problem according to McNally, one that his book attempts to address, is in distinguishing the concept of “mental disorder,” and all that that classification entails, from the differing degrees of “mental distress” in response to the emotional tangles, ruptures, or situational predicaments of everyday life.

McNally believes that some forms of psychopathology “are likely natural kinds discovered by observant clinicians across cultures and throughout history.” These include mania, melancholia, panic disorder, obsessive-compulsive disorder, and alcoholism.  (Although McNally describes schizophrenia as a biological disorder of recent vintage, he doesn’t consider it a “natural kind” because there are likely distinct phenotypes.) He recognizes other illness, like multiple personality disorder, as instantiations of one of Ian Hacking’s (1999) “interactive kinds” whereby psychiatric classification has a feedback effect on the behavior of the people being classified, as well as beliefs, institutions, and practices. [1]  Still other illnesses may reflect what he considers an encroachment of psychiatry on “normal suffering” as a result of life’s “inevitable disappointments and limitations,” e.g., sexual dysfunction, social anxiety disorder, eating disorders,  and PTSD – disorders that are tied to particular contexts, motives, and practices. (McNally, who is the author of a previous, terrific book, Remembering Trauma, is particularly critical of our capacity for “conceptual bracket creep in the definition of trauma.” )

He concludes that mental illnesses can never be defined on the basis of any single approach (or explanatory level)  “because the questions asked by the stakeholders may require different kinds of answers.” The various definitions are based on the contexts in which disorders occur.

New books challenging our assumptions about psychopathology by McNally, Ethan Watters (Crazy Like Us), Irving Kirsch (The Emperor’s New Drugs), Jonathan Metzl (The Protest Psychosis), Daniel Carlat (Unhinged), Robert Whitaker (Anatomy of an Epidemic) and Gary Greenberg (Manufacturing Depression) are kicking up dust clouds all over biological psychiatry (see NYRB for a recent, 2-part essay review  on the Kirsch, Whitaker, and Carlat books). Public debate matters because there are multiple stakeholders, a slew of treatments (some dubious), overmedicalization, unmet need, and an ethical decision to be made on whether or how to intervene in the face of psychological suffering. Psychiatrists, researchers, and the nearly fifty percent of us whom anthropologist Emily Martin refers to as living under the description of a psychiatric disorder will find McNally’s even-handed approach to the DSM’s validity issue of immense value.

[1] Although McNally refers specifically to “interactive kinds,” Hacking (2007) has since dispensed with the term: “Interactions among classifications, people, institutions, knowledge and experts are essential to the explanation of the looping effect and making up people, but there is no well-defined type of classification of people worth calling interactive or human kinds. Interaction, yes, but interactive kinds as a distinct class, no” (2007, p. 293, fn. 21).

References

Angell, M. (2011, June 23). The epidemic of mental illness: Why? The New York Review of Books, 58(11). Retrieved from http://www.nybooks.com/issues/2011/jun/23/

Carlat, D.  (2010). Unhinged: The trouble with psychiatry – a doctor’s revelations about a profession in crisis. New York: Free Press.

Greenberg, G. (2010). Manufacturing depression: The secret history of a modern disease. New York: Simon & Schuster.

Hacking, I. (1999). The social construction of what? Cambridge, MA: Harvard University Press.

Hacking, I. (2007). Kinds of people: Moving targets. Proceedings of the British Academy, 151, 285–318.

Kirsch, I. (2010).  The emperor’s new drugs: Exploding the antidepressent myth. New York: Basic Books.

McNally, R. (2003). Remembering trauma. Cambridge, MA: Belknap Press.

McNally, R. (2010). What is mental illness? Cambridge, MA: Belknap Press.

Metzl, J. (2010). The protest psychosis: How schizophrenia became a black disease. Boston: Beacon Press.

Watters, E. (2010). Crazy like us: The globalization of the American psyche. New York: Free Press.

Whitaker, R. (2010). Anatomy of an epidemic: Magic bullets, psychiatric drugs, and the astonishing rise of mental illness in America. New York: Crown.