Social and cultural anthropology: salience for psychiatry
Authors: Kleinman Arthur 
Published: January 2013

AbstractAnthropology's chief contribution to psychiatry is to emphasize the importance of the social world in diagnosis, prognosis, and treatment, and to provide concepts and methods that psychiatrists can apply (the appropriate cross-disciplinary translation first being made, however). But that is not the only contribution that anthropology offers. Ethnographers are aware that knowledge is positioned, facts and values are inseparable, and experience is simply too complex and robust to be easily boxed into tight analytical categories. Hence a sense of the fallibility of understanding, the limitation of practice, and irony and paradox in human conditions is the consequence of ethnography as a method of knowledge production. Anthropology also complements the idea of psychosomatic relationships with evidence and theorizing about sociosomatic relationships. Here moral processes—namely what is at stake in local worlds—are shown to be closely linked with emotional processes, which are frequently about experiences of loss, fear, vexation, and betrayal of what is collectively and individually at stake in interpersonal relationships. Change in the former can change the latter, and this can at times work in reverse as well. Examples include the way symptoms intensify or even arise in response to fear and vexation concerning threats perceived as serious dangers to what is most at stake. The relationship of poverty to morbidity and mortality is a different example of sociosomatic processes. Poverty correlates with increased morbidity and mortality. Psychiatrists have often had trouble getting the point that public health and infectious disease experts have long understood. But it is not just diarrhoeal disease, tuberculosis, AIDS, heart disease, and cancer that demonstrate this powerful social epidemiological correlation—so do psychiatric conditions. Depression, substance abuse, violence, and their traumatic consequences not only occur at higher rates in the poorest local worlds, but also cluster together (much as do infectious diseases), and those vicious clusters define a local place, usually a disintegrating inner-city community. Hence the findings of the National Co-Morbidity Study in the United States of America that most psychiatric conditions occur as comorbidity is a step toward this ethnographic knowledge—that in the most vulnerable, dangerous, and broken local worlds, psychiatric diseases are not encountered as separate problems but as part of these sociosomatic clusters. Finally, anthropology is also salient for policy and programme development in psychiatry. Against an overly narrow neurobiological framing of psychiatric conditions as brain disorders, anthropology in psychiatry draws on cross-national, cross-ethnic, and disintegrating community data to emphasize the relationship of increasing rates of mental health problems, especially among underserved, impoverished populations worldwide, and increasing problems in the organization and delivery of mental health services to fundamental transformations in political economy, institutions, and culture that are remaking our epoch. In so doing, anthropology projects a vision of psychiatry as a discipline central to social welfare and health policy. It argues as well against the profession's ethnocentrism and for the field as a larger component of international health. Anthropology (together with economics, sociology, and political science) also provides the tools for psychiatry to develop policies and programmes that address the close ties between social conditions and mental health conditions, and social policies and mental health policies. In this sense, anthropology urges psychiatry in a global direction, one in which psychiatric knowledge and practice, once altered to fit in more culturally salient ways in local worlds around the globe, have a more important place at the policy table.