Paper short abstract:

Mental health patients' accounts of bodily distress are often challenged by clinicians. This paper explores an unexpected counter-challenge that substantiates patient claims. What is the role of the ethnographer in documenting the experiential truths that lie outside of authorised knowledge?

Paper long abstract:

‘That’s just their anxiety.’ While conducting ethnographic fieldwork in mental health settings in Alberta, Canada (2016-2019), I often heard clinicians voice this ‘just anxiety’ interpretation of patients’ physical distress. Patients, clinicians continued, needed psychiatric medication or psychotherapy—interventions targeting their anxious minds, not their sick bodies.

My doctoral research investigates the challenges of individuals who experience what I call ‘strange transformations’—pathological changes in individuals’ bodies that impact their minds. Although an individual may require medication for tuberculosis, surgery for a brain tumour, or hormones for thyroid dysfunction, the psychological disturbances accompanying these conditions may garner excessive attention from clinicians. Misinterpretation of the psychological traits of physical conditions as mental disorders (often classified as anxiety) has been shown to have dire consequences, as it interferes with access to appropriate services and contributes to disproportionately high rates of premature death.

Nonetheless, patients' accounts of the prominence of their physical symptoms are frequently contested by clinicians. Epistemic clashes arise not only along emic-etic power gradients, but also between contrasting authoritative interpretations of disease etiology and health outcomes. This paper follows my deeper ethnographic exploration into how some patients may be investigated for ‘strange transformations’ (referred to as ‘physical cause’ in the F06 block of classifications in the ICD-10; as ‘another medical condition’ in the DSM-5). I highlight the role of the ethnographer in documenting the experiential truths that lie outside of authorised knowledge (Geissler 2013).

Paper short abstract:

This paper discusses the epistemological and ethical frameworks that structure psychiatric and Peruvian vegetalista practices and the implications for the verification of truths by those interested in advancing the therapeutic applications of ayahuasca and other sacred plants.

Paper long abstract:

The past two decades have often been referred to as a ‘renaissance’ in psychedelic science that will contribute to a revolution in psychiatry. Researchers, health practitioners, businesses, and mainstream media have promoted the promises of a society in which psychedelics are fully medicalized to address the growing mental health crisis and a slew of other psychiatric concerns. Questions abound concerning appropriate professional conduct and the boundary work of who is considered a legitimate practitioner: medically-trained psychiatrists or people trained in long apprenticeships, receiving knowledge passed down through generations? Further, there is need for discussion on the ethical frameworks that may structure these therapeutic processes or the social and cultural assumptions that influence the epistemic qualification of psychedelics as psychiatric pharmacotherapies rather than the many other ‘local meanings’ or significations rooted in Indigenous and traditional understandings of sacred plants. To begin addressing these questions, I ground this paper in ethnographic fieldwork on ayahuasca shamanism in Peru, where a plurality of healing approaches in the context of vegetalismo and associated psychotherapeutic practices have given form to a therapeutic milieu with intersecting ontological configurations that lack a common worldview, yet exert influence on each other. I examine the continuities and disjunctures between the vegetalista tradition and the growing professionalization of psychedelic therapists that draws on both shamanic traditions and psychiatric regimes of knowledge and authority to produce new truths and relativities in these intercultural and epistemologically complex spaces.

Paper short abstract:

Focusing on the families of forensic patients, this paper considers the stakes and complexity of negotiating narrative authority for experiences centred around other people’s suffering, both through severe mental illness and through violence that has resulted in death or serious injury.

Paper long abstract:

This paper reflects on my experience as the daughter of a forensic patient planning to research the experience of other family members of people institutionalised after serious violent crimes that occurred during psychiatric episodes.

The Covid-19 crisis brought to the fore how systemic uncertainty undermines mental health. However, mental illness resulting in serious violent crimes continues to be understood as detached from systemic issues, in its causes and how its impacts refract into society beyond the impact on the primary victim(s). People requiring institutionalisation after violent crimes remain outside the scope of debates relating to wider social and economic issues. The stigmatisation of their families precludes these wider implications from being understood, with a dearth of academic research focused on families of forensic patients (Robinson et al. 2017). However, a bricolage of literature on adjacent experiences - the secondary victims of violent crimes, the families of psychiatric patients and families/carers of incarcerated people - trace patterns through which mental illness, poverty and other forms of socially-constructed inequalities intertwine and refract through generations (Condroy & Minson 2020, Davis 2012, Miller and Barnes 2015). Drawing on this patchwork and its omissions, I consider the stakes and the complexity of negotiating narrative authority for experiences centred around other people’s suffering – both through severe mental illness, and through violence that has resulted in death or serious injury – shedding light on the shaky foundations on which the truth of families has to be built, and the ramifications this may have for ethnographic research.