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- Convenors:
-
Junko Kitanaka
(Keio University)
Amy Borovoy (Princeton University)
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- Sessions:
- Wednesday 7 April, -
Time zone: America/Chicago
Short Abstract:
By examining the rise of community psychiatry and alternative therapies for mental health, this panel seeks to explore what ideas of mental illness, personhood, and environment these practices help advance, and how they may be transforming the way people envision psychological health.
Long Abstract:
As the era of mental hospitals is closing in for most parts of the world, many societies are witnessing a rise of community psychiatry and alternative therapies for mental health. Despite the prevailing concern that the forces of global mental health might homogenize psychiatric care via a biomedical model, these areas have instead seen flourishing therapeutic cultures that range from various forms of self-help group, "self-study" programs for those who want to do research on their mental health, meditation practices, as well as art and talk therapies that constitute vibrant therapeutic landscapes in urban centers. While some of these remain within a more commercialized domain, alongside established psychiatric institutions, others, such as self-study groups have begun to formally challenge the received knowledge of psychiatry, instead asserting their own ideas about the causes of mental illness and recovery. We investigate these new practices in the context of a radical rethinking of social and environmental issues, emblemized by an interest in "user-controlled research" and "coproduction" of health and mental health services. We also illuminate growing trends to see mental health care as a social welfare problem, to remove distinctions between professionals and recipients, and to rethink these services as "doing for" rather than "doing to." By mapping out the emerging therapeutic cultures with one focus on East Asia but not limited to it, this panel seeks to investigate what ideas of mental illness, personhood, and environment these practices help advance, and how they may be transforming the way people envision psychological health.
Accepted papers:
Session 1 Wednesday 7 April, 2021, -Paper short abstract:
Since 2016, Peru is transitioning from a mental healthcare model based in asylums and psychiatric hospitals to Community Mental Health. In this paper, I argue that this transitional moment provides insight into the dynamics that arise in the community when total institutions start to fade away.
Paper long abstract:
Peru is currently undergoing an important institutional transition regarding mental health. Since 2016, the government has started transitioning state-sponsored treatment for several mental illnesses from an asylum/institutionalization model to a community mental health model. To effectively address mental health afflictions and other psychosocial conditions in the wake of de-institutionalization, the goal is to build at least one hundred community mental health centers around the country. Thus far, twenty-nine have been built. This reform also aims to place mental health in the public agenda and address the stigma surrounding mental illness. In this paper, I present the case of the community mental health center in Carabayllo, the “flagship” facility of the ongoing reform, located in a poor semi-urban district at the outskirts of Lima, Peru. Drawing from three months of fieldwork and interviews with psychiatrists, community mental health workers and residents of Carabayllo, I argue that this transitional moment provides insight into the dynamics that arise in the community when total institutions start to fade away. I explore residents’ reflections on this transition, considering in particular the anxieties they express over the proximity of mental illness and the symbolic and spatial dimensions they reveal of the relationship between clinic and community. With the asylum reconfiguring and the community-based model spreading in the city through its different agents, I signal the diverse challenges the residents of Carabayllo articulate against the closeness of mental illness and the extension of the clinic.
Paper short abstract:
Drawing on fieldwork in community psychiatry in Tokyo, this paper asks how clinicians attempt to realize the values of their own profession in relationships with communities. To do so, clinicians reinterpret the notion of clients' rights, which remains contested in psychiatric settings.
Paper long abstract:
Against the backdrop of the structural and institutional limitations clinicians face, and as psychiatry both expands its sphere of recognition and is increasingly critiqued globally, how do clinicians negotiate their own values in the process? Drawing on fieldwork in community psychiatry in impoverished areas of Tokyo, this paper responds to this question. Though in the U.S. the deinstitutionalization movement from the 1960s established community psychiatry, the shift also created new problems such as mass institutional closings. By contrast, in Japan, a strong antipsychiatry movement from the 1960s ultimately failed to bring deinstitutionalization. As a result, Japan now has the largest number of long-term psychiatric beds per population among OECD countries. Yet, with policy have changed from the 2000s towards shorter hospitalization, some clinicians have begun to shift toward community psychiatry and are exploring new values that psychiatry can stand for as they try to reestablish clients’ rights. However, clinicians face several setbacks: economic constraints of their institutions; the fact that the notion of rights remains a polysemous concept; and the struggle against contestations around the notion of rights as it tends to evoke a complex feeling of inferiority in clients. In this context, Clinicians often face ideological conflicts about what constitutes “rights” for their clients and ask themselves what it means to respect their autonomy/ agency. This paper thus explores how clinicians redefine and reinterpret the notion of rights, as they attempt to realize the values of their own profession in relationships with communities.
Paper short abstract:
This paper considers the felt need to escape the clinic among military mental health care providers in the wars in Iraq and Afghanistan to theorize the forms of exposure such escapes imagine and enact.
Paper long abstract:
This paper considers the felt need to escape the clinic among military mental health care providers in the wars in Iraq and Afghanistan to theorize the forms of exposure such escapes imagine and enact. Exposure, particularly through the idiomatic experience of leaving the relative control, safety and professional routine of the clinic, features as a key ethic and therapeutic register in the practice of care among deployed military psychologists and social workers. Exploring how providers are enjoined to get out of the clinic through so-called “walkabouts” – improvised ambulations around base used to establish para-therapeutic contact with soldiers through casual encounters in the dining hall, gym, and out in the motor pool – I show how provider exposure is a critical way of doing the work of war that expands the reach of “the clinic” across the topography of counterinsurgency, and informalizes and disperses the patient encounter across the spaces and interactions of deployed military life. I theorize provider exposure as a “point of contact,” a concept I use to highlight the range of symbolic and bodily vulnerabilities as well as the therapeutic and professional opportunities that can unfold in the raw encounters of the walkabout. Points of contact are conditioned by the historical and material particularities of counterinsurgency, the institutional stigma of military mental health, and the professional anxieties of care providers of the officer class as they navigate the division of labor and hierarchy of power that separate them from enlisted soldiers.