ISSN 0344-8622 35(2012)1+2 - Arbeitsgemeinschaft Ethnomedizin

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ISSN 0344-8622 35(2012)1+2 - Arbeitsgemeinschaft Ethnomedizin
Curare
ISSN 0344-8622
35(2012)1+2
Sonderbände – Special Volumes
Schmerz – Interdisziplinäre Perspektiven. Beiträge zur 9. Internationalen
Fachkonferenz Ethnomedizin in Heidelberg 6.–8.5.1988
• K. Greifeld, N. Kohnen & E. Schröder (Hg) • 1989 • 191 S.
Vol. 7
Anthropologies of Medicine. A Colloquium on West European and North
American Perspectives
• B. Pfleiderer & G. Bibeau (eds) • 1991 • 275 pp.
Vol. 8
Gebären – Ethnomedizinische Perspektiven und neue Wege
• W. Schiefenhövel, D. Sich & C. E. Gottschalk-Batschkus (Hg)
1995 • 461 S. • ISBN 978-3-86135-560-1
Vol. 9
Ethnomedizinische Perspektiven zur frühen Kindheit/Ethnomedical
Perspectives on Early Childhood
• C. E. Gottschalk-Batschkus & J. Schuler (Hg)
• 1996 • 470 S. • ISBN 978-3-86135-561-8
Vol. 10
Transkulturelle Pflege
• C. Uzarewicz & G. Piechotta (Hg)
• 1997 • 262 S. • ISBN 978-3-86135-564-9
Frauen und Gesundheit – Ethnomedizinische Perspektiven/Women and
Health – Ethnomedical Perspectives
• C. E. Gottschalk-Batschkus, J. Schuler & D. Iding (Hg)
• 1997 • 448 S. • ISBN 978-3-86135-563-2
Vol. 11
Vol. 12
The Medical Anthropologies in Brazil
• A. Leibing (ed)
• 1997 • 245 pp. • ISBN 978-3-86135-568-7
Vol. 13
Was ist ein Schamane? Schamanen, Heiler, Medizinleute im Spiegel west­
lichen Denkens/What is a Shaman? Shamans, Healers, and Medicine Men
from a Western Point of View
• A. Schenk & C. Rätsch (Hg)
• 1999 • 260 S. • ISBN 978-3-86135-562-5
Vol. 14
Ethnotherapien – Therapeutische Konzepte im Kulturvergleich/
Ethnotherapies—Therapeutic Concepts in Transcultural Comparison
• C. E. Gottschalk-Batschkus & C. Rätsch (Hg)
• 1998 • 240 S. • ISBN 978-3-86135-567-0
Vol. 15
Kulturell gefordert oder medizinisch indiziert? Gynäkologische Erfahrungen
aus der Geomedizin/Postulated by Culture or Indicated by Medicine?
Gynecological Experiences from Geomedicine
• W. Föllmer & J. Schuler (Hg)
• 1998 • 344 S. • ISBN 978-3-86135-566-3
Vol. 16
Trauma und Ressourcen/Trauma and Empowerment
• M. Verwey (Hg)
• 2001 • 358 S. • ISBN 978-3-86135-752-0
VWB – Verlag für Wissenschaft und Bildung
ISBN 978-3-86135-767-4
35(2012)1+2
Vol. 6
Zeitschrift für Medizinethnologie • Journal of Medical Anthropology
hrsg. von/edited by: Arbeitsgemeinschaft Ethnomedizin e.V. – AGEM
Kultur, Medizin und Psychologie im „Trialog“ III
AGEM 1970–2010 & Transkulturelle Psychiatrie: Rückblicke und Ausblicke V
Impressum
U2
Zum Titelbild/Front picture Curare 35(2012)1+2: Kultur und Psychiatrie/Culture and Psychiatry.
Pragmatische Anwendungen in der Psychiatrie – eine Bricolage zwischen Medizinischer Soziologie
und Kulturwissenschaften?/Pathways of Application in Psychiatry—Bricoleurs between Medical Sociology and Cultural Anthropology?
Legende zu den abgebildeten Buchtiteln (von links nach rechts und von oben nach unten):
Van Keuk E., Ghaderi C., Joksimovic L & David. D. (Hg) 2010. Diversity. Transkulturelle Kompetenz in klinischen und sozialen Arbeitsfeldern. Stuttgart: Kohlhammer // Hoffmann K. & Machleidt W. (Hg). 1997. Psychiatrie im Kulturvergleich. Beiträge des Symposiums
1994 des Referats transkulturelle Psychiatrie der DGPPN im Zentrum für Psychiatrie Reichenau (Das transkulturelle Psychoforum 2). Berlin: VWB – Verlag für Wissenschaft und Bildung // Fengler C. & Fengler T. 1980. Alltag in der Anstalt. Wenn Sozialpsychiatrie praktisch
wird. Eine ethnomethodologische Untersuchung. Rehburg-Loccum: Psychiatrie Verlag // Freidson E. 1979. Der Ärztestand. Stuttgart:
Enke [1970. Profession of Medicine: a Study of the Sociology of Applied Knowledge. New York: Dodd, Mead & Company] // Zutt J. (Hg)
1972. Ergriffenheit und Besessenheit. Ein interdisziplinäres Gespräch über transkulturell-anthropologische und -psychiatrische Fragen.
(Symposium von 1968). Bern und München: Francke // Dörner K. 1969. Bürger und Irre. Zur Sozialgeschichte und Wissenssoziologie der
Psychiatrie. Frankfurt am Main: EVA // Wohlfart E. & Zaumseil M. (Hg) 2006. Transkulturelle Psychiatrie – Interkulturelle Psychotherapie. Heidelberg: Springer // Hegemann T. & Salman R. (Hg) 2001. Transkulturelle Psychiatrie. Konzepte für die Arbeit mit Menschen
aus anderen Kulturen. Bonn: Psychiatrie-Verlag [2010 neu bearbeitet als „Handbuch Transkulturelle Psychiatrie“] // Machleidt W. &
Heinz A. (Hg) 2010. Praxis der interkulturellen Psychiatrie und Psychotherapie. Migration und psychische Gesundheit. München: Urban
und Fischer in Elsevier
[Idee zur Kollage dieses Titelbildes: E. Schröder in Zusammenarbeit mit A. Aglaster]
Hinweise für Autoren / Instructions to Authors
Hinweise für Autoren
Sprachen: deutsch und englisch.
Manuskripte: Curare veröffentlicht Originalbeiträge. Bitte liefern Sie
mit dem Manuskript (unformatiert im Flattersatz) eine Zusammenfassung (ca. 250 Wörter, Titel und ca. 5 Schlagwörter) in Deutsch,
Englisch und Französisch. Fußnoten sollten vermieden werden.
Danksagungen sind in der ersten Fußnote unterzubringen. Alle Fußnoten sollten gleich als Anmerkung am Ende des Textes vor die Literaturhinweise.
Zitate: Direkte und indirekte Zitate bitte direkt im Text aufführen,
Quellenangabe im Text: (Autor Jahreszahl: Seiten). Im Manuskript
können anstatt der Kapitälchen bei den Autoren diese auch normal
geschrieben und dann unterstrichen werden.
Literaturangaben in alphabetischer Reihenfolge am Ende des Textes:
U3
Instruction to Authors
Language: German or English.
Manuscripts: Original manuscripts only will be accepted. Please
provide additionally to the manuscript (unformated ragged type) an
abstract (appr. 250 words, appr. 5 keywords, and the title) in English,
French, and German language. Footnotes should be avoided. Acknowledgements should be in the first footnote. All footnotes become
endnotes after text and before the bibliography.
References: Please quote in-text citations in the following form: (Author year: pages). If small capitals are not possible to handle, normal
writing and underlining of the name.
Literature in alphabetical order at the end of the mansuscript.
The form for listing of references is as follows:
• Zeitschriften / Journals:
Stein C. 2003. „Beruf PsychotherapeutIn“: Zwischen Größenphantasien und Versagensängsten. Imagination 25,3: 52–69.
Fainzang S. 1996. Alcoholism, a Contagious Disease. A Contribution towards an Anthropological Definition of Contagion. Culture, Medicine
and Psychiatry 20,4: 473–487.
Bei Zeitschriften mit Namensdoppelungen, z.B. Africa das Herkunftsland in Klammern dazu setzen. / Journals which occur with the same name,
e.g. Africa put in brackets the country of origin.
Arbeitsgemeinschaft Ethnomedizin – AGEM, Herausgeber der
• Bei speziellen Themenheften mit Herausgeber(n) oder Gastherausgeber(n) / In case of an issue on a special theme and with editor(s) or
guest editor(s):
Maier B. 1992. Nutzerperspektiven in der Evaluierung. In Bichmann W. (Hg). Querbezüge und Bedeutung der Ethnomedizin in einem holistischen
Gesundheitsverständnis. Festschrift zum 60. Geburtstag von Hans-Jochen Diesfeld. (Themenheft/Special theme). Curare 15,1+2: 59–68.
Die Arbeitsgemeinschaft Ethnomedizin (AGEM) hat als rechtsfähiger Verein ihren Sitz in Hamburg und ist eine Vereinigung von Wissenschaftlern und die Wissenschaft fördernden Personen und Einrichtungen, die ausschließlich und unmittelbar gemeinnützige Zwecke verfolgt. Sie bezweckt die Förderung der interdisziplinären Zusammenarbeit zwischen
der Medizin einschließlich der Medizinhistorie, der Humanbiologie, Pharmakologie und Botanik und angrenzender Naturwissenschaften einerseits und den Kultur- und Gesellschaftswissenschaften andererseits, insbesondere der Ethnologie,
Kulturanthropologie, Soziologie, Psychologie und Volkskunde mit dem Ziel, das Studium der Volksmedizin, aber auch
der Humanökologie und Medizin-Soziologie zu intensivieren. Insbesondere soll sie als Herausgeber einer ethnomedizinischen Zeitschrift dieses Ziel fördern, sowie durch regelmäßige Fachtagungen und durch die Sammlung themenbezogenen
Schrifttums die wissenschaftliche Diskussionsebene verbreitern. (Auszug der Satzung von 1970)
• Rezensierter Autor, der im laufenden Text (Schüttler nach Fischer-Harriehausen 1971: 311) zitiert wird:
Schüttler G. 1971. Die letzten tibetischen Orakelpriester. Psychiatrisch-neurologische Aspekte. Wiesbaden: Steiner. Rezension von FischerHarriehausen H. 1971. Ethnomedizin I,2: 311–313.
Curare, Zeitschrift für Medizinethnologie • Curare, Journal of Medical Anthropology (gegründet/founded 1978)
Zeitschrift für Medizinethnologie
Journal of Medical Anthropology
Herausgeber im Auftrag der / Editor-in-chief on behalf of:
Arbeitsgemeinschaft Ethnomedizin e.V. – AGEM
Ekkehard Schröder (auch V.i.S.d.P. ) mit
Herausgeberteam / Editorial Board Vol. 33(2010) - 35(2012):
Gabriele Alex (Tübingen) [email protected] // HansJörg Assion (Detmold) [email protected] // Ruth Kutalek (Wien)
[email protected] // Bernd Rieken (Wien) bernd.­
[email protected] // Kristina Tiedje (Lyon) [email protected]
Geschäftsadresse / office AGEM: AGEM-Curare
c/o E. Schröder, Spindelstr. 3, 14482 Potsdam, Germany
e-mail: [email protected], Fax: +49-[0]331-704 46 82
www.agem-ethnomedizin.de
Beirat/Advisory Board: Michael Heinrich (London) // Mihály
Hoppál (Budapest) // Sushrut Jadhav (London) // Annette Leibing
(Montreal, CAN) // Danuta Penkala-Gawęcka (Poznań) // Armin
Prinz (Wien) // Hannes Stubbe (Köln)
Begründet von/Founding Editors: Beatrix Pfleiderer (Hamburg)
– Gerhard Rudnitzki (Heidelberg) – Wulf Schiefenhövel (Andechs) – Ekkehard Schröder (Potsdam)
Ehrenbeirat/Honorary Editors: Hans-Jochen Diesfeld (Starnberg) – Horst H. Figge (Freiburg) – Dieter H. Frießem (Stuttgart)
– Wolfgang G. Jilek (Vancouver) – Guy Mazars (Strasbourg)
• Autor einer Buchbesprechung / Reviewer:
Pfeiffer W. 1988. Rezension von / Bookreview from Peltzer K. 1987. Some Contributions of Traditional Healing Practices towards Psychosocial
Health Care in Malawi. Eschborn: Fachbuchhandlung für Psychologie, Verlagsabt. Curare 11,3: 211–212.
• Bücher und Monographien / Books and Monographs:
Pfleiderer B., Greifeld K., Bichmann W. 1995. Ritual und Heilung. Eine Einführung in die Ethnomedizin. Zweite, vollständig überarbeitete und
erweiterte Neuauflage des Werkes „Krankheit und Kultur“ (1985). Berlin: Dietrich Reimer.
Janzen J.M. 1978. The Quest for Therapy in Lower Zaire. (Comparative Studies in Health Systems and Medical Care 1.) Berkeley and L.A., CA:
University of California Press.
IMPRESSUM 34(2011)3
• Sammelband / Collection of essays (papers) (name all authors):
Schiefenhövel W., Schuler J., Pöschl R. (Hg) 1986. Traditionelle Heilkundige – Ärztliche Persönlichkeiten im Vergleich der Kulturen und medizinischen Systeme. Beitr. u. Nachtr. zur 6. Intern. Fachkonferenz Ethnomedizin in Erlangen, 30.9.–3.10.1982. (Curare-Sonderband/Curare
Special Volume 5). Braunschweig, Wiesbaden: Vieweg.
Blacking J. (Ed) 1977. The Anthropology of the Body. (A.S.A. Monograph 15). London: Academic Press.
Verlag und Vertrieb / Publishing House:
VWB – Verlag für Wissenschaft und Bildung, Amand Aglaster
Postfach 11 03 68 • 10833 Berlin, Germany
Tel. +49-[0]30-251 04 15 • Fax: +49-[0]30-251 11 36
e-mail: [email protected]
http://www.vwb-verlag.com
• Artikel aus einem Sammelband / Article in a collection of papers:
Schuler J. 1986. Teilannotierte Bibliographie zum Thema „Traditionelle Heilkundige – Ärztliche Persönlichkeiten im Vergleich der Kulturen
und medizinischen Systeme“. In Schiefenhövel W. et al. (Hg), a.a.O.: 413–453. (wenn das Werk mehrfach zitiert wird, sonst komplett nach
obiger Anweisung zitieren, Seitenzahlen am Schluss, … Braunschweig/Wiesbaden: Vieweg: 413–453)
Loudon J.B. 1977. On Body Products. In Blacking J. (Ed), op. cit.: 161-178 (if the vol. is cited more than one time, otherwise citation of references as above, pages at the end, … London: Academic Press: 161–17)
Bezug / Supply:
Der Bezug der Curare ist im Mitgliedsbeitrag der Arbeitsgemeinschaft Ethnomedizin (AGEM) enthalten. Einzelne Hefte können
beim VWB-Verlag bezogen werden // Curare is included in a
regular membership of AGEM. Single copies can be ordered at
VWB-Verlag.
Vornamen vollständig, wenn es einheitlich bei allen Autoren ist / Prenames can be used if all authors are also cited with prenames
Curare-Sonderbände sind Bücher und werden nicht als Zeitschrift zitiert, sondern als Sammelband mit Herausgeber(n) / Curare Special Volumes
are books and are not cited as a journal but as collection of essays with editor(s).
Abonnementspreis / Subscription Rate:
Die jeweils gültigen Abonnementspreise finden Sie im Internet
unter // Valid subscription rates you can find at the internet under:
www.vwb-verlag.com/reihen/Periodika/curare.html
Copyright:
© VWB – Verlag für Wissenschaft und Bildung, Berlin 2012
ISSN 0344-8622 ISBN 978-3-86135-767-4
Die Artikel dieser Zeitschrift wurden einem Gutachterverfahren
unterzogen // This journal is peer reviewed.
VWB – Verlag für Wissenschaft und Bildung
Arbeitsgemeinschaft Ethnomedizin – AGEM, editor of
Curare, Journal of Medical Anthropology and Transcultural Psychiatry, founded 1978.
New subtitle 2008: Curare, Zeitschrift für Medizinethnologie • Curare, Journal of Medical Anthropology
AGEM, the Working Group “Ethnomedizin”/Medical Anthropology, registered association with legal capacity seated in Hamburg/Germany, is an association of scientists and academics as well as persons and institutions promoting science, serving exclusively and directly
non-profit purposes. It pursues the promotion of interdisciplinary co-operation between medicine, including history of medicine, human
biology, pharmacology, and botany and adjacent natural sciences, on the one hand, and cultural studies and social sciences, especially ethnology, cultural and social anthropology, sociology, psychology and the sociology of medicine. With view to this goal, and also to diffuse
widely the scientific discourse, it acts in particular as publisher of a journal in the field of medical anthropology/“Ethnomedizin”, organises
specialist conferences on a regular basis, and collects and make accessible relevant literature. (Extract of rules of 1970)
www.agem-ethnomedizin.de
Curare 35(2012)1+2
Inhalt
1
Zeitschrift für Medizinethnologie
Journal of Medical Anthropology
hrsg. von/ed. by Arbeitsgemeinschaft Ethnomedizin (AGEM)
Inhalt / Contents
Vol. 35 (2012) 1+2
Doppelheft / Double Issue
Kultur, Medizin und Psychologie im „Trialog“ III.
AGEM 1970–2010 und Transkulturelle Psychiatrie:
Rückblicke und Ausblicke V
herausgegeben von / edited by:
Ekkehard Schröder
Ekkehard Schröder: Professionen im interdisziplinären Arbeitsfeld „Kultur und Psychiatrie“.
Editorial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Hauschild: Ethnomedizin als ärztliche Anwendung? Editorial (Reprint 1984) . . . . . . . . . . . 7
Forum
Uwe Henrik Peters: Ethnomedizin – an der Grenze zwischen Ethnologie und Medizin
oder übergreifend? (Festvortrag zum 40jährigen Jubiläum der AGEM, Heidelberg 2010) . . . . . . . . 9
Helene Basu, Nina Grube & Arne Steinforth: Social Anthropogy and Transcultural Psychiatry:
Contextualizing Multi-disciplinary Conributions to the “International Conference on Religion,
Healing, and Psychiatry”, Münster, February 22–25, 2012 (Report) . . . . . . . . . . . . . . . . 17
Luc Ciompi: Ist die chronische Schizophrenie ein Artefakt? (Reprint 1982) . . . . . . . . . . . . . . . . . . . 29
Der Ärztestand auf dem Prüfstand. Mosaik aus Eliot Freidsons „Der Ärztestand“ nach der
berühmten Studie “Profession of Medicine” von 1970 (Ausgewählte Reprints aus der deutschen
Erstausgabe 1979) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Artikel zur Krankenhausethnologie
Nina Grube: Von Heimatstationen und Helfersystemen: Die Ambivalenz „sozialer Beheimatung“
in der institutionalisierten Psychiatrie . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Curare 35(2012)1+2
42
Contents
2
Carolin Fischer, Eckhardt Koch, Matthias Johannes Müller & Stefan Strohschneider:
Patienteninteraktion auf einer Station für interkulturelle Psychiatrie und Psychotherapie in
Marburg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Murray Last: Dying by Design? (Reprint 2009) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Artikel zu: Ist Besessenheit eine Psychopathologie?
Yvonne Schaffler: Besessenheit in der Dominikanischen Republik im Frühstadium:
„Wilde“ Besessenheit (caballo lobo) aus psychodynamischer und praxistheoretischer Perspektive 72
Gunter Hofer: Besessenheit, ein Phänomen der menschlichen Lebenswelt (Reprint 1984) . . . . . . 85
Berichte/Reports
Von der Differenzsensibilität zur Rassismuskritik. Bericht zur 7. Tagung der PsychTransKult AG
Tirol, Innsbruck, April 2011 (Oscar Thomas-Olalde & Beatrice Partel) – S. 97 // Psychiatrie
und Migration zwischen Ost und West. Bericht zum 1. Kongress der DRGPP, Nürnberg 27.–29.
Mai 2011 (Olena Chumanska & Yana Kyrylenko) – S. 101 // Report of the International
Conference “Health in Transition (Bio) Medicine as Culture in Post-socialist Europe”, Charles
University in Prague, Czech Republic, June 10–11, 2011 (Christine Binder-Fritz) – S. 102
// Tagungsbericht zum MAS-Symposium Basel, 6. Juni 2011 (Katarina Greifeld) – S. 108 //
Langsame Veränderungsprozesse in christlich-missionarischer Tätigkeit: „Vom Pionier zum
Partner – Christliche Gesundheitsarbeit in Bewegung“. Ein Bericht vom Eine-Welt-Tag des
Deutschen Instituts für ärztliche Mission (DIFÄM) in Tübingen, 26. Juni 2011. (Assia Maria
Harwazinski) – S. 109 // 6. Münchner Forensik-Symposium, Juli 2011: „Forensische Psychiatrie
als Randkultur – zwischen interkultureller Spannung und multikultureller Integration“ (Herbert
Steinböck) – S. 111 // 1st Medical Anthropology Network Conference of EASA: “Medical
Pluralism: Techniques, Politics, Institutions” Rome, 7–10 September 2011 (Roberta Raffaetà
& Emanuele Bruni & Giulia Zanini) – S. 113 // 1. Nationaler Kongress Psichiatria e Cultura
nell’Italia multietnica zum 30. Todestag von Michele Risso, Mailand, 28.–29. September 2011
(aus dem Italienischen) – S. 118 // Lebe jeden Tag als wäre es dein letzter, denn irgendwann
wirst du Recht haben. Eine Nachlese zur Fachtagung „Am Lebensende fern der Heimat – Tod
und Sterben in einer Migrationsgesellschaft“ in Berlin, 9.–10. Februar 2012 (Nevin Altintop) –
S. 119.
Buchbesprechung/Book Reviews
Bernd Nissen (Hg) 2009. Die Entstehung des Seelischen – Psychoanalytische Perspektiven.
(Ronny Krüger) – S. 122 // Markus Wiencke 2011. Kulturen der Gesundheit. Sinnerleben im
Umgang mit psychischem Kranksein. Eine Anthropologie der Gesundheitsförderung. (Katarina
Greifeld) – S. 127 // Hamed Abdel-Samad 2009. Mein Abschied vom Himmel. Aus dem Leben
eines Muslims in Deutschland. (Assia Maria Harwazinski) – S. 129 // Andrea Gysling 2009.
Die analytische Antwort. Eine Geschichte der Gegenübertragung in Form von Autorenportraits.
(Benno Zöllner) – S. 131.
Filmrezensionen
„Lourdes“, von Jessica Haussner, D, A, Fr, 2009. (Assia Maria Harwazinski) – S. 132
// Geburtsvorgänge im Vergleich in Dokumentarfilmen aus verschiedenen Ländern. Der
VWB – Verlag für Wissenschaft und Bildung
Contents
3
Schwerpunkt des 11. Frauen-Film-Fests in Tübingen 2011 (Assia Maria Harwazinski) – S. 133
// Aus der Website der AGEM zum Thema Filme & Media – S. 137.
Nachrufe/Obituaries
„Keine Spuren mehr im Rauchfang der Lüfte – sprachloser Himmel.“ Zum Tode von
Hans Keilson (1909–2011) (Roland Kaufhold) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
In Memoriam Wolfgang M. Pfeiffer (1919–2011). Erinnerungen and die Erlanger Zeit (Wulf
Schiefenhövel) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Nachruf auf Aart Hendrik van Soest (1928–2011) (Hans-Jochen Diesfeld) . . . . . . . . . . . . . . . . . . 146
Zum Tod von Horst-Eberhard Richter (1923–2011) (Hans-Jürgen Wirth) . . . . . . . . . . . . . . . . . . . 147
Tagungsprogramm der 25. Fachkonferenz Ethnomedizin: Diskurse um Körpermodifikationen
im interdisziplinären Arbeitsfeld Ethnologie und Medizin, Heidelberg, den 8.–10. Juni 2012. . 155
Résumés des articles Curare 35(2012)1+2: 001–160 . . . . . . . . . . . . . . . . . . . . . . . 157
Die Autorinnen und Autoren in Curare 35(2012)1+2 . . . . . . . . . . . . . . . . . . . . . . . . 159
Zum Titelbild . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Impressum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hinweise für Autoren/Instructions to Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . U2
U2
U3
„Darstellung eines Schamanenkampfes (Höhle von Lascaux, Altsteinzeit), so die gängige
Interpretation, zeigt die schon frühe bildhafte Darstellung „psychischer Kräfte“, wie häufig aus einer pluridisziplinären Erschließung von Daten aus der Ethnologie, Psychologie
und Psychiatrie angenommen werden kann (hier nach Lommel A. 1980 (2.Aufl.) Schamanen und Medizinmänner. Magie und Mystik früher Kulturen. München: Callwey: 188).
Endredaktion: Ekkehard Schröder
Redaktionsschluss: 30. April 2012
Die Artikel in diesem Heft wurden einem Reviewprozess unterzogen./The articles in this issues are peer-reviewed.
Curare 35(2012)1+2
Forum
17
Social Anthropology and Transcultural Psychiatry:
Contextualizing Multi-Disciplinary Contributions to the
“International Conference on Religion, Healing, and Psychiatry”,
Münster, 22. 02.–25. 02. 2012
Helene Basu, Nina Grube & Arne Steinforth
The Context
For three days in February 2012 anthropologists,
sociologists, psychologists and psychiatrists came
together at Westfälische Wilhelms-Universität to
discuss the place of religion in the field of “Transcultural Psychiatry” across different countries
(Ger­many, Great Britain, Ireland, France, Belgium,
Finland, India, Ghana, Nigeria, USA and Canada).
As in Germany the field of “Transcultural Psychiatry” (also often referred to as “intercultural”) is
predominantly seen as a branch of medicine and/or
psychology complicated by “culture”, the fact that
the conceptual orientation of the conference has
been put forward by anthropologists seems a novel,
and perhaps even somewhat transgressive, move. A
historical overview written by Ekkehard Schröder
clearly brings out that in Germany “Transcultural
Psychiatry” properly belongs to the psy-disciplines:
All the major conferences since 1968 were organized by institutions with a more or less psychiatric
background (Schröder 2009).1 While psychiatrists,
clinical psychologists and psychoanalysts were interested in comparing their categories, therapies and
treatment methods with those observed in so-called
“traditional cultures”, German anthropologists for a
long time were slow, sometimes even overtly hostile, to enter into conversations with psy-disciplines,
or, for that matter, to develop Medical Anthropology. Medical Anthropology became a recognized
specialization in German anthropology departments
only from the late 1990s onwards.2 Psychiatry, however, until recently hardly figured in German contributions to Medical Anthropology. The University of
Münster for example was in the 1970s and 1980s an
important site on the map of Transcultural Psychiatry in Germany—not because of any contribution
made by anthropologists but because of the work of
the psychiatrist and clinical psychologist Wolfgang
Pfeiffer (Pfeiffer 1994).
More than thirty years later, the situation has
changed. Since a few years, a new kind of (trans­
Curare 35(2012)1+2: 17–28
cultural) “Psychiatric Anthropology” is emerging
at the Institut für Ethnologie in Münster: interdisciplinary courses are held jointly by psychiatrists
and anthropologists, a multidisciplinary research
group has formed and anthropological projects are
engaged with research in and on psychiatric and religious institutions (e. g. in Germany, India, different parts of Africa, or Brazil) dealing with mental
disorder (Basu 2009, 2010a, 2010b, Grube 2011,
2012, Kurz (forthcoming), Postert 2002, 2004,
2010, Steinforth 2009a, 2009b, 2009c, 2010, 2011,
Strauss 2011). Rather than subsuming or identifying religious with cultural institutions—and opposing them to modern, scientific and secular ones—,
we felt it necessary to differentiate between religion
and culture and explore their relationships in regard
to global modernities and ideas of mental distress
and practices of healing from a comparative perspective. The conference brought together scholars
who implicitly or explicitly engage with these issues.
In recent years, psychiatrists, psychoanalysts
and psychologists have shown a renewed interest
in questions related to the interconnections between
religion, self and mental health/illness while anthropologists and scholars of religion are turning to
study the interface of psychiatry and religion (e. g.
Blanch 2007, Csordas 1994, Huguelet & Koenig
2009, Jones 2004, Kaiser 2007, Leavey 2004,
Littlewood & Lipsedge 2004, Sluhovsky 2007).
We draw on broad understandings of both religion
and psychiatry. “Religion” we consider in terms of
social, cosmological and spiritual as well as culturally and historically shifting notions of the person,
whereas by “psychiatry” we include diverse psy-approaches (e. g. psychoanalysis and different psychotherapy schools). The conference aimed at exploring the concepts, practices and challenges evolving
at the interface between religion and psychiatry in
a globalized world. The circulation of psychiatric
knowledge, the global spread of Christian sects
18
(e. g. Pentecostalism), New Age spirituality and the
deterritorialization of local religious systems share
a particular concern with mental health, wellbeing
and healing (Bullard 2007, Cook & Powell 2009,
Dein 2008, Kendall 2009, Luig 2007, Meyer 2004,
Sloan et al. 1999).
Currently there is much scholarly debate on the
place of religion in the modern world. These debates often focus upon problems thought to have
been vanquished with the transformations brought
about by modernization such as secularization and
the eventual disappearance of religion from the public sphere (Taylor 2007). The realization is growing, however, that this has not happened and that the
expectation was perhaps built on a misconceived teleological view of social progress (Casanova 2007).
To complicate things further, it has become increasingly apparent that the talk of a “return of religion”
makes sense only when the view is narrowly confined to historical Europe masking out the largest
part of the world (including the US). In many parts
of the world religion has never been absent from the
public sphere but the former still claim to partake
in modernity (e. g. Kaviraj 2004). In the wake of
these debates and the unfolding of transnational religious phenomena, the concept of religion (and of
secularization) itself has become destabilized (Asad
2003, Beyer & Beaman 2007, Csordas 2009, De
Vries 2008). Religion does not disappear but it may
appear in new shapes (Hervieu-Léger 2004).
While the relationships between the religious and
the political spheres figure importantly, issues pertaining to psychiatry are rarely addressed in these
debates. The proliferation of a medical sphere of
psychiatry distinct from religion and religious healing, however, was of central significance in forming notions of the “normal”, “modern” individual
or self and in developing instruments for measuring
and controlling its behavior (Foucault 1973, Furedi
2004). In sociological terms, psychiatry increasingly came to adopt a social function which had
been the domain of religion: a theology providing
a theory of the “normal person” with its corollaries
of definitions of abnormality, illness, normality and
health (salvation) as well as corresponding practices
of healing (for Christian Europe, cf. Trüb 1978).
The separation modern thought postulates between
“pre-modern” (unscientific) and “modern” (rational) understandings of mental disorder has become
a foundation of psychiatric self-conceptions. In the
Helene Basu, Nina Grube & Arne Steinforth
same way, however, in which ideas of modernity
hinging on secularization and the privatization of
religion are becoming increasingly unsettled by the
perseverance of religion in the contemporary world,
psychiatry is faced with the challenge posed by alternative modes of healing, categories of illness and
subjective experiences of mental suffering rooted
in various religious traditions (Christian, Hindu,
Muslim, African or African derived cosmologies,
spirituality etc.). Anthropologists of religion, on the
other hand, are no less required to turn to an unfamiliar territory, i. e. psychiatry, when studying the
ways their subjects deal with personal adversities
and mental trouble. It is in this context that psychiatrists, psychologists, sociologists and scholars of religion and anthropology entered into conversations
by sharing their ideas, experiences and research
findings.
The Conference
I. Conceptual Approaches
One of the more unequivocal foci of most presentations—and the ensuing debates—dealing with the
interface between psychiatry and religion was the
notion (or notions) of personhood.
Alain Ehrenberg (Centre National de la Recherche
Scientifique, Paris, France) provided the prelude to
the ensuing debates by presenting the keynote lecture on the diversification and transformation of
Western individualism. Focusing on the comparative study of social values, Ehrenberg demonstrated
how diverging discourses of psychology and psychoanalysis in the US and France intersect with political ideals of freedom, perceptions of the state and
differing ideals of individual/personal autonomy.
Roland Littlewood (Department of Anthropology
and Department of Mental Health Sciences, University College London, UK) in his lecture Did Christianity lead to schizophrenia? Psychosis, Psychology
and Self-Reference set the ground for the historical
and comparative exploration of the relationship
between Christian religion and the development
of the modern Self as the matrix for the evolution
of the core mental illness dealt with in psychiatry: “schizophrenia”. Drawing on descriptions of
madness in Greek, Hebrew, Yoruba and medieval
philosophical sources acknowledged as phenomena
of “proto-schizophrenia” (thereby not denying its
“current near ubiquity”), Littlewood demonstrated
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how “proto-schizophrenia” has been “propelled into
schizophrenia” in the course of the historical unfolding of modernity and individualism. The argument
focuses on three closely related processes: the emergence of an undivided monotheistic God, an individual self separated from its environment and the
passing of agency from multiple external sources to
an inner, self-conscious self. Significantly, the transformation of agency through Western Christian history and ensuing secularization entails the crucial
dynamic which converts proto-schizophrenia from
“indigenous psychology” into “schizophrenia” of
modern psychiatry.
Laurence Kirmayer (Division of Social and Transcultural Psychiatry, McGill University, Montreal,
Canada) talked about New Varieties of Religious
Experience. While acknowledging the need to
recognize differential power constellation within
and between psychiatry and alternative healing
practices, he nevertheless began with the observation that “spirituality is for many people a source
of strength, resilience and a vehicle for healing”,
and therefore of interest for mental health in general and psychiatry in particular. Situating his approach in the multi-cultural, secularized society of
Canada, Kirmayer drew attention to a change of
basically hostile clinical/psychoanalytical attitudes
against religion derived from Freud to apprehending spirituality as a multifaceted notion referring to
practices of the Self on different levels and in diverse contexts. Two issues are central in this change
of attitudes: 1) the fact that spiritual practices are
perceived in marked contrast to organized religion
(e. g. the Catholic Church); 2) religion and spirituality involve different types of ontology which are
more or less in conflict with biomedical ontology
based on concepts of individualism. For Kirmayer,
cultural concepts of the person provide a bridge
between mental health and spiritual practices. This
angle, moreover, brings into focus basic commonalities and similarities between indigenous religions
and phenomena of—what some contributors have
termed “post-secular”—spirituality realized in experiences of suffering and practices of healing.
Addressing the question of why and how religion/
spirituality continues to flourish in global modernities and transnational circulations, Kirmayer directed attention to basic aspects of human life such
as universal capacities for creativity, imagination
Curare 35(2012)1+2
19
and, more generally, the contingencies of human
life. Against this background, Kirmayer developed
a complex argument about healing in terms of becoming transformed in a religious/spiritual practice
through lived, embodied experiences.
Jozef Corveleyn (Faculty of Psychology and Educational Sciences, Katholieke Universiteit Leuven,
Belgium) introduced another point of view by presenting a sophisticated overview of psychoanalytic
approaches to religion with a special focus on French
and Belgian authors (New Trends in the Psychoanalytic Approach to Religion). Significantly, while, as
Kirmayer had pointed out, the influence of psychoanalysis in psychiatry had contributed to a basically
hostile attitude towards religion by clinical practitioners, Corveleyn submitted Freud’s position on
religion to a critical reevaluation. Referring to his
three main works on religion (Totem and Tabu, The
Future of an Illusion, Moses & monotheistic religion), Corveleyn drew attention to the position of
Freud as a writer (“a self-proclaimed atheist well
acquainted with religion”) and to certain shortcomings of his analysis of religious phenomena.
The latter resulted, according to Corveleyn, from
Freud not clearly distinguishing between religion as
a cultural phenomenon in the sense of a Geertzian
definition and religiosity as a personal experience.
The problem with Freud’s writings on religion according to Corveleyn rests on the fact that he attempted to explain religion in terms of individual
psychodynamic psychology. In contrast to his writings on psychopathology, Corveleyn pointed out,
Freud’s interpretation of religion lacked empirical and methodological rigor. More recently, work
in the psychology of religion which is indebted to
psychoanalytic paradigms (in itself diverse, ranging
from the theory of drives to ego and object psychology), then, no longer attempt to explain religion as a
cultural phenomenon. Rather, the focus has shifted
to questions regarding the role of personal desires,
fantasies and personal motives related to religious
ideas and experiences.
II. Collaborations and Collisions
The largest number of contributions dealt with interactions between mental health policies and/or religious and psychological and psychiatric institutions
as well as practitioners and practices of healing.
20
Andreas Heinz (Klinik für Psychiatrie und Psychotherapie, Charité, Berlin, Germany) in his paper
on Return of the Religious—Good shamanism and
exorcism? A difference in discourse or a return of
the uncanny? subjected the psychiatric model of the
brain in terms of a hierarchy of functional regions to
a critical reevaluation by demonstrating its shared
legacy with 19th century evolutionist anthropological constructions of the “primitive”. Heinz made two
related arguments: 1) he maintained that integrating spiritual healing into psychiatry implies coping
with the colonial situation which extends into postcolonial realities—“when psychiatry hits on other
people”; 2) a simple contrast between the power of
psychiatry and spirituality/traditional healing would
not do since both involve relationships of power. As
Littlewood, Heinz focused on schizophrenia but
emphasized the concern of European philosophical
ideas with rationality in terms of the “I being in control of my thoughts”. He showed how Western psychiatry’s historical course of producing ways to deal
with the “irrationality of psychosis” has been founded on a deep misunderstanding of other cultures—
a misunderstanding which has become inbuilt into
psychiatric concepts and continues to inform them.
The “return of the uncanny” becomes manifest for
Heinz in the homologies between the hierarchical
model of the brain (higher = rational control, lower
= emotional, passionate driven, dangerous) and the
classification of evolutionary “higher” and “lower”
people: Psychiatric models of mental disorder posit
the loss of control of rational thought as an “invasion
of some dangerous drives”. In a second line of argument Heinz turned to the problematic of integrating
religion, or rather the demands made by religious
experts such as Christian priests and Muslim specialists, into psychiatric practice “at home”. Thus,
while in his own clinic Catholic priests vie for influence over patient’s treatment with representatives
of Muslim communities demanding equal treatment
by the integration of Muslim faith based treatments;
these claims are countered by secular practitioners
of both religions who point, for example, to the fact
that “80 % of (Muslim) patients have problems with
religion”. And, for Heinz, psychiatrists belonging
to the Christian sect of Opus Dei seeking to “heal
homosexuality” are as problematic as exorcists who
“demonize patients”. These problematic contradictions need to be analyzed in terms of power relation-
Helene Basu, Nina Grube & Arne Steinforth
ships internal to diverse cultural healing traditions
embedded in religions.
Gerard Leavey (Director of Research, Northern
Ireland Association for Mental Health, Belfast,
Northern Ireland) in his paper on Collaboration
or collision: clergy, mental health and suicide presented an interesting account of the state requiring
Catholic priests’ involvement in strategies of suicide prevention, or rather aftercare, in Northern Ireland. For the first time, a scholar has looked at how
pastors experience suicide by members of their congregation, how they view and deal with one of the
most critical mental health issues, suicide. Northern
Ireland was the last country in Europe which decriminalized suicide in 1966. For the clergy, thus,
one of the main challenges arose from the theological judgment of suicide as a sin against God (body
as gift of God), self and the community—and the
necessity to adjust to changing social conditions by
responding with a theological shift from condemnation to compassion. However, as Leavey pointed
out, the clergy are ill-equipped to provide suicide
prevention services in a secularizing society and to
a clientele marked by marginality, various forms of
abuses (drugs, sexual) and disrupted families, unemployment etc. While in such social milieus spiritual messages seem to make little sense, pastors on
the other hand lacked psychological training and
techniques to deal with problems such as domestic
violence, community and family break downs. As a
consequence, clergy confronted with suicide often
experience severe mental stress themselves (anxiety, depression, burn out), while the church does not
provide a space for the clergy to come to terms with
what could be called their counter-transference.
Thus, while the government seeks the support of
the church in providing mental health services, the
clergy is forced into a “role they never wanted”.
Thomas Csordas (Department of Anthropology,
University of California, San Diego, USA) in his
talk on Psychiatry and the Sweat-lodge approached
biomedical psychiatry and indigenous (in this case:
North American Navajo) spiritual and ritual healing
practices not in terms of an opposition but in terms
of “cultural resources that can be brought to bear in
situations of serious emotional, cognitive, and behavioral disturbances”. He presented a case study
of the integration of indigenous Navajo treatment
with psychiatry at a psychiatric ward opened in a
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21
reservation in 2005. Of the 36 psychiatric staff, 25
were ethnic Navajo. Except for one traditional healer, all others were trained in biomedical psychiatry.
Admission to the ward is based on conventional
psychiatric criteria (DSM IV). Treatment included
psychopharmacology, family therapy sessions and
sweat-lodge practices (such as initiation, purification, singing, praying and speaking about personal
problems). While Csordas elaborated upon the
idea of integration aiming at overcoming the gulf
between two distinct practices, he nevertheless emphasized the contrast between notions of a Western
self on which psychiatric treatment is based and a
Navajo self embedded in a social ecology. The fusion of two therapeutic modalities in this case also
included a kind of “identity therapy” whereby the
psychiatric standpoint is translated into Navajo
conceptualizations. Working with techniques of
embodiment, psycho-pharmacological agents, for
example, become comparable to embodied objects
inhabiting the Navajo universe.
plies a traditional dichotomy between an illness of
the body and an illness of the spirit that may leave
the body in dreams and become host of witches and
sorcery—is central to the critical discourse of mental health campaigners denouncing it as manifesting the ignorance of “bush villagers” in contrast to
the knowledge of the medically educated. In these
debates, mental illness is a medical disease and psychiatric drugs are considered as the only genuine
treatment. However, as Read pointed out, this discourse becomes complicated by the limited efficacy
of psychiatric treatment for cases of chronic mental
illness such as psychosis as well as by ignoring how
psychiatry and spiritual healing are “interwoven for
patients in Ghana”. Rather than assuming a spiritual
cause from the beginning, it is only when the illness
persists despite treatment that a spiritual cause is assumed. Thus, “debates about spiritual illness arise
in dialectic with hospitals”. Sicknesses become reinforced by biomedicine and distinguished according to “doctor’s” or “pastor’s sickness”.
Turning from North America to Ghana, Ursula
Read (Department of Anthropology, University
College London, UK) presented a paper based on
her anthropological fieldwork on “Doctor sickness” or “pastor sickness”? Contested domains
of healing power in the treatment of mental illness
in Kintampo, Ghana. Instead of integration in the
multi-ethnic and multi-religious context of Ghana,
Read found competing discourses of madness/
mental illness and modalities of healing. Her focus rested on the relationship between Pentecostal
Church healers and mental health workers/biomedical practitioners. In her talk, she delineated diverse
perspectives: those of health seekers (patients and
their families), of mental health organizations (including NGOs and WHO) and of Pentecostal pastor-healers. For those afflicted with mental illness
seeking treatment involves “roaming around” and
trying out various treatment options with psychiatric treatment or hospitalization being “the last stop”.
Pentecostal healing is practiced on prayer camps organized by charismatic pastors claiming powers to
cast out evil spirits and demons. Healing at prayer
camps involves chaining patients, confession, enforced fasting—practices which are subjected to
controversy especially by mental health and human
rights workers. The notion of the person on which
these practices draw—a “dividual” self which im-
The ethnographic film (Drugs and Prayers: Indian
Psychiatrists in the Realm of Saints) presented by
Helene Basu (Institut für Ethnologie, Westfälische
Wilhelms-Universität Münster, Germany) deals
with the collaboration of religious specialists at a
Muslim healing center and psychiatrists in India.
It shows similar effects of postcolonial discourses
of medicalization in India resulting in conceptual
distinctions between “doctor’s” and “saint’s illnesses”.
Curare 35(2012)1+2
Peter Ebigbo (Department of Psychological Medicine, University of Nigeria, Enugu, Nigeria), by
contrast, presented in his paper Separating the seed
from the chaff: The dilemma of widespread belief
in spirits in modern day Africa an account from the
perspective of a practitioner trained in psychology
in Germany and practicing in Nigeria where people
suffer from spirit illnesses rather than from mental
illness. Mirroring the differentiation of discourses
of sickness, Ebigbo distinguished his patients according to their worldviews (beliefs in spirits) in
“traditional”, “Westernized” or “mixed”. Ebigbo’s
discussion focused neither on the question if multiple (spiritual, psychological and medical) modalities of treatment constitute a resource nor on the
discursive competition between them but on the
question of how he could, in his own practice, reconcile diverse psychological therapeutic methods
22
(e. g. Family Therapy, Behavior Therapy, Psychodynamic methods) with indigenous practices of healing such as—what he called—the “Native Judgment Family Therapy”, a method practiced by his
own father. Central in this vein is an understanding
of the Nigerian conception of health in the sense of
being embedded within a web of harmonious social
relationships which itself reflects a cosmological
(holistic) model of the person.
Arne Steinforth (Institut für Ethnologie, Westfälische Wilhelms-Universität Münster, Germany),
in his presentation titled Man in the Middle: Discourses on Money, Magic, and Mental Disorder in
Malawi, addressed the plurality of healing institutions in Africa from an anthropological angle by
addressing the transformation of specific concepts
of the person. He demonstrated that, within his Malawian setting, mental disorder is associated with recent processes of social change and with a perceived
loss of social cohesion that comes with it. Drawing
on Kirmayer’s (2007) distinction between different
configurations of the person, Steinforth pointed
towards the structural incompatibility between
secular concepts of psychiatry and the profoundly
religious approach to mental disorder prevalent
in many African societies, questioning the transformative effect of globalization as creating more
secularized, psychiatry-compatible individuals. He
argued that while, on the level of social discourse,
the introduction of new and Western-influenced
lifestyles is regarded as equivalent with the rise of
European/North American individualism, thorough
analysis reveals the deeply socio-cosmological embeddedness of the person in Malawi – that is all the
more pronounced when actors apply ritual means to
achieve their personal goals. In the end, Steinforth
argued, recent transformations would therefore do
very little to make psychiatry more adaptable in African setting, thereby highlighting the urgent need
for psychiatry to rethink its conceptual boundaries.
Hans-Jörg Assion (LWL Klinik für Psychiatrie,
Psychotherapie und Psychosomatik, Dortmund,
Germany) in his talk on Traditional Healing in
Muslim Societies in a way dealt with a similar problem from a reverse position: German psychiatrists
who see themselves firmly grounded in science and
enlightenment rationality (cf. Heinz) are faced with
“alien believes” about mental disorder brought into
the hospital by immigrants. As Turkish patients are
Helene Basu, Nina Grube & Arne Steinforth
one of the largest migrant populations in Germany,
Assion focused on Islamic folk notions of causes of
disorder (e. g. evil eye) and ritual practices of healing
(protective amulets, praying, reading of the Koran)
by Muslim healers (hojas). He asked if it is reasonable “to integrate traditional beliefs in modern psychiatric treatment”. Referring to a study conducted
in a German psychiatric hospital, Assion argued that
accepting “traditional beliefs” of patients by mental
health professionals, as well as tolerating patients
to seek help from ritual healers in addition to undergoing psychiatric treatment, may in fact have
a positive impact on the overall outcome of treatment. Ironically, though, the Turkish woman patient
affected by a psychotic crisis, whose case Assion
discussed, discontinued psychiatric treatment in the
hospital prematurely, but left her amulets behind for
the hospital staff to ponder about.
William Sax (Südasien-Institut, Ruprecht-KarlsUniversität, Heidelberg, Germany) in his paper
Ritual Healing and Psychiatry in South Asia took a
counter position speaking as an anthropologist who
studies ritual healing in Northern India. Sax categorically negated the suggestion that insights from
ritual healing should be integrated into health care
systems. By this he did not mean that psychiatrists
should not accept that patients may hold diverse
ideas about their problems. Rather, Sax delineated
the fundamental differences between medicine and
ritual in terms of dualistic and non-dualistic/holistic conceptions of mind-body-Self, the person, and
the ideology of individualism, Indian “dividualism”
with its value upon the unity of the family and correspondingly diverging medical-therapeutic and
ritual trajectories and goals. Ritual healing, moreover, addresses not only (mental) illness but a wide
range of adversities and suffering. While medicine
seeks to relieve symptoms, rituals aim at restoring
the person suffering from “behavioral problems
rather than mental illness” to a place within a sociocosmological universe. Conceding that it would be
a mistake to apply biomedical criteria to ritual healing, Sax nevertheless asked for taking ethnographic
evidence serious. He argued for leaving untouched
the “structural blindness” demonstrated by public
health administrators’ non-perception of ritual healers. In support of his claim Sax cited three points: 1)
the ideology of individualism on which biomedical
psychiatry rests is incompatible with South Asian
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understandings of the person; in India, individualization would be seen as a pathology rather than
normality; 2) the asymmetries between health workers/psychiatrists and ritual healers are too great to
be overcome, so that “cooperation” would mean the
loss of the positive attributes of ritual healing; 3) for
psychiatrists, it will be impossible to validate ritual
therapy precisely because science constitutes itself
“by eliminating these things”. In medical literature,
Sax pointed out, ritual is defined as a technique
without effects which therefore must be eliminated.
In concluding, Sax deconstructed the notion of ritual healing as a “residual category” lumping together
practices which have little in common except that
they “do not grow out of scientific tradition and are
seen by that tradition as irrational”. Thus, the act of
incorporating them into biomedical practice would
mean to count measure and regulate ritual healers
whereby their diversity, flexibility and context attendance would inevitably be destroyed.
III. Psychiatrists, Psychoanalysts and Religious
Subjectivity
Another aspect dealt with by conference participants concerned the problem of how to understand
patients’ and their families’ recourse to religiosity
when faced with mental illness. Significantly, speakers in this section engaged more explicitly with the
notion of religion and how to deal with it in regard
psychotherapy, understanding the experience of
mental illness or people’s health seeking behavior.
Wielant Machleidt (Prof. em., Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Germany) in his
paper on What is the role of spirituality and religion
in mental healing processes discussed the somewhat ambivalent attitude shown by psychiatrists
and psychoanalysts in Germany when patients introduce “religiousness” into the therapeutic process.
Machleidt emphasized that religion and spirituality
“played a marginal role in psychotherapeutic treatments because of increasing secularization in Western medicine” and acknowledged the noticeable
“scientification” of psychoanalysis in the wake of
more recent neurophysiological research. Conceding a certain “rivalry” between psychiatrists and
priests, Machleidt approached patients’ religiosity
in terms of purely individualistic constructions of
belief assuming that religion in itself is irrational.
Of sole interest for the psychotherapist are, accordCurare 35(2012)1+2
23
ing to Machleidt, how a patient idiosyncratically
constructs “gods and spirits” in terms of the categories of the therapist, i. e. as “individually intrinsic
objects”. While patients are seen as “creators of
their Gods as a mirror image of themselves”, psychotherapy helps them to “set in motion their downfall”. Machleidt then presented a case study of a
Kurdish-Turkish patient whose “sub-psychotic crises” entailed “incomplete processes of integration”
manifesting in 1) “a proximity-distance problem”;
2) in experiencing the “erosion of family ties in a
foreign environment” and 3) in “his religiousness
beneath a secular surface”. The psychotherapist interpreted the patients’ recourse to praying to Allah
(which he did in a somewhat unusual posture: rather
than turning his body towards the West or Mecca, he
turned to the moon) as “an example of the psychotic
self-will” which allowed him to experience “feelings of exaltation and omnipotence”. Acknowledging that religiousness helped the patient to cope
with an existential crisis, the psychotherapist nevertheless understood his desire to assume a religious
role (Quran scholar, dervish) as an expression of his
mental illness, that is as fantasies fuelled by “delusions of grandeur”, which ultimately ran counter to
the therapeutic goal of “overcoming his proximitydistance problems”. Machleidt cited this case as an
example for the possible salutogenetic effect of religiousness when controlled in a therapeutic setting,
but also drew attention to the “dangers of religiousness/spirituality” when they unfold in relationships
of dependency.
Ellen Corin (Division of Social and Transcultural
Psychiatry, McGill University, Montreal, Canada)
spoke about The religious texture of the experience
in psychosis—A bifocal vision from India. Drawing
on Gananath Obeyeskere’s translation of psychoanalytic concepts into anthropology (Obeyesekere
1990), Corin apprehends religion from a bi-focal
perspective. Religion extends into the most intimate
aspects of human existence, while also constituting socially and culturally constructed symbolic
systems framing individual experiences. Fieldwork
conducted in Quebec, Africa and India made her
aware of the heterogeneous character of religion
both at the level of individuals as well as within various cultural contexts. In her talk, Corin explored
the ways people in India diagnosed with schizophrenia—“an experience that often resists words
24
and meanings”—cope with it by appropriating “cultural signifiers for expressing, articulating and taming their experiences”. Her findings are based on a
study she conducted in collaboration with researchers and clinicians, Drs. Thara and Padmavati, from
“Schizophrenia Research Foundation (SCARF)” in
Chennai. Corin presented four narratives of male
patients diagnosed with schizophrenia, one belonged to a Muslim-, two to a Christian- and one
to a Hindu-family. In each case, religiosity is part
of the family background, but patients appropriate
religious symbols in highly idiosyncratic ways. For
the Muslim patient, for example, expressing “an intense sense of fear, confusion and uncertainty” the
performance of daily ritual gestures situates him
“within a religious ethos” serving as a “symbolic
container”. This young man’s religious orientation
may be seen to be a response to the values of the
father who encourages his son to go to the mosque
and dargah (Muslim shrine). However, there is a
discontinuity between the parents’ understanding
of proper religious behavior and the son’s – while
he refuses to visit holy places with his parents, the
mother does not “perceive the religious dimension
of her son’s behavior”. Seen from the situation of
the patient, he made use of a culturally legitimized
way of withdrawing from the pressures of the world
by seeking orientation from religious figures. On
the personal, idiosyncratic level he created “a protected inner space for himself, inhabited by spiritual
references, by staying alone”. The analysis of patients’ narratives led Corin to apprehend the resort
to religious references as “situated on a continuum
between normality and pathology”. Building upon
phenomenological psychiatric concepts, Corin understands the relevance of religious signifiers appearing in the narratives of schizophrenic patients
as attempts to “find an asylum within language”,
a “defense against real or imagined rejection” and
a search for “naming the enigmatic experience of
strangeness and alienation”. However, her research
also shows that “in the first phase of psychosis religious references may lose their articulating power
and get absorbed within the turmoil of psychosis”.
Significantly, while the search for causes hardly figures in the narratives of patients, these come prominently to the fore in the narratives of relatives. Since
relatives are faced with the challenge to reintegrate
the patient within the social world, they give much
more space for the search for the causes of the prob-
Helene Basu, Nina Grube & Arne Steinforth
lem—seeking answers from a wide range of ritual
practitioners such as faith healers, temple priests or
astrologers.
The search for health and help from psychiatric as
well as diverse religious institutions was taken up
by Johannes Quack (Südasien-Institut, RuprechtKarls-Universität, Heidelberg, Germany) in his
paper “What do I know?” Scholastic fallacies and
pragmatic religiosity in mental health seeking behavior in India. Building upon Bourdieu’s critique
of the “scholastic fallacy” (i. e. attributing intellectualistic interpretations to any speaker), Quack argues for an approach taking “pragmatic religiosity”
into account when considering people affected by
mental disorder (patients and/or relatives) seeking
help from a range of ritual institutions as well as
from psychiatry. Quack thus adds to the conceptual discussion of the notion of “religion” from the
subjective perspective of patients. His fieldwork
question concerns the role of religion in the Indian
mental health system. As psychiatrists in Germany
(or elsewhere), Indian psychiatrists conceive of
their practice as “secular”—which is, nevertheless,
situated in a vast field of religious and medical pluralism. Focusing on the narratives of patients who
seek help from a range of healing sources, Quack
emphasized that what matters more than “explanatory models” is people’s desire to get well. Strategies of seeking mental health therefore should be
understood as transgressing religious and medical
boundaries (“pragmatic religiosity”) rather than as
fixed cultural models determining people’s behavior
in terms of either psychiatry or ritual healing.
Two more papers dealt with India. One was Katy
Gandevia’s (Tata Institute of Social Sciences,
Mumbai, India) who presented case studies of how
families deal with a mentally ill member. Spiritual
practices provide resources for resilience.
Sushrut Jadhav (Centre for Behavioural & Social
Sciences in Medicine, University College London, UK) presented findings from a study on local
knowledge and practices of mental health of Dalit
communities in Western India. He addressed the
question of how to assess the psychological consequences of caste discrimination and how to access
the “inner worlds of Dalits”. Focusing on a comparison of the consequences of Dalit conversions
to Christianity and Buddhism, Jadhav stressed the
fact that conversion is an open process which is not
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Conference on Religion, Healing, and Psychiatry. Münster 2012
25
completed in one generation. He found that Dalits
converting to a Christian church entered into a psychological process of internalizing different habitus
and ways of speaking whereas conversion to Buddhism entailed a move from a psychological to a
political arena.
ters into the secular. Healing the self’s inner feelings
through the rhetoric and performance of lamenting
thus becomes the ultimate value—“facing the other
in a kind of sacred nakedness”—, a soteriology and
search for salvation, not only of individuals but of
the Finnish nation as a whole.
IV. Spirituality and Post-Secularism
Terhi Utriainen (Department of World Cultures,
University of Helsinki, Finland) in her presentation
on Angel-Practices in the Post-Secular Culture:
Healing the Emotions and enhancing the sense of
Agency, argued that European societies have long
arrived in a post-secular age. Illustrating her argument with her own fieldwork, she showed how
women from different religious backgrounds engage
in “angel-practices” using angels as a resource in
phases of existential and emotional crises triggered
through divorces, unemployment and burn-out.
Angel-therapy is used to connect with the angels,
befriend them and turn them into allies in managing
their relationships, lifestyles and complex emotions.
Utriainen shows how such a “feel-good” religion is
used by these women to develop a sense of agency
but also how it is marketed globally for the profit of
an ever-growing new-age industry.
From healing mental illnesses, behavioral problems
or supernatural afflictions, some contributors turned
to more general desires of “healing the self” propelled by “New Age” practices in Western settings.
Jim Wilce (Department of Anthropology, Northern
Arizona University, Flagstaff, USA) in his paper
Emotional authenticity in Finnish lament revival
demonstrated how “the triad religion, healing, and
psychiatry involves a unique hybridity” becoming
manifest in the “apotheosis of apparently secular
value” namely the (individual) Self. Wilce, whose
earlier work on psychiatry and possession in Bang­
ladesh is well known, observed that while psychiatrists in Bangladesh reject all relations with religion,
in what he called the “post-secular” situation of
healing in Finland numerous connections to a key
religious concept—the sacred—are made. The term
“post-secular” was coined by Terhi Utriainen and
other Finnish scholars to bring into focus new perspectives on religious worlds and the secular. The
term takes account of the fact that secular values
(such as embodied in the individual self) and spaces
are sacralized or spiritualized. Post-secular spirituality in this sense takes issue with understandings derived from Foucault of the power and dominance of
the psy-disciplines over the self in modern Western
societies such as put forward by the British sociologist Nikolas Rose (Rose 2007). In Finland, at least,
Wilce argues that Finnish neo–lament groups which
revive originally Karelian practices of lamenting
stemming from a shamanistic tradition represent a
post-secular spirituality which is as significant as the
influence of the psy-disciplines. Are these influences asymmetrically or symmetrically related? Rather
than stressing a disjunction between both tendencies, Wilce seeks to demonstrate in his analysis of
neo-lamenting practices (“weeping with words and
melody”) how both the psy-sciences and religion
become hybridized, rather than stating “simply the
psychologization of all societies, Western societies
and religions”. Thus, terms like therapy, holism and
spirituality are key words by which the religious enCurare 35(2012)1+2
Résumé
Taken together, the presentations confirm the necessity for scholars and practitioners alike to engage
with the place of religion in the realm of Trans­
cultural Psychiatry. In a general sense, they demon­
strate how the values of modernity (rationality, science, secularism) shape the self-understanding of
psychiatric professionals across the globe—whether in Germany, India, Nigeria or the US—but that
their approaches towards ritual, religious or spiritual discourses and practices of dealing with mental
disorder vary widely. In Germany, it seems, mental health professionals are most sceptical towards
“religiousness”, whereas in Canada or the US they
seek to accord meaning and legitimacy to spiritual,
ritual and religious practices. In countries like Nigeria, India or Ghana, moreover, professionals show a
more ambivalent attitude, on the one hand having to
confront “own” (often discursively devalued) traditions, on the other competing with (old and new)
religious or cosmological agendas.
From an anthropological standpoint, rather than
truth itself it is truth claims and asymmetrical power
relationships between and within local (or national) institutional settings of psychiatry and religion
26
which shape and impact upon people’s experiences
of mental disorder, what to do about it and where to
seek help. Power, moreover, is a multi-dimensional
category ranging from issues of governmentality
(such as national mental health care systems) to
subjective experiences of agency and empowerment. The asymmetries inscribed in the social roles
of “doctors” and “healers” seem to predefine the hierarchical inferiority of the latter—be it in the US,
in Germany or, e. g., in India. The same holds true in
Europe where, by Leavey’s observations, the mental health responsibilities of Faith-Based Organizations (or FBOs) are, on the one hand, relied upon
while their competence and expertise are, at the
same time, questioned. So, while power is a “complex strategic situation” (Foucault) at work in the
interplay between alternative actors that address issues of mental health, it is also an attribute connected to religious concepts and institutions that may
represent a healing resource for persons affected
by psychiatric illness. In this sense, spiritual power
associated with religious entities, categories, and
activities may activate a suffering person’s agency
and thereby help to overcome psychiatric distress.
Different strands of “religion”, then, are mobilized
in diverse cultural settings. Jadhav identified conversion to Christianity or Buddhism as a central tool
to overcoming caste-related discrimination and its
psychological impact among Dalits in India. Within
ethnically and culturally diverse Canadian settings,
a focus on spirituality may offer sources for fashioning identity and invoke heterodox powers (Kirmayer). Utriainen’s Finnish data, on the other hand,
suggests that direct personal involvement with entities of spiritual power (i. e. angels) features as an
important support of personal agency that facilitates
dealing with the hardships of everyday life as well
as with severe personal crisis in a society dominated
by the values of secularism. In various African setting, moreover, the involvement of cosmological
agents and agencies within the sphere of psychiatry
and healing is depicted as resulting from the immediate conceptual connection between therapeutic
efficacy and spiritual power (Ebigbo). Read’s Ghanaian data highlights that the rise of Pentecostalism is directly linked to its healing ministry that is
conceived of as more powerful and thus superior to
biomedicine whose promises of miraculous cures
fail to convince patients. And the Malawian data
as presented by Steinforth suggests that both the
Helene Basu, Nina Grube & Arne Steinforth
conceptualization of psychiatric illness and its alleviation are deeply rooted in ideas of spiritual power
and relationships with the cosmological sphere.
The conference’s presentations and discussions
were able to show that today’s practices and contexts
of Transcultural Psychiatry are far from becoming
homogenized by biomedical psychiatry as advocated by the WHO. Instead, questions of mental health
and affliction, the search for adequate treatment as
well as therapy management processes differ locally, adapting circulating psychiatric knowledge, taking into account national structures of health care
systems and relating to local traditions of healing.
Psychiatric and religious discourses and practices in
the realm of mental health often have contested and
historically specific relationships, they form economic markets and engage in processes of distinction and separation. In the contact zones of global
flows and local cultures they create specific options
for treatment and unique modalities of healing.
What follows from this for an “anthropology of
psychiatry”? The different ways in which mental
health professionals, scholars of religion and psychology and anthropologists addressed mental disorder and practices of healing by taking into account
religion, modernity, and personhood/subjectivity
may offer some new orientation. Medicine and psychiatry tend to take socio-cultural realities and their
own positions within them for granted: Biomedical
self-understanding situates itself squarely within the
modern, emphasizing progressive advancement and
the gain of ever expanding territories of knowledge
(e. g. neurosciences), contrasting science with religion and truth with belief; its terrain is the human
body—an assembly of fragmented organs functioning according to biological programs—and the individual human brain or psyche. The division of labor
between somatic medicine, psychiatry and psychology reflects the Cartesian dualism of body and
mind, whereas psychoanalysis has contributed new
theories of the post-enlightenment individual, his/
her autonomy and overcoming of irrational instincts
through processes of sublimation and rationality.
Ingrained in these kinds of self-understanding—
notwithstanding the fact of internal contestations,
for example the long held criticisms raised by biomedicine against psychoanalysis of being unscientific—is the dissociation and strict delineation from
“cultural traditions” defined by what they are not:
scientific, rational, self-reflective and modern. For
VWB – Verlag für Wissenschaft und Bildung
Conference on Religion, Healing, and Psychiatry. Münster 2012
anthropology, such discourses of medicalization
and psychologization constitute the foci of analysis.
The problem then becomes situating diverse practices of healing embedded in alternative (religious,
cosmological) discourses in broader historical
contexts in which biomedicine/psychiatry asserts
its presence. The anthropological contribution to
the field of Transcultural Psychiatry may therefore
entail a transformation from an auxiliary function
(such as, explaining cultural models of “others” to
clinical therapists) to provide ethnographic knowledge of all kinds of practices—including “modern
psychiatry”—related to mental disorder and thus
contributing to a truly multi-disciplinary field of
research.
Acknowledgement
We would like to thank the Fritz Thyssen Stiftung
for a grant making this conference possible.
Notes
1 This also applies to the more recent conferences organized by
transculturally oriented psychiatrists and mental health workers dealing with immigrant or settled down “foreigners”, their
mental health problems, how to appropriately treat them and
how to come to terms with alterity, or the German preoccupation with “Fremdheit”. See http://www.transkulturellepsychiatrie.de/
2 For recent approaches in Medical Anthropology, see e.g. Alex
2010, Dilger & Hadolt 2010, Fiedermutz-Laun et al. 2002,
Sax, Quack & Weinhold 2010, as well as www.agem-ethno
medizin.de and www.medicalanthropology.de.
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Helene Basu has studied social anthropology, sociology and comparative religion at the Free University
Berlin. PhD 1993 (Habshi-Sklaven, Sidi-Fakire. Muslimische Heiligenverehrung im westlichen Indien,
Berlin 1994), Habilitation 2001 (Von Barden und Königen. Ethnologische Studien zur Göttin und zum Gedächtnis in Kacchch, Frankfurt/M 2004). Since 2006 she is professor of social anthropology at Westfälische
Wilhelms-Universität Münster. Since 2007 prinicipal investigator in the Cluster of Excellency „Religion
and Politics in pre-modern and modern Cultures“ at Münster University. Her main areas of research are
contemporary Indian religions (Hinduism, Islam), Indian Ocean studies, and Cultural Psychiatry.
Institute of Social Anthropology
Westfaelische Wilhelms-Universitaet
21, Studtstrasse
48149 Muenster – Germany
e-mail: [email protected]
Nina Grube obtained her M.A. in
Social Anthropology, Political Science and Sociology at the Freie
Universität Berlin in 2007. For her
dissertation at the Institut für Ethnologie, Westfälische WilhelmsUniversität Münster, she currently
works on a research project on biomedical and religious practices in
the context of mental health among
West African migrants in Berlin.
Arne S. Steinforth obtained his
PhD at the Institut für Ethnologie,
Westfälische Wilhelms-Universität
Münster where he works as a lecturer and postdoctoral research fellow.
As part of the cluster of excellence
Religion and Politics in Pre-modern
and Modern Cultures, his current
research focuses on faith healing
and the performance of authority in
South-eastern Africa.
e-mail: [email protected]
e-mail: [email protected]
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Sonderbände – Special Volumes
Schmerz – Interdisziplinäre Perspektiven. Beiträge zur 9. Internationalen
Fachkonferenz Ethnomedizin in Heidelberg 6.–8.5.1988
• K. Greifeld, N. Kohnen & E. Schröder (Hg) • 1989 • 191 S.
Vol. 7
Anthropologies of Medicine. A Colloquium on West European and North
American Perspectives
• B. Pfleiderer & G. Bibeau (eds) • 1991 • 275 pp.
Vol. 8
Gebären – Ethnomedizinische Perspektiven und neue Wege
• W. Schiefenhövel, D. Sich & C. E. Gottschalk-Batschkus (Hg)
1995 • 461 S. • ISBN 978-3-86135-560-1
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• 1998 • 240 S. • ISBN 978-3-86135-567-0
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aus der Geomedizin/Postulated by Culture or Indicated by Medicine?
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• 1998 • 344 S. • ISBN 978-3-86135-566-3
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