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Rethinking Psychiatry [Anglais] [Broché]

Arthur Kleinman

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I am sitting in a small interview room at the Hunan Medical College in south central China. Lire la première page
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Couverture | Copyright | Table des matières | Extrait | Index | Quatrième de couverture
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Amazon.com: 4.7 étoiles sur 5  3 commentaires
18 internautes sur 19 ont trouvé ce commentaire utile 
4.0 étoiles sur 5 New Perspectives 31 octobre 2001
Par disco75 - Publié sur Amazon.com
Format:Broché
Kleinman brings an anthropological perspective to the field of psychiatry, examining the forces of culture and society on how deviant, nonconforming behavior is produced, labelled, and reacted to. Much like Gerald Erchak (The Anthropology of Self and Behavior), Kleinman considers what a diagnosis is and how it is influenced by a society's definitions of illness and disease.
The book addresses first the question, What Is A Psychiatric Diagnosis? It next addresses the question, Do Psychiatric Disorders Differ in Different Cultures, answering "Sometimes." The author asks Do Social Relations and Cultural Meanings Contribute to the Onset and Course of Mental Illness? Here he examines the connections between the economy of a society and the prevalence of psychiatric diagnoses. He also considers the role of social change in the prevalence and nature of mental illness.
A very interesting portion of the book is titled How Do Professional Values Influence the Work of Psychiatrists? Kleinman offers a transcript of an initial session between a U.S. patient and psychiatrist. The subsequently formulated diagnosis and treatment plan are provided. The patient's diary entry following the session shows the discrepancy in world views between physician and patient. Next is an examination of a session between a Chinese psychiatrist and patient.
How Do Psychiatrists Heal? is the title of the next section of the book. Here, Kleinman looks at the clinical tools of psychiatry as compared to the healing tools of other cultures. Considered are the institutional settings of healing, the nature of the healing interaction, practitioner characteristics, styles of communication, clinical considerations, cultural settings, and extratherapeutic factors. An examination of how symbols are used in healing in psychotherapy and other folk cures follows. The book concludes with thoughts about the question What Relationship Should Psychiatry Have to Social Sciences?
21 internautes sur 23 ont trouvé ce commentaire utile 
5.0 étoiles sur 5 A thought-provoking analysis 1 avril 2000
Par marared - Publié sur Amazon.com
Format:Broché
Dr. Kleinman offers an insightful perspective on the concept of psychiatric illness and healing that integrates contributions from many disciplines. This is a beautiful example of thinking "outside the box" that challenges traditional psychiatry while remaining respectful of the methodology of both psychiatry and anthropology. Dr. Kleinman elucidates a meaningful middle ground between the criticisms of the "anti-psychiatrists" such as Szasz and Goffman, and the traditional psychiatric hierarchy. This is an enlightening work which will appeal to those who find themselves frustrated with the limitations of traditional diagnostic categories and conceptualizations of mental illness as residing solely within the individual, and who are searching for ways to understand illness experiences as a social phenomenon.
I first read this book about four years ago, and continue to come back to it. The ideas expressed here have significantly impacted my understanding of my own field and have greatly influenced the direction of my subsequent research and teaching.
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5.0 étoiles sur 5 An Explosive Introduction 9 octobre 2013
Par Brendan Bombaci - Publié sur Amazon.com
Format:Broché
By Brendan Bombaci (anthropology grad student)

Kleinman is a luminary with the capacity to bind two disciplines, much in the same way Lawrence Kirmayer is. For the anthropologist and psychiatrist both, it is immediately obvious that he asks crucial and timely questions in Rethinking Psychiatry, each at the core of every chapter, and from each of which he spawns cogent hypothetical answers. He approaches the psychotherapeutic methods of myriad cultures, including that of the Western world, as though they were fundamentally one-in-the-same, drawing from a long-past unicultural identity, and so deftly compares aspects of their frameworks - such as the use of trance states - but contrasts their culturally specific idiomatic intricacies. In this, as the main theme throughout the book, he weaves in and out of how political, religious, and corporate social structures influence the methodologies and the outcomes of psychiatrical practices from culture to culture, and effortlessly identifies the Western error of total-faith-in-science, and the "category fallacy" (Kleinman 1988:14-15) that is basically the culturally ignorant misdiagnosis of illnesses. My one negative opinion is that the last two chapters of the book are framed as standalone but rather seem to be recapitulation and therefore feel a bit redundant, or at least outstandingly implied, as a result. No matter - I believe that this book is a good introduction to the academic and professional thinking of Arthur Kleinman, with many quality references to show that he is not just postulating from an armchair, and, that his ultimate call-to-action for a culturally educated/mediated Western psychiatry is both heartfelt and ahead of its times.

Starting off with the first three questions (as chapter names), which I will cover through the next two paragraphs, Kleinman asks "what is a psychiatric diagnosis," and "do psychiatric disorders differ in different cultures" (covering both the methodological issues and findings of the latter question). Canonical social scientists will use quantitative demographic information to figure out what racial and/or ethnic background an individual has, based on generalized abstract schemes - usually national origins and incomplete biomedical frames rather than actual cultural difference - that may not "determine how well that abstraction fits with the raw [cultural] data," and without determining "[...] whether anything salient was omitted from the theoretical scheme" (Strauss and Corbin 2007:159). They are thereby at a lack of grounded theory and are working with premodern, preconceived conceptualizations about how people of the world react and act. Using McHugh and Slavney's "two kinds of verification that psychiatric researchers struggle to establish in studies of the prevalence, manifestations, course, and treatment response of particular psychiatric disorders - namely, reliability and validity" (Kleinman 1988:10), an example of the problems this lack can create is given by Kleinman (1988:12) wherein Native Americans who hear voices of the deceased may be regarded in the West as psychotic (but normal amongst themselves) even though the validity verification cannot hold up, and even as American children may experience the same thing in bereavement of a family member and not be considered psychotic at all.

With mentations of the category fallacy and this last rubric, one can more holistically critique Western psychiatry and empathize enough to see how psychiatric disorders differ in different cultures. The most "rigorous" psychiatric studies conducted by the World Health Organization - the 1973-1979 International Pilot Study of Schizophrenia, and the famous follow-up 1986 Determinants of Outcome Study (Kleinman 1988:18-22) - were loaded by the Western diagnostic framework, and thereby with preconceived notions that all cultures experience schizophrenia in the same way. Only similarities between patients (in India, Nigeria, Colombia, Denmark, the United Kingdom, the Soviet Union, and the US) were chosen for inclusion in the outcomes of the first study - excluding important differences in the ways that many surveyed people were reporting mental or somatized illness as well as the finding that most courses of schizophrenia in less developed societies were better than those of industrialized ones. Ironically to this Western viewpoint, Mayr noted in 1981 (Kleinman 1988:19) that such perceptions are "the inverse of the argument evolutionary biologists advance to explain the great diversity of species worldwide [...wherein] biology is viewed as the major source of variation." Kleinman outlines many such variations in how cultures experience and express illness (1988:36-38, 42, 44-45, 47-50, e.g.), even arguing that trance is not a "primitive" pathology or healing method (1988:51) but one that dissolves dualistic thinking - which is perhaps why it works even in hypnosis practice in the West (1988:123), being that many non-dualistic cultures experience better illness outcomes.

Further along in the book we see how (chapter titles given) "social relations and cultural meanings contribute to the onset and course of mental illness" and "professional values influence the work of psychiatrists." It becomes apparent that there are many factors which separate the ways in which cultures do illness, how they treat it, and how they try to embody (and persuade with) symbolism, or not, as a way to take it on successfully (or not). His view is that of the biopsychocultural model of illness and treatment which accounts for, as the name implies, "the development of codes for communicating at cellular, psychological, and behavioral [symbolic] levels" (Kleinman 1988:132, emphasis added) which, in complex ways that deserve careful attention, altogether cause, define, and are affected by illnesses. He outlines the stages through which biopsychocultural healing takes place in much of the non-Western world (1988:131-134), which is a generally less alienating, more socially integrated and supportive, and cultural mythos-coding process that is likely to greatly contribute to the positive courses and outcomes of illness therewith, at the very least by decreasing the worry-inducing, self-deprecation increasing, and socially nerve-wracking effects of psychological illness amplification, or looping (Kirmayer 2007:836). His proposed "program for teaching anthropology at [three] different levels and in different contexts of psychiatry" (1988:153-159, emphasis added) is a well thought-out call-to-action for professionals in these two disciplines to educate and actively work with one another in residency, in academe, and in therapeutic sessions, in order to lessen the dangerous psychological and biomedical impact of Western ethnocentricity and scientific faith on the non-Western world, and, implicitly, to boost the capabilities and social agency of the cognitive anthropology discipline. This book is easy to digest, clear and magnetic in argument, and crucial in medical relevance, and gives you an inkling of how its author came to be such a big name in transcultural psychiatry. Although redundant at times, it is one that every anthropologist and medical student should read.

References
Corbin, Juliet, and Anselm Strauss
2007 Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory, 3rd ed. New York: Sage Publications.

Kirmayer, Laurence J., MD, and Normal Sartorius, MD, PhD
2007 Cultural Models and Somatic Syndromes. Psychosomatic Medicine 69:832-840.

Kleinman, Arthur, M.D.
1988 Rethinking Psychiatry: From Cultural Category to Personal Experience. New York: The Free Press.
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