This blog reflects my deep interest in the different ways the various cultures and subcultures in this world conceive of the world and our lives within it. I was born in Asia, hold a UK passport, lived for most of my adult life in France, and now live in the US as a resident alien, working as a psychotherapist in private practice in San Francisco. Issues of cultural identity and displacement are very close to 'home' for me, and for many of my clients.

Saturday, August 20, 2011

The Anthropology of Money

Students at the University of California at Irvine have created an online exhibition on the anthropology of money, drawing on information from relatives and friends in immigrant communities in Southern California. The home page says:

"This project took the student researchers to Little Saigon, Little India, the Cambodian Corridor of Long Beach, Los Angeles's Chinatown, Little Armenia, the clubs of Hollywood, the dorms of UC Irvine and the barrios of East LA. It also involved phone calls to far-away relatives and friends, and travels through memories contained in family photo-albums, scrapbooks, and sacred texts."

The exhibition discusses:

  • various types and uses of lucky money in Hawaiian, Chinese and Muslim culture
  • tandas and cundinas: Mexican-American and Latino-American rotating credit associations
  • Lakshmi and ritual uses of money in Hindu culture
  • the mid-Lent festival in Armenian culture
  • ghost money in Chinese culture
  • 'edible money' in the form of dumplings in Chinese culture.

Saturday, August 6, 2011

Roots Trump Radiation? A Vital Lesson from the Ukraine

I came across a fascinating article about a community of elderly Ukrainian women who live in the Chernobyl dead-zone, in evident good health. After initially being relocated out of the radiation-contaminated area around the nuclear plant, these women decided within a few weeks to return home to the villages that had been their ancestral home. They have been there for the last twenty-five years.
The women farm beets, potatoes and other crops in the irradiated soil, forage for berries and mushrooms, and hunt game in the forest. Deer are said to be heavily contaminated, yet they are eaten. Although one of the women has thyroid cancer (which is treated), they have, on average, out-lived their peers who did not come back, by ten years.
The article suggests that the psychological effects of forced dislocation, separation from one's land and one's roots, and from one's community, are more dangerous than massive doses of radiation.
This is a deeply provocative idea, but in the context of massive doses of radiation in Japan, some of which have drifted to the US, it's a paradoxically comforting one.
Could it be that grounding into a deep relationship with the land, living in a close-knit community, eating humbly and locally, and living a very simple lifestyle, is in itself curative? These elderly Ukranian peasant women know something profound, and their indigenous wisdom holds an important lesson for the rest of us.

Thursday, May 26, 2011

Susto: Loss of Soul Through Terrible Fright

Susto is a disorder you might get in Central or South America, resulting from your soul having left your body as a result of a severe fright. (A more severe form of susto is called espanto, and considered potentially fatal.)

Symptoms of susto include: nervousness, insomnia, despondency, lack of attention to your appearance, listlessness, fear of the event happening again, and stomach upsets.
Susto clearly has much in common with PTSD, including the fact that sometimes it doesn't set in until months or years after the event that caused it. See the list of symptoms listed by one curandera, and you will note that many of them correspond to those of PTSD.

But the notion of
soul loss captures something essential to the experience of great fear--something that is not captured by the notion of PTSD and the neurological explanations that go with that diagnosis. Great fear (and also great loss) do make you feel as though you had lost some essential part of oneself. The lively, life-filled part: your soul.

Susto is treated by local healers in the US using herbal teas, limpias (cleansing rituals) and barridas (sweeping rituals). During the barrida the client recounts the traumatic event, and then receives a healing usually involving having his or her body swept with a crucifix or some other ritual object such as an egg. Usually a series of barridas is necessary to heal a person from susto.

According to
Dr. Dennis O'Neil, at Palomar College, California: "Among the Maya Indians of Southern Mexico and Guatemala, [the] ceremony typically involves a lengthy series of ritual actions in the presence of the patient's friends and relatives. It usually begins with prayers to the Catholic saint of the village. Next, a chicken egg and special herbs are passed over the patient's body to absorb some of the illness. Later, the egg may be left where the soul loss occurred, along with gifts to propitiate the supernatural being who has the patient's soul. The patient is then partly stripped and "shocked" by liquor being sprayed from the curandero's mouth. The patient may then be massaged and finally "sweated" on a bed placed over or near a hot stove. Alternatively, the patient may be covered with many blankets to induce profuse sweating."

Wednesday, May 25, 2011

A Lacanian Reading of Koro

Koro is the belief that one's penis is retracting fatally into one's body--or that is has been stolen, through witchcraft or spirit medecine. It can be a personal or a social delusion, and it affects men in parts of Asia and Africa.

In 1967 there was a major epidemic of koro in Singapore, which lasted for about ten days of general panic. Emergency rooms filled up with men clutching desperately at themselves in an attempt to stop the syndrome.

In rural parts of China, penises have been traditionally stolen by a spirit in the form of a fox, who wanders the countryside looking for victims. It sounds whimsical, but in some parts of Africa, people have been lynched for stealing someone's penis.

Koro is listed in Appendix I of the DSM-IV-TR. Clearly in the West it corresponds to Panic Disorder, and perhaps to Body Dismorphic Disorder. But what underlies it is more interesting than its classification. In that respect, perhaps a rereading of Freud would be more useful--or perhaps better still Lacan.

Lacan rereads Freud's "penis" as the "Phallus"--not the physical, literal organ, but a metaphor for the power in the world that a man is granted by virtue of being male. Phallus envy makes sense in a way penis envy does not.

In the case of koro, narcissistic injury, symbolised as loss of Phallus (a man's power and status in the world), might be experienced as "my penis is shrinking". Interpreted this way, the disorder becomes less of a curious folktale for and more a deeply comprehensible expression of fear and distress.

Koro From A Taiwanese-American Perspective
This detailed comment was sent to me by Mindy Chang.
In some rural parts of China, there is the belief that fox spirits are responsible for stealing the penises of hapless male victims. The fox spirit is well known in Japanese folklore as a kitsune and in Chinese folklore as hu li jing. Some are good and some are bad. They are often feared because they are powerful and cunning, and if you anger one, you will be punished and cursed. Some of the bad ones appear in the form of beautiful women who seduce young men because they are deficient in yin life force; hence koro.

In some ways, they are similar to the Chinese snake spirits that appear as beautiful young women and seduce men, much like their Western succubae counterparts. The tiger spirit, a.k.a. tiger mother, also is invariably a female spirit that steals young babies to eat; male babies are especially desirable since they are traditionally valued more than girl babies. The snake and tiger spirits are also cunning like their fox spirit sisters.

Either way, these malevolent female spirits represent the unconscious fear Asian men often have of strong Asian women in a predominately patriarchal society. Therefore, it makes sense that a peasant living in rural China might believe these folk tales and be conservative enough to accuse a woman of stealing his penis or masculinity.

According to traditional Chinese medicine, a man’s life force resides in his seed, which is expelled through his penis. This belief is not unlike the passage in the Bible where God chides Onan for spilling his seed upon the ground. One may also recall the passage in Amy Tan’s book “The Joy Luck Club” where the woman who cannot get pregnant is confined to her bed so that her husband’s seed will impregnate her and his yin will not go to waste.

There are some Chinese people who still partake of traditional Chinese remedies that are particularly exotic, such as dried tiger penis. Although officially use of ingredients from exotic animals is illegal, there is a thriving black market trade, thanks to demand, that is met by poachers. The idea is that if a man eats a tiger penis, he will take on the strength and virility of the male tiger; essentially, the tiger’s yin.

When treating koro, it might be beneficial to use traditional Chinese remedies (other than the illegal dried tiger penis). Whether the remedies actually work or the effects are psychosomatic, it matters not so long as the patient believes he will get well because he believes in the remedy.

Wednesday, May 18, 2011

Dinner? Or Pot-Luck. High Versus Low Context Cultures

Anthropologist Edward T Hall codified cultures as either high-context or low-context. His distinction captures an otherwise indefinable set of nuances that can mysteriously rub you the wrong way if you spend substantial time in culture at the other side of the polarity from your own.

In high-context cultures, relationships are vital, and the meaning of much of what is going on is held in the context, rather than being explicitly said. Think of the Japanese tea ceremony, or about doing business in the Middle East, where you drink endless cups of tea and talk together about everything but business for hours, before you get to what a person from a low-context culture would think of as 'the point'. These cultures tend to be emotional and intuitive, valuing long term relationships and trust.

In low-context cultures, little is implicit. My favourite example is the way, when laughing at a joke, Americans will also say, "That's funny," as though laughing didn't already signal that the joke was funny. In low-context cultures, relationships tend to be shorter in duration, life tends to be action and task-oriented, and 'the rules' tend to be codified and made explicit.

Hall's distinction helps me to understand why I--a person from a high-context culture--miss French dinner parties, which go on for hours over carefully prepared food and carefully selected wine. Inviting people for dinner in America doesn't fill the gap of what I miss--for a start because here people tend to expect to eat and then do something: "dinner and a movie." Likewise, I abhor the pot-luck, because for me the careful, loving, planned preparation of the dinner makes it an aesthetic offering from me to my invitees--it's not just food to share.

But it's not just that. It's that here, a dinner invitation doesn't mean what it means to me. So I've found that though people may come to eat if asked, they don't necessarily invite me back, because (for them) my dinner party was not situated within an unfolding and implicitly understood network of back and forth invitations that create and maintain the basic fabric of social relationships. They're not being rude. It's just that we're operating in a different paradigm.

In a high-context culture, inviting someone to dinner is a bid for relationship. Accepting a dinner invitation is a response indicating openness to relationship. It implicates you. It may even imply a certain indebtedness, relationally. These cultures draw a clear distinction between public and private life, so inviting someone into your home implies trust and closeness. The different elements of behaviour--bringing a gift, preparing the food, praising the food, conversing appropriately and lengthily, spending the time--all evoke feelings of connection and belonging.

So what I miss is not the dinner party itself. The dinner party itself is empty. What counts is the depth beneath it, the meaning behind it, the implicit within it--the very aspects almost impossible to describe to a person from a low-context culture. If you're reading this and really don't get what I'm on about, or think it's ridiculous, you're probably from a low-context culture!

Neither type of culture is better than the other. People from a low-context culture can be intensely frustrated by high-context cultures, in which everything happens as a result of who you know, and in which everything takes seemingly endless amounts of time. Everyone is always late. You have to have connections to get anything done. Everything's based on gifts--or are they bribes? These cultures often seem charming and quaint from the outside, but within them you're an outsider, and as such you can feel mystified by the unwritten rules, subtly excluded, and stymied by the lack of clarity.

Edward Hall's distinction explains why the misunderstandings between America and the cultures of the Middle East are endless. The Middle East is seen as full of feuds and nepotism--aka they value long term relationships and are fiercely loyal, with an intense sense of honour. The US is seen as a false friend--aka they feel free to change their allegiances and renew their strategies according to the situation as it unfolds. No interpretation is more correct than the other, but they are very, very different.

Understanding the basis for the differing interpretation at least helps us to avoid getting caught up in our emotional reactions to what feels culturally 'wrong' based on our own norm.

Thursday, April 14, 2011

You Are What You Speak: Sapir-Whorf

The Sapir-Whorf principle is also known as 'the principle of linguistic relativity'. It claims that our conception of the world is shaped by--even controlled by--our language.

The 'strong' version of the Sapir-Whorf hypothesis holds that that language determines thought--in other words, you can't think at all outside the boxes created by the words you use. The 'weak' version holds that language influences, but does not completely determine thought.

This theory led linguists in the 70's to investigate colour perception. They eventually found that although we tend to segment the colour spectrum according to the ways our language provides for us, we are nevertheless able to see all the colours. (This supports the weak version.) Traditional Welsh, for example, has the word 'glas', that describes a certain grey/green/blue colour. English speakers don't have that word, but they can see the colour.

In her science fiction novel, Native Tongue, Suzette Haden Elgin shows how linguistic relativity works, and how the words we have available to us control what we do and do not perceive. She does it by inventing both a word, and the concept that it describes:

"When you look at another person, what do you see? Two arms, two legs, a face, an assortment of parts. Am I right? Now, there is a continuous surface of the body, a space that begins with the inside flesh of the fingers and continues over the palm of the hand and up the inner side of the arm to the bend of the elbow. Everyone has that surface; in fact, everyone has two of them.
I will name that the 'athad' of the person. Imagine the athad, please. See it clearly in your mind -- perceive, here are my own two athads, the left one and the right one. And there are both of your athads, very nice ones.
Where there was no athad before, there will always be one now, because you will perceive the athad of every person you look at, as you perceive their nose and their hair. From now on.... Now it exists. Now I can say, 'What beautiful athads you have.' "

The process of learning another language in sufficient depth to really speak it changes us. Every language describes the world differently. Those of us who are bilingual can tend to feel we have two personalities inside us, with slightly (or considerably) different conceptions of the world. The way we are in the world, and who we feel ourselves to be, varies depending which language we are speaking.

Even if are monolingual, we may have had a flavour of what this is like. Most of us have probably had the experience of knowing something, but knowing that we knew it until someone named it for us. For example, I knew I had a certain way of interacting with nature, but couldn't describe it, or explain why it was different from another way of interacting with nature, until I read Martin Buber's book I And Thou. Buber coined the term "I/Thou relationship". When I read it, I knew instantly what he meant, that it described my experience, and that it rendered that experience communicable for the first time. This reflects the weak form of linguistic relativity--I was able to experience something, but that experience was not fully conceivable until I was provided with language that could express it.

This is why communication--especially therapy--is tricky across languages. It's one root of 'othering'--it's hard to really get the world view of a person of a different linguistic culture, and even harder to get that their 'strange' worldview is equally real, equally normal, and equally valid, unless you have had the experience of trying to squeeze your reality through the funnel of a foreign language.

First, Know Your Djinn: More on Ethnopsychiatry


Ethnopsychiatry was developed in Paris by Dr Tobie Nathan—a classically trained psychiatrist treating immigrant patients from West and North Africa, who did not respond well to methods based on a Western paradigm.

A significant part of the problem these particular clients have is that they have not been able to acculturate to the host culture, and so they live in a dislocated zone: between a culture from which they have been separated, and one within which they do not or cannot fit. Since much of their problem consists in this dislocation, the act of being reconnected with their ancestral culture, and strengthened in their identity as one who carries this culture, even in a foreign land, is a vital part of their return to health.

Patients at the ethnopsychiatry center are seen with their families, by a treatment team which includes an ‘ethno-clinical mediator’, who is a specialist in the patient’s language and culture. The consultation happens in the patient’s own language, with an interpreter so that the patient does not have to translate their reality through the filter of a foreign language which lacks or distorts the ideas they need to express.

Ethnopsychiatry: basic assumptions
Ethnopsychiatry posits that our culture is intrinsic to who we are, rather than something overlaid on top of a ‘neutral’ self. Our personal identity therefore is inextricable from our cultural identity.

Ethnopsychiatry is based on structuralist analysis: the idea that anything (including any symptom) has meaning only by virtue of its position at the intersection of a matrix of interwoven relationships. So behind any pathology is a whole system of thought, actions, actors, and purposes--which constitute its meaning and its usefulness in expressing psychic dis-ease.

In order to effectively treat someone, you have to use their own, culturally-ratified values and beliefs. Each culture has its own system of values and beliefs around personal misfortune, illness, therapists, and treatment techniques. This is of course not only true of people from traditional cultures—in Western society, we believe that talking about emotions will help, that crying is good for us, and that taking pills can make us better. These are no more ‘normal’ than going to a shaman and making a fetish doll; they just seem more normal to us, since we grew up being taught that these are effective means of curing ourselves.

“Curing” the client involves making meaning out of the patient’s symptoms, in terms of their own cultural mythology and values. This results not only alleviates symptoms, but helps the client (re)connect to their culture—strengthening their identity, as part of a stronger cultural identity.

Example 1: The djinn
The djinn (spirit), is an important part of the range of psychopathologies available to the people of North Africa. To think of a djinn merely as an imaginary spirit would be an error, since this leaves out the web of social and cultural factors that carry the real significance of the djinn in peoples’ lives. A djinn is radically other, but still the mirror image of the human being. Djinns have gender, they can reproduce by having children, and they have a religion, being Muslim, Christian, Jewish or Pagan. However, “they live in the other world; the world of the night, the desert, the forest, the bush, of rubbish, of ruins, of sewers, of the blood of animals”. Djinns are creatures of boundaries and limits. One of their functions is to mediate difficult transitions.

Since all djinns are different, in order to treat someone possessed by a djinn, the healer must get to know the djinn, find out its name and geneology, discover what its intentions are, investigate what it desires and needs, identify the objects it likes, and define the acts and rituals it expects. With this information, the healer can enter into rites that constitute negotiations with the djinn. Finally the healer can identify the benefits the client gains from his or her association with the djinn.

In this approach, ethnopsychiatry joins James Hillmann, with his insistence on respecting the pathology for its living message, rather than trying to diagnose it, dissect and label it, analyze and interpret it. It also joins with the most effective traditional healers in that the aim is not to cure the patient of believing in djinns, but rather to respect the djinn and treat with it in a creative, ritualistic way according to its nature, for the good of the patient, the healer and in some cases also the djinn itself.

Dr Nathan relates a case study concerning a child who becomes possessed by a djinn. The child is the identified patient, but in fact the symptoms relate to the parents’ problems with fitting into the host culture, as well as to the father’s past history, as a spiritually ‘pure’ man who was celibate for 40 years before marriage. The djinn possesses the boy when he starts school; in other words, when he enters into the foreign French society in which they live, and becomes therefore himself in some ways a foreigner, which makes him ‘impure’ culturally. (It’s notable that when the djinn possesses the boy, he insults his father in French, not in Arabic.) The djinn represents the otherness and impurity to which the father cannot adjust, and at the same she represents the solution to the problem, for the presence of the djinn takes the boy out of school and compels the family to return to tradition in order to treat the boy.

Treatment
Much of the treatment in ethnopsychiatry seems to consist in the patient being heard and understood by people who understand his or her language and culture. The normalization and validation, and the intrinsically healing effect of being mirrored within this containing relationship cannot be underplayed. Discussing the symptoms within the context of the client’s culture helps the client to constitute a meaning for the symptoms. This helps the patient to reinforce—or in the case of children of immigrants to create—their identity within their cultural framework. Which translates to a reinforcement or creation of his or her identity per se.

Sometimes however, the ethnopsychiatric team goes further, deliberately representing the patient’s problem to the patient in terms which it considers will most likely facilitate (re)construction of meaning, and subsequent healing. This is always done by taking into account not only the cultural interpretation of the symptoms, but also the key ways the culture itself is constituted. Example 2 shows how this is done.


Example 2: Drug addiction in a gypsy family


In gypsy (Roma) society one of the “basic cultural defense mechanisms lies in strengthening the cultural borders, constantly defining a limit between the inner and outer worlds”. Since the tribe moves continually, the culture is not held externally, but rather each individual holds the culture within them, and “is the guardian of the group’s soul”. Drug addiction is new in French gypsy society, and it threatens this system. Drugs come into gypsy society through the gadjé (mainstream house-dweller culture), and drug addiction is considered to be a sign of a kidnapped soul.

In the case of a young gypsy woman addicted to heroin, and rejected by her mother who considers her to have crossed over to the gadjé and to have become non-human, the ethnopsychiatry team points out to the mother and daughter that the drug problem is not part of gypsy culture. They then suggest that the problem is linked to the death of the grandmother, because since she died, the family has no longer been protected (magically). They do this based on their knowledge that gypsy culture is “organized on the basis of witchcraft logic, in which every individual is involved sooner or later, either as a victim or perpetrator of acts of witchcraft”.

The mother, it turns out, has long suspected that the mother of her gadjé daughter-in-law used witchcraft to attract her son. The team encourages the mother to follow the dead grandmother’s request that she go to church and pray regularly (this gypsy tribe is traditionally Christian). After this, the mother brings to them an object she has found, which is clearly a curse set by a member of the family.

The treatment has consisted in reducing the isolation both of the daughter within the family, and of the family within the culture, by reinserting both mother and daughter within the cultural belief system. The intervention has also set in motion various self-healing actions within the culture:
1. The evil was identified as coming from outside, from the gadjé, which activates the “closing-in response of the gypsy world”.
2. Drug-addicted people are seen as “kidnapped souls”, so the treatment has to follow that cultural meaning, and counterbalance the kidnapping. Identifying the cause of the addiction as a curse made by someone in the family restores agency to mother and daughter, who can now make meaning of the situation and resort to counter-curses to combat the drug addiction, within the system of the culture.

Conclusion

Ethnopsychiatry is a profoundly pragmatic practice, based on a structuralist analysis of meaning, the individual and society. It is similar to certain other strands of psychotherapy in that it considers a symptom to arise not from intra-psychic pathology, but rather to be the best and truest possible expression of a dis-ease that has a social or familial cause. Tobie Nathan, like James Hillman, believes that, “in cases of psychic disorder, the patient’s suffering expresses the deepest truth of his being.” And like Hillman he considers that “healing” the patient is an act of monotheistic aggression. Instead of analyzing the symptom and diagnosing it, ethnopsychiatry addresses it within its own (cultural) system of meaning.