What to do in the face of the Trump phenomenon?

http://www.newyorker.com/cartoons/daily-cartoon-022316-hat

This cartoon speaks to the sentiment I and many of my colleagues are feeling about the historical moment of racism and xenophobia that has given rise to Trump. It’s scary and often we feel paralyzed in the face of the hate and ire that Trump spouts, which gives voice to the anti-Obama racist backlash and the backlash to the multiculturalism of the 1990s and 00s more generally. What to do in the face of this? Short of emigrating to Canada or Mexico following a possible Trump Presidency, this phenomenon seems to give those of us working in higher education even more import and motivation for our work – building acceptance, understanding, and value for cultural differences through our teaching and research.

Access Denied

This is a great blog on the intersection between migration and health. I’d encourage all my colleagues and students to consider posting and responding in order to reinvigorate this site. 

From Alienation to Protection: Central American Child Migration – Heide Castañeda, Lauren Heidbrink, and Kristin Yarris

Encounters of Care and Violence (at somatosphere.net)

Link to piece I wrote with Heide Castañeda at:

http://somatosphere.net/2014/09/encounters-of-violence-and-care-central-american-transit-migration-through-mexico.html

despedida a puebla

another summer in Puebla draws to its end, students are back at the School of Medicine, in their white coats and shoes, buying textbooks and registering for coveted classes. I return to Eugene to the task of developing my book manuscript during a much-needed no-teaching term this fall. As always, the work I do with MHIRT in Mexico continues to inform my conception of mental health, illness, culture, psychiatry, and contemporary globalization. In a compelling 1997 article in Transcultural Psychiatry, Gilles Bibeau argued that, to remain relevant to contemporary globalization, anthropologists working on issues of mental health need to hone their conceptualizations of both culture and of mental illness. He proposed that notions of borders, margins, and paradoxes are most useful in our conceptual toolkit, for they help us make sense of “the transitional stage in which most individuals and societies find themselves…living at the interface of local and global worlds, torn between multiple attachments and … the necessity to assume a more flexible pluralist frame of reference in the shaping of a larger world” (Bibeau 1997:10). In thinking about several interviews with psychiatric patients this summer and last, this quote is incredibly apropos to their situation. For instance, in one case – that of a 40-something year old man, he attributed his psychosis to a period of unemployment that followed nearly a decade of work as an upper-level manager for a major multinational firm in Puebla, which shut its doors in the late 90s partially as a result of NAFTA’s effects on the Mexican economy; in another – that I describe below – a 20-something woman attributes her major depression and anxiety to the rifts that have formed between herself and her parents around her gender identity, desire for independence, and rejection of “traditional” female gender roles. There are many other cases to mention, including that of a 20-something year old university student who told us that his first major depressive episode was a result of the “shock” of moving to Puebla (city) from a small pueblo, which he describes as like a “boom” (his word) of cultural change, which drastically reshaped his sense of self and social relationships. I can also apply Bibeau’s insights to my own lived experience of Puebla, a city that is as “traditional” (in its centro histórico, with its zócalo, iglesia, cafés, artesian shops, narrow streets, and 18th-century tiled buildings) as it is “modern” (in its zona Angelópolis, filled with multi-lane freeways, track housing developments, huge shopping centers, and chain stores like Costco, Mega grocery store, and import car dealerships). Moving around the city everyday, it’s hard not to feel the city as caught between the historical tensions of Mexican development and national identity; further, I often think in a city such as this, where the “traditional” and “modern” coexist and clash, how much sense disorders such as major anxiety and schizophrenia actually make – they seem apt embodied expressions of the state of this particularly unruly social and cultural world. 

Culture, Gender, and Mental Health

Culture, Gender, and Mental Health

In my research in Mexico with two fantastic MHIRT trainees, we are exploring the utility of the Cultural Formulation Interview (CFI) of the DSM-V. To our knowledge, ours is one of the first research studies to examine the CFI in clinical practice outside the United States. The DSM-V was only released in 2013, and the inclusion of the CFI in this manual (albeit as an Appendix) has been viewed by medical and psychological anthropologists as a step forward in the effort to incorporate what we refer to as patients’ illness experience (basically, how sufferers’ perceive and respond to their mental health problem, how it impacts their social roles and relationships, etc.) and explanatory models of illness (the different ways that clinicians and patients make sense of mental illness, how they view causality, symptomatology, and course of treatment). The CFI, and this lived-experience-of-illness approach, owes a great debt to the decades of work of anthropologist-psychiatrist Arthur Kleinman (for those who don’t know his work, a good primer for a popular audience is the 2006 What Really Matters: Living a Moral Life Amidst Uncertainty and Danger). Our CFI study, which we are conducting in a major public psychiatric hospital in Puebla, includes enrolling providers (psychiatrists and psychiatric residents) and their patients, and observing providers implement the CFI with patients. CFI questions include questions about social support and alternative treatments tried by patients. We are particularly interested in how well this interview picks up on aspects of patients’ cultural backgrounds that are relevant to their diagnosis, illness and treatment. Interestingly, the CFI doesn’t ask directly about gender or family relationships, two dimensions of cultural experience that seem to be salient and significantly associated with mental distress among the patients we are observing. For instance, in two interviews with young women diagnosed with depression-anxiety disorders, it was clear that tensions around independence/education/career choices/women’s responsibilities as caregivers and expectations for women’s marital roles were central to each woman’s experience of depression and (their word) “angustia”. One patient, “Lorena”, attributed her depression and anxiety to the tensions between “como pensaba que iba a ver mi vida y como actualmente la estoy viviendo” (“how I thought my life would be and how I’m actually living it”) – echoing the arguments made by Kleinman about how illness experience always indicates this existential dilemma – opening up the differences between life as we imagine or envision it to be and the uncertainty and challenges involved with life as actually lived. Lorena referred specifically to having studied for a post-secondary degree in tourism and administration, having travelled for her work to different parts of the country, and having a professional career as experiences that have shaped her expectations for independence as a woman – she seeks parity in gender roles and greater control over her life choices and wants these same things for her daughter (now 6 years old). These desires are raising conflicts for Lorena, however — both with the father of her child and with her own parents, who don’t necessarily share the same expectations for their daughter. Such dynamics around gender, family, and generation are very much “cultural” – reflecting shifts between “tradition” and “modernity” in contemporary Mexican society (and have been described by Anthropologist Jennifer Hirsch in her work on changing expectations for conjugal relationships in Mexican and Mexican-American communities). Nonetheless, and despite their apparent importance to patients such as Lorena, the CFI doesn’t ask about gender roles nor do providers view gender as part of “cultural” experience. The role of gender in culture and mental health/illness is definitely something I will continue to contemplate in this research…

narrating major mental illness

In her wonderful book, Life Writing and Schizophrenia: Encounters at the Edge of Meaning, my colleague Mary Wood analyzes first-person accounts of schizophrenia, including that of her own mother, and shows how those suffering from major mental illness are in fact able to make sense out of their experiences. The interpretive process in Wood’s book is multi-layered: family members try to make sense of signs of distress, psychiatrists interpret clinical symptoms, and sufferers reflect on past psychotic episodes in ways that inscribe them with significance within particular social, historical, and cultural worlds. Wood writes, “Rather than being merely swept up in confused, fragmented, chaotic narratives, my mother was caught within too many narratives whose endings were already known. This is an important lesson I learned from my mother about schizophrenia and one that clinicians do well to keep in mind. It’s a distortion to say simply that someone living with schizophrenia has a false sense of reality. It is rather the case that the person’s sense are perceiving something with acute intensity” (pg. 288). I’ve been reading Wood’s chapter on her mother’s illness this first week of fieldwork in the major public psychiatric hospital here in Puebla. The interviews we are conducting ask patients to describe their explanatory model of illness- drawing directly on the work of Arthur Kleinman and other psychological anthropologists, the interviews aim to elicit first-person accounts of: what caused the “problem”, what the “problem” is, what possible remedies for the “problem” are, and how the psychiatric care the patient is receiving at the hospital can be improved to better address the “problem” — all from the patient’s perspective. I will describe the source of this interview guide in another post, but for now I want to share a bit of the story of a patient I will call Marcelo, who I interviewed yesterday. Marcelo is in his early 50s but has been living with schizophrenia for over 30 years, his first major psychotic episode occurred when he was 21, and he attributes the break to several factors: the death of a brother, the death of his father, and early childhood trauma, including hunger, poverty, and violence. Keeping Wood’s claims about sufferers’ ability to narrate their own experiences in mind, I was struck by how much Marcelo’s account of his illness support Wood’s argument. Marcelo remembered with lucidity dates of important life events and of major hospitalizations, he recalled names of many of his past clinical providers, and told a detailed story about being a goat-herder as a child but facing his father’s beatings when he lost a goat. Interestingly, and in what is not unusual in my experience working with those diagnosed with schizophrenia in Mexico, Marcelo also attributes one crisis episode (“crisis of nerves” in his words) to his experience as an undocumented migrant living in the U.S. for four years several decades ago. Throughout an over 40-minute interview, Marcelo was attentive to the interviewer, illustrative in his responses, and seemed comfortable with the setting. I was particularly surprised by his ability to narrate his experience because, after reviewing his chart notes, the attending psychiatry resident had warned me that Marcelo had recently suffered an episode of psychosis and she wasn’t sure he would be able to participate in our interview. This clinical perception – of schizophrenics as unable to narrate their experience – pervades not just the clinical encounter, but prevention programs and popular perceptions as well. Even well-established prevention programs are based on recognizing signs and symptoms of schizophrenia, such as false beliefs or hallucinations, that reinforce the idea that a schizophrenic mind doesn’t “make sense” but rather “makes nonsense”. While, like Wood, I in no way want to minimize the suffering that comes with major psychotic episodes, Marcelo’s case reminds me of the importance of recognition – here, I mean, recognizing the other’s ability to make sense and make significance out of suffering. 

mental health research in Puebla, MEX

In my third summer of work with the Minority Mental Health Research & Training program (http://dornsife.usc.edu/latino-mental-health), I am helping mentor students conducting research related to prevention, diagnosis, and treatment of major mental illness. My days are spent at the BUAP (Benemérita Universidad Autónoma de Puebla)’s department of psychiatry, and at the psychiatric hospital where we are conducting research. The research project I’m supervising aims to assess the applicability, acceptability, and utility of the Cultural Formulation Interview, a tool that is part of the new DSM-V and is intended to evaluate the relation of culture to patients’ experiences of mental distress. So far, the major obstacle to our research is the reluctance of clinicians (psychiatrists and residents) to participate in the study. I think they believe we are evaluating them, rather than the instrument itself; also a barrier is their lack of time with back-to-back patient appointments, doing our 45 minute interview is a burden that our offer of a 200 peso gift card just can’t compensate for! More posts soon, from Puebla…

rights/vulnerabilities of migrants in transit

Again I find myself studying the vulnerabilities of persons in transit, migrants, or “peregrinos” as staff at the local office of Caritas here in Mazatlán refers to them. There is too much to say in one blog post about the situation of Central Americans in transit para “el Norte” and too many images to share: the role of NGOs and people of faith- such as Caritas and local Catholic parroquias- in offering shelter, showers, meals, medical attention and a safe place to rest to migrants; the role of the authorities (municipal police, immigration officers) in protecting or violating migrants’ rights (some of the worse assaults against transiting migrants are perpetuated by the police who rob, extort, and otherwise threaten them); the ways members of local communities respond in solidarity- offering food, a phone call home, a shower – and show the best side of human kindness; the violence perpetrated by gangs and other armed actors against migrants in transit; the violence of the journey itself, with the treacherous journey by train resulting in exhaustion, skin rashes, dehydration, limb loss/falls/injuries, even death; and the trains themselves, “la bestia”, the huge steel wheels creaking along tracks that in an instant can mean loss of limb or life for a migrant atop. Today in a visit to the local migration delegación, this picture was on a wall, trying to warn migrants of the dangers of transit. Indeed, the Mexican migration authorities told us, their role in this transnational story of movement, violence, and displacement is “purely administrative”, as a 2012 migration law in Mexico reinforces a reformed, and more humanitarian, discourse about migrants –no longer referred to by immigration officials here as “illegal” but as “extranjeros sin documentos” or “personas no documentadas”, the officials’ role is not to “deport” but to “return”, and they assert that this is a “humanitarian gesture”, given that the most dangerous part of the journey lies in the deserts ahead, sending people back, via plane and consulate intervention, to their home countries may indeed be a life-saving act. Or is the humanitarian response that of the local Caritas group, which offers showers, a clean bed, a change of clothes, and a warm meal before migrants travel onwards towards their dreams/illusions of a better life?

campus violence

This term, I am struck by the high levels of violence on university campuses. This weekend’s incident at UCSB is of course troubling and tragic. Other recent incidents of rape and sexual violence at UO, and the UO Office of the President’s inept and inadequate response, are also troubling instances of a university administration unable to move beyond tired tropes of “procedure” and “policy”, and unwilling to face the potential political and financial fallout of standing up to the Athletics Establishment. At UO in the past month since the rape involving three basketball players and a botched Eugene Police Department response (that included making the incident/crime report publicly available on the web, which inappropriately included the name of the victim and details of the incident still under investigation), students have reacted with a range of responses, including: stigma and rejection, trauma and re-living their own past experiences of sexual violence, and anger and organizing to pressure the campus Administration for change. (All topics I’m discussing in my small seminar class this term, allowing a space for students to process this incident and its aftermath.) Student pressure has culminated in a list of demands made on the Administration, including: asking for an overhaul of EPD and campus police response to incidents of rape and sexual assault, increased funding for support services for sexual violence survivors on campus, and a required general education course covering sexual violence-related topics. These are strong and explicit demands that make particular sense during a political moment when the Obama Administration is advancing a campaign to address sexual violence and rape on college campuses nation-wide (estimates are that 1:4 college women will experience sexual violence) and yet the UO higher-ups have thus far failed to act. Shameful. 

I don’t yet know the details of the UCSB case of this weekend, but news coverage of the violence there is troubling as well. For one, it seems the perpetrator was receiving counseling and other forms of mental health services, and his “mental instability” is used almost as justification for violence – perpetuating stereotypes equating mental illness with violence and sidelining issues of gun laws and accessibility to firearms that make deadly violence possible. In addition, it seems the attacker was targeting women specifically (a sorority was one of his targets and two women standing outside among his victims), implying deep-seated links between misogyny and violence that reflect the larger cultural problem of sexual violence on university campuses and beyond.  

on embodied stress among academics…

Recently, I’ve been involved in a search for a department head in an academic unit with which I’m affiliated. In talking with other, more senior, faculty who have known and worked with the outgoing Head for a good number of years, it has become apparent that he will be impossible to replace. So much of the functioning of the unit depended on his volunteer labor, something we in academia are not unfamiliar with (in our promotion reviews, it’s called “service”, and, while spoken of as a reflection of one’s commitment to the university, it counts for very little in terms of achieving tenure, which is a decision – at my large, public university at least – based almost entirely on one’s research profile.)  What has been interesting for me to contemplate is the reason almost unanimously given among my colleagues for the outgoing Head’s success: “He sleeps only five hours a night”.  Indeed, I’ve had my own conversations with said Head (a senior male tenured Professor in his late 50s or early 60s) in which he boasts proudly of arriving to work at 7:00am and staying until 7:00pm every day. I’ve had a good share of my own twelve hour days in the past year and a half as an Assistant Professor (whether in the office, or with the work I take home and do late at night on my couch), and this may be part in parcel of the professional world of A) junior professorship and/or B) late neoliberal global capitalist order in which we find ourselves caught up at this moment in history. Not just in academia, but in so many (all?) professions at this historical moment, it seems to me we gain credibility through our suffering. To wit: “I’m so busy” is a ubiquitous greeting, so much so that it’s nearly lost it’s meaning. Who is not busy, I wonder, when faced with this claim uttered by everyone I run into on campus on a given day? “I’m so stressed”. “I’m over-committed”. “I have so much work to do”. Who doesn’t feel stressed to their limits most of their work week?  The thing is, in academia, it seems to me that these complaints are doing some additional work that seems like lending a veneer of credibility to our work, or should I say, a sheen of legitimacy to ourselves and our own stressed-out existences. Not sleeping and sacrificing one’s personal wellbeing are monikers of someone who is focused, dedicated to their career, ultimately worthy of the one-day-to be-granted title “Professor”.

 

As another example, I remember a faculty meeting (this time in a different academic unit from the one mentioned above) last year in which the Department Head missed a few agenda items in her facilitation of the meeting. When she realized this, she reflexively uttered the following as an excuse: “I’m sorry, it’s that I only slept five hours last night”. Immediately after this phrase was put out onto the table, another tenured female faculty member said, “Oh, that’s good; I only slept three hours last night”. What was this about? I thought. Some sort of race-to-the-most-stressed-out bottom?  A competition to see who had slept the least? This is crazy! It’s as if we don’t have legitimacy in academia unless we (and our minds and bodies) suffer. Just think what would happen if we walked around responding to the question, “How are you?” with something like: “Great! I had a solid eight-hour sleep, I made myself a healthy breakfast, had a good workout, got into the office at 9:30am and now I’m enjoying doing some writing before I teach this afternoon and then leave at 5:00pm [in my ideal work day, there is no lunch “break” because I’d rather get done and get out sooner – most of us eat at our desks through lunch anyway] to head home to spend the evening on a nature walk with a friend/sharing dinner with my family/doing community service at my child’s school/volunteering at the nursing home/animal shelter”. Can you imagine faculty talking to one another like that? That wouldn’t be an academic institution of repute at all, now, would it?!

 

My thought here is that we are all upholding the inequities- historically patterned by gender, class, color- in the university by engaging in this sort of self-sacrificial competition. Traditionally, academic labor was done by white men, who counted and depended on the reproductive labor of their wives/ female partners at home, (maybe also the sexual services of female graduate students, but that’s a rant for another time), the child rearing labor of paid servants/domestic workers (often immigrants and people of color), and low-wage service workers providing everything from lawn care, dry cleaning, laundry, restaurants, and car-washing services. The Department Head who spends 12-plus hours at the office and only 5 hours asleep certainly had some help at home raising his two children (now adults) all those years pre- and post-tenure, right? How could such schedules have been maintained without the unpaid reproductive labor of women and lower-status men? Who would have done his laundry, cooked his food, cleaned his house all those long hours while he was at the office?

 

If anything, I hope to reflect on the way we all, through our idioms of distress (“I’m so stressed/busy/sleepless”), support and uphold contemporary inequities in labor and power through our own exploitation. If we women who find ourselves occupying academic jobs now continue to perpetuate this race of self-sacrificial behavior, are we not just embodying our own exploitation (and that of our colleagues) with our constant refrains of “I’m so stressed… I haven’t slept all week… I don’t have time for exercise/meditation/yoga/dog walks/children/community work/sex/relationships/church/community/sports/writing groups/volunteer work/knitting/cooking”?!? I know that I may sound Pollyannaish in even putting this discussion out there, that I should be grateful for my tenure-track job in a social context of un- and under-employed PhDs, etc. But my argument might have implications for the job market as well: if we all did a little less self-sacrificial work, respecting our limits, the 8-hour work day, weekends, and holidays, would not institutions eventually need to hire more people to do the work that so many of us do essentially for “free” under the current regime of compete-to-see-who-works-the-hardest?