Archive for July, 2014

22
Jul
14

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. 

Advertisements
19
Jul
14

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…

11
Jul
14

rights/vulnerabilities of migrants in transit

photoAgain 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?