Deep China Kleinman, Arthur; Yan, Yunxiang; Jun, Jing ...
2011., 2011-09-26
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Deep China investigates the emotional and moral lives of the Chinese people as they adjust to the challenges of modernity. Sharing a medical anthropology and cultural psychiatry perspective, Arthur ...Kleinman, Yunxiang Yan, Jing Jun, Sing Lee, Everett Zhang, Pan Tianshu, Wu Fei, and Guo Jinhua delve into intimate and sometimes hidden areas of personal life and social practice to observe and narrate the drama of Chinese individualization. The essays explore the remaking of the moral person during China's profound social and economic transformation, unraveling the shifting practices and struggles of contemporary life.
...mental health services should be scaled up as an essential component of universal health coverage and should be fully integrated into the global response to other health priorities, including ...non-communicable diseases, maternal and child health, and HIV/AIDS. ...barriers and threats to mental health need to be addressed; these include the lack of awareness of the value of mental health in social and economic development, the lack of attention to mental health promotion and protection across sectors, the severe demand-side constraints for mental health care caused by stigma and discrimination, and the increasing threats to mental health due to global challenges such as climate change and growing inequality. ...mental health needs to be protected by public policies and developmental efforts; these intersectoral actions should be undertaken by each country's leaders to engage a wide range of stakeholders within and beyond health, including sectors in education, workplaces, social welfare, gender empowerment, child and youth services, criminal justice and development, and humanitarian assistance. ...investments in research and innovation should grow and harness novel approaches from diverse disciplines such as genomics, neuroscience, health services research, clinical sciences, and social sciences, both for implementation research on scaling up mental health interventions and for discovery research to advance understanding of causes and mechanisms of mental disorders and develop effective interventions to prevent and treat them.
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The majority of theoretical models have defined stigma as occurring psychologically and limit its negative effects to individual processes. This paper, via an analysis of how ‘face’ is embodied in ...China, deepens an articulation of how the social aspects of stigma might incorporate the moral standing of both individual and collective actors defined within a local context. We illustrate (1) how one's moral standing is lodged within a local social world; (2) how one's status as a ‘moral’ community member is contingent upon upholding intrapersonal and social-transactional obligations; and (3) how loss of face and fears of moral contamination might lead to a ‘social death’. We first draw from Chinese ethnographies that describe the process of human cultivation before one can achieve fully ‘moral’ status in society. We integrate findings from empirical studies describing how social-exchange networks in China are strictly organized based on the reciprocation of favors, moral positioning, and ‘face’. We further ground these Chinese constructs within a theoretical framework of different forms of capital, and discuss the severe social consequences that loss of face entails. By utilizing the examples of schizophrenia and AIDS to illustrate how loss of moral standing and stigma is interwoven in China, we propose a model highlighting changes in moral status to describe how stigma operates. We suggest that symbolic restoration of moral status for stigmatized groups takes place as local-level stigma interventions. By analyzing the moral aspects of ‘face’, we propose that across cultures, stigma is embedded in the
moral experience of participants, whereby stigma is conceived as a fundamentally moral issue: stigmatized conditions threaten what matters most for those in a local world. We further propose that stigma jeopardizes an actor's ability to mobilize social capital to attain essential social statuses.
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Reimagining global health Farmer, Paul; Kleinman, Arthur; Kim, Jim ...
2013., 20130918, 2013, 2013-09-07, Volume:
26
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Bringing together the experience, perspective and expertise of Paul Farmer, Jim Yong Kim, and Arthur Kleinman, Reimagining Global Health provides an original, compelling introduction to the field of ...global health. Drawn from a Harvard course developed by their student Matthew Basilico, this work provides an accessible and engaging framework for the study of global health. Insisting on an approach that is historically deep and geographically broad, the authors underline the importance of a transdisciplinary approach, and offer a highly readable distillation of several historical and ethnographic perspectives of contemporary global health problems. The case studies presented throughout Reimagining Global Health bring together ethnographic, theoretical, and historical perspectives into a wholly new and exciting investigation of global health. The interdisciplinary approach outlined in this text should prove useful not only in schools of public health, nursing, and medicine, but also in undergraduate and graduate classes in anthropology, sociology, political economy, and history, among others.
This innovative volume is an extended intellectual conversation about the ways personal lives are being undone and remade today. Examining the ethnography of the modern subject, this preeminent group ...of scholars probes the continuity and diversity of modes of personhood across a range of Western and non-Western societies. Contributors consider what happens to individual subjectivity when stable or imagined environments such as nations and communities are transformed or displaced by free trade economics, terrorism, and war; how new information and medical technologies reshape the relation one has to oneself; and which forms of subjectivity and life possibilities are produced against a world in pieces. The transdisciplinary conversation includes anthropologists, historians of science, psychologists, a literary critic, a philosopher, physicians, and an economist. The authors touch on how we think and write about contingency, human agency, and ethics today.
A review of English-language journals published since 1990 and three global mental health reports identified 11 community studies on the association between poverty and common mental disorders in six ...low- and middle-income countries. Most studies showed an association between indicators of poverty and the risk of mental disorders, the most consistent association being with low levels of education. A review of articles exploring the mechanism of the relationship suggested weak evidence to support a specific association with income levels. Factors such as the experience of insecurity and hopelessness, rapid social change and the risks of violence and physical ill-health may explain the greater vulnerability of the poor to common mental disorders. The direct and indirect costs of mental ill-health worsen the economic condition, setting up a vicious cycle of poverty and mental disorder. Common mental disorders need to be placed alongside other diseases associated with poverty by policy-makers and donors. Programmes such as investment in education and provision of microcredit may have unanticipated benefits in reducing the risk of mental disorders. Secondary prevention must focus on strengthening the ability of primary care services to provide effective treatment.
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Research and clinical experience reliably and repeatedly demonstrate that the determinants of health are most accurately conceptualized as biosocial phenomena, in which health and disease emerge ...through the interaction between biology and the social environment. Increased appreciation of biosocial approaches have already driven change in premedical education and focused attention on population health in current U.S. health care reform. Medical education, however, places primary emphasis on biomedicine and often fails to emphasize and educate students and trainees about the social forces that shape disease and illness patterns. The authors of this Commentary argue that medical education requires a comprehensive transformation to incorporate rigorous biosocial training to ensure that all future health professionals are equipped with the knowledge and skills necessary to practice social medicine. Three distinct models for accomplishing such transformation are presentedSocMed’s monthlong, elective courses in Northern Uganda and Haiti; Harvard Medical School’s semester-long, required social medicine course; and the Lebanese American University’s curricular integration of social medicine throughout its entire four-year curriculum. Successful implementation of social medicine training requires the institutionalization of biosocial curricula; the utilization of innovative, engaging pedagogies; and the involvement of health professions students from broad demographic backgrounds and with all career interests. The achievement of such transformational and necessary change to medical education will prepare future health practitioners working in all settings to respond more proactively and comprehensively to the health needs of all populations.
James was a leading public intellectual from the late 19th century to 1910, when he died as a result of heart disease. ...Sutton describes a broad early Jamesian vision of what we would now call ...“mental health”: a unifying field of psychosomatic processes, neurasthenia, depression, psychosis, placebo responses, the widest range of counselling and psychotherapy (lay and professional), and self-healing. Battling against the vulgar reductionism of medical materialism and the paralysing cynicism of therapeutic nihilism, James proselytised for an early form of community health that included a pluralistic idea of health care, akin to social medicine, with its connection to the social sciences and humanities. The fact that James's Gifford Lectures at the University of Edinburgh, The Varieties of Religious Experience: A Study in Human Nature (1902), have never been out of print in the USA and are still among the most popular books in courses on the study of religion, surely is much more about James's insistence that personal and collective experience not institutions, theology, or history are more the grounds of religion than it is an example of religion as health or healing.
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Covid-19 is an inherently social disease, with exposure, illness, care, and outcomes stratified along familiar social, economic, and racial lines. However, interventions from public health and ...clinical medicine have focused primarily on the scale-up of technical and biomedical solutions that fail to address the social contexts driving its distribution and burden. Fused with a moment of reckoning with racial injustice and economic inequality in the U.S. and across the world, these disparities charge policy leaders to develop, study, and share a response grounded in social medicine. As a yardstick for formulating, evaluating, and implementing health policy and care delivery, social medicine recommends at least three things: integrating health, social, and economic responses; bringing care to the points of greatest need; and focusing on broad equity-driven reforms in the pandemic's wake. With these tools, Covid-19 presents us with an opportunity to address the inequities that the disease highlights, exploits, and may otherwise entrench.
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