Archive for the 'anthropology' Category

WEIRD paper redux

Ethan Watters is at it again. Watters is the author of Crazy Like Us the book and blog of the same name, and a few weeks ago he published “We Aren’t the World” in Pacific Standard, a very readable piece about the WEIRD paper — Heine, Norenzayan, and Henrich’s “The Weirdest People in the World.” The paper is not new — it was published in 2010 — but it does continue to raise intriguing questions about the cultural specificity of most findings in psychology.

What’s WEIRD? Western, Educated, Industrialized, Rich and Democratic. What’s weird about them? It turns out they… er, we… are probably the worst population to do psychological research with if you want to get a picture of the average human psychology. Read the paper here.

More evidence that measuring local concepts of distress matters

The latest issue of Psychological Assessment includes an article by University of Pennsylvania postdoctoral research fellow (and soon to be Manhattan College Assistant Professor) Nuwan Jayawickreme that provides support for the use of locally developed distress measures in post-disaster settings that are beyond the cultural boundaries of Western psychology’s usually realm. Are Culturally Specific Measures of Trauma-Related Anxiety and Depression Needed? The Case of Sri Lanka provides empirical evidence suggesting that once locally-developed measures of posttraumatic distress are administered, administering measures of PTSD and depression (as defined by DSM-IV) does not provide any more useful information vis-a-vis an individual’s impairment of day-to-day functioning.

Developing psychological distress measures in non-Western disaster zones has been on the agenda of many in the disaster mental health field for over a decade now. The essential problem is that conceptualizations of mental health problems and the way that different people from different cultures express their distress vary widely. So, when mental health professionals need to assess individuals to see if they need treatment, they need a measure (questionnaire, survey, or some other standard measurement tool) that is sensitive to that population. How  are such tools to be developed? Jayawickreme explains:

Identifying such idioms first need to use ethnographic methods to understand how the social world interacts with the individual’s physical and psychological processes. Such ethnographic studies usually involve an in-depth examination of a specific culture’s conceptualization of a particular experience. Once the concepts and the idioms used by the community in question have been identified, questionnaires or inventories can be developed to assess these concepts, which are then validated using iterative statistical and field testing methods

And that’s what he did. And then he administered this measure, called the Penn/RESIST/Peradeniya War Problems Questionnaire (PRP-WPQ), the PTSD Symptom Scale (or PSS, a standard PTSD scale developed by trauma treatment luminary — and Jayawickreme advisor — Edna Foa) and the Beck Depression Inventory (the BDI, a standard measure of depression) to 197 Tamil Sri Lankans living in the war torn northern and eastern parts of the island. And then he looked at the incremental ability of the PTSD Symptom Scale and the Beck Depression Inventory to predict a measure of functional impairment.

Jayawickreme’s regression analysis showed what some of us have been talking about (and even publishing empirical results on) for a while now: Using measures of psychological distress with local populations that incorporate terms that they can understand is better at getting at the functional impairment due to this distress than using DSM-IV based measures.

The current findings provide support for the notion that sensitive measurement of  psychopathology in non-Western, war affected populations may require the development of instruments that incorporate local idioms of distress. As noted earlier, there are limited resources available for providers of psychosocial aid in non-Western, war-affected countries. Given the considerable needs of such populations, it may seem inappropriate to engage in what appears to be a costly and complicated process to develop measures incorporating local idioms of distress. The current results do indicate that the PSS and the BDI predict functional impairment to a substantial degree. However, the current results also suggest that measures incorporating idioms of distress may improve our ability over and above the established measures to identify those who are functionally impaired because of mental illness and who therefore need assistance.

“Canine PTSD” or “Army dogs suffer from Pavlovian conditioning”

McGill University’s Summer Program in Social and Cultural Psychiatry presents wonderful opportunities to share ideas with those who think a lot about culture and mental health, culture in mental health, and, perhaps most interesting, the culture of mental health. Allan Young, whose historical ethnography of posttraumatic stress disorder, The Harmony of Illusions, is a must-read for anyone interested in trauma studies, passed along the following example of PTSD’s exaggerated role in current US culture, from the Army Times:

Dogs bring home war’s stress, too

By Michelle Tan – Staff writer
Posted : Thursday Dec 30, 2010 9:41:04 EST

SAN ANTONIO — Dogs suffer from post-traumatic stress, too.

Years of war and frequent deployments have affected military working dogs just as they have humans, and Dr. Walter Burghardt is trying to do something about it.

Dr. Burghardt explains:

“The dogs that go overseas … we’re starting to see some distress-related issues,” he said. “It results in difficulty doing work. They’re distracted by loud noises. We’re not saying it’s the same as in people, but there are common things.”

That includes hypervigilance or showing interest in escaping or avoiding places in which they used to be comfortable. For example, a dog that used to work at a security checkpoint or gate may try to pull away on his leash when he sees he’s being led to that checkpoint or gate, Burghardt said.

Some of the dogs also become very clingy or more irritable or aggressive, the doctor said.

“Canine PTSD” is either the most extreme example of what Richard McNally calls PTSD’s “bracket creep” or some perhaps nonintentional Pavloivan insight into the nature of stress response. Or perhaps both. If we take the “symptoms” reported in the article as accurate, and I have no reason to doubt the staff writers at the Army Times, then yes, dogs get stressed and want to avoid the sources of their stressors — classical conditioning, a la Ivan Pavlov (1849-1936; Pavlov even demonstrated conditioning using dogs, until they drowned in their cages when the River Neva flooded the basement of his laboratory). But canine posttraumatic stress disorder?

In case you were concerned that the Army veterinarians were not being careful about differential diagnosis, or perhaps even that some dogs might be faking in order to cash in on the generous disability benefits for veterans with PTSD:

[Dr. Burghardt] cautioned, “canine [post-traumatic stress disorder] is only diagnosed if the dog has combat exposure or repeated, prolonged deployments.”

The article continues with a description of the treatment given the dogs to get them right back “in the service”… which is, of course, the goal of treating human PTSD in the military as well.

More from McGill’s Summer Program: The Affliction Film Series

McGill University’s Summer Program in Social and Cultural Psychiatry is not just about the differences between Swedes and Irish. As part of the summer program’s keynote course, Cultural Psychiatry, McGill luminary Laurence Kirmayer includes a number of film clips in the syllabus to give students a chance to observe some of the phenomena that gets diagnosed by psychiatrists using Western psychiatric categories, but may perhaps make more sense by examining the patient’s cultural and historical context.

One of the most striking films shown (so far) comes from Robert Lemelson’s psychiatric anthropology series, Afflictions: Culture and Mental Illness in Indonesia. In “Shadows and Illuminations,” a man presents with visual and auditory hallucinations of Balinese spirits, disorganized behavior and inappropriate dress. His family and neighbors regard him as odd, so it’s not the case that he is just odd to our foreign eyes. Our psychiatric practice tells us to look for schizophrenia. He reports the symptoms began with the death of his daughter, and we think perhaps it is a posttraumatic stress reaction of some sort. He is examined by two traditional healers and a psychiatrist, all of which have their own treatments, but none of which seem to help. Accommodations are made for the man’s behavior in his own home, and he seems to get a little better. Improvement had nothing to do with our diagnosis, or lack thereof.

Each story in the series situates behavior and concepts of illness within the families and societies in which they occur. Not satisfied with biological explanations of these patients’ problems, Lemelson’s films remind us that psychiatric practices have non-psychiatric implications, specifically around family relations, historical meaning-making, and even implications related to the freedom of the individuals with mental health problems.

Windshield ethnographers, Human Terrain Teams, and counterinsurgency: Improving the military’s cultural competence

I just finished reading Nathan Hodge’s Armed Humanitarians: Rise of the Nation Builders, about the evolution of the United States’ military’s mission in Iraq and Afghanistan in the last decade. There’s plenty to learn from Hodge, a staff writer at the Wall Street Journal, and the value of the book will be judged, I expect, for its documentation of (1) the massive philosophical changes that occurred within the military in response to instability in the wake of “regime change” in Baghdad and Kabul and (2) the massive outsourcing of military-relevant tasks to security firms, services corporations, and… anthropologists? Anthropologists and related social scientists were all involved in a new tactic, the use of Human Terrain Systems.

In a chapter titled “Windshield Ethnographers,” Hodge introduces us to the Human Terrain System which was based on the idea that “brigade commanders needed social scientists to provide advice” so that they didn’t have to rely on a “library loaded with ethnographic data” when making their rounds establishing alliances with local sheiks and mullahs. Five-person Human Terrain Teams would be embedded with brigades or regiments in order to provide intelligence — or, as social scientists call it, information (there’s some discussion of this in the awkward situations this distinction produced) — on local customs, relations between local leadership, and the little things that can really mess up inter-cultural communication (like an American soldier talking directly to an Afghan woman of the house).

What convinced the military that they should forge alliances with pointy-headed academics? Well, Hodge describes the source as an article by a policy fellow at the Office of Naval Research, Montgomery McFate, published in Military Affairs in 2005. Anthropology and Counterinsurgency: The Strange Story of their Curious Relationship argued that the military should bring in anthropologists and other social scientists in order to serve their new nation building objectives.

Once called “the handmaiden of colonialism,” anthropology has had a long, fruitful relationship with various elements of national power, which ended suddenly following the Vietnam War. The strange story of anthropology’s birth as a warfighting discipline, and its sudden plunge into the abyss of postmodernism, is intertwined with the U.S. failure in Vietnam. The curious and conspicuous lack of anthropology in the national-security arena since the Vietnam War has had grave consequences for countering the insurgency in Iraq, particularly because political policy and military operations based on partial and incomplete cultural knowledge are often worse than none at all.

Essentially, McFate was arguing that in order to succeed militarily against a counterinsurgency, the military had to improve its cultural competence. (There really are too many cynical comments to make at this point — I will refrain… but feel free to contribute in the comments section below.)

Hodge writes well, and he refrains from the holier-than-thou commentary that has become typical in critiques of the US’s blunders in Iraq and Afghanistan. His history is well-sourced, and much of the book is built on his own, first-hand, reporting. Put this on the required reading list for humanitarian aid workers, and maybe for soldiers too.


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