Brown School of Social Work, Washington University in St Louis, St. Louis, MO, USA.
Cult Med Psychiatry. 2013 Mar;37(1):195-225. doi: 10.1007/s11013-012-9295-6.
Large numbers of individuals in U.S. prisons meet DSM criteria for severe psychiatric disorder. These individuals also have co-occurring personality and substance abuse disorders, medical conditions, and histories of exposure to social pathologies. Based on nine months of ethnographic fieldwork in a U.S. prison, focusing on staff narratives, I utilize interpretivist and constructivist perspectives to analyze how mental health clinicians construct psychiatric disorder among inmates. Discrete categorization of disorders may be confounded by the clinical co-morbidities of inmates and the prison context. Incarcerated individuals' responses to the institutional context substantially inform mental health staffs' illness construction and the prison itself is identified as an etiological agent for disordered behaviors. In addition, diagnostic processes are found to be indeterminate, contested, and shaped by interactions with staff. Analysis of illness construction reveals that what is at stake for clinicians is not only provision of appropriate treatment, but also mandates for the safety and security of the institution. Enmeshed in these mandates, prison mental health becomes a particular local form of psychiatric knowledge. This paper contributes to anthropological approaches to mental disorder by demonstrating how local contexts mediate psychiatric knowledge and contribute to the limited ethnographic record of prisons.
大量美国监狱中的囚犯符合 DSM 严重精神障碍标准。这些人还同时患有人格障碍和物质滥用障碍、患有各种疾病，并且有接触社会病理学的历史。基于在美国监狱进行的九个月的民族志实地工作，重点是工作人员的叙述，我利用解释主义和建构主义观点来分析心理健康临床医生如何在囚犯中构建精神障碍。障碍的离散分类可能会因囚犯的临床合并症和监狱环境而变得复杂。被监禁者对机构环境的反应极大地影响了心理健康工作人员对疾病的构建，监狱本身被确定为行为障碍的病因。此外，诊断过程被发现是不确定的、有争议的，并受到与工作人员互动的影响。对疾病构建的分析表明，对于临床医生来说，不仅要提供适当的治疗，还要确保机构的安全。在这些命令的交织中，监狱心理健康成为一种特殊的地方形式的精神科知识。本文通过展示当地环境如何调节精神科知识并为监狱的有限民族志记录做出贡献，为精神障碍的人类学方法做出了贡献。
