Department of Anthropology, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
Cult Med Psychiatry. 2017 Dec;41(4):499-540. doi: 10.1007/s11013-017-9539-6.
Drawing on clinical data from 15 months of on-site participant observation in the only public psychiatric hospital in the state of Puebla, Mexico, this article advances our understanding of globalization in relation to psychiatry. I challenge the construction of psychiatry as only treating the individual patient and provide grounded doctor-patient-family member interaction in a Mexican psychiatric clinic in order to review what happens when doctors cannot interact with patients as atomized individuals even though in theory they are trained to think of patients that way. Challenged by severe structural constraints and bolstered by lessons from other nations' efforts at deinstitutionalization, psychiatrists in Puebla push to keep patients out of the inpatient wards and in their respective communities. To this end, psychiatrists call upon co-present kin who are identified both as the customer and part of the caretaking system outside the clinic. This modification to the visit structure changes the dynamic and content of clinical visits while doctors seamlessly respond to unspoken beliefs and values that are central to local life, ultimately showing that efforts to define a "global psychiatry" informed by global policy will fail because it cannot exist in a uniform way-interpersonal interaction and personal experience matters.
本文以墨西哥普埃布拉州唯一一家公立精神病院 15 个月的现场参与者观察的临床数据为基础，探讨了全球化与精神病学的关系。我对将精神病学仅仅视为治疗个体患者的做法提出了质疑，并提供了墨西哥一家精神病诊所中基于实际情况的医患-家庭成员互动，以反思当医生不能将患者视为个体化的个体进行互动时会发生什么，尽管从理论上讲，他们是经过这样的训练的。普埃布拉的精神病医生受到严重结构限制的挑战，并从其他国家在非住院化方面的努力中吸取了经验教训，他们努力将患者留在门诊病房和各自的社区中。为此，精神病医生呼吁共同在场的亲属，这些亲属既是诊所外的顾客，也是护理系统的一部分。这种访问结构的改变改变了临床访问的动态和内容，而医生则能够流畅地应对那些对当地生活至关重要的未言明的信念和价值观，最终表明，受全球政策影响的“全球精神病学”定义的努力将失败，因为它不可能以统一的方式存在——人际互动和个人经验至关重要。
