Lemelson Robert, Tucker Annie
University of California, Los Angeles.
Transcult Psychiatry. 2017 Aug;54(4):540-561. doi: 10.1177/1363461517722869. Epub 2017 Jul 28.
In the past two decades, ethnographic, epidemiological and interdisciplinary research has robustly established that culture is significant in determining the long-term outcomes of people with neurodevelopmental, neuropsychiatric and mood disorders. Yet these cultural factors are certainly not uniform across discrete individual experiences. Thus, in addition to illustrating meaningful differences for people with neuropsychiatric disorder between different cultures, ethnography should also help detail the variations within a culture. Different subjective experiences or outcomes are not solely due to biographical idiosyncrasies-rather, influential factors arising from the same culture can have different impacts on different people. When taking a holistic and intersectional perspective on lived experience, it is crucial to understand the interaction of these factors for people with neuropsychiatric disorders. This paper teases apart such interactions, utilizing comparative case studies of the disparate subjective experiences and illness trajectories of two Balinese people with Tourette syndrome who exhibit similar symptoms. Based on longitudinal person-centered ethnography integrating clinical, psychological, and visual anthropology, this intersectional approach goes beyond symptom interpretation and treatment modalities to identify gendered embodiment and marital practices as influenced by caste to be significant determinants in subjective experience and long-term outcome.
在过去二十年中，人种志、流行病学和跨学科研究有力地证实，文化在决定神经发育障碍、神经精神障碍和情绪障碍患者的长期预后方面具有重要意义。然而，这些文化因素在不同个体经历中肯定并非千篇一律。因此，人种志除了要阐明不同文化中神经精神障碍患者之间的显著差异外，还应有助于详细说明一种文化内部的差异。不同的主观体验或结果并非仅仅源于个人经历的特殊性——相反，同一文化中产生的影响因素可能对不同的人产生不同的影响。从整体和交叉的视角看待生活经历时，了解这些因素对神经精神障碍患者的相互作用至关重要。本文通过对两名患有抽动秽语综合征且症状相似的巴厘岛人的不同主观体验和疾病轨迹进行比较案例研究，梳理了这种相互作用。基于整合了临床、心理和视觉人类学的纵向以人为本的人种志，这种交叉方法超越了症状解读和治疗方式，将受种姓影响的性别体现和婚姻习俗确定为主观体验和长期预后的重要决定因素。
