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跨文化精神病学:去殖民化时代的文化差异、普遍性和社会精神病学。

Transcultural Psychiatry: Cultural Difference, Universalism and Social Psychiatry in the Age of Decolonisation.

机构信息

Department of English, Germanic and Romance Studies, University of Copenhagen, Copenhagen, Denmark.

出版信息

Cult Med Psychiatry. 2021 Sep;45(3):359-384. doi: 10.1007/s11013-021-09719-4. Epub 2021 Apr 27.

Abstract

In the mid-twentieth century, in the aftermath of WWII and the Nazi atrocities and in the midst of decolonisation, a new discipline of transcultural psychiatry was being established and institutionalised. This was part and parcel of a global political project in the course of which Western psychiatry attempted to leave behind its colonial legacies and entanglements, and lay the foundation for a more inclusive, egalitarian communication between Western and non-Western concepts of mental illness and healing. In this period, the infrastructure of post-colonial global and transcultural psychiatry was set up, and leading psychiatric figures across the world embarked on identifying, debating and sometimes critiquing the universal psychological characteristics and psychopathological mechanisms supposedly shared among all cultures and civilisations. The article will explore how this psychiatric, social and cultural search for a new definition of 'common humanity' was influenced and shaped by the concurrent global rise of social psychiatry. In the early phases of transcultural psychiatry, a large number of psychiatrists were very keen to determine how cultural and social environments shaped the basic traits of human psychology, and 'psy' practitioners and anthropologist from all over the world sought to re-define the relationship between culture, race and individual psyche. Most of them worked within the universalist framework, which posited that cultural differences merely formed a veneer of symptoms and expressions while the universal core of mental illness remained the same across all cultures. The article will argue that, even in this context, which explicitly challenged the hierarchical and racist paradigms of colonial psychiatry, the founding generations of transcultural psychiatrists from Western Europe and North America tended to conceive of broader environmental determinants of mental health and pathology in the decolonising world in fairly reductionist terms-focusing almost exclusively on 'cultural difference' and cultural, racial and ethnic 'traditions', essentialising and reifying them in the process, and failing to establish some common sociological or economic categories of analysis of Western and non-Western 'mentalities'. On the other hand, it was African and Asian psychiatrists as well as Marxist psychiatrists from Eastern Europe who insisted on applying those broader social psychiatry concepts-such as social class, occupation, socio-economic change, political and group pressures and relations etc.-which were quickly becoming central to mental health research in the West but were largely missing from Western psychiatrists' engagement with the decolonising world. In this way, some of the leading non-Western psychiatrists relied on social psychiatry to establish the limits of psychiatric universalism, and challenge some of its Eurocentric and essentialising tendencies. Even though they still subscribed to the predominant universalist framework, these practitioners invoked social psychiatry to draw attention to universalism's internal incoherence, and sought to revise the lingering evolutionary thinking in transcultural psychiatry. They also contributed to re-imagining cross-cultural encounters and exchanges as potentially creative and progressive (whereas early Western transcultural psychiatry primarily viewed the cross-cultural through the prism of pathogenic and traumatic 'cultural clash'). Therefore, the article will explore the complex politics of the shifting and overlapping definitions of 'social' and 'cultural' factors in mid-twentieth century transcultural psychiatry, and aims to recover the revolutionary voices of non-Western psychiatrists and their contributions to the global re-drawing of the boundaries of humanity in the second half of the twentieth century.

摘要

在二十世纪中叶,第二次世界大战和纳粹暴行之后,正值非殖民化进程中,一种跨文化精神病学的新学科正在建立和制度化。这是全球政治项目的一部分,在此过程中,西方精神病学试图摆脱其殖民遗产和纠葛,并为西方和非西方精神疾病和治疗观念之间更具包容性和平等性的交流奠定基础。在这一时期,建立了后殖民时代全球和跨文化精神病学的基础设施,世界各地的主要精神病学家开始确定、辩论,有时甚至批评据称在所有文化和文明中共同存在的普遍心理特征和精神病理学机制。本文将探讨这种精神病学、社会和文化对“共同人性”的新定义的探索是如何受到同时期全球社会精神病学兴起的影响和塑造的。在跨文化精神病学的早期阶段,许多精神病学家非常热衷于确定文化和社会环境如何塑造人类心理学的基本特征,来自世界各地的精神科医生和人类学家都试图重新定义文化、种族和个体心理之间的关系。他们中的大多数人都在普遍主义框架内工作,该框架假设文化差异只是症状和表现的表层,而所有文化中精神疾病的普遍核心仍然是相同的。本文将认为,即使在这种明确挑战殖民精神病学的等级和种族主义范式的背景下,来自西欧和北美的跨文化精神病学的创始几代人往往以相当简化的方式来理解非殖民化世界中更广泛的心理健康和病理学环境决定因素——几乎完全专注于“文化差异”以及文化、种族和民族“传统”,在此过程中对其进行本质主义和实体化,未能建立西方和非西方“心态”的一些共同社会学或经济学分析类别。另一方面,正是非洲和亚洲的精神病学家以及来自东欧的马克思主义精神病学家坚持应用那些更广泛的社会精神病学概念——如社会阶层、职业、社会经济变化、政治和群体压力和关系等——这些概念在西方的心理健康研究中很快变得至关重要,但在西方精神病学家与非殖民化世界的接触中却基本缺失。以这种方式,一些主要的非西方精神病学家依靠社会精神病学来确定精神病学普遍主义的界限,并挑战其一些欧洲中心主义和本质主义倾向。尽管他们仍然赞同占主导地位的普遍主义框架,但这些从业者援引社会精神病学来引起人们对普遍主义内部不一致性的关注,并试图修改跨文化精神病学中挥之不去的进化思维。他们还为重新想象跨文化的相遇和交流做出了贡献,认为这是具有创造性和进步性的(而早期的西方跨文化精神病学主要通过致病和创伤性的“文化冲突”的棱镜来看待跨文化)。因此,本文将探讨二十世纪中叶跨文化精神病学中“社会”和“文化”因素不断变化和重叠的定义的复杂政治,并旨在恢复非西方精神病学家的革命性声音及其对二十世纪下半叶人类边界重新划定的贡献。

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