Csordas Thomas J
Department of Anthropology, University of California San Diego, La Jolla, CA, USA.
Transcult Psychiatry. 2023 Jun;60(3):443-456. doi: 10.1177/13634615211038167. Epub 2021 Nov 3.
Psychiatry and anthropology have a long relationship, and it is worth examining aspects of how that relation is carried over into the developing field of Global Mental Health (GMH). One place at which the two disciplines overlap significantly is in addressing religious phenomena and ritual performance in relation to mental health, and one of the greatest challenges for GMH is how productively to take into account forms of indigenous healing based on religion and ritual. In this paper I compare recent texts in GMH written from the standpoint of psychiatry and anthropology, observing that the psychiatric texts emphasize evidence-based determination of treatment efficacy, while the anthropological texts emphasize ethnographic understanding of treatment experience. Reconciling these two emphases constitutes a challenge to the field, attending to contextual variations in treatment events, illness episodes, phenomenological factors both endogenous and intersubjective, and sociopolitical factors both interpersonal and structural. In addressing this challenge, I propose an approach to therapeutic process that on the empirical level can facilitate comparison across the diversity of healing forms, and on the conceptual level can constitute a bridge between efficacy and experience. This approach is predicated on a rhetorical model of therapeutic process including components of disposition, experience of the sacred, elaboration of alternatives, and actualization of change that highlights experiential specificity and incremental change. Deploying this model can help meet the challenge of understanding efficacy and experience in indigenous healing, and prepare the ground for the further challenge of how practitioners of GMH relate to and interact with such forms of healing.
精神病学与人类学有着悠久的关系，值得探讨这种关系如何延伸至全球心理健康（GMH）这一新兴领域。这两个学科显著重叠的一个领域是处理与心理健康相关的宗教现象和仪式表现，而GMH面临的最大挑战之一是如何有效地考虑基于宗教和仪式的本土治疗形式。在本文中，我比较了从精神病学和人类学角度撰写的GMH近期文本，观察到精神病学文本强调基于证据确定治疗效果，而人类学文本强调对治疗体验的人种志理解。调和这两种侧重点对该领域构成了挑战，需要关注治疗事件、疾病发作、内源性和主体间现象学因素以及人际和结构层面的社会政治因素中的背景差异。在应对这一挑战时，我提出一种治疗过程方法，在实证层面上可以促进对各种治疗形式的比较，在概念层面上可以在效果和体验之间架起一座桥梁。这种方法基于一种治疗过程的修辞模型；该模型包括性情、神圣体验、替代方案阐述以及突出体验特异性和渐进性变化的变革实现等要素。运用这一模型有助于应对理解本土治疗中效果和体验的挑战，并为GMH从业者如何与这些治疗形式建立联系并互动这一进一步挑战奠定基础。
