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Culture and Psychopathology

The Anthropology of Mental Illness

Georgi Onchev

The book sets itself the ambitious task of exploring the relationship between human culture and the phenomenon of mental illness, that which has embarrassed, fascinated, and challenged educated minds throughout the centuries. Various manifestations of this phenomenon are examined in specific cultural contexts, presented with notable competence, and illustrated with memorable descriptions of clinical cases. (…) The book and its author have many merits—the capacity to present a highly specialized subject in an intelligible, absorbing, and simultaneously profound manner; respectable erudition and academic self-discipline; and the notable skill of handling different domains of knowledge, among others. The most remarkable quality, however, is the author’s concern both for the reader—who is carefully led into quite unknown and still frightening territory—as well as for his protagonists, the mentally ill. All told, I believe that this book will be of interest not just to students of psychiatry, psychology, and anthropology, but also to a broader circle of readers who are excited by the wretched and admirable destiny of being human.

Haralan Alexandrov

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12 Treatment and Culture

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A strange disease requires a strange cure.

W. Shakespeare

Beyond the technological framework of medicine, the expectations and means of health care delivery are definitely influenced by cultural attitudes. Health care transformations are more visible and understandable on the political and economic levels. The main change is, however, cultural, and can be briefly defined as a transition from paternalism to autonomy.154 This transition modifies traditionally undisputed roles. The physician is no longer the savior from A.J. Cronin’s novels who travels with his leather bag through snowdrifts to a woman in labor, nor is he an undisputed authority, but this new physician is an expert offering therapeutic services. Patients are not the passive recipients of prescriptions, but rather are informed customers who may accept or refuse these services. The degree to which a patient’s choice is assisted in his best interest by a doctor determines a model of either partnership—with a high degree of such assistance—or one of consumerism, wherein services are offered like any other commodity with advertising, competition, and the ultimate aim of being sold. A contradiction of the health care context in societies going through a state of transition exists between the “liberal” consumerist model of service delivery and “conservative” paternalistic mentalities in attitudes held towards the patient.

The central place of patient autonomy and informed consent in bioethics32, 179 has been determined by changes within a broader cultural context in which the role of one’s inner experience...

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