Globalization of Psychiatry
Psychopharmaceutical marketing has also contributed to the globalization of psychiatry and the high prevalence of depression, as documented by research in India (Ecks 2013, Ecks and Basu 2009, Sumeet and Jadhav 2009), Japan (Appelbaum 2006, Kirmayer 2002, Kitanaka 2011), Brazil (Béhague 2009; Biehl 2005, 2006; Leibing 2009) and Argentina (Lakoff 2005, 2006).
While ethnographic studies tend to corroborate the existence of a global psychopharmaceutical hegemony (Good 2010), the distribution of spending on pharmaceuticals is strongly asymmetric and is determined by economic incentives (Petryna and Kleinman 2006). In the area of mental health, the result is overdiagnosis and overmedication in the richest countries and dismal negligence in the poorer ones (Kleinman 2012).
Such an imbalance in the distribution of resources must be placed in the framework of the discussion concerning the contribution of mental disorders to the global burden of disease (GBD) as measured in Disability-Adjusted Life Years (DALYs, or number of years lost due to ill health, disability, or early death).
List of studies cited by Vidal and Ortega
India
Ecks, Stefan. 2013. Eating Drugs: Psychopharmaceutical Pluralism in India. New York: NYU Press.
Summary of Eating Drugs: Psychopharmaceutical Pluralism in India
A Hindu monk in Calcutta refuses to take his psychotropic medications. His psychiatrist explains that just as his body needs food, the drugs are nutrition for his starved mind. Does it matter how—or whether—patients understand their prescribed drugs?
Millions of people in India are routinely prescribed mood medications. Pharmaceutical companies give doctors strong incentives to write as many prescriptions as possible, with as little awkward questioning from patients as possible. Without a sustained public debate on psychopharmaceuticals in India, patients remain puzzled by the notion that drugs can cure disturbances of the mind. While biomedical psychopharmaceuticals are perceived with great suspicion, many non-biomedical treatments are embraced.
Stefan Ecks illuminates how biomedical, Ayurvedic, and homeopathic treatments are used in India, and argues that pharmaceutical pluralism changes popular ideas of what drugs do. Based on several years of research on pharmaceutical markets, Ecks shows how doctors employ a wide range of strategies to make patients take the remedies prescribed. Yet while metaphors such as "mind food" may succeed in getting patients to accept the prescriptions, they also obscure a critical awareness of drug effects.
This rare ethnography of pharmaceuticals will be of key interest to those in the anthropology and sociology of medicine, pharmacology, mental health, bioethics, global health, and South Asian studies.
Japan
Kirmayer, Laurence J. 2002. “Psychopharmacology in a Globalizing World: The Use of Antidepressants i...
Summary of Depression in Japan: Psychiatric Cures for a Society in Distress
Since the 1990s, suicide in recession-plagued Japan has soared, and rates of depression have both increased and received greater public attention. In a nation that has traditionally been uncomfortable addressing mental illness, what factors have allowed for the rising medicalization of depression and suicide? Investigating these profound changes from historical, clinical, and sociolegal perspectives, Depression in Japan explores how depression has become a national disease and entered the Japanese lexicon, how psychiatry has responded to the nation's ailing social order, and how, in a remarkable transformation, psychiatry has overcome the longstanding resistance to its intrusion in Japanese life.
Questioning claims made by Japanese psychiatrists that depression hardly existed in premodern Japan, Junko Kitanaka shows that Japanese medicine did indeed have a language for talking about depression which was conceived of as an illness where psychological suffering was intimately connected to physiological and social distress. The author looks at how Japanese psychiatrists now use the discourse of depression to persuade patients that they are victims of biological and social forces beyond their control; analyzes how this language has been adopted in legal discourse surrounding "overwork suicide"; and considers how, in contrast to the West, this language curiously emphasizes the suffering of men rather than women. Examining patients' narratives, Kitanaka demonstrates how psychiatry constructs a gendering of depression, one that is closely tied to local politics and questions of legitimate social suffering.
Drawing upon extensive research in psychiatric institutions in Tokyo and the surrounding region, Depression in Japan uncovers the emergence of psychiatry as a force for social transformation in Japan.
Brazil
Béhague, Dominique. 2009. “Psychiatry and the Politicization of Youth in Pelotas, Brazil: The Equivo...
Summary of Vita: Life in a Zone of Social Abandonment
Zones of social abandonment are emerging everywhere in Brazil’s big cities—places like Vita, where the unwanted, the mentally ill, the sick, and the homeless are left to die. This haunting, unforgettable story centers on a young woman named Catarina, increasingly paralyzed and said to be mad, living out her time at Vita. Anthropologist João Biehl leads a detective-like journey to know Catarina; to unravel the cryptic, poetic words that are part of the “dictionary” she is compiling; and to trace the complex network of family, medicine, state, and economy in which her abandonment and pathology took form.
An instant classic, Vita has been widely acclaimed for its bold fieldwork, theoretical innovation, and literary force. Reflecting on how Catarina’s life story continues, this updated edition offers the reader a powerful new afterword and gripping new photographs following Biehl and Eskerod’s return to Vita. Anthropology at its finest, Vita is essential reading for anyone who is grappling with how to understand the conditions of life, thought, and ethics in the contemporary world.
Biehl, João. 2006. “Pharmaceutical Governance.” In Petryna, Lakoff, and Kleinman 2006.
Leibing, Annette. 2009. “Tense Prescriptions? Alzheimer Medications and the Anthropology of Uncertai...Argentina
Summary of Pharmaceutical Reason: Medication and Psychiatric Knowledge in Argentina
When a French biotechnology company seeks patients in Buenos Aires with bipolar disorder for its gene discovery program, they have unexpected trouble finding enough subjects for the study. In Argentina, the predominant form of mental health expertise - psychoanalysis - does not recognize the legitimacy of bipolar disorder as a diagnostic entity. This problem points to a broader set of political and epistemological debates in global psychiatry. Drawing from an ethnography of psychiatric practice in Buenos Aires, Andrew Lakoff follows the contested extension of novel techniques for understanding and intervening in mental illness. He charts the globalization of the new biomedical psychiatry, and illustrates the clashes, conflicts, alliances, and reformulations that take place when psychoanalytic and biological models of illness and cure meet. Highlighting the social and political implications that new forms of expertise about human behavior and thought bring, Lakoff presents an arresting case study that will appeal to scholars and students alike.
This last article, as well as some of the others, are part of the book above, Global Pharmaceuticals, edited by Adriana Petryna, Andrew Lakoff, and Arthur Kleinman. If you're interested in exploring further, click below to find the book:
Description of Global Pharmaceuticals
In some parts of the world spending on pharmaceuticals is astronomical. In others people do not have access to basic or life-saving drugs. Individuals struggle to afford medications; whole populations are neglected, considered too poor to constitute profitable markets for the development and distribution of necessary drugs. The ethnographies brought together in this timely collection analyze both the dynamics of the burgeoning international pharmaceutical trade and the global inequalities that emerge from and are reinforced by market-driven medicine. They demonstrate that questions about who will be treated and who will not filter through every phase of pharmaceutical production, from preclinical research to human testing, marketing, distribution, prescription, and consumption.
Whether considering how American drug companies seek to create a market for antidepressants in Japan, how Brazil has created a model HIV/AIDS prevention and treatment program, or how the urban poor in Delhi understand and access healthcare, these essays illuminate the roles of corporations, governments, NGOs, and individuals in relation to global pharmaceuticals. Some essays show how individual and communal identities are affected by the marketing and availability of medications. Among these are an exploration of how the pharmaceutical industry shapes popular and expert understandings of mental illness in North America and Great Britain. There is also an examination of the agonizing choices facing Ugandan families trying to finance AIDS treatment. Several essays explore the inner workings of the emerging international pharmaceutical regime. One looks at the expanding quest for clinical research subjects; another at the entwining of science and business interests in the Argentine market for psychotropic medications. By bringing the moral calculations involved in the production and distribution of pharmaceuticals into stark relief, this collection charts urgent new territory for social scientific research.
Watch these talks by the book's editors:
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