Eugene Raikhel

Cultures of the Internet: Identity, community and mental health

The Internet and World Wide Web have woven together humanity in new ways, creating global communities, new forms of identity and pathology, and new modes of intervention. This issue of Transcultural Psychiatry presents selected papers from the annual McGill Advanced Study Institute (ASI) in Cultural Psychiatry on ‘‘Cultures of the Internet’’ which took place in Montreal, April 26–29, 2011. The ASI addressed four broad areas: (a) how the Internet is transforming human functioning, personhood, and identity through the engagement with electronic media; (b) how electronic networking gives rise to new groups and forms of community, with shifting notions of public and private, local and distant; (c) the emergence of new pathologies of the Internet, e.g., Internet addiction, group suicide, cyberbullying, and disruptions of neurodevelopment; and finally, (d) the use of the Internet in mental health care, for example, by consumer advocacy and support groups, aswell as for the delivery of health information, web-based consultation, treatment intervention, and mental health promotion. In addition to some of the ASI papers, this issue includes other recent contributions to the journal on related themes. In this introductory essay, we set out some of the broad implications of the Internet and related new media and information communication technologies (ICT) for cultural psychiatry.

Editorial: From Amrita to Substance D: Psychopharmacology, Political Economy, and Technologies of the Self

In this issue of Transcultural Psychiatry, we present papers from the 9th Annual Advanced Study Institute in Cultural Psychiatry, ‘Psychopharmacology in a Globalizing World,’ which took place in Montreal, June 12–15, 2007. Recent years have seen a dramatic increase in the use of psychiatric medications among children, adolescents, and adults in many countries. Psychopharmaceuticals are big business and are at the center of the globalization of psychiatry. Psychiatric knowledge and practice as well as the experience of patients taking medication are shaped by the interests of pharmaceutical companies and by wider social and cultural attitudes toward medication. This meeting brought together scholars from health and social sciences to examine the cultural shaping and consequences of the use of psychiatric medications. Presentations addressed marketing and the political economy of psychopharmacology, the production of scientific ‘evidence’ and professional practices, the medical and nonmedical uses of medications, popular attitudes toward medication, and phenomenological pharmacology. Medications can be said to have social lives in several senses. They are important commodities, widely consumed and generating huge profits for multinational corporations. This consumption is fostered by active marketing, spurred on by changes in popular culture that promote the use of medications to manage both psychiatric disorders and milder forms of distress. Psychiatric practitioners and institutions contribute to this

Social barriers to diagnosis and treatment of breast cancer in patients presenting at a teaching hospital in Ibadan, Nigeria.

Globally, breast cancer is the most frequent malignancy in women, and stage at diagnosis is a key determinant of outcome. In low- to middle-income countries, including Nigeria, advanced stage diagnosis and delayed treatment represent a significant problem. That social barriers contribute to delay has been noted in previous research; however, few specific factors have been studied. Using semi-structured interviews, this study identifies social barriers to diagnosis and treatment for patients who presented at University College Hospital Ibadan, Nigeria. Transcripts from the interviews were coded and analysed thematically. Thirty-one patients and five physicians were interviewed. The median age of patients was 51 (range: 28 to above 80), 83% were Christian and 17% were Muslim. Preliminary analysis showed that delays in diagnosis reflected a lack of education as well as the utilisation of non-physician medical services such as pharmacists. Delays in treatment were often due to fear of unanticipated surgery and cost. The majority of women did not know the cause of their breast cancer, but some believed it was caused by a spiritual affliction. This study suggests that further education and awareness of breast cancer for both patients and providers is needed in order to increase early stage diagnosis.

What’s in the ‘Treatment Gap’? Ethnographic Perspectives on Addiction and Global Mental Health from China, Russia, and the United States

Recent years have seen the emergence of a ‘global mental health’ agenda, focused on providing evidence-based interventions for mental illnesses in low- and middle-income countries. Anthropologists and cultural psychiatrists have engaged in vigorous debates about the appropriateness of this agenda. In this article, we reflect on these debates, drawing on ethnographic fieldwork on the management of substance use disorders in China, Russia, and the United States. We argue that the logic of ‘treatment gaps,’ which guides much research and intervention under the rubric of global mental health, partially obscures the complex assemblages of institutions, therapeutics, knowledges, and actors framing and managing addiction (as well as other mental health issues) in any particular setting.

Postsocialism, the psy-ences and mental health

Over the past decades, the formerly socialist countries of East Central Europe and Eurasia have experienced a range of transformations which bear directly upon the domains of mental health, psychiatry, and psychology. In particular, the disciplines and professions concerned with the human mind, brain, and behavior (“the psy-ences”) were strongly affected by sociopolitical changes spanning the state-socialist and postsocialist periods. These disciplines’ relationship to the state, their modes of knowledge production, and the epistemic order and subjectivities they contributed to have all undergone dramatic ruptures. In this essay, we trace the literature on these issues across three thematic domains: (a) history and memory; (b) the reform of psychiatry in an era of global mental health; and (c) therapy and self-fashioning. We argue for a closer articulation between the social science and historical literature on socialism and its “posts” and the literature among anthropologists, sociologists, and historians on the sciences of the mind and brain, and we suggest that each of these literatures helps to critically open up and enrich the other.

Epigenetics and the Suicidal Brain: Reconsidering Context in an Emergent Style of Reasoning

In this chapter, we consider the models of suicide risk emerging from environmental epigenetics research at the McGill Group for Suicide Studies. We argue that this research represents an emergent style of reasoning in which a range of contextual and environmental factors are both molecularized and located in the brain. We also argue that implicit in this research is a notion of a “suicidal brain”: a brain that responds to adverse life experiences with an increase in risk of suicidal behaviour. In examining both this concept and its attendant styles of reasoning, we highlight some of the issues which research in environmental epigenetics raises for the study of suicide, as well as for the social sciences more broadly.