Psychiatric Subjectivity and Cultural Resistance

Psychiatric Subjectivity and Cultural Resistance

Experience and Explanations of Schizophrenia in Contemporary China

Western psychiatry was introduced in China in the late 19th century, and it began to grow rapidly since the 1980s

But, it couldn’t replace other illness explanations and healing practices; many patients with mental disorders (and their families) prefer to explain their illness in non-biomedical terms and seek help from Chinese medical doctors or folk healers rather than psychiatric professionals.

C A S E _ S T U D Y

Mrs. Liang came to visit her 19-year-old daughter, Hua, who was diagnosed with undifferentiated schizophrenia and had been hospitalized for two months. Mrs. Liang informed Dr. of her decision to take her daughter out of the hospital to consult some Chinese Medicine practitioners she had found in her hometown.

Warned by Dr. Feng that she would have to take respon­sibility for all the consequences, especially her daughter’s potential relapse, she repeated: “I went to check it out in the countryside. Some people did get well after taking Chinese Medicine.” Then she changed the topic from medicine to the power of “thinking” by telling a story of a former inpatient who cured himself by thinking

Open Ended

In your opinion,

what does power of "thinking" mean?

"It’s all about thinking things through (xiangtong) on your own. If you don’t think it through, you’ll be sick all your life, you know?"

R E S E A R C H _ Q U E S T I O N S

- Why do patients and families resist psychiatry?

- How do they resist?

- What is the relationship between subjectivity and modernity in contemporary China?

S C H I Z O P H R E N I A

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S U B J E C T I V I T Y

Why should we look at schizophrenia in order to understand resistance to psychiatry?

Multiple Select

What are the diagnostic symptoms of Schizophrenia?

Select all that apply.

• Delusions

• Disorganized speech and/or behavior

• Lack of Motivation

• Hallucination

• Tendency to self-harm

Schizophrenia is a psychiatric diagnosis that describes a mental disorder characterized by abnor­malities in the perception or expression of reality

Psychiatrists see schizophrenia as a “disorder of the self”

Understanding schizophrenia as a “self-disorder” sheds light on psychiatric presumptions about selfhood, on which anthropologists argue that the orienting axis for self-awareness and self-other interaction is embedded in culture.

When the patient is charged with suffering from disorders of the individualistic self, he/she or the family might use culturally salient narratives to claim a different kind of explanation, to create shared meanings with others, and to make illness experience intelligible

Thus, schizophrenia “offers a paradigm/model case for scientific understandings of culturally fundamental and ordinary processes and capacities of the self, the emotions, and social engagement”

B I O P O W E R

_ I N D I V I D U A L I Z A T I O N _

R E S I S T A N C E

The study adopts a Foucaultian approach to analyze processes of subject formation recently mobilized within Chinese psychiatry

Multiple Choice

Who was

Michel Foucault?

• Psychologist

• Philosopher

• Psychiatrist

Foucault in Psychiatric Power:

self with an individually bounded body-psyche is not a historical constant or a natural subject, but rather an invention of the modern bourgeoisie

He distinguishes between:

(i) “juridical individual” or the ideal self - through whom “the bourgeoisie claimed power,”

(ii) the “disciplinary individual” or the abnormal person alienated from the ideal - on whom the bourgeoisie exercised power

“From the oscil­lation between the power claimed and the power exercised, were born the illusion and the reality of what we call Man” 

But there is no cultural or linguistic heritage of “Man” in China for anthropologists to refer this theory in context and verify this

Instead, the coexistence of ideals of the modern self AND schizophrenia as a drastic self-disorder within contemporary Chinese psychiatry is used and studied

The two formations together effects the process of objectification. 

Contradictory forms of selfhood emerge in reaction to processes of individualization, modernization, and state control in contemporary China, and DO NOT accept the argument of a unified, disembedded self emerging in (high) modernity 

Referring Foucault’s idea of a “microphysics” of power relations and Scott’s (2008) idea of “everyday forms of resistance,”: 

Resistance in ward is observed as small intentional acts of complaint or defiance that suggest personal or collective dissatisfaction with the status quo, challenging unwanted situations.     

Since the sub­ject is involved in and constituted by power relations with thoughts, knowledge, and discursive formations, she can sometimes resist power relations through using subjugated knowledge as her discur­sive weapon.

Foucault has proposed two major forms of subjugated knowledge that are used in resistance or confrontation: (i) historical knowledge “that have been buried or masked in functional coherence or formal systematization;” (ii) non-conceptual knowledge, as insufficiently elaborated knowledge: naive knowledge, hierarchi­cally inferior knowledge, knowledge that are below the required level of erudition or scientifically These subjugated knowl­edges are “not something invented by the individual himself; they are models that he finds in his culture and are proposed, suggested, imposed upon him by his culture, his society, and his social group” Thus, the term “cultural resistance” to depict the use of culturally informed knowledges and practices for resisting power relations.

F I E L D _ S I T E

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R E S E A R C H _ M E T H O D S

Summer of 2009 and 2010

In the schizophrenia wards of CBH, a renowned psychiatric hospital in Guangzhou

A B O U T _ G U A N G Z H O U

• First trading port in China open to foreign countries

• Long exposed to Western ideas

• It is a place of ideological multiplicity

A B O U T _ C B H

• among the best psychiatric hospitals in China

• so when people resist psychiatric explanations and treatments, it is unlikely that they are just dissatis­fied with the quality of care; rather, they are resisting psychiatric treatment in its optimal form

A B O U T _ P A T I E N T S

• 3 schizophrenia wards: 1 Women, 2 Men (each with about 90 patients)

• The geographical and socioeconomic backgrounds of the patients varied

• They were mostly from urban, low-income residents, the population

M E T H O D S _ U S E D

• Participant Observation

• Unstructured interview

• Reviewing medical records

P A R T I C I P A N T _ O B S E R V A T I O N

• Presented himself as a researcher not affiliated with the hospital

• Observed their daily interac­tions in the ward, especially negotiations of different explanations of schizophrenia by doctors, nurses, families, and patients

U N S T R U C T U R E D _ I N T E R V I E W S

• Interviewed selected doctors, patients, and family members regarding their experiences and explanations of schizophrenia 

• rela­tively unstructured - implemented when hanging out with the respondents casually, having presented himself as someone willing to listen to them.

• Listened to not only casual explanatory models but also to the basic temporal event sequences in people’s illness narratives

R E V I E W I N G _ M E D I C A L _ R E C O R D S

• Focused on the (i) psychiatric diagnoses, (ii) expla­nations, and their (iii) relations to the patients’ course of illness. 

• However, the medical records were not referred as direct representations of clinical “facts,” but as speech act to understand what influences other interactional practices

• Additionally, attention was paid to (i) how family members’ oral accounts of patients’ illness were described, and (ii) how doctors used medical records to challenge patients’ own narratives.

P S Y C H I A T R I C

_ A N D _

_ C O N S T I T U T I O N _

O F _ T H E _ S E L F

3 characteristics of the normal self 

- Self-ownership: this behavior is mine; I’m the person who does this, not others.

- Volition: my behavior has intentions and motivations

- Integration: one’s thoughts, emotions and behaviors are integrated

R E S I S T A N C E

_ T O _

_ P S Y C H I A T R Y _ A N D _

C H I N E S E _ M E D I C I N E

I N _ S E A R C H _ O F

A _ H O L I S T I C _ C U R E

R E L I G I O N

_ R E A L I T Y _

R E S I S T A N C E

T A B L E _ O F _ C O N T E N T S

- Schizophrenia and Subjectivity

- Biopower, Individualization, Resistance

- Field Site and Research Method

- Psychiatry and Constitution of the Self

- Resistance to Psychiatry and Chinese Medicine 

- In search of a Holistic Cure

- Religion, Reality, and Resistance