Proofs - Personal Webspace for QMUL - Queen Mary, University of ...

Epilogue
A. Kleinman
Esther and Sydney Rabb Professor of Anthropology, Professor of Psychiatry
Victor and William Fung Director, Asia Center, Harvard University
It is so important to see European, and especially German,
anthropologists and psychiatrists deal with the health and
health care problems experienced by immigrants and ethnic
minorities. This is evidence of several important 21st century
developments: the increasing diversity of European societies,
the growing interest in culture in European medicine,
the connection of cross- cultural studies in the mental health
fi eld to global health, and interdisciplinary efforts of social
scientists and physicians to go beyond conventional biomedical
categories and practices in order to construct a new object
of enquiry: that is, a more patient and family oriented way
of examining caregiving and carereceiving. This collection
illustrates the value of taking culture seriously in medicine
because of the cultural processes that affect patients, families
and communities. But the collection points toward yet another
reason why culture matters; and that is that medicine itself is
affected by cultural processes and in turn is one of the leading
edges of the wedge of culture that remakes everyday life
everywhere today. Furthermore, in the face of anti- immigrant
political movements in Europe and North America, medicine
and anthropology can exercise a countervailing infl uence that
carries its own long- term cultural signifi cance.
Perhaps the most infamous recent example of how the
culture of medicine operates to affect health and health care is
medicalization or what is also called overdiagnosis. Worldwide,
ICD and DSM categories legitimize practices that end up redefi
ning normality as pathology, that convert risk factors into
disease and that also make such early diagnosis of disease that
physiology and symptoms diverge ever more with people feeling
well who can be shown to have the earliest possible biological
evidence of treatable conditions, at which point it is entirely
uncertain whether to treat or not.
© 2012 Elsevier Masson SAS. All rights reserved.
European Psychiatry 27 (2012) / supplement n°2 / S81-S82
Proofs
68767
EUROPEAN
PSYCHIATRY
THE JOURNAL OF THE EUROPEAN PSYCHIATRIC ASSOCIATION
ISSN 0924-9338
June 2012
Vol. 27 - Supplement n°2
pp. S1-S81
Migration
and Mental Health
S1 Editorial
A. Heinz, U. Kluge
S4 The willingness to participate in health research
studies of individuals with Turkish migration
backgrounds: barriers and resources.
A qualitative analysis of focus groups
D. Dingoyan, H. Schulz, M. Mösko
S10 Socio-economic status and emotional distress
of female Turkish immigrants and native
German women living in Berlin
MC. Aichberger, Z. Bromand, A. Heredia
Montesinos, S. Temur-Erman, A. Mundt, A.
Heinz, MA. Rapp, M. Schouler-Ocak
S17 Mental health of Turkish woman in Germany:
resilience and risk factors
Z. Bromand, S. Temur-Erman, R. Yesil,
A. Heredia Montesinos, MC. Aichberger,
D. Kleiber, M. Schouler-Ocak, A. Heinz,
MC. Kastrup, MA. Rapp
S22 The infl uence of stigma on depression, overall
psychological distress, and somatization
among female Turkish migrants
A. Heredia Montesinos, MA. Rapp, S. Temur-
Erman, A. Heinz, U. Hegerl, M. Schouler-Ocak
S27 Translation and adaptation of the Zung
Self-Rating Depression Scale for application
in the bilingual Azerbaijani population
F. Mammadova, M. Sultanov, A. Hajiyeva,
M. Aichberger, A. Heinz
S32 Construction and interpretation of self-related
function and dysfunction in Intercultural
Psychiatry
A. Heinz, F. Bermpohl, M. Frank
S44 Explanatory models and concepts of West
African Malian patients with psychotic
Symptoms
F. Napo, A. Heinz, A. Auckenthaler
S50 How to express mental health problems:
turkish immigrants in Berlin compared to native
Germans in Berlin and Turks in Istanbul
A. Vardar, U. Kluge, S. Penka
S56 Health services and the treatment of
immigrants: data on service use, interpreting
services and immigrant staff members
in services across Europe
U. Kluge, M. Bogic, W. Devillé, T. Greacen,
M. Dauvrin, S. Dias, A. Gaddini, NK. Jensen,
E. Ioannidi-Kapolou, R. Mertaniemi,
R. Puipcinós i Riera, S. Sandhu, A. Sarvary,
JFF. Soares, M. Stankunas, C. Straßmayr,
M. Welbel, A. Heinz, S. Priebe
S63 The German concept of “intercultural opening”
as an answer to challenges of migration
- the development of an assessment tool
for the appraisal of its current implementation
in the mental health care system
S. Penka, U. Kluge, A. Vardar, T. Borde,
D. Ingleby
S 70 Cross-cultural training in mental health care
– challenges and experiences from Sweden
and Germany
S. Bäärnhielm, M. Mösko
S75 Teaching psychiatry and establishing
psychosocial services – lessons
from Afghanistan
I. Missmahl, U. Kluge, Z. Bromand, A. Heinz
S80 Afterword
A. Kleinman
DSM- 5 has stirred controversy even prior to its formal
release by the American Psychiatric Association by removing
bereavement as a reason to exclude the diagnosis of depression.
Since depression and grief have the same symptoms, this
means in effect that after 2 weeks of grieving, individuals will
be diagnosed as clinically depressed and treated with drugs
and psychotherapy. There is no evidence such treatment works
with normal individuals who are overdiagnosed or pressured
by medicalization to trade normality for pathology. Hence what
becomes a profi t center for the psychopharmacology- psychiatry
industrial complex is simultaneously an enormous cultural
change with potentially profound consequences for individuals,
families, communities and medicine itself. At the same time, we
have come to understand that medicine can be, unfortunately,
a powerful source of stigma for conditions like mental illness,
AIDS, and TB. This is yet another example of culture at work in
medical practices and relationships.
Globalization not only increases migration, and thereby
diversifi es and pluralizes societies; it also is responsible for
deep and extensive culture change. The new generations of
young adults and children have been so thoroughly infl uenced
by the internet, social media, and other new technologies that
their subjectivity and interpersonal relations are distinctive. For
example, my colleagues and I in our recent book, Deep China:
the Moral Life of the Person, show that Chinese today, especially
young adults and children, are much more individualistic, materialistic,
and globalized than earlier generations. Their priority for
relationships, unlike their parents and earlier generations, is for
horizontal rather than vertical ties. Romantic love has replaced
fi lial relations as the core emotional and moral attachment. This
generation is more interested in personal happiness, selfi sh
interests, and sexual fulfi llment, and spiritual quests than their
14_Kleinman.indd S81 14/06/2012 14:46:56