Wk 3 ? lecture 5, April 11, 2011 Importance of talk therapy ? help them reach a deeper understanding of the problem they have in their lives, help them solve these problems Psychotropic drugs ? seen to affect the brain (the brain as an organ, as opposed to the mind) > as they learned more about these drugs and the effect of the brain, we see more development of these drugs and emphasis on neurobiology Trend toward seeing depression as a disease of the body > a chemical imbalance that can be corrected Seeing it more and more as a condition of the realm of the body, rather than of the mind Psychotherapy ? getting squeezed out of the training of physicians and clinical practice Market forces > partitioning into the realm of psycho-pharmaceuticals in the realm of psychiatry Leon Eisenberg Cant have either mindless (growing trend toward prescribing psychotropic drugs) but neither can you have brainlessness (without having an appreciation of these drugs and help people get on with their lives) No one would want to go back to the day where there were no drugs for psychotropic problems such as schizophrenia The Mindful Body: A Prolegomenon to Future work in Medical Anthropology Nancy Scheper-Hughes and Margaret Lock Prolegomenon > what is it? Dictionary.com ?a preliminary discussion; introductory essay, as prefatory matter in a book; a prologue? Current observations to help set a future agenda for work in medical anthro Epistemological legacy ? Cartesian dichotomy between mind and body; notion of models of world that direct our ways of knowing about the world Because of this we are left without a language with which to address mind body interactions > radical disconnectedness of our thought Increasing visisbility and discussion of models in both medical and social models; seeking to avoid conceptualizing the body as a self-enclosed machine More holistic vision involving body, mind, and societal interactions More anthropological vision ? suggests that rather than the models that we looked at, we should aim for a more integrated framework, where health and illness are experience by the notion of mindful bodies which are situated in social context Anthropological discussion of concepts ? conceptual frames of disease & illness Explanatory models & framework? more specific to an individual case Conceptual frames in 1970s ? link with biomedicine and medical anthro Biomedicine ? the healing system which developed on the basis of medical scientific research mainly carried out in Europe and north America > central to training in medical schools Bio indicates orientation ot the physiological, physical ailments and physical treatments (drugs, surgery) Linked to notion of improved clinical care George Engel ? 1977 ? published paper in Science Journal ?The need for a new biomedical model: a challenge for biomedicine? Psychiatry?s crisis revolves around the question of whether the categories of human distress with which it is concerned are properly considered ?disease? as currently conceptualized Crisis in psychiatry, also a crisis in biomedicine more generally What are the boundaries of their professional responsibility and what implications does this have for clinical care? ?It leaves no room within its framework for the social, psychological, and behavioral dimensions of illness., the biomedical model not only requires that disease be dealt with as an entity independent of social behavior, it also demands that behavioral aberrations be explained on the basis of disordered somatic (biochemical or neurophsyciological) processes? Beiomedical ? the curing of disease ?Medicines crisis stems from the logical inference that since disease is defined in terms of somatic parameters, physicians need not be concerned with psychosocial issues which lie outside medicines responsibility and authority? What were the implications for psychiatry? >psychiatrists should be limiting their field to brain dysfunction; psychologists, social workers, counselors should deal with matters of the mind, a re-visioning of psychiatry; other suggestion to get rid of psychiatry all together Attempt to include them all under the same umbrella > one approach Boundaries of professional responsibility > Eric Cassell Physicians jobs to relieve suffering A ?modern paradox? > suffering being caused by treatment rather than being alleviated by treatment Iatrogenic ?side effects/problems that come from the treatment itself healthcare providers suggesting the pain isn?t real the way in which mind and body dualism has an even greater reach > tries to talk about individuals undergoing serious diseases maintains that persons are vulnerable to suffering because the operative division says that the medical realm is body and the nonmedical is everything else if the person isn?t in the category of the body, the only remaining place for the person is in the category of the mind it?s the person who suffers, who is negatively impact suffering imposes difficulty for biomedicine medical system because it is experienced by persons, no merely by body > social and psychological entity; can happen unknowingly ?people suffer from what they have lost of themselves in relation to the world of objects, events, and relationships? Biomedicine is not the same around the world Filed of medical anthro Conceptual frameworks about disease and illness Critiqued but still used quite a bit today Disease and illness ? bring up the contrast in differences in perspectives between biomedical practitioners and their patients Clinicians actively interested in clinical interactions >these individuals at forefront of discussions of medical anthro Arthur Kleinman ? medical anthropologist / psychologist Mentor to Kleinman ? Eisenberg Eisenberg ?patients suffer ?illnesses?, doctors diagnose and treat ?diseases?? Patient non-compliance Diseases: Aer what biomedical practitioners are trained to discover and treat Are assessed through the lens of what has been called the ?doctring of specific etiology?
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