United States

Peru is currently undergoing an important institutional transition regarding mental health. Since 2016, the government has started transitioning state-sponsored treatment for several mental illnesses from an asylum/institutionalization model to a community mental health model. To effectively address mental health afflictions and other psychosocial conditions in the wake of de-institutionalization, the goal is to build at least one hundred community mental health centers around the country. Thus far, twenty-nine have been built. This reform also aims to place mental health in the public agenda and address the stigma surrounding mental illness. In this paper, I present the case of the community mental health center in Carabayllo, the “flagship” facility of the ongoing reform, located in a poor semi-urban district at the outskirts of Lima, Peru. Drawing from three months of fieldwork and interviews with psychiatrists, community mental health workers and residents of Carabayllo, I argue that this transitional moment provides insight into the dynamics that arise in the community when total institutions start to fade away. I explore residents’ reflections on this transition, considering in particular the anxieties they express over the proximity of mental illness and the symbolic and spatial dimensions they reveal of the relationship between clinic and community. With the asylum reconfiguring and the community-based model spreading in the city through its different agents, I signal the diverse challenges the residents of Carabayllo articulate against the closeness of mental illness and the extension of the clinic.

AAA Annual Meeting 2021

Proximity and Suspicion: The Transition to Community Mental Health in Lima, Peru

decolonization

mental health

ethics

Truth and Responsibility
“Truth and Responsibility” is a call to reimagine anthropology to meet the demands of the present moment. The imperative to bear witness, take action, and be held accountable to the truths we write and circulate invites us to reflect on our responsibility in reckoning with disciplinary histories, harms, and possibilities. To whom are we giving evidence and toward what ends? For whom are we writing? To whom are we accountable, and in what ways? We are thrilled to announce the theme of the 2021 AAA Annual Meeting to be held in Baltimore, MD: Truth and Responsibility.

Many consider anthropology to be a holistic social science dedicated to cross-cultural understanding as a way to reduce bigotry and more fully comprehend “what it means to be human.” Others push against this readily circulated origin story, arguing that “human” remains a highly contested, political category—evident as the presumed set of rights and protections associated with the “human” continue to be stripped away violently in the communities in which some of us live and work. Which violent histories and epistemologies must anthropologists take responsibility for in telling truth(s) about the discipline’s development? How do the dual histories of settler colonialism and slavery continue to influence anthropological thought and practices? In these political times, how can anthropologists throughout the globe work to secure a capacious, progressive vision of the human? How might movements for anti-racism, decoloniality, queer liberation, and healing such as #BlackLivesMatter, #ProtectMaunaKea, and #MeToo push a future anthropology out of the ashes of the anthropological past? Finally, what are the limits and possibilities of the anthropological imagination?

Across subfields, we find truths in patterns of human behavior, language, evolution, and cultural worlds. Industry-positioned anthropologists do this by extending the boundaries of the discipline not as an administrative solution to job shortages but as a source of intervention and knowledge production. Increasingly, anthropologists who make use of the scientific method question how status and identity help to decide which facts come to represent truth. How might quantitative researchers use our methods to identify patterned truths, and what responsibility do we hold in challenging conventional wisdom about these patterns? What responsibility do we have to both our colleagues and larger publics, to push toward increased transparency and ethical grounding in our data collection, analysis, and presentation?

Pedagogy is a key medium for the communication of anthropological truths. Which (and whose) truths are foregrounded in our curricula? What are the possibilities for a liberatory pedagogy in a precarious, “post-truth” era? Conferences, museums, organizing spaces, and classrooms are sites where pedagogy and various forms of communication can help us interrogate the performativity of truth. How might anthropologists conceive of truth performances? Might visual, aural, and choreographic performances during AAA sessions offer anthropologists alternative genres for truth-telling and truth-making that provoke discussions about responsibility?

In accordance with the urgency of the year’s theme, the questions posed in this call for papers do not have easy answers. The hope is that those who submit proposals will take up these questions and engage in collective thinking and imagining about the truths we hold, the truths we challenge, and the responsibilities we bear in co-creating a free and more equitable world. All panel proposals should have a statement about how the panel has incorporated the goals of equity, diversity, and inclusion, and/or analysis of power.

Executive Session proposals have already been selected and speak directly to the theme “Truth and Responsibility.” To practice the critical reflexivity this call for papers invites, we asked that Executive Session submissions explicitly address the diversity of session participants, such as organizational/institutional affiliation, career stage, race, ethnicity, disability, sexuality, class, religion, national identity, and gender. Proposals for Executive Sessions that demonstrated a commitment to equity and inclusion and/or a clear analysis of power (i.e. anti-imperialist, anti-white supremacist, decolonial, anti-ableist, feminist, anti-transphobic, anti-xenophobic, etc) were given priority. We are excited to be in conversation with residents of the Baltimore region and look forward to the discussions, performances, and actions generated by the dynamic group of anthropologists attending the 2021 AAA Annual Meeting.

“Truth and Responsibility” is a call to reimagine anthropology to meet the demands of the present moment. The imperative to bear witness, take action, and be held accountable to the truths we write and circulate invites us to reflect on our responsibility in reckoning with disciplinary histories, harms, and possibilities. To whom are we giving evidence and toward what ends? For whom are we writing? To whom are we accountable, and in what ways? We are thrilled to announce the theme of the 2021 AAA Annual Meeting to be held in Baltimore, MD: Truth and Responsibility.

technical paper

Recent years have seen a surge of anthropological research on mental health in the Global North and South. Anthropological approaches have grappled with syndemics, critically engaged with Global Mental Health, considered the intersections of disability, race, class, and other identities in mental health care, and have questioned the effects of possibly traumatic fieldwork experiences on the mental health of anthropologists themselves. Anthropologists have also charted the impact of governmental and quasi-governmental organizations’ distribution of mental health care services, the growth of psychiatric user/survivor movements, and activism(s) at the intersection of mental health services, education, and criminal justice systems. Given increased interest in this field, our double panel asks: What does the future of the anthropology of mental health look like? What theoretical perspectives and methods will ground our research practice in the years to come? What role does the anthropology of mental health play in critically interrogating, sustaining, enhancing, and - in certain instances - undermining formal and informal projects of mental health and wellness? Recent and up-and-coming work conducted by junior and senior scholars engaged with research on mental health will include theoretical approaches grounded in decolonial perspectives, Mad Studies, religious studies, community engaged research, posthumanism, and critical medical anthropology. It will also include an analysis of mental health policy reform and their effects in various countries, as well as a discussion on experimental ethnographic methods in the anthropology of mental health, such as drawing, time-diaries, and song-writing.

New and Emerging Perspectives in the Anthropology of Mental Health I

Questions of how to harness digital technologies for promoting mental health are a hotbed of governmental, health policy and social debate. Campaigns for optimizing digital healthcare largely focus on promoting patient responsibilization, encouraging the development of more informed patients who draw on digital resources as part of self-care projects. Arguably, however, while “self-care” often involves the promotion of patient self-responsibility, it simultaneously foregrounds other modes of ethical engagement, such as care for, or from, (known/unknown) others and concerns over states’ and corporations’ responsibilities for ensuring mental wellbeing. Indeed, the broader literature on responsibility suggests that rather than an overriding emphasis on personal responsibility, advanced liberal societies create a much more fertile and contested ground upon which multiple, competing responsibilities flourish, even as part of projects of self-care. Digital technologies add additional layers to how responsibility is enacted, reshaping experiences of time and space by enabling new forms of continuous, or seemingly continuous, person-person and person-technology relations, and consequently refracting users’ sense of where agency lies (i.e. in themselves, in their relations with (human) others, or in technologies themselves). Online activities furthermore often involve multiple temporal horizons, in terms of enactments of care as well as the perceived trajectories of mental health. Drawing on a case study of a newly emerging online ethics engaged in by young New Zealanders, this paper examines how interpersonal dynamics, human-technology relations, and questions of agency are recasting understandings and enactments of care, temporality and responsibility in young people’s efforts to secure mental wellbeing.

Beyond DIY Health: Care, Temporality, and Responsibility in Young New Zealanders' Engagements with Digital Mental Health

In this talk, I consider the labor of emotions (Hoschchild 1983) accomplished by children and myself during the one-year ethnography I conducted in a mental health facility and at patients’ houses in Morocco. As a non-white woman who experienced similar troubles as some of my female interviewees, I describe their use of the chart of activities, a therapeutic tool developed to control depressive symptoms, while analyzing my own emotions in this particular disposal.      I suggest that that my research contributes to “decolonize children and adolescent mental health studies”, questioning the influence of “EuroAmerican models of child development”  (Béhague & Lézé 2015). To do so, I have developed a double approach: firstly, I documented the everyday life of non-WEIRD (Western Educated Industrialized Rich and Democratic) young psychiatric patients (Henrich and Heine 2010); secondly, I chose an ethnographic perspective inspired by psychoanalysis (Lorimer 2010). This posture, in which emotions are central, has encouraged me, amongst other things, to be attentive to all forms of non-verbal expression, including my own, and to disclose the ordinary activities co-produced by the children and myself. Detailing our everyday labor to face depression, this analysis, done alongside a post-colonial angle, offers another understanding of the experience of certain speechless children diagnosed with a psychiatric trouble.   To conclude, I favor a posture that acknowledges the fieldwork’s emotions as an epistemological asset, inviting anthropologists to be emotionally engaged to operate alternative narrative and reflexive turns and to foster a renewal in mental health studies.

Decolonizing children and adolescent mental health : what the labor of emotions can do for anthropology and anthropologists.

Recent global mental health debates have focused on the challenges of acknowledging the diversity of local experiences of distress. Emic-etic, hybrid, glocalized, flexible and integrative approaches have been proposed to find the optimal balance between universalizing and localized categories. One of the most compelling challenges concerns how to elicit local interpretations of mental suffering without imposing a normative, Western-biased communicative protocol. Questionnaires, scales, semi-structured interviews and survey guidelines have been implemented and, in some occasions, integrated in the mainstream Western biomedical and psychiatric systems of classification (e.g. the Cultural Formulation Interview, CFI, in the DSM-5, 2013). Most if not all these tools rely essentially on verbalization. Marginal attention has been dedicated to non-verbal communication. Nevertheless, growing evidence shows that verbalization is not necessarily the most adequate way of communicating distress in many societies, where other strategies (e.g. strategic silence, ritualization, figuration) may be more culturally appropriated. How to integrate non-verbal communication in ethnographic practice and cross-cultural psychiatry? My ethnographic focus is a form of demonic possession (grisi siknis) diffused prevalently among Miskito women of Caribbean Nicaragua and Honduras. During fieldwork, I communicated with those affected by grisi siknis  through their drawings of demons. The figurative process proved to be also effective for coping and, in several occasions, for healing. I develop theoretical considerations and a preliminary research agenda to explore further the interplay between non-verbal communication, glocal nosologies, experimental ethnography and the cultural diversity of distressing experience.

Figurations of Distress, Glocal Nosologies and Non-Verbal Communication in Global Mental Health

This presentation examines Temple-Stay, a short-term retreat program held for lay persons at Buddhist monasteries, in the context of the prevailing social malaise and happiness discourse in South Korea. Temple-Stay was initially designed by the Chogye Order, the predominant sect of Korean Buddhism, and the Ministry of Culture and Tourism, to engage foreign visitors during the 2002 World Cup. However, it proved to be unexpectedly popular with local residents as well. In a society, where the percentage of the population seeking professional attention for mental health issues remains relatively low, many Koreans have been drawn to this government-subsidized retreat as a safe, affordable, and low-profile getaway. In fact, Temple-Stay has recently been advertised as "a journey for my happiness" and as a scientifically proven stress reducer. The instrumental use of Buddhist teachings and practices has been criticized by some scholars for misrepresenting the true nature of Buddhism or for appropriating it for other ulterior motivations. How should we make sense of the Buddhist establishment's own parceling of the monastic experience as a healing commodity? Based on ethnographic research and an examination of the history, marketing, and program content of Temple-Stay, this presentation shows that its popularity in the twenty-first century has been due to effective marketing of the program as a healing experience and to the perceived need for such a commodity. It then discusses both the risks and opportunities that the marketization of the program presents to the Buddhist establishment and lay participants.

Temple-Stay in South Korea: A Wellness Journey amid a Happiness Crisis

This paper focuses on the use of time-diaries as a way to incorporate the voices of my participants in my dissertation research, which focused on how individuals with chronic mental illnesses navigated the mental health care system in New Orleans, Louisiana. During my fieldwork, race became a prevalent theme, as my interlocuters initially questioned if I was Black or white. Race also impacted how my participants responded to some of my methods, particularly interviews, and I found differences in how Black participants responded to interviews vs. white participants. As a way to decolonize my methods and include participants in the research process, I employed the use of time-diaries, where I asked individuals to record how they felt and what they did for a two-week period. In this paper, I discuss the challenges with using time-diaries amongst individuals with chronic mental illnesses but also highlight the successes. I examine how giving a direct voice to this population through the employment of time-diaries provides a way to empower this population within the disability rights movement. What truths do individuals with chronic mental illness share when given the chance to do so in their own voice? How do they share their stories? Aligning with this year’s theme of “Truth and Responsibility,” I conceive this method as a way “to meet the demands of the present moment” in the anthropology of mental health.

Utilizing Time-Diaries: Challenges and Success in Ethnographic Research amongst Individuals Diagnosed with Chronic Mental Illnesses

Recent anthropological work has stressed how fundamental mobility is to the human condition. People move in all kinds of ways for all kinds of reasons. Even in the most sedentary societies there is often great mobility: young men move for trade and war and sometimes marriage; young women move for trade and marriage and sometimes war. In other societies, movement is more endemic and expanding. The conventional categories for all this mobility tend to distinguish movement as temporary or permanent, but the truth often lies in between. There are also conventional categories for the reasons for mobility•particularly economic versus sociopolitical and forced versus voluntary•but once again the truth often lies in between. The complexities of migration are even more forbidding when we remember that mobility is not only an aspect of individual lives but of family and group lives over multiple generations. As they move through space, migrants also move through analytic and legal categories that are anchored in a range of political and cultural contexts: their home country, their destination country, all the places in between, and an international regime that sometimes aids and sometimes hinders their movement. This makes human mobility a difficult topic in general, but particularly for an anthropology of policy. How do we analyze in an academic manner this intertwining of culture, politics, and policy in local, national, and transnational contexts? How do we also aim for more instrumental goals, such as a rational policy model that is more inclusive of the range and complexity of human mobility? Furthermore, how do we balance unpacking policy for analytic purposes and repacking it for instrumental ones? The panelists in this session address this conundrum for a range of migrants and a range of contexts in which policy about migrants is formulated, implemented, and assessed. The range of migrants discussed in the panel is great: from high-skilled migrants, to refugees, to deportees, to undocumented border-crossers, to people who are treated as migrants even when they are not. The range of issues faced by the migrants is also great: from how to obtain entry, to social inclusion or hostility on arrival, to zones of exclusion after entry in which even legally established rights are frequently abridged. As well, the contexts in which anthropologists must work are subject to rapid change because of political tumult (as with Donald Trump) or with unexpected social conditions (as with Covid-19). Those contexts (and their frequent changes) affect migrants but also affect how anthropologist engage with migrants and with migration policy. Anthropologists must learn from migrants how migration works on the ground, but also how to explain to migrants how formal migration policy is intended to work. They must learn how to engage within the migration system on behalf of migrants but also how to contest that system from the outside. For anthropologists involved in migration culture, policy, and politics, the truths and obligations are inevitably both of understanding and action.

Migration: Culture, Politics, and Policy

High skilled professional immigration in the United States is at once highly desired and highly contested by government leaders. Policy makers recognize the need for highly skilled labor, particularly in the areas of engineering and computer science, to ensure that the U.S. leads the world in technological innovation. However, the workings of the immigration system are complex, bureaucratic and opaque, leaving immigrants feeling frustrated with long wait times and unexplained delays. In my fieldwork with professional immigrants in semiconductor manufacturing, conducted from Aug 2018 • June 2019, it was necessary to study the immigration system in order to understand how it impacts my participants’ decision making. My role as an anthropologist is complex. On the one hand, the real experts on this system are not policy experts or anthropologists, but the immigrants who navigate the system. Their lives depend upon figuring out the hidden rules; their experience of uncertainty creates a sense of urgency in understanding the inner workings of the black box. I have relied on their expertise to help me understand how the immigration system actually operates, as opposed to how it is supposed to operate. On the other hand, immigrants’ singularity of focus on their own ethnic, religious, and national groupings leads to a certain narrowness of vision, to which an anthropologist can add perspective and context. I argue that part of our responsibility as anthropologists should be to provide a wider perspective on immigration reform along with gentle reminders to push for inclusive policies.

Advocating for Inclusion Amongst Professional Immigrants in the United States

Refugee movement continues to increase globally. A mobilities perspective examines possibilities for movement and stoppage within a post-resettlement context and a focus on policies that shape refugees’ post-resettlement experiences. The Refugee Well-being Project (RWP) is a multi-level social justice intervention that improves refugees’ mental health and well-being through increasing access to resources and social support. Refugees are paired with undergraduate students who learn from each other and co-advocate. Guided by a mobilities framework, the RWP project challenges the predominant policy focus that emphasizes economic self-sufficiency and refugee policies framed around vulnerability. The RWP achieves this through a holistic focus on multiple aspects of refugees’ lives (e.g., social, economic, physical and mental health, cultural, educational) that contribute to their well-being. Moreover, RWP centers the strengths and agency of refugees as capable individuals, families and communities who can and should define their priorities and goals. In addition, RWP highlights the need for policies and practices that extend support for refugees in a context of limited federal support. Further, through its focus on social inclusion, RWP offers important insights into refugee mobilities post-resettlement that call attention to needed policy changes. Social inclusion is a bidirectional process that encourages refugee belonging and involvement in U.S. society, but also asks that U.S. communities become more welcoming and inclusive of refugees. These insights have particular relevance in times of heightened xenophobia and discrimination against newcomers, and provide foundational ideas for refugee policies that encourage inclusion and contribute to a society strengthened by refugee perspectives and experience.

Resettlement Mobilities: How the Refugee Well-being Project Promotes Social Inclusion of Refugees in the United States

In 2017, Cambodian and American activists, alongside the Cambodian Government, temporarily halted deportations of Cambodian American refugees from the U.S. However, mere months later, after the United States Government issued retaliatory visa sanctions against Cambodia, deportations not only resumed, but increased in frequency and number, and included more disabled and dying individuals. Nonetheless, activists argue these efforts sparked more “wins” in the fight to change deportation policy, thereby exemplifying “the egg versus the rock”•a Khmer maxim used to signify when those with relatively less power (the egg) challenge those with more (the rock). When the two collide, although the egg ultimately loses, it still stains, and therefore damages, the rock. With this aphorism as a starting point, I ask what it means to engage in such policy challenges to the deportation of Cambodian American refugees with lawful permanent residency in the United States. Thinking through both the above-mentioned example as well as lawsuits and pardon campaigns to halt individual deportations, I seek to destabilize static notions of who has power, and examine the role of the activist anthropologist in navigating and understanding these complex policy frameworks. Furthermore, I interrogate what it means to conduct fieldwork with various stakeholders as they attempt to enact such grassroots-level policy change•particularly when such changes have unforeseen consequences. Finally, I attend to the discomfort that emerges when the activist anthropologist is asked to engage in efforts that she believes may be contrary to the overall goals of the movement or may otherwise harm her interlocutors.

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Proximity and Suspicion: The Transition to Community Mental Health in Lima, Peru

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