Etnoepidemiología y salud mental: perspectivas desde América Latina / Ethnoepidemiology and mental health: insights from Latin America

RESUMEN En este ensayo, exploro las implicaciones teóricas y metodológicas de un abordaje etnoepidemiológico, que busca integrar hallazgos de investigaciones en salud mental con nuevos modelos conceptuales. Con este propósito, en primer lugar, evalúo las raíces y los usos del término "etnoepidemiología" para designar tres tipos de estrategias de investigación para la producción de conocimiento científico: tipo I (estudios de factores de riesgo socioculturales y grupos de riesgo definidos étnicamente); tipo II (estudios de modelos populares de distribución y ocurrencia de enfermedades en poblaciones); y tipo III (estudios etnográficos de proyectos y líneas de investigación epidemiológica). Como ejemplo, se presentan y discuten características metodológicas seleccionadas de tres estudios en los que he participado. Posteriormente detallo los desarrollos metodológicos derivados de esta experiencia de hacer investigación, generando nuevos modelos para la investigación transcultural y transdisciplinaria de las prácticas en salud mental y, por último, en las conclusiones, comento algunas implicaciones generales del estudio de los problemas de salud mental desde un punto de vista etnográfico y epidemiológico integrado, en sociedades diversas y profundamente desiguales, como las de la América Latina contemporánea.

ABSTRACT In this essay, I explore methodological as well as theoretical implications of an ethno-epidemiological approach, aiming to integrate research findings in mental health into new conceptual models. With this objective, I first evaluate the roots and uses of the term "ethnoepidemiology" to designate three research strategies for scientific knowledge production: type I (studies of sociocultural risk factors and ethnically defined risk groups); type II (studies of lay models of distribution and occurrence of illness in populations); type III (ethnographic studies of projects and areas of epidemiologic research). As an illustration, selected methodological features of three studies in which I have participated are presented and discussed. I then elaborate upon methodological developments derived from this experience of doing research, generating new models for transcultural transdisciplinary research of mental health practices. Lastly, I comment on some broad implications of studying mental health problems from an integrated ethnographical and epidemiological point of view, in diverse and deeply unequal societies such as those of contemporary Latin America.

A etnopsicanálise de Devereux no filme Jimmy P: uma introdução à clínica transcultural / El etnopsicoanálisis de Devereux en la película Jimmy P: una introducción a la clínica transcultural / The ethnopsychoanalysis of Devereux in the movie Jimmy P: an introduction to the transcultural clinic

RESUMO Georges Devereux (1908-1985) é conhecido como, juntamente com Géza Rohéim (1891-1953), um dos criadores da etnopsicanálise, disciplina que articula os saberes da Psicanálise e da Antropologia. Sua primeira grande obra foi Psychoterapie d'un indien des plaines, livro publicado em 1951 e que narra a análise de um indígena Blackfoot, ex-combatente da Segunda Guerra. O livro foi a base para a elaboração do filme Jimmy P., traduzido no Brasil como Terapia intensiva. O objetivo deste artigo é apresentar uma discussão introdutória a algumas das ideias de Devereux a partir de recortes do filme Jimmy P., dirigido por Arnaud Desplechin em 2013. Além disso, também buscamos as aproximações e inovações do autor em relação a Freud. Concluímos que, no que diz respeito às aproximações enquanto técnica e prática entre Devereux e Freud, observamos no filme que Devereux incorpora à sua técnica a prática da interpretação dos sonhos, a associação livre e faz referências à teoria freudiana durante o tratamento, como o complexo de Édipo e a transferência. A partir das intuições freudianas sobre a relação entre cultura e psiquismo, Devereux avança para a formulação de uma etnopsicanálise, resultado do reconhecimento do entrelaçamento inseparável de esquemas individuais e culturais. Se as proposições de Devereux fomentaram na França o desenvolvimento de uma prática clínica que considera as diferenças culturais de populações de imigrantes oriundas de diferentes países, mais promissoras ainda parecem ser as chances de florescimento de uma psicanálise transcultural num terreno fértil em diversidade étnica como o Brasil.

RESUMEN Georges Devereux (1908-1985) es conocido, juntamente con Géza Rohéim (1891-1953), como uno de los creadores del etnopsicoanálisis, asignatura que articula los saberes del Psicoanálisis y de la Antropología. Su primera gran obra fue Psychoterapie d'un indien des plaines, libro publicado en 1951 y que narra el análisis de un indígena Blackfoot, ex-combatiente de la Segunda Guerra. El libro fue la base para la elaboración de la película Jimmy P. y fue traducido en Brasil como Terapia intensiva. El objetivo de este artículo es presentar una discusión introductoria a algunas de las ideas de Devereux a partir de trechos de la película Jimmy P., dirigida por Arnaud Desplechin en 2013. Además, buscamos las aproximaciones e innovaciones del autor con relación a Freud. Concluimos que, en lo que dice respecto a la aproximación en cuanto a la técnica y práctica entre Devereux y Freud, observamos en la película que Devereux incorpora a su técnica la práctica de la interpretación de los sueños, la asociación libre y hace referencias a la teoría freudiana durante el tratamiento, como el complejo de Edipo y la transferencia. A partir de las intuiciones freudianas sobre la relación entre cultura y psique, Devereux avanza para la formulación de un etnopsicoanálisis, resultado del reconocimiento del entrelazamiento inseparable de esquemas individuales y culturales. Si las proposiciones de Devereux fomentaron en Francia el desarrollo de una práctica clínica que considera las diferencias culturales de poblaciones de inmigrantes oriundas de diferentes países, más promisoras aún parecen ser las probabilidades de florecimiento de un psicoanálisis transcultural en un terreno fértil en diversidad étnica como Brasil.

ABSTRACT Georges Devereux (1908-1985) is known for being, together with GézaRohéim (1891-1953), one of the creators of ethnopsychoanalysis, a subject that articulates the knowledge of Psychoanalysis and Anthropology. His first great work was Psychoterapie d'un indien des plaines, a book published in 1951 and that narrates the analysis of a Blackfoot American Indian, ex-combatant of the Second War. The book was the basis for the elaboration of the movie Jimmy P., translated in Brazil as Terapiaintensiva. The aim of this study was to present an introductory discussion to some of Devereux's ideas from clippings of the film Jimmy P., directed by Arnaud Desplechin in 2013. In addition, we also looked for the author's approaches and innovations in relation to Freud. We concluded that, in the matter of approaching as a technique and practice between Devereux and Freud, we observe in the movie that Devereux incorporates to his technique the practice of dream interpretation, free association, and makes references to Freud's theory during the treatment, as the Oedipus complex and transference. Starting from Freudian intuitions about the relation between culture and psyche, Devereux advances for the formulation of an ethnopsychoanalysis, a result of the recognition of the inseparable interweaving of individual and cultural schemes. If the propositions of Devereux promoted in France the development of a clinical practice that considers the cultural differences of populations of immigrants from different countries, more promising still appear to be the chances of a transcultural psychoanalysis flourishing in a fertile terrain in ethnic diversity such as Brazil.

El ritual y la locura: psiquiatría y cultura en Colombia / The Ritual and the madness: psychiatry and culture in Colombia

Este artículo explora, desde la antropología médica, el papel del ritual en la enfermedad mental. En él se plantea un debate entre el paradigma biomédico de la enfermedad mental, en donde se privilegia la palabra médica, y un paradigma aquí denominado "híbrido", en donde se privilegia la palabra del enfermo. Este último es híbrido en cuanto permite la combinación de elementos de la racionalidad científica, con una expresión conceptual y una vivencia emocional de la "locura" que apela a la magia y al ritual según lógicas culturales peculiares de la población colombiana. Esta es una polémica de insoslayable importancia en la práctica cotidiana de la clínica psiquiátrica e Colombia. Para una mejor comprensión de sus dimensiones, se revisan teorías relativas al surgimiento de la racionalidad científica y a la consolidación de la modernidad occidental. El punto de vista defendido es que la ciencia no es un buen árbitro entre la creencia y el conocimiento. Además, que una visión épica de la modernidad como un proceso inflexible de corrección y sustitución de las superticiones y los errores premodernos, bien puede ser infundada y ella misma errónea. De tal manera, no se propone que se deseche el conocimiento científico en el tratamiento de la "locura" sino a que lo ritual ocupe la dimensión que le corresponde para una comprensión holística de la enfermedad...

This article explores, from a medical anthropological perspective, the role of ritual in mental illness. Thus, a debate is stated between the biomedical paradigm of mental diseases, in which medical discourse is emphasized, and a paradigm which is here called "hybrid", and where the patient´s discourse is privileged. The latter is a hybrid paradigm in so far as it combines some elements of scientific rationality, with an emotional and conceptual illness narrative which makes use of magical and ritual elements peculiar to a particular cultural logic characteristic of this country´s population...

Stress among Chinese, Korean-Chinese and Korean High School Students: A Transcultural Study / 신경정신의학

In this transcultural comparison, we examined areas of stress, coping strategies and psychosomatic symptoms resulting from such strategies in Chinese, Korean-Chinese and Korean high school students. A total of 1,042 second-year high school students participated in this study: 213 Chinese from Yanbien, China: 368 Korean-Chinese from Yanbien, China ; and 466 Koreans from Seoul, Korea. We administered the Stress Questionnaire Form for High school Students(Won and Lee 995), the Ways of Coping-Revised(Lazarus and Folkman 1984) and the Physical Symptom Scale of Stress(Allen and Hyde 1980) to investigate areas of stress, coping strategies and psychosomatic symptoms, respectively. The findings were understood and interpreted from focus group discussions. Although there were no differences in total stress scores among the three groups, there were significant differences in areas of stress. Chinese students manifested the highest stress scores in peer relation, family problem, heterosexual problem, the future-employment, and religious problem. Koreans scored the highest in academic performance, school life, extracurricular activity, psychological-personality problem, value system, and the future-employment. The Korean-Chinese students scored the highest in extracurricular activity, family-economic problem. In terms of collectivism versus individualism, Chinese students' stress was related more toward the collective situation, whereas the Korean students faced increased stress regarding the individual situation. In coping strategies, the Chinese were characterized by active coping, Koreans by passive coping and the Korean-Chinese by a mixture of the two. Koreans had the highest scores in psychosomatic symptoms, suggesting unfavorable coping strategies. The Korean-Chinese students seemed to lie intermediate between Koreans and Chinese in all three study areas, implying their cultural pluralism.

Anxiety and depression of the Korean residents in China / 영남의대학술지

In order to survey the reality of anxiety and depression among the Koreans residing in china, a study was conducted between January and March of 1991, on the residents of Yun-Kil city, with subjects of 472 Koreans and 479 Chinese. The evaluation was based on the questionnaires, named Combined self-rating anxiety depression scale (CADS), distributed among the subjects. ANOVA and t-test were applied for data processing. The results were as follows: There was not significant difference in the mean of total scores between the two groups. The scores of Koreans were 29.70±7.03, while those of Chinese were 29.45±9.01. The score of the CADS above 50 (clinically significant level) was seen in 12 (2.54%) Koreans and 21 (4.38%) Chinese. The anxiety-depression scores relating to the items of indigestion and decreased appetite, sleep disturbance, apprehension, decreased libido were relatively high among the Koreans. The items appeared low in scores among the Koreans were faintness, fear, suicidal rumination, hopelessness, paresthesias. The highs among the Chinese were facial flushing, anxiousness, dissatisfaction, suicidal rumination. The items appeared low among the Chinese were fear, faintness, paresthesias, weight loss, suicidal rumination. In the compatison of evaluation by items between the two groups, the items placing the Koreans significantly higher over the Chinese are indigestion & decreased appetite, sleep disturbance, apprehension, decreased libldo. The Chinese marked significantly higher in facial flushing, anxiousness, dissastisfaction, suicidal rumination. Those in the case of female (p<0.01 respectively), less than twenty years old (p<0.01 respectively), dissatisfied with family relationship (p<0.01 respectively), with past history of psychiatric hospitalization (Koreans p<0.01, Chinese p<0.05), pessimistic toward future, present, past self image (p<0.01 respectively) had significantly higher scores in both groups. In religion, neither group showed significant difference. In religion, neither group showed significant difference. In marital status, the Koreans showed a higher degree of divorce and separation and the Chinese in singleness (p<0.01 respectively). The Korean were higher in illiteracy and the Chinese had more college education (p<0.01 respectively). In place of growth, The Koreans showed not much difference in the areas while more Chinese grew up un large cities (p<0.01). More Koreans lived in the dormitory while the Chinese were engaged more in self-cooking (p<0.01 respectively), In pocket money per mouth, more Koreans were less than 1 dollar while the Chinese were between 7 and 10 dollars (p<0.01 respectively). There were no significant difference between two groups about religion.