Power, change, and 'the culture of psychiatry'

It is not uncommon to encounter 'the culture of psychiatry' used as a descriptive or even explanatory concept in discussions of psychiatric practices and services, specifically in research addressing cultural aspects of psychiatry. Drawing on data from research on the role of culture in psychiatric services in the Boston area, this paper critically examines the attribution of a 'culture' to psychiatry, which is prevalent not simply in mainstream psychiatric literature, but also in certain lines of cultural psychiatry, specifically those dedicated to political and anti-racist activism. It is argued that the use of such terminology could be misleading as it implicitly attributes a sense of coherence and agency to what may best be described as a set of related discourses and sociopolitical practices. It is further suggested that, given the implications of using such terminology as 'culture' in our discussions of psychiatry as a social institution, a scientific discourse, or a clinical practice, it would be more fruitful to address the analytic concepts of power, meaning, and the sociopolitical functions of psychiatry instead.

The ego, the ocular, and the uncanny: why are metaphors of vision central in accounts of the uncanny?

I am my own twin, Always with me, same as me, and always watching me! From interview with a psychotic patient Every man carries with him through life a mirror, as unique and impossible to get rid of as his shadow W.H. Auden, 1989, p.93 I cannot urge you too strongly to a meditation on optics. Jacques Lacan, 1991, p.76 This paper outlines the basic arguments for a reading of the notion of the uncanny that draws on direct and metaphorical significances of the ocular in the development of human ego. It is argued that a specular-oriented reading of the uncanny as made possible through Lacan's model for ego development introduces a significant analytic device capable of explaining diverse features of the uncanny experience that escaped the traditional phallic/castration-based reading. To examine this claim, evidence is presented from a number of contexts to demonstrate how uncanny experiences are typically constructed through and associated with themes and metaphors of vision, blindness, mirrors and other optical tropes. Evidence is also presented from a historical point of view to demonstrate the strong presence of ocular and specular themes, devices and associations in a tradition of literary and psychological writing out of which the notion of 'the uncanny' (including Freud's own formulation) emerged. It is demonstrated that the main instances of the uncanny, such as doppelgangers, ghosts, déjà vu, alter egos, self-alienations and split personhoods, phantoms, twins, living dolls and many more in the list of 'things of terror' typically share two important features: they are closely tied with visual tropes, and they are variations on the theme of doubling. It is then argued that both of these features are integrally associated with the developmental processes of ego formation and self-identity, thus explaining the strong association of the uncanny accounts and experiences with ocular and specular motifs and metaphors.

The complexity of trauma response: a 4-year follow-up of adolescent Cambodian refugees.

OBJECTIVE: The objective of this study was to document the psychosocial adjustment of young refugees during their adolescence and its association with the war-related trauma experienced by their family before migration. METHOD: Data were collected on 57 young Khmer resettled in Montreal and followed from early to late adolescence. The associations between premigratory exposure to political violence and postmigratory mental health and social adjustment were estimated for early, mid-, and late adolescence. RESULTS: The associations between premigratory exposure to political violence and postmigratory psychosocial adjustment fluctuated over the adolescence period. Overall, the adolescents whose families were more highly exposed to political violence tended to report a more positive social adjustment and less mental health symptoms than those less exposed. CONCLUSION: The high expectations of Cambodian parents towards their children and the preservation of traditional values despite the Khmer rouge attempts to eradicate them might contribute to explain the paradoxical association between the families' exposure to political violence and the adolescents' psychosocial adjustment in the host country. Although children and adult refugees seen in clinical setting are reminders of the negative effects of adversity, resilience should be more systematically explored in community samples to further our understanding of the long-term effects of trauma.