Philosophy, Psychiatry, & Psychology

Quinton Deeley’s paper offers a clear, informative, and provocative approach to the problem posed by the interpretation of illness or sickness (both terms are used in the culture and medicine field) from an integrative and comprehensive standpoint. His presentation is classically in line with the now quite popular and widely referred to perspective of “a meaning-centered” cultural anthropology as applied to medicine and psychiatry. This well known perspective aims to integrate a range of factors pertaining to an individual’s or group’s approach to behavioral events and processes that are medically and psychiatrically relevant. In his article, Deeley essentially applies the meaning-centered approach in trying to make sense of a rather typical case of spirit possession. In doing this he reviews and uses perceptively a number of other theoretical points of view and traditions.

Deeley begins by first reviewing the multimodal framework of Geoffrey Samuel, which was developed in order to suitably describe and analyze the interface between culture, biology, and local happenings of potential medical and psychological significance. Deeley then constructively applies this framework to the case of spirit possession and aphonia that he evaluated in a psychiatric setting in India by obtaining a narrative of illness from the patient’s brother. This narrative provided a picture of the illness, the meanings attributed to it by the patient’s family, and the types of healing approaches that the family resorted to prior to psychiatric hospitalization. The narrative of illness rather closely reflects the rationale, methods, and procedures used by early exponents of the meaning-centered approach in cultural anthropology that has been applied to medicine and psychiatry. This approach is most classically represented in the work of professors Byron Good and Arthur Kleinman of Harvard University (who have served as the chief editors of the very successful journal entitled Culture, Medicine, and Psychiatry).

In his presentation, Deeley also reviews and relies on literature pertaining to dissociation, although his assessment of the classical psychoanalytic approach seems dated and superficial, and the review of the biogenetic structuralists adds close to nothing to his presentation. Indeed, this latter review rather transparently demonstrates the fact that a number of approaches to brain/behavior and culture/biology relations essentially restate matters in different idioms. While Deeley adequately covers the dilemma of untangling conscious from unconscious factors in dissociation phenomena, I believe he gives too much emphasis and credence to the strictly conscious, willful motivations, as in his use of the malingering possibility in spirit-possession phenomena. Malingering is not a concept ordinarily used (nor entertained) [End Page 125] to make sense of trance and possession or illness/sickness phenomena in local, culturally contrastive settings, and its use in this case was somewhat jarring to me. However, the way he later uses this alternative in highlighting moral considerations is helpful, as is mentioned later.

If I understand Deeley’s discussion of pertinent scientific literatures correctly, I believe that explanatory models of dissociation cannot be said really to become “incorporated into preexisting ecologies of mind,” as he asserts. Explanatory models of dissociation as he presents them are external, observer-imposed formulations, and to some extent these types of formulations are alien to participants in modal states and the social manifold that he describes in the case. Those participants, of course, represent their situation using (“lay,” “folk,” “popular”) explanatory models and idioms of distress that they draw from their society, culture, and local setting. They could be said to construct illness or sickness episodes by drawing on relevant symbols and meanings (i.e., explanatory models) from their culture and local situation. These particular explanatory models can be viewed as logically similar to academic, observer-imposed explanatory models. The latter kind of explanatory models of clinicians/scientists do not so much become incorporated into ecologies, modal states, or social manifolds of actors as they can be used by an analyst/observer to qualify, hypothesize about, and perhaps better understand implications inherent in the modal states in question. In other words, so-called modal states and social manifolds—and Deeley’s equating of these with ecologies of mind—constitute models or representations of situations...