Edward Sapir’s disciplinary trespass and critical synthesis of linguistics, anthropology, and psy... more Edward Sapir’s disciplinary trespass and critical synthesis of linguistics, anthropology, and psychiatry preceded by nearly a century our current enthusiasms for interdisciplinarity in the humanities, social sciences, and medicine. His accumulation of postgraduate degrees in the early 1900’s would put him in the company of a growing number of 21st century dual degreed scholars in medicine, humanities, public health, and social sciences, particularly anthropology. In a prior commentary on Sapir, Kirmayer (2001) gives us an insightful and comprehensive view from a cultural psychiatry framework. The focus here is from an anthropological gaze, albeit one infiltrated by a career of research, both ethnographic and multi-method, centered on people living with schizophrenia and other enduring Axis 1 psychiatric diagnoses. Equally informing this commentary are nearly three decades devoted to teaching humanities and social sciences to medical students with and within an interdisciplinary department of scholars and clinicians across awide spectrumof disciplines and practices. The intermittent flirtations between psychiatry and anthropology during the early 20th centurywere both exquisitelywell and ill timed. Freud’s Totem and Taboo (1918) and Civilization and Its Discontents (1931) were contemporaneous with Sapir’s graduate training and subsequent engagement with psychiatry. The psychoanalytic interest in meaning making in sociocultural context were well timed and provided intellectual nutrition for anthropological forays into the non-material worlds of religion, ritual, illusions, delusions, and personhood via the culture and personality school. That promising commons was ill timed when in mid-century came the explosion of psychopharmacology as a first treatment option, next the decade of the brain meant to medicalize and destigmatize mental illness, and the demand for “evidence based” treatment that was ill suited for “talking” therapies that were not easily quantified or broken into measurable components. Psychiatric care remained deployed largely in a binary mode— “talking therapies” available to the very wealthy, and confinement and various somatic interventions for those with few if any resources. Psychoanalytic training and practice diminished rapidly. Medical and psychiatric anthropology evolved from the roots of the culture and personality school, leaving behind, as psychiatry had in large part, the capacious intellectual atmosphere in which Sapir wrote and thought about psyche, personhood, difference, and culture.
Carolina Digital Repository (University of North Carolina at Chapel Hill), 2016
Purpose-Behavioral and social science (BSS) competencies are needed to provide quality health car... more Purpose-Behavioral and social science (BSS) competencies are needed to provide quality health care, but psychometrically validated measures to assess these competencies are difficult to find. Moreover, they have not been mapped to existing frameworks, like those from the Liaison Committee on Medical Education (LCME) and Accreditation Council for Graduate Medical Education (ACGME). This systematic review aimed to identify and evaluate the quality of assessment tools used to measure BSS competencies. Method-The authors searched the literature published between January 2002 and March 2014 for articles reporting psychometric or other validity/reliability testing, using OVID, CINAHL, PubMed, ERIC, Research and Development Resource Base, SOCIOFILE, and PsycINFO. They reviewed 5,104 potentially relevant titles and abstracts. To guide their review, they mapped BSS competencies to existing LCME and ACGME frameworks. The final, included articles fell into three categories: instrument development, which were of the highest quality; educational research, which were of the second highest quality; and curriculum evaluation, which were of lower quality. Results-Of the 114 included articles, 33 (29%) yielded strong evidence supporting tools to assess communication skills, cultural competence, empathy/compassion, behavioral health counseling, professionalism, and teamwork. Sixty-two (54%) articles yielded moderate evidence and 19 (17%) weak evidence. Articles mapped to all LCME standards and ACGME core competencies; the most common was communication skills. Conclusions-These findings serve as a valuable resource for medical educators and researchers. More rigorous measurement validation and testing and more robust study designs are needed to understand how educational strategies contribute to BSS competency development. In a 2004 report, the Institute of Medicine (IOM) concluded that, although 50% of the causes of premature morbidity and mortality are related to behavioral and social factors, medical school curricula in these areas are insufficient. 1-3 The behavioral and social science (BSS) domains that the IOM deemed critical in their report included: (1) mind-body interactions in health and disease, (2) patient behavior, (3) physician role and behavior, (4) physician-patient interactions, (5) social and cultural issues in health care, and (6) health policy and economics. 1 Within these six domains, the IOM identified 26 high priority topics, such as health risk behaviors, principles of behavior change, ethics, physician well-being, communication skills, socioeconomic inequalities, and health care systems design. 1 The Association of American Medical Colleges (AAMC) similarly identified core BSS content areas and connected them with other educational frameworks, including the Canadian Medical Education Directions for Specialists (CanMEDS) competency framework and the Accreditation Council for Graduate Medical Education (ACGME) core competencies. 4 In addition, the Liaison Committee on Medical Education (LCME) incorporates, as part of its educational program requirements for accreditation, BSS domains 5 and requires that schools identify the competencies in these areas that both the profession and the public can expect of a practicing physician. Medical schools must use both content and outcomes-based Carney et al.
... SASB). The psychotherapeutic process: A research handbook. Benjamin, LornaSmith; Foster, Shar... more ... SASB). The psychotherapeutic process: A research handbook. Benjamin, LornaSmith; Foster, Sharon W.; Roberto, Laura Giat; Estroff, Sue E. Greenberg, Leslie S. (Ed); Pinsof, William M. (Ed), (1986). The psychotherapeutic ...
ABSTRACT: Alisse Waterston and Charlotte Corden’s Light in Dark Times (2020) began as an address ... more ABSTRACT: Alisse Waterston and Charlotte Corden’s Light in Dark Times (2020) began as an address by the president of the American Anthropological Association and was transformed into “a work of art and anthropology” by a member of the audience. The result was a coauthored book-length graphic essay that is expansive in subject matter, and in the representation of ideas, scholars, and questions about what it means to be human and how we will pass the time that is given us on earth. Light and dark are central to the visual representations that serve as the background to a story about what is necessary to become a person who is honest. This critical assessment reflects on the content and form of that story, which predated the COVID pandemic, widespread political unrest, and assaults on truth, evidence, language, categories, education, and “others” in the US and elsewhere. The format is both challenging to read and interesting to think with. As teaching and learning increasingly become animated and visualized, Light in Dark Times is a worthy introduction to these ways of apprehending the vexing questions and conundrums presently in such abundant supply.
Carolina Digital Repository (University of North Carolina at Chapel Hill), 2020
BACkgRound: There is an urgent need for medical school curricula that address the effects of stru... more BACkgRound: There is an urgent need for medical school curricula that address the effects of structural influences, particularly racism, on health, healthcare access, and the quality of care for people of color. Underrepresented racial minorities in the United States receive worse health care relative to their White counterparts. Structural competency, a framework for recognizing and understanding social influences on health, provides a means for understanding the structural violence that results from and perpetuates racism in classroom and clinical education. Some medical schools have incorporated art into their curricula to increase empathy generally, yet few programs use art to address racial disparities in medicine specifically. oBjECTIvE: "Can We Talk About Race?" (CWTAR) aims to increase medical students' empathy for racial minorities and increase the ease and ability of students to address racial issues. CWTAR also provides a unique context for ongoing conversations about racism and structural inequality within the health care system. METhodS: Sixty-four first-year medical students were randomly selected to participate in CWTAR. The on-campus Ackland Art Museum staff and trained student facilitators lead small group discussions on selected artworks. A course evaluation was sent to all participants consisting of 4 questions: (1) Likert scale rating the quality of the program, (2) the most important thing learned from the program, (3) any differences between discussion at this program versus other conversations around race, and (4) suggestions for changes to the program. Free text responses were content coded and analyzed to reveal common themes. RESulTS: Out of 64 students, 63 (98%) responded to at least one course evaluation question. The majority (89%) of participants rated the program quality as either "Very Good" or "Excellent." Of the 37 students who responded to the free text question regarding the most important thing they learned from the program, 16 (44%) responses revealed students felt that they were exposed to perspectives that differed from their own, and 19% of respondents reported actively viewing a subject through another's perspective. Of the 33 students who responded to the free text question regarding any differences between discussion at this program versus other conversations around race, 48% noted an increased comfort level discussing race during the program. A common theme in responses to the question regarding suggested changes to the program was a more explicit connection to medicine in the discussion around race. ConCluSIonS: Student responses to CWTAR suggest that the program is effective in engaging students in discussions of racial issues. More investigation is needed to determine whether this methodology increases empathy among medical students for racial minorities specifically.
In 1978, Erving Goffman was the discussant for a session on psychiatric ethnography at the Americ... more In 1978, Erving Goffman was the discussant for a session on psychiatric ethnography at the American Anthropological Association meetings. He opened his remarks by declaring that, since he had written Asylums, “everything written in this area is essentially a footnote.” Taken aback at the time by this none too humble assessment, I have since come almost to agree with Goffman. Rob Barrett’s meticulous ethnography of an Australian psychiatric hospital in the late 1980s illustrates how very little has changed in psychiatric hospitals, in hospital ethnography, and in social constructivist views of schizophrenia since 1968. Barrett’s purpose, in this anthropology dissertation-cum-book, is to locate schizophrenia in the clinical setting in which it is “experienced, diagnosed, and treated” (p. 1). As a staff psychiatrist of six years at Ridgehaven Hospital, the pseudonym for the site, Barrett is arguably either uniquely situated to study a social organization that produces schizophrenia or especially disqualified by his role as one of the producers. The text does not settle this matter because there are some penetrating insights into the layered world of the hospital and its work that perhaps only a clinician could know alongside multiple missed reflections of the author’s complicity in obliterating experience and personhood for many patients and an absence of unapologetic critique of what is happening in the work of the hospital. This is especially apparent in the opacity and nearly lifeless way in which patients are presented in the book and in the frank omission of staff conflicts from the analysis because the author is concerned “lest the antagonists be identified” (p. 91). Barrett’s abbreviated discussion of his roles and some of the tensions are confined to methods— little of the intellectual and professional ferment that such a study should generate is evident in the book. Barrett’s analysis of the three primary professions at Ridgehaven— psychiatry, nursing, and social work—is clear and accessible. He argues that in spatial terms, psychiatry claims the inner person, nursing deploys itself to the surface of the person, and social work inhabits context and surroundings. In this way, turf wars are avoided and the person/patient can be possessed happily by three differing claimants. His narrative of these three groups of workers in the manufacture of schizophrenia is hauntingly similar to what we would find in almost any psychiatric unit and hospital in the United States. Some of the words used in the jokes differ, but the jokes themselves do not. The setting and its procedures, history, architecture, and staff are exhaustively chronicled in the book. Due either to writing style, unfortunate editing, or dissertation sequelae, these descriptions are punctuated repeatedly with footnotes that refer to
Edward Sapir’s disciplinary trespass and critical synthesis of linguistics, anthropology, and psy... more Edward Sapir’s disciplinary trespass and critical synthesis of linguistics, anthropology, and psychiatry preceded by nearly a century our current enthusiasms for interdisciplinarity in the humanities, social sciences, and medicine. His accumulation of postgraduate degrees in the early 1900’s would put him in the company of a growing number of 21st century dual degreed scholars in medicine, humanities, public health, and social sciences, particularly anthropology. In a prior commentary on Sapir, Kirmayer (2001) gives us an insightful and comprehensive view from a cultural psychiatry framework. The focus here is from an anthropological gaze, albeit one infiltrated by a career of research, both ethnographic and multi-method, centered on people living with schizophrenia and other enduring Axis 1 psychiatric diagnoses. Equally informing this commentary are nearly three decades devoted to teaching humanities and social sciences to medical students with and within an interdisciplinary department of scholars and clinicians across awide spectrumof disciplines and practices. The intermittent flirtations between psychiatry and anthropology during the early 20th centurywere both exquisitelywell and ill timed. Freud’s Totem and Taboo (1918) and Civilization and Its Discontents (1931) were contemporaneous with Sapir’s graduate training and subsequent engagement with psychiatry. The psychoanalytic interest in meaning making in sociocultural context were well timed and provided intellectual nutrition for anthropological forays into the non-material worlds of religion, ritual, illusions, delusions, and personhood via the culture and personality school. That promising commons was ill timed when in mid-century came the explosion of psychopharmacology as a first treatment option, next the decade of the brain meant to medicalize and destigmatize mental illness, and the demand for “evidence based” treatment that was ill suited for “talking” therapies that were not easily quantified or broken into measurable components. Psychiatric care remained deployed largely in a binary mode— “talking therapies” available to the very wealthy, and confinement and various somatic interventions for those with few if any resources. Psychoanalytic training and practice diminished rapidly. Medical and psychiatric anthropology evolved from the roots of the culture and personality school, leaving behind, as psychiatry had in large part, the capacious intellectual atmosphere in which Sapir wrote and thought about psyche, personhood, difference, and culture.
Carolina Digital Repository (University of North Carolina at Chapel Hill), 2016
Purpose-Behavioral and social science (BSS) competencies are needed to provide quality health car... more Purpose-Behavioral and social science (BSS) competencies are needed to provide quality health care, but psychometrically validated measures to assess these competencies are difficult to find. Moreover, they have not been mapped to existing frameworks, like those from the Liaison Committee on Medical Education (LCME) and Accreditation Council for Graduate Medical Education (ACGME). This systematic review aimed to identify and evaluate the quality of assessment tools used to measure BSS competencies. Method-The authors searched the literature published between January 2002 and March 2014 for articles reporting psychometric or other validity/reliability testing, using OVID, CINAHL, PubMed, ERIC, Research and Development Resource Base, SOCIOFILE, and PsycINFO. They reviewed 5,104 potentially relevant titles and abstracts. To guide their review, they mapped BSS competencies to existing LCME and ACGME frameworks. The final, included articles fell into three categories: instrument development, which were of the highest quality; educational research, which were of the second highest quality; and curriculum evaluation, which were of lower quality. Results-Of the 114 included articles, 33 (29%) yielded strong evidence supporting tools to assess communication skills, cultural competence, empathy/compassion, behavioral health counseling, professionalism, and teamwork. Sixty-two (54%) articles yielded moderate evidence and 19 (17%) weak evidence. Articles mapped to all LCME standards and ACGME core competencies; the most common was communication skills. Conclusions-These findings serve as a valuable resource for medical educators and researchers. More rigorous measurement validation and testing and more robust study designs are needed to understand how educational strategies contribute to BSS competency development. In a 2004 report, the Institute of Medicine (IOM) concluded that, although 50% of the causes of premature morbidity and mortality are related to behavioral and social factors, medical school curricula in these areas are insufficient. 1-3 The behavioral and social science (BSS) domains that the IOM deemed critical in their report included: (1) mind-body interactions in health and disease, (2) patient behavior, (3) physician role and behavior, (4) physician-patient interactions, (5) social and cultural issues in health care, and (6) health policy and economics. 1 Within these six domains, the IOM identified 26 high priority topics, such as health risk behaviors, principles of behavior change, ethics, physician well-being, communication skills, socioeconomic inequalities, and health care systems design. 1 The Association of American Medical Colleges (AAMC) similarly identified core BSS content areas and connected them with other educational frameworks, including the Canadian Medical Education Directions for Specialists (CanMEDS) competency framework and the Accreditation Council for Graduate Medical Education (ACGME) core competencies. 4 In addition, the Liaison Committee on Medical Education (LCME) incorporates, as part of its educational program requirements for accreditation, BSS domains 5 and requires that schools identify the competencies in these areas that both the profession and the public can expect of a practicing physician. Medical schools must use both content and outcomes-based Carney et al.
... SASB). The psychotherapeutic process: A research handbook. Benjamin, LornaSmith; Foster, Shar... more ... SASB). The psychotherapeutic process: A research handbook. Benjamin, LornaSmith; Foster, Sharon W.; Roberto, Laura Giat; Estroff, Sue E. Greenberg, Leslie S. (Ed); Pinsof, William M. (Ed), (1986). The psychotherapeutic ...
ABSTRACT: Alisse Waterston and Charlotte Corden’s Light in Dark Times (2020) began as an address ... more ABSTRACT: Alisse Waterston and Charlotte Corden’s Light in Dark Times (2020) began as an address by the president of the American Anthropological Association and was transformed into “a work of art and anthropology” by a member of the audience. The result was a coauthored book-length graphic essay that is expansive in subject matter, and in the representation of ideas, scholars, and questions about what it means to be human and how we will pass the time that is given us on earth. Light and dark are central to the visual representations that serve as the background to a story about what is necessary to become a person who is honest. This critical assessment reflects on the content and form of that story, which predated the COVID pandemic, widespread political unrest, and assaults on truth, evidence, language, categories, education, and “others” in the US and elsewhere. The format is both challenging to read and interesting to think with. As teaching and learning increasingly become animated and visualized, Light in Dark Times is a worthy introduction to these ways of apprehending the vexing questions and conundrums presently in such abundant supply.
Carolina Digital Repository (University of North Carolina at Chapel Hill), 2020
BACkgRound: There is an urgent need for medical school curricula that address the effects of stru... more BACkgRound: There is an urgent need for medical school curricula that address the effects of structural influences, particularly racism, on health, healthcare access, and the quality of care for people of color. Underrepresented racial minorities in the United States receive worse health care relative to their White counterparts. Structural competency, a framework for recognizing and understanding social influences on health, provides a means for understanding the structural violence that results from and perpetuates racism in classroom and clinical education. Some medical schools have incorporated art into their curricula to increase empathy generally, yet few programs use art to address racial disparities in medicine specifically. oBjECTIvE: "Can We Talk About Race?" (CWTAR) aims to increase medical students' empathy for racial minorities and increase the ease and ability of students to address racial issues. CWTAR also provides a unique context for ongoing conversations about racism and structural inequality within the health care system. METhodS: Sixty-four first-year medical students were randomly selected to participate in CWTAR. The on-campus Ackland Art Museum staff and trained student facilitators lead small group discussions on selected artworks. A course evaluation was sent to all participants consisting of 4 questions: (1) Likert scale rating the quality of the program, (2) the most important thing learned from the program, (3) any differences between discussion at this program versus other conversations around race, and (4) suggestions for changes to the program. Free text responses were content coded and analyzed to reveal common themes. RESulTS: Out of 64 students, 63 (98%) responded to at least one course evaluation question. The majority (89%) of participants rated the program quality as either "Very Good" or "Excellent." Of the 37 students who responded to the free text question regarding the most important thing they learned from the program, 16 (44%) responses revealed students felt that they were exposed to perspectives that differed from their own, and 19% of respondents reported actively viewing a subject through another's perspective. Of the 33 students who responded to the free text question regarding any differences between discussion at this program versus other conversations around race, 48% noted an increased comfort level discussing race during the program. A common theme in responses to the question regarding suggested changes to the program was a more explicit connection to medicine in the discussion around race. ConCluSIonS: Student responses to CWTAR suggest that the program is effective in engaging students in discussions of racial issues. More investigation is needed to determine whether this methodology increases empathy among medical students for racial minorities specifically.
In 1978, Erving Goffman was the discussant for a session on psychiatric ethnography at the Americ... more In 1978, Erving Goffman was the discussant for a session on psychiatric ethnography at the American Anthropological Association meetings. He opened his remarks by declaring that, since he had written Asylums, “everything written in this area is essentially a footnote.” Taken aback at the time by this none too humble assessment, I have since come almost to agree with Goffman. Rob Barrett’s meticulous ethnography of an Australian psychiatric hospital in the late 1980s illustrates how very little has changed in psychiatric hospitals, in hospital ethnography, and in social constructivist views of schizophrenia since 1968. Barrett’s purpose, in this anthropology dissertation-cum-book, is to locate schizophrenia in the clinical setting in which it is “experienced, diagnosed, and treated” (p. 1). As a staff psychiatrist of six years at Ridgehaven Hospital, the pseudonym for the site, Barrett is arguably either uniquely situated to study a social organization that produces schizophrenia or especially disqualified by his role as one of the producers. The text does not settle this matter because there are some penetrating insights into the layered world of the hospital and its work that perhaps only a clinician could know alongside multiple missed reflections of the author’s complicity in obliterating experience and personhood for many patients and an absence of unapologetic critique of what is happening in the work of the hospital. This is especially apparent in the opacity and nearly lifeless way in which patients are presented in the book and in the frank omission of staff conflicts from the analysis because the author is concerned “lest the antagonists be identified” (p. 91). Barrett’s abbreviated discussion of his roles and some of the tensions are confined to methods— little of the intellectual and professional ferment that such a study should generate is evident in the book. Barrett’s analysis of the three primary professions at Ridgehaven— psychiatry, nursing, and social work—is clear and accessible. He argues that in spatial terms, psychiatry claims the inner person, nursing deploys itself to the surface of the person, and social work inhabits context and surroundings. In this way, turf wars are avoided and the person/patient can be possessed happily by three differing claimants. His narrative of these three groups of workers in the manufacture of schizophrenia is hauntingly similar to what we would find in almost any psychiatric unit and hospital in the United States. Some of the words used in the jokes differ, but the jokes themselves do not. The setting and its procedures, history, architecture, and staff are exhaustively chronicled in the book. Due either to writing style, unfortunate editing, or dissertation sequelae, these descriptions are punctuated repeatedly with footnotes that refer to
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