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Mental Health in Asia and the PacificReview - Mental Health in Asia and the Pacific
Historical and Cultural Perspectives
by Harry Minas and Milton Lewis (Editors)
Springer, 2017
Review by Sharon Packer, MD
Dec 5th 2017 (Volume 21, Issue 49)

This is a unique book, because of both its content and its approach. It goes without saying that it is an important book for mental health practitioners and administrators situated in Asia and the Pacific Islands and for medical historians and cultural anthropologists specializing in those regions. It is an equally fascinating read—although not necessarily a directly relevant read--for psychiatrists and other mental health practitioners who are interested in Asia yet are based far away from Asia, as is the case with this reviewer.

For American psychiatrists and healthcare administrators who treat either recent Asian-American immigrants or refugees or students--or more comfortable or culturally Americanized second and third generations who trace their ancestry to Asia—this book is an eye-opener, especially for those who rely on the American Psychiatric Association's clinically-oriented cultural psychiatry courses for guidance on the treatment of patients of Asian ancestry.

This collection is not a clinical review by any stretch. It focuses on the history of medicine and epidemiology with a lesser stress on cultural considerations. It reminds us that the editors, who hail from New Zealand and Australia, hold perspectives that are far-removed from perspectives of American and probably also Canadian readers. Even though New Zealand, Australia, the U.S. and Canada all share European roots, North Americans cannot have the intimate perspective about Asia and the Pacific experienced by "down under" practitioners.

For instance, many chapter authors differentiate precolonial from postcolonial influences. The authors remind us that Western medicine and Western psychiatry are often associated with colonialism in Asia, a term that rarely carries positive connotations today. Colonialism is probably not the first association of American-born and educated psychiatrists—even if colonialism merits high consideration in today's college curriculum--and so this reminder is especially helpful.  Moreover, several chapters identify the cumulative influences of sequential colonizers, making these chapters read like archaeological records as much as cultural catalogues. As an example, Vietnamese psychiatry reflects the influence of French colonizers as well as post-Vietnam War American governmental standards, along with influences from American aid societies, non-government organizations (NGOs), international UN helpers, plus residuals from short-term Japanese occupiers. 

Each chapter is 15 to 20 pages.  Chapters are divided by country. Nearly twenty chapters convey a wealth of information. Fascinating and infuriating anecdotes abound. We encounter horrifying information about Cambodia, whose Khmer Rouge government massacred physicians when they purged the professionals, so that only 47 physicians survived, with not a single psychiatrist among them.

Australia and New Zealand are included among the Asian countries. The only Asian country that is missing is China. In the introduction, the editors apologize for this omission even though they offer an abundance of far-reaching information about other Asian countries and far-flung Pacific Islands. It would be nice to have more data about China, considering its importance to the world at large today, and considering the ever-increasing Chinese-American population in the U.S. today, but that omission hopefully opens the doors for other scholars.

The authors remind us that Western views of Asia are often romanticized out of proportion to reality and typically reflect residual attitudes from centuries past. Marco Polo's pursuit of the Silk Road and the riches of the Orient are less relevant than the words of the French philosopher Jean- Jacques Rousseau, which still reverberate. Rousseau extolled primitivism and lamented that "man is born free but everywhere he is in chains". Following his lead, artists such as Paul Gaugin repudiated European materialist values, expatriated to Tahiti and adopted a tribal lifestyle in an unspoiled natural setting, still uncontaminated by European settlers (apart from himself).  Gaugin's attempts to shed the mantle of civilization were not entirely successful, for he often returned to Europe to sell his art. Yet his artistic legacy left an indelible mark on European thought and art, and Europe influenced America.  The Baby Boomers' trek eastward, via the "hippie trail," or toward Enlightenment imported from Asia, are other examples of this reoccurring Western infatuation with Asia of the imagination.

          Steering clear of such romanticizing yet without polemicizing, this book goes far beyond the kuru and culture-specific psychoses that punctuate the pages of standard American psychiatric texts and even the DSM-5. It highlights the vast differences in the suicide rates among Indian indentured laborers compared to the native Fijian populations and points fingers at economic stresses experienced by the Indian laborers as well as their lack of social support when far from home.  The discussion of psychosis among the Papua New Guinea native population is equally intriguing. The chapter on New Guinea explores the oft-repeated (but patently false) adage that mental illness was absent before the arrival of the colonizers or the white man—but it dispels this notion by plumbing historical sources and citing convincing references.

Much emphasis is placed on the role of the asylum in Asia, or in certain cases on the role played by the therapeutic farm in the rehabilitation of persons with serious psychiatric problems. Fascinating discussions about indigenous beliefs about the origins of mental illness—be it from karma or ancestral curses or malevolent spirits—clarify the resistance to mental health care found among certain Asian peoples. Once the authors explain why some folks believe that reversal of such illness is futile, given its immutable origins, the reader has an "aha" moment and understands reluctance to accept even well-intended psychiatric intervention.    

The chapter on India is especially riveting, if only because India is such an interesting amalgam of so many cultures, each with their own approach to behavioral aberrations.  This chapter is longer than the other chapters, and is authored by more authors (five in total). The authors address the more recent "Britishization" of Indian health care, as well as historically important approaches retained from the [Muslim] Mogul Empire, which transmitted the Galenic medical tradition that had been lost to the Western world after Christianity triumphed in Europe and suppressed "pagan" medicine of the Greeks.  Curiously, India has lower rates of mental health disorders than Western countries, but higher rates than other Asian countries.

I could go on and on citing intriguing passages from this book—but this is but a book review and not the book itself.  Let me conclude by saying how useful this book is in treating patients from Asian ancestry--not so much because the information directly impacts psychiatric care because it invites more open and enlightened discussions about family backgrounds and the disparity between the families left behind in their home countries and the lives they live in the US. I heartily recommend this unique volume to anyone who is remotely interested in cross-cultural psychiatry and who wants to view the world through a very different lens.

 

© 2017 Sharon Packer

 

Sharon Packer, MD is a psychiatrist who is in private practice in Soho (NYC) and Woodstock, NY. She is an Asst. Clinical Professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine. Her books includeDreams in Myth, Medicine and Movies (Praeger, 2002), Movies and the Modern Psyche (Praeger, 2007) and Superheroes and Superegos: The Minds behind the Masks (Praeger/ABC-Clio, 2010). In press or in production are Sinister Psychiatrists in Cinema (McFarland, 2012) and Evil in American Pop Culture (ABC-Clio, 2013, co-edited with J. Pennington, PhD.) She can be contacted at drpacker@hotmail.com .


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