Transforming subjectivities: global mental health, biopolitics, & depression in Chile

depression;biopolitics;global mental health;psychiatry;globalization

Cuthbertson, Courtney

关键词: depression;    biopolitics;    global mental health;    psychiatry;    globalization;   

Others  :  https://www.ideals.illinois.edu/bitstream/handle/2142/49455/Courtney_Cuthbertson.pdf?sequence=1&isAllowed=y

美国|英语

来源: The Illinois Digital Environment for Access to Learning and Scholarship

【 摘 要 】

As the leading cause of disability around the world (WHO 2012), depression has become a major public health concern.The global mental health movement has organized to increase access to mental health care within primary care and to protect the human rights of those who experience mental illnesses.Within this movement, the World Health Organization (WHO) MIND Project which operated in the early 2000s aimed to increase services and legal protections for people with mental illness, through collaboration with national governments and with the assertion that through such collaboration, global psychiatric knowledge would trickle down to the general population.Foucault (1978) has argued that in contemporary society, governance takes place through biopolitics as the “making live” of populations through construction of health problems as simultaneously political and economic ones.Rose (2007) posited that the outcome of living in such a society is the creation of individual-level biological citizenship, where people increasingly see themselves in biological ways.Biological citizenship is theorized as an active process of describing the self in biologically-colored languages while also making demands upon the state for the provision of health care.This dissertation project examined the potential transfer of psychiatric knowledge from the global organizational level to the level of individuals in Chile, a country claimed as a success of the global mental health movement.This project utilized qualitative, ethnographic methods over a six-month period in Santiago, Chile, to explore the biopolitical management of depression, including discourse analysis, observations, and interviews.Observations took place in the psychiatry departments of two public hospitals.Interviews were conducted with people undergoing treatment for depression at either hospital, care providers working in mental health, and a set of people outside of the medical realm who may or may not have had any experience with depression.Discourse analysis of texts from global and national levels revealed that the management of mental health, and depression specifically, occurred in ways congruent with biopolitical governance (Foucault 1978, Rabinow & Rose 2006).Observations and interviews showed that depression was seen in contradictory ways, both social and biological.While patients generally felt any of a myriad of interpersonal problems caused their depression, depression was explained as being seen as an illness similar to physical ailments, requiring biomedical intervention.Outsiders and providers more often relied on biological explanations for the mental illness, but all of the interview participants felt depression was on the rise.Many felt the increase in depression throughout the population was due to society becoming more fast-paced, competitive, and individualistic, with superficial communication and relationships between people.Such feelings of disconnect from the larger population being interpreted as depression represent the medicalization of anomie (Durkheim 1997), in line with biopolitical governance through the inspiration of self-regulation (with regards to pharmaceutical treatments) for the good of the whole.A vast majority of those interviewed were women, who often described their responsibilities as overwhelming them, leading to depression; one woman explained that continuing to hold responsibility over the household in addition to the pressures of the workplace (also called the stalled revolution; Hochschild and Machung 2012) was too much to bear.Through medicalizing women’s experiences, such feelings of being overwhelmed are constructed and handled as issues of individual biology rather than problems within the social structure.None of the patients or the outsiders made explicit statements that the state should be responsible for the care of depression, even when asked about health care.The findings from this research indicate the need to widen biological citizenship to include implied biological definitions and passive demands on the state, as a new gradational biological citizenship.