This subfield grew out of the culture and personality school (ca. 1930-1950), when psychoanalysts and anthropologists sought to collaborate to understand how mental processes differed or were similar across greatly different societies. Margaret Mead, Ruth Benedict, and Irving Hallowell are those anthropologists most often associated with this school. Although, most anthropologists became critical of the basis of the field in psychoanalysis and a correlation of individuals with entire cultures, a small group of social and cultural anthropologists continue, none the less, to pursue this direction, and over time they have developed broader ties with psychology, as can be readily seen by their leading research interests in cognition, lifecycle development, and ethnopsychological categories. Anthropologists working in this tradition have studied self-concepts and self-images, emotion terms, interpersonal processes and their relation to personhood, as well as experiences of childhood, child rearing, adolescence, midlife, and ageing. Psychological anthropology has been influential in recent years in psychology, where a sister subdiscipline called cultural psychology has started up in close connection to it.

Physicians were among the founders of anthropology, and some, like the British polymath W.H.R. Rivers, combined medicine and anthropology. Another source of medical anthropology was social medicine and public health; indeed the great German pathologist and social medicine advocate, Rudolph Virchow, was one of the first to use the term ‘medical anthropology’. Thus, medical anthropology’s early roots were applied. After the Second World War, the field took off as anthropologists developed an interest in the theoretical and empirical aspects of non-Western medical traditions, religious healing and its relation to medicine, and increasingly in experiences of suffering. In more recent years, medical anthropologists, of whom there are several thousand worldwide, have developed special interests in infectious diseases (especially diarrhoeal disease, malaria, tuberculosis, and AIDS), female reproductive lifecycle problems, the health problems of children and the aged, substance abuse, cancer, diabetes, disabilities, medical ethics, and the economic and social transformation of health care. One of the earliest and abiding interests has been in psychiatric diagnosis, disorders, and treatments. This subfield of social and cultural anthropology has many ongoing relationships to cultural psychiatry (see Chapter 2.6.1) and has been active in recent years in the effort to introduce mental health concerns into international health (see Chapter 1.3.2 and 7.3). Indeed, the cultural sections of the DSM-IV were contributed by a taskforce that included both medical anthropologists and cultural psychiatrists, in equal numbers.

One of the crucial contributions of anthropology is theoretical, namely a critique of the theoretical biases inherent in psychiatric science and clinical practice. This may seem self-evident because unlike any other branch of medicine, there is no blood test, biopsy, or radiograph to diagnose psychiatric disorder (leaving aside Alzheimer’s disease, which is after all a neurological disorder). That means that psychiatric diagnosis is based on the establishment of symptom and syndromal criteria, which are based in turn in language, lay categories, and everyday social experience. Cultural bias can enter this process in several ways. Anthropologists have shown that this can happen when diagnostic criteria that have been developed in one society are applied to another where they lack validity. This is called a ‘category fallacy’, a term introduced by Kleinman.⁽¹⁾ Classic examples include trance and possession states in many non-Western societies, which are frequently normative and normal experiences. Failure to recognize this phenomenon, and therefore the diagnosis of persons in religious trance as psychotic, creates a category fallacy in the application of the diagnostic criteria of psychosis to normal people. The cultural critique has been applied to personality disorders as well, because this category of disorder models self-processes on a Euro-American, middle-class, and usually male behavioural type and lifestyle. Anthropologists argue for a much more flexible and interactive understanding of subjectivity that changes in basic ways in response to different social circumstances.

In the 1990s, cultural critique has been important in highlighting the influence of institutional racism in psychiatric diagnosis, referral, and treatment. Leading examples are the overdiagnosis of African-Americans and African-Caribbean Britons with schizophrenia, the tendency to perceive them as more dangerous and less amenable to psychotherapy, and differences in the way their discharge and aftercare are organized. Anthropologists have examined how racism is unwittingly built into psychiatric categories and infiltrates the model cases used to illustrate diagnostic criteria, and also the way that psychiatrists are trained to replicate such patterns in the practice of triage.

Cultural critique, informed by the cross-cultural and international data, is the basis for anthropologists’ doubts about the validity of many of the psychiatric conditions detailed in DSM-IV and ICD-10. The ethnographic database strongly suggests that, apart from brain tumours and infections, Alzheimer’s disease, metabolic encephalopathy, substance abuse, and other well-documented brain-based disorders such as certain sleep disorders, only six psychiatric syndromes of adults can be found cross-culturally; i.e. only these have stability as syndromes outside the cultural mainstream of Euro-American societies. The conditions are schizophrenia, brief
reactive psychoses, major depression, bipolar disease, a range of anxiety disorders from panic states through phobias to obsessive-compulsive disorder, and trauma, whether understood as PTSD or in other categories. Most of the other hundreds of conditions described in DSM-IV, for example, are culture bound to Euro-America.