Experiencing the other- Chinese psychiatry

I went to China this summer to try to "understand the Chinese urban experience,  and see a bit of how psychiatry is practised", that was the idea anyway. It was more of a scoping exercise, and I didn't really think it through. The research part of my trip went reasonably well, and I was able to make contact with a consultant interested in the environmental aetiology of mental illness, and hopefully we should be collecting usable data soon. However, from the month I spent on the schizophrenia ward of a psychiatric department in China, going on ward-rounds, talking to patients, and talking to relatives, I have been left with a pervasive unsettled feeling that is complicated to explain.

What I remember are the stories, told by patients, and more often not by their families, of the individual struggles, both against everyday life, but also against things indescribable... society, I guess. stigma, definitely. institutions, perhaps.

The doctors were lovely, dedicated, yet there was a brisk matter of fact atmosphere. There was a recognition that weeks of  intensive hospital stay followed by cold turkey wasn't the best management, however the responsibility for service change and redesign lay somewhere else, higher up in some bureaucratic chain.

The patients had travelled vast distances sometimes across provinces to seek help at the large metropolitan centre where I was at. In a country of only children, with very strong reciprocal familial obligations, the devastation was implicit and unsaid.

Those were the lucky ones. There is national health insurance in China, but only if you have a job, have good huco (area registration- insurance is scare in rural areas), or families are rich enough to afford the monthly payments themselves. I wonder how many patients have simply been abandoned by their families. Mental illness is very much a luxury.

There is so much more to say, but I need some time to let things sink in. Feeling unsettled is mixed in with frustration, powerlessness, and many many more questions. China has a very different way of doing things, and is it really my place to try and change things?

New media experiences

There is no question of a doubt that I have grown up in the era of new media, twitter, facebook, blogger, but this is the first time I'm becoming aware and receptive to the extent to which these new ways of engagement have affected the nature of our social interactions, and identity formation as just one aspect of more global trends.

It is this angle that is most immediate from our experiences of everyday life- in print, T.V, film, billboards, these have all become incorporated into fb likes, twitter feeds, so that using products now becomes an active assertion of our own identity. In many senses we have now captured a form of virtual advertising that is peer to peer, and also overlies a sense of materialism and capital relations into these expressions of identity. This in many senses involves the new horizontalisation of identity and material relations, but it is not quite so absolute as before objectification would occur in face to face interactions. Inherently re-raises Daniel Miller's questions about the commodification of modernity.

even without thinking about media theory, we can make passing observations about the nature new spaces for exhibition. Facebook now used between friends to share common cultural references in temporal chronology, for one, maintains a group identity of functioning in the same social space. The number of friends as a status symbol, photographs as making lived experiences somehow more 'real'. This compulsion for validity, may be said to be driven and shaped by these new media, or simply just facilitates fulfilment of latent desires. This is still uncertain; with the possible paths for exploration still unmapped. Also to what extent does the technology and structure of facebook discover or create these new aspects of our social world?

There must be some overlap with narrative and literature, than began personal intrigue. Susan Sontag's questions about journalism, about boundaries being created between foreign spaces and now. In looking at photographs from distant places, as exotice, we can now scrutinise the fundamental details of each other's lives. The idea of the diary is transformed into the blog, which adds an element of other people, that is immediately proximate. We now get instant feedback, and instant interaction between author and reader, across geographical space. The guardian ran an immersion competition to Rwanda, where the 'suffering' became personal, and this subverted a way of knowing. Knowing in terms of the experience of another, instead of an authority.

we are eroding the influence of mass media hegemony, however coercion may have appeared in different ways as shared symbols and compulsions- both negative and positive in terms of 'insecurities' and concern about 'who we are' and what we want in life. These expectations of experience is the attitude of youth and possibility. What we know and see now about new media is still in kindergarden, but we should be aware of the dangers of stunted emotional growth.

Global Mental Health

This emerging discipline, or the beginnings of an organised "movement",  is lead by academics trying to unify two agendas- identifying service gaps, and creating pressure for something to be done to fill these gaps. Although this is well meaning at the core, it is still problematic at the peripheries. At the extreme, they are trying to incorporate mental health to be synonymous to development. It is particularly interesting to me because it couples themes and issues from two of my papers this year that would otherwise not be in such proximity; globalisation, and mental health and public policy.

There are many tangential questions from which to start to unpack their overall motivations. How do they position themselves within the public health and mental health discourse? As an amalgamation between global public health, and mental health, is it too inter-disciplinary, or does the common purpose and interactions that it begins to articulate benefit from more a more focused and explicit research agenda? And also, inherent to these considerations is the tension between method and theory. In this case, it underlies both critique of its purpose and empirical methodology. This research does have a complicated mix of agendas and assessment of their historical origins is important for future trajectories.

Here, the idea of agency is key- immediately research is not a passive process, and there are inherent expectations of applicability. Therefore, the changes that the movement advocate, and the levers that are pulled, fits in somewhere along a broader framework that exists in the social sciences that have historical and philosophical origins. It's justification of its organisation and institutions is still very much underpinned by the The moral and political philosophies which western society, whether Hobbesian individualism, or even Keynesian ideas about the role of the state. In essence they focus on an idea of human capital in terms of different degrees of capacity. It is this that underlies  political and policy discussion, and in a sense also the interpretation of data that is used to justify our choices. How a human being is 'diagnosed' and 'treated', it situated within the complicated web of societal attitudes, and historical ideas.

Another way to critique this would be from a the perspective of the archaeology of knowledge and post-modern idea of a plurality of understandings and knowledge. The social-cultural space for 'therapy' to replace 'traditional' modes of treatment for coping with everyday life. Everything can be analysed through the lense of modern values- inherently based on rights, ideas of social justic, anti stigma campaigns, but how did this evolve from previously public health theories, and how are these different understandings negotiated and used.