This chapter, “Mental health activism and the demand for recognition,” overviews developments in mental health activism in the United Kingdom and the United States from the late nineteenth century to the present day. It begins by outlining the discourse of “mental hygiene, the “antipsychiatry” of the 1960s, the 1970s civil rights movements, and the consumer/service-user/survivor movements. The chapter continues with a focus on contemporary Mad Pride activism, describing the origins of the movement, the elements of the discourse, and the social and political demands that arise from it. It also discusses the problem of essentialism as it relates to social identities including Mad identity. The chapter concludes with an overview of philosophical engagement with Mad Pride and mad-positive activism.
IntroductionCultural congruence is the idea that to the extent a belief or experience is culturally shared it is not to feature in a diagnostic judgement, irrespective of its resemblance to psychiatric pathology. This rests on the argument that since deviation from norms is central to diagnosis, and since what counts as deviation is relative to context, assessing the degree of fit between mental states and cultural norms is crucial. Various problems beset the cultural congruence construct including impoverished definitions of culture as religious, national or ethnic group and of congruence as validation by that group. This article attempts to address these shortcomings to arrive at a cogent construct.ResultsThe article distinguishes symbolic from phenomenological conceptions of culture, the latter expanded upon through two sources: Husserl’s phenomenological analysis of background intentionality and neuropsychological literature on salience. It is argued that culture is not limited to symbolic presuppositions and shapes subjects’ experiential dispositions. This conception is deployed to re-examine the meaning of (in)congruence. The main argument is that a significant, since foundational, deviation from culture is not from a value or belief but from culturally-instilled experiential dispositions, in what is salient to an individual in a particular context.ConclusionApplying the concept of cultural congruence must not be limited to assessing violations of the symbolic order and must consider alignment with or deviations from culturally-instilled experiential dispositions. By virtue of being foundational to a shared experience of the world, such dispositions are more accurate indicators of potential vulnerability. Notwithstanding problems of access and expertise, clinical practice should aim to accommodate this richer meaning of cultural congruence.
Spirit possession is a common phenomenon around the world in which a non-corporeal agent is involved with a human host. This manifests in a range of maladies or in displacement of the host's agency and identity. Prompted by engagement with the phenomenon in Egypt, this paper draws connections between spirit possession and the concepts of personhood and intentionality. It employs these concepts to articulate spirit possession, while also developing the intentional stance as formulated by Daniel Dennett. It argues for an understanding of spirit possession as the spirit stance: an intentional strategy that aims at predicting and explaining behaviour by ascribing to an agent (the spirit) beliefs and desires but is only deployed once the mental states and activity of the subject (the person) fail specific normative distinctions. Applied to behaviours that are generally taken to signal mental disorder, the spirit stance preserves a peculiar form of intentionality where behaviour would otherwise be explained as a consequence of a malfunctioning physical mechanism. Centuries before the modern disciplines of psychoanalysis and phenomenological-psychopathology endeavoured to restore meaning to 'madness,' the social institution of spirit possession had been preserving the intentionality of socially deviant behaviour.
This article explores an aspect of the cultural modulation of recovery in psychosis. It begins with the idea that recovery hinges on the ability of subjects to relate to their distressing experiences in ways that expand rather than diminish agency. Based on fieldwork in the Dakhla oasis of Egypt and subsequent analysis, it is argued that interpretations of psychosis as spirit possession offer a broader range of intentionality than biomedical interpretations and therefore broader possibilities of relating to psychotic states. Modes of relating to spirits may take active or passive forms, the former consistent with the recovery goal of symptom control. Factors constitutive of the active, agency-expanding mode of relating include: the nature of spirits; the values and beliefs of the subject; the broader cultural/religious discourses which may make it either more or less likely for the subject to achieve the desired state of control over symptoms.
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