Numbers and Meaning: A Dialogue in Cross-Cultural Psychiatry
Numbers and Meaning: A Dialogue in Cross-Cultural Psychiatry
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数字与意义：跨文化精神病学的对话
DOI：
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发表时间：
1994
影响因子：
17.3
通讯作者：
I. Krause
中科院分区：
文献类型：
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作者：
I. Krause
引言 人类学和精神病学之间关于文化和精神疾病的争论正在日益激烈。近年来，我们看到精神病学家承认症状学上的文化差异”2，精神病学家重视非西方医学范式，因为它们提供了研究否则可能被系统性忽视的问题的机会3-5，我们看到人类学家将西方心理学理论应用于非西方背景6-9。因此，双方似乎正在划定共同点。然而，尽管存在这种普遍共识和良好意愿，但解决有关实际问题的前景仍是未知数。如何将人类学和精神病学的研究方法结合起来，似乎很遥远。例如，如何整合定性和定量的研究方法以及如何进行跨文化比较？精神病学家关心的是了解痛苦的迹象和症状，以及如何表达这些症状以及如何治疗它们。这两种参考框架之间的分歧可能阻碍了一致方法的发展，并且肯定导致了普遍主义和特殊主义观点的简化。问题不在于精神病学如何成为定性的，或者人类学如何成为定量的，而在于如何划分劳动，如何平等地尊重这两种范式以及它们如何相互告知。作为困难的一个例子，我想描述一项旨在整合精神病学和人类学的研究。这项研究涉及贝德福德的锡克教和印度教旁遮普人群，其目的是考察旁遮普症状学在多大程度上挑战了传统精神病学研究方法，以了解该人群的躯体症状和抑郁症状，与其他非西方症状学研究一样10，它涉及西方精神病学类别和问卷的验证。作为该项目的人类学家，我特别关心人类学验证的复杂性，我提供这个例子来说明精神病学家如果要继续追求文化敏感的研究方法和健全的跨文化比较，需要注意哪些问题。我的部分将首先简要描述贝德福德研究和精神病学，介绍我们首先使用 1992 年 6 月 9 日的一般健康调查问卷和我们自己设计的旁遮普语调查问卷获得的结果。然后我将继续考虑旁遮普人在考虑健康和疾病时所使用的一些想法和主题。我认为，从人类学的角度来看，躯体症状的验证必须包括对更广泛的意义主题和人格建构的考虑，更一般地说，这不仅涉及对非西方医学范式的审查，而且还涉及对思维模式的考虑。
Introduction The debate between anthropology and psychiatry about culture and mental illness is gathering momentum. We have seen in recent years psychiatrists acknowledging cultural variation in symptomatology"2, psychiatrists valuing non-western medical paradigms for the opportunity these offer to study issues which otherwise might have been systematically ignored3-5 and we have seen anthropologists applying western psychological theories to non-western contexts6-9. The two sides thus appear to be demarcating a common ground. However, despite this general agreement and good will, the prospect of answers to pragmatic questions about how to combine anthropological and psychiatric research methods, seems remote. How, for example can qualitative and quantitative methods of research be integrated and how can cross-cultural comparison be operationalized? The difficulties derive from different frames of reference. Psychiatrists are concerned with knowing about the signs and symptoms of suffering, about how these are expressed and how they can be treated. Anthropologists are concerned with developing a framework which is sufficiently receptive to embrace and comprehend the sense which people themselves make oftheir suffering. The tension between these two frames of reference may have impeded development of a consistent approach and has certainly led to much simplification in terms of universalist and particularist perspectives. The issue is not so much how psychiatry can become qualitative or how anthropology can become quantitative, but how the labour should be divided, how the two paradigms can be equally respected and how they can inform one another. As an example of the difficulties, I want to describe a study which was aimed at an integration of psychiatric and anthropological research methods. The study concerned the Sikh and Hindu Punjabi population in Bedford and its objective was to examine the extent to which Punjabi symptomatology challenged orthodox psychiatric research methods into the prevalence of somatic and depressive symptoms in this population. As with other studies of non-western symptomatology2"10 it was concerned with the validation ofwestern psychiatric categories and questionnaires. As the anthropologist on the project I was particularly concerned with the complexities of anthropological validation and I offer this example as an illustration of the kind of issues to which psychiatrists need to pay attention if they are to continue in their pursuit of culturally sensitive Paper read to research methods and sound cross-cultural comparison. Section of I shall first briefly describe the Bedford study and Psychiatry, present the results we obtained first from the use of 9 June 1992 the General Health Questionnaire and second from a Punjabi questionnaire which we ourselves designed. Then I shall move on to consider some of the ideas and themes used by Punjabis themselves when they consider health and illness. I suggest that from the point of view of anthropology, validation of somatic symptoms must include a consideration of wider themes of meaning and constructions of personhood and more generally that this involves, not only an examination of non-western medical paradigms, but also a consideration of modes of thought.