Transforming Therapy: Mental Health Practice and Cultural Change in Mexico

Transforming Therapy: Mental Health Practice and Cultural Change in Mexico. Whitney Duncan, Nashville: Vanderbilt University Press, 2018, 272 pp.

Whitney Duncan’s compelling monograph, Transforming Therapy, is a theoretically sophisticated, ethnographically vivid, and carefully written account of the circulations of psychological and psychiatric globalization, psy-sociality, and self-making in Oaxaca, Mexico. This experience-near ethnography is deeply attentive to the ways that interior and social lives are inseparable from broader processes of globalization. Duncan’s extensive fieldwork in Oaxaca included participant observation in a women’s group and a psychiatric hospital, at conferences and workshops, and in interpersonal relationships, in addition to interviews with mental health care providers, both psychiatric and psychological, as well as curanderos and other healers with backgrounds in medicina tradicional (traditional medicine) in the region. The context of Oaxaca provides a fertile ground for this study because of the recent rapid rise of psychological and psychiatric frameworks and services there. In addition, many who live in Oaxaca have had their lives touched directly by their own or family members’ migration to the United States, migrations driven mostly by economic exigencies. Duncan’s account links the rise of psy-frameworks to the global processes that lead to migration and its physical and emotional effects.

In the book, Duncan posits an interesting analytical distinction between psychological and psychiatric globalization, examining each on its own terms in particular contexts. She explains that psychological globalization entails the global spread of psychological frameworks and regimes of self-care, self-improvement, and self-making in everyday life. In this regime, treatment for psychological disorder requires individuals to undertake various modes of therapeutic engagement as a rational subject to become a more orderly, modern, and productive citizen and self. Duncan defines psychiatric globalization as the global spread of psychiatric clinical care, focused on DSM and ICD nosologies for diagnosing and treating various kinds of mental disorder and emotional distress. In this regime, psychiatric disorder is to be remedied with individualistic treatment largely focused on pharmaceutical prescriptions. Both psychological and psychiatric globalization reinforce an individualistic notion of the self as separate from family, society, and wider processes. The etiology of the problem is figured within the individual, and treatment demands self-directed regimes of care.

Importantly, Duncan’s monograph reveals the complexities of these processes and the possibilities they also offer for social transformations. She shows that forms of self-work in group therapy provide a framework for new ways of talking about emotional distress related to social disruption; a means of healing ruptured social bonds; and a basis for social transformation. Here, her analysis significantly complicates theorizing about governmentality and the psy-disciplines’ global circulations as top-down processes. Instead, her ethnography identifies people’s agency in defining their own experiences. Through psy-sociality, they instead are able to mobilize new conceptual frameworks to speak and act to exert some forms of control.

A major contribution of this account is its phenomenological approach. Duncan attends to the affective dimensions of migration processes and the myriad ways that the structures of inequality and poverty that incentivize economic migration from Oaxaca to the United States contribute to emotional anguish and social suffering among Oaxacans and their families in both sites. Duncan outlines the relationship of migration processes to projects of Mexican nation-state building in the wake of NAFTA and touches on issues of gang and other forms of disintegrating violence that traverse borders. Through her deft presentation of ethnographic detail and narratives, Duncan shows how these affective dimensions of migration are left to the individuals and their families to contain and cope with as issues interior to themselves. Attributing social suffering to individual mental health problems and then treating individuals for those problems serves, Duncan shows, to elide the very real material and economic sources of that suffering. She defines the “psy-imaginary” as the predominant notion that capacity for transformation of suffering lies within individuals, necessitating transformation work on the self as a panacea for what are ultimately social and structural problems.

Duncan’s ethnography also interestingly reveals the ways that psy-processes are gendered. This insight comes through particularly strongly in her work in La Paz, a women’s support group. In this group, women shared their experiences and discovered how expectations for gendered performances of female subservience in familial and other relationships caused them distress. This group identification allowed them to question and at times change the ways they performed gender in their relationships. For women in various spheres of Duncan’s research, gender-based intimate violence emerged as a source of distress, in some instances highlighting how cross-border distress for migrants and their kin intersects with forms of violence within families and between domestic partners. Although understated, the book constructively suggests how global movements around violence against women have played a role in psy-globalization, and it adds a gendered dimension to theorizing about psy-globalization more generally.

This well-cited account serves as an excellent resource for scholars and students alike in its attention to the breadth and depth of contemporary anthropological research and theorizing around mental health issues in global contexts. The engaging presentation of ethnographic detail and narrative makes it valuable as a text for students, and Duncan’s methodological approaches are particularly instructive for graduate students learning how to conduct ethnographic research. At every turn, Duncan takes great care to cite key scholars in her domains of analysis, including psychological anthropology, migration, and critical and phenomenological medical anthropology. This adds to the richness of the overall work and its valuable contributions to the field.

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