Mental Disorder: Anthropological Insights. Nichola Khan, Toronto: University of Toronto Press, 2017, 129 pp.
In Mental Disorder: Anthropological Insights, Nichola Khan offers readers an ambitious overview of the anthropology of psychiatry and mental health. The book aims to “bridge the gap between research and teaching,” and thus is explicitly intended for pedagogical use. As someone who teaches in this area, I know that to attempt to introduce students to the key questions, theoretical approaches, and debates in this increasingly dense field of study is a daunting task. I constantly lament not being able to cover more ground and include everything I think is important and relevant. Given the limits of what one can cover in a nine-week quarter, I tend to opt for depth over breadth in my courses.
While Khan is obviously not able to cover everything either, her book nevertheless offers an impressively broad, if not comprehensive, overview of many important issues, theoretical perspectives, controversies, and debates surrounding the anthropology of mental health and illness—and it does so in a short format, just over 100 pages. In other words, Khan opts for breadth over depth in this book. This means that there are many issues on which she touches only superficially. Although at times I found this superficiality somewhat frustrating, the book ultimately functions very well as an invitation to readers to further explore areas that intrigue them, and Khan offers study guides and lists of additional resources to facilitate the reader’s ability to do just that.
Following a preface and introduction in which Khan lays out some basics of terminology and attempts to draw some useful distinctions among disciplinary and theoretical perspectives, the first two chapters take a mainly historical perspective, tracing epistemic shifts across time in both psychiatry and anthropology. Beginning with a history of the culture concept in anthropology, Khan does the important work of historicizing the way the relationship of culture to mental disorder has been conceptualized by anthropologists. Hence, the focus is really on anthropological approaches to mental health, rather than on an analysis of psychiatric approaches. Despite this, Khan provides some overview of the history of psychiatry as well, since the anthropology of mental health has developed largely in tandem with psychiatric approaches, as a reaction, counterpoint, or critique of the dominant Euro–American epistemologies and the biopolitics they encompass. With their focus on how anthropologists have carried out this reacting, counterbalancing, and critiquing, these first chapters have a deeply meta-analytic feel, which seems somehow premature in the book’s chronology, coming prior to a more concrete discussion of how we could or should understand mental disorder and how it is experienced by people in specific places and times.
The book really seems to hit its stride in Chapters 3–7, when the discussions become more focused and less esoteric. In Chapter 3, Khan focuses on cultural psychiatry, beginning with its colonial history and tracing its evolution to the present. She includes an excellent discussion of culture bound syndromes and controversies surrounding this concept, including the politics of its inclusion in the central text of clinical mental health practice, the Diagnostic and Statistical Manual of Mental Disorders (DSM). Here, Khan rightly celebrates the contributions that anthropologists have made to recent advances in the DSM, demonstrating nicely the ways in which anthropological critique has directly resulted in practical change. Throughout the book, Khan emphasizes the value of both critique and efforts to conduct research that is relevant to and can benefit people by influencing policy and practice. This message should be especially welcome to students, who often struggle with how to balance these imperatives.
In Chapter 4, Khan explores the politics of trauma and its signature affliction, post-traumatic stress disorder. This is a particularly strong chapter in which Khan is highly effective at drawing out links among the historical development of the concept of trauma as we currently know it, the unique temporal and moral implications of post-traumatic suffering, and the role of trauma in the global politics of suffering and victimhood in contexts of political violence, humanitarianism, and the mass movement of people. Here and in Chapter 5, on the “Big Three: Schizophrenia, Depression, and Bipolar Disorder,” Khan presents anthropological analysis and critique without eliding the real suffering and distress that many people endure.
Chapter 6 is focused on global mental health, and Khan again does a nice job of balancing the need for critique with productive research to improve the lives of people suffering around the world. As part of this effort, she effectively lays out the links between contemporary global mental health policy and colonialism, while also introducing the notion of “postcolonial disorders.” Finally, in Chapter 7, “Drugs, God, and Talking: Shaping New ‘Orders’ out of ‘Disorder’” Khan addresses questions of treatment and healing in various forms, focusing in particular on a critique of psychopharmacology and the implications of a pharmacological approach to treatment on both an individual and a global scale.
Throughout the book, Khan weaves together a great deal of literature, presenting a summary of high profile research and theoretical positions advanced by anthropologists studying mental disorder. Of course, scholars sometimes disagree with one another, and Khan deftly presents the controversies and debates that have developed in the field, giving voice to multiple sides of each issue. For example, she does justice to both sides in her discussion of the critical dialogue that developed between Didier Fassin on the one hand, and Wilkinson and Kleinman on the other, over the politics of the “social suffering” genre of anthropological work.
As I mentioned, Khan includes with each chapter a series of study questions and recommendations for further reading. With only a few exceptions, the study questions included at the end of each chapter are excellent—provocative, thought provoking, and original. I can imagine using some of these questions as the basis of writing assignments or in-class discussions in my own courses, and I view them as among the most valuable resources that Khan’s book has to offer. More generally, Khan has done a service to those of us who teach in this area by providing an excellent survey of the field. While I found the writing a bit dense at times for undergraduate readers, I would nevertheless recommend the book for use in both upper-level undergrad and graduate courses related to the anthropology of psychiatry and mental health. It will function well in such courses as a broad overview around which individual instructors can arrange additional depth, according to their specific priorities and preferences.