Reviewed Book
Psychiatric Encounters: Madness and Modernity in Yucatan, Mexico. Beatriz Reyes‐Foster, New Brunswick, NJ: Rutgers University Press, 2018, 197 pp.
It is relatively easy to critique biomedicine—perhaps especially institutional psychiatry—as a form of social control, as a crucial cog in the system of neoliberal governmentality. It is much harder to write a compassionate clinical ethnography that does justice to patients, practitioners, and institutions and that has historical depth and contemporary valence. And it is nearly impossible to do the latter while also introducing novel theoretical frameworks to the anthropological study of mental illness and disturbing contemporary notions of madness, Maya indigeneity, mestizaje, and Mexicanness. In Psychiatric Encounters, Beatriz Reyes-Foster manages to do all of the above, and in a way that experts and undergraduates alike can both learn from and deeply enjoy.
Let us take, for example, an encounter between Lucía and Dr. Tun, two of the many patients and psychiatrists whose voices Reyes-Foster brings to life in her richly rendered ethnography of “Las Lomas,” a public psychiatric hospital in Yucatan, Mexico. Lucía describes to Dr. Tun her understanding that she controls the state government:
I’m telling you, I give orders, and they are followed. Whatever the governor does, I’m sending her the order, like through, maybe telepathy. Or by fairy. … See, I work through nature. I don’t do any harm, I only do good. […] I can’t stay [in the hospital]! The change in political power is coming up, election day is July 2nd. And I have to go.
(pp. 124–25)
Dr. Tun, a thoughtful, psychanalytically trained psychiatrist generally resistant to overmedicating her patients, attempts to understand Lucía’s “delusion” and verbally coax her into an alternate, more “ordered and logical” (p. 127) view of reality. Ultimately, though, Dr. Tun announces that “this poor girl is going to ECT [electroconvulsive therapy]” (pp. 125–26).
Lucía and Dr. Tun, like nearly all of the patients and psychiatrists at Las Lomas and psychiatric institutions around the world, are negotiating various “regimes of truth” (p. 127), each with their own content, structure, goals, and history. Psychiatrists are trying (yet only sometimes succeeding) to humanize their patients in inhumane conditions. For their part, patients are asserting their own narratives, identities, senses of self, and cosmologies in the face of severe social suffering and oppression. In this book, rather than privilege one regime of truth over another, Reyes-Foster successfully tacks back and forth between multiple ways of knowing, both ethnographic and theoretical. Moving between these worlds, readers come to understand the intimate ways in which patients, their family members, and resource-strapped psychiatrists in a state-run institution are all woven into a “colonial matrix of power.”
This is a matrix made through ongoing forms of racism and dispossession in Mexico as much as through the country’s history of revolution, and it is remade and refashioned with every attempt to become—and every resistance to becoming—“modern.” Indeed, the reader realizes early on that the book is as much an ethnography of coloniality and Mexico’s (oft-thwarted) quest for modernity as much as it is an ethnography of a psychiatric hospital, Yucatan, or any other place. What are the enduring effects of colonialism on the psyche of a people? How do neocolonial states, their institutions, and their treatments of ‘madness’ reflect conflicted desires to become modern?
At Las Lomas, psychiatrists have power, and that power reflects and produces the colonial matrix. But in this same context, patients insist on their own humanity; objects and spirits are agentive aspects of Maya “indigenous ontology” (p. 150); and truth and personhood are unfixed, in flux. While psychiatry and the modern neoliberal Mexican state may privilege one (“Western,” “rational,” “responsible,” “sane,”) regime of truth over another (“indigenous,” “cultural,” “relational,” “mad”), Reyes-Foster’s ethnography itself reveals another possibility: a world in which such binaries break down and in which “multiple ways of being-in-the-world” coexist (p. 42).
In this sense, at least for the duration of the book, readers themselves experience what Reyes-Foster terms “La Zona del Estar,” an “area of flux and change within the colonial matrix of power” (p. 42), in which the lines between the sane and mad, past and present, internal and external, decolonial and colonial, modern and unmodern, subject and object, human and nonhuman blur even as agents of the state try to redraw them. Impressively, Reyes-Foster accomplishes this for the most part with straightforward, accessible prose that manages to intervene theoretically and still beautifully center the voices of her interlocutors. As a whole, the book showcases the small and large ways in which coloniality functions, and how people both contest and reproduce it within particular contexts and constraints. Reyes-Foster shows how the hospital is microcosm of Mexico and of the would-be modern world more generally: simultaneously a zone of abandonment and hope, of being and nonbeing.
Importantly, Psychiatric Encounters engages in a productive and “deliberate epistemic decolonization” (p. 17) that decenters Euro–American-centric anthropological theory and approaches to mental illness in favor of indigenous and decolonial frameworks proposed by scholars including Audra Simpson, Ramón Grosfoguel, Silvia Rivera Cusicanqui, Juan Castillo Cocom, Nestor García Canclini, and Walter Mignolo. This is a welcome intervention to psychiatric anthropology as well as to the field of global mental health. In places, I would have liked to see the aforementioned works—and Reyes-Foster’s ethnography—in even more conversation with scholars engaging similar questions around madness and coloniality in other regions (e.g., many whose work appears in DelVecchio Good et al.’s [2008] Postcolonial Disorders volume), but ultimately Reyes-Foster’s decisions around theoretical engagements insightfully reflect and lay bare the forms of coloniality she encounters in her field site.
Psychiatric Encounters also provides excellent teaching and learning tools for considering the ethics of fieldwork in psychiatric institutions. What does it mean for an anthropologist to don a (required) white doctor’s coat as she or he makes the rounds in the hospital, and how does this affect her or his interactions? How do the anthropologist’s identity and privilege permeate her or his interactions with patients and practitioners alike? What does one do with fascinating transcripts from doctor–patient interactions in the acute ward, where patients cannot easily provide consent? (In that example, Reyes-Foster ultimately decides to go beyond her IRB requirement to merely provide pseudonyms and creates composite characters).
In his 2012 chapter “Medical Anthropology and Mental Health: Five Questions for the Next Fifty Years,” Arthur Kleinman noted the “impressive anthropological literature on the experience of psychiatric treatment in the U.S. and Europe,” and lamented the fact that, in contrast, very little research exists on “the treatment and research experiences of the mentally ill in poor and middle-income societies. If anthropology is to advance global mental health, this omission must be corrected” (Kleinman 2012, 188). In the years since Kleinman’s observation, a number of ethnographies have heeded his call, but to my knowledge, Reyes-Foster’s is the first published full-length ethnography of a psychiatric institution in Latin America. In this sense alone, it is a monumental contribution. Put together with the numerous other contributions outlined above, it is unmissable.
References Cited
DelVecchio Good, M.-J., S. Teresa Hyde, S. Pinto, and B. Good, eds. 2008. Postcolonial Disorders. Berkeley: University of California Press.
Kleinman, A. 2012. Medical Anthropology and Mental Health: Five Questions for the Next Fifty Years. In Medical Anthropology at the Intersections: Histories, Activisms, and Futures, edited by M. C. Inhorn and E. A. Wentzell, 116–28. Durham: Duke University Press.