Outline for an Externalist Psychiatry (2): An Anthropological Detour
Philosophy, Psychiatry, & Psychology September 1, 2024 DOI: 10.1353/ppp.2024.a937773 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Ethnography Peer reviewed |
|---|---|
| Population | Akha swidden farmers living in highland Laos and neighboring borderlands |
| Duration | 19 months of ethnographic fieldwork |
| Key findings | Argues that the Akha medicinal, ritual, and shamanic system constitutes a functioning biopsychosocial approach that reframes psychiatric illness as a 'problem in living' and treats its social dimension by shifting the patient's social environment, succeeding where modern internalist psychiatry falls short; suggests that developing an externalist psychiatry requires questioning the accepted ontology of social causes of psychiatric illness. |
Abstract
Abstract:Philosophical speculation about how psychiatric externalism might function in practice has yet to fully consider the multitude of externalist psychiatric systems that exist beyond the bounds of modern psychiatry. Believing that anthropology can inform philosophical debate on the matter, the paper illustrates one such case. The discussion is based on 19 months of first-hand ethnographic fieldwork among Akha, a group of swidden farmers living in highland Laos and neighboring borderlands. First, the paper describes the Akha set of medicinal, ritual, and shamanic practices, analyzing issues of stigma and medical pluralism within it. Second, it makes the case that the Akha realize a functioning biopsychosocial system which comes with a well-developed set of resources for treating the social dimension of illness. Externalism among the Akha re-frames psychiatric illness as a ‘problem in living,’ which becomes manageable as such. The paper claims that, in so doing, the Akha system succeeds in many of the areas where modern internalist psychiatry falls short, and that it does so because Akha society is structured in such a way so that its practitioners can shift the social environment around the patient. As a takeaway for philosophers, it suggests that the development of an externalist psychiatry must begin from questioning the accepted ontology of the social causes of psychiatric illness.