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Rethinking Psychiatry: From Cultural Category to Personal Experience

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Kleinman brings an anthropological perspective to the field of psychiatry, examining the forces of culture and society on how deviant, nonconforming behavior is produced, labelled, and reacted to. Much like Gerald Erchak (The Anthropology of Self and Behavior), Kleinman considers what a diagnosis is and how it is influenced by a society's definitions of illness and disease.

The book addresses first the question, What Is A Psychiatric Diagnosis? It next addresses the question, Do Psychiatric Disorders Differ in Different Cultures, answering "Sometimes." The author asks Do Social Relations and Cultural Meanings Contribute to the Onset and Course of Mental Illness? Here he examines the connections between the economy of a society and the prevalence of psychiatric diagnoses. He also considers the role of social change in the prevalence and nature of mental illness.

A very interesting portion of the book is titled How Do Professional Values Influence the Work of Psychiatrists? Kleinman offers a transcript of an initial session between a U.S. patient and psychiatrist. The subsequently formulated diagnosis and treatment plan are provided. The patient's diary entry following the session shows the discrepancy in world views between physician and patient. Next is an examination of a session between a Chinese psychiatrist and patient.

How Do Psychiatrists Heal? is the title of the next section of the book. Here, Kleinman looks at the clinical tools of psychiatry as compared to the healing tools of other cultures. Considered are the institutional settings of healing, the nature of the healing interaction, practitioner characteristics, styles of communication, clinical considerations, cultural settings, and extratherapeutic factors. An examination of how symbols are used in healing in psychotherapy and other folk cures follows. The book concludes with thoughts about the question What Relationship Should Psychiatry Have to Social Sciences?

Dr. Kleinman offers an insightful perspective on the concept of psychiatric illness and healing that integrates contributions from many disciplines. This is a beautiful example of thinking "outside the box" that challenges traditional psychiatry while remaining respectful of the methodology of both psychiatry and anthropology. Dr. Kleinman elucidates a meaningful middle ground between the criticisms of the "anti-psychiatrists" such as Szasz and Goffman, and the traditional psychiatric hierarchy. This is an enlightening work which will appeal to those who find themselves frustrated with the limitations of traditional diagnostic categories and conceptualizations of mental illness as residing solely within the individual, and who are searching for ways to understand illness experiences as a social phenomenon.

I first read this book about four years ago, and continue to come back to it. The ideas expressed here have significantly impacted my understanding of my own field and have greatly influenced the direction of my subsequent research and teaching.