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Medical anthropological investigation as to the effect of supportive semi-therapeutic sessions on reorganization of embodied experience, sensory awareness, and split selves - Dr. K. Miyasaka
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Medical anthropological investigation as to the effect of supportive semi-therapeutic sessions on reorganization of embodied experience, sensory awareness, and split selves - Dr. K. Miyasaka

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The purpose of this investigation is: ...

The purpose of this investigation is:
- a new pathway to medical anthropology of split selves as found in shamanistic s?ances, and psychiatric disorders, with relevance ot self-help group settings.
In particular, the effect of small-group semi-therapeutic sessions as observed in Urakawa Bethel house will be discussed with reference to "cultural personhood.“

This work was presented during the II Workshop on Medical Anthropology in Rome, on October 14th - 15th 2011

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    Medical anthropological investigation as to the effect of supportive semi-therapeutic sessions on reorganization of embodied experience, sensory awareness, and split selves - Dr. K. Miyasaka Medical anthropological investigation as to the effect of supportive semi-therapeutic sessions on reorganization of embodied experience, sensory awareness, and split selves - Dr. K. Miyasaka Presentation Transcript

    •  “ Medical anthropological investigation as to the effect of supportive semi-therapeutic sessions on reorganization of embodied experience, sensory awareness, and split selves” Keizo Miyasaka,   Keio Univ. Tokyo Oct. 15, 2011: 9:30~10:15 Presentation for the II Workshop in Medical Anthropology.   Relio Institute of Integral Development, ARSO, Rome.
    • The purpse of the   investigation  
      • a new pathway to medical anthropology of split selves as found in shamanistic s?ances, and psychiatric disorders, with relevance ot self-help group settings.
      • In particular, the effect of small-group semi-therapeutic sessions as observed in Urakawa Bethel house will be discussed with reference to "cultural personhood.“
    • Focus on personhood/selfhood
      • Distribution of different “minds,” in the same person: insanity? Multiple personalities? Or the states for a possible integration towards a new personhood. Reason & Emotions
      • Personhood vs personality
      • - mediates or integrates bodily sensations, physical states and thinking, ethonomical reactions -> Embodiment
      • - e.g. transformed forms of emotions via cultural personhood ~body
      Lambek, Michael “How to Make Up One’s Mind: Reason, Passion, and Ethics in Spirit Possession.” University of Toronto Quarterly, 79(2), spring 2010:107-128.
    • Ref:
      • Lambek, Michael “How to Make Up One’s Mind: Reason, Passion, and Ethics in Spirit Possession.” University of Toronto Quarterly, 79(2),spring2010:107-128.
      • Lambek, M. & Strathern, A. (Eds.) Bodies and Persons. Cambridge,1998.
      • Seligman, Rebecca. “The unmaking and making of self: Embodied suffering
      • and mind-body healing in Brazilian Candomble.“ Ethos, 38(3), 2010:
    • Possessed spirits & Everday life
      • Complex interactions between a possessed spirit(s) and surrounding people ( family members).
      • Spirits on different mediums interact joyfully, and maintain friendship.
      • Medium can go on everyday-life while not in trance.
      • Ritual regulations on or code switching of different states of consciousness
    • The framework of the research on cmparing shaman’s multiple selves, and schizoprenic split selves
      • Shaministic trance, training to trans sessions.
      • Schizophrenic split personality: hallucinatory senses or sensations (visual or auditory)
      • In both cases, there are usual physical-sensory processes that unmake an integrated every experiential world
    • Ref:
      • Csordas, Thomas J. et al (Eds.) Embodiment and Experience:The Existential Ground of Culture and Self. Cambridge Univ., 1994
      • Jenkins, J. H. & Barrett, R. J. Schizophrenia, Culture, and Subjectivity:
      • The Edge of Experience. (Cambridge Studies in Medical Anthropology)
      • Cambridge University Press, 2003.
    • Ref:
      • Stephen, Michele & Suryani, Luh Ketut
      • “ Shamanism, Psychosis and Autonomous Imagination.” Culture, Medicine and Psychiatry, 24(1), 2000:5-40)
      • --argues that an initiatory madness or illness is experienced by only a minority of balians (Balinese indigenous healers)
      • who are most likely women healers who are most likely women healers
    • Performers in Trance? One’s soul –self sees one’s dance while dancing Maureen Flemming: Slow Dance + Butoh Oriented Dacne
    • Ohno Kazuo ……..Min Tanaka
    • Australina performing artist Stelarc
    • Typologies? Processual models? subculture~practicing culturla formation via institutional reformations
      • Inter- or multi-cultural interfaces~ bilingual/multi-lingual, code-switching patterns in differently situated & sensibility-emotions that are anchored in symbolic expressions, narratives. .
      • Changes of psychiatric therapy sessions : e.g. Ethnopsychiatry; Extension of Morita therapy : modification of the concept of culture
    • Subculture:Typologies or processual stages
      • Self-help groups for searching new or combined medical practice inserted in-between meical insitutions, patients, families, and supporting members
      • Towards a further innovation of a sub-culture of the people in “mentally disorder”. ~~Bethel House in Urakawa, Hokkaido, Japan.
    • Research Angles
      • both needs a stable positive group support for not negating unusual sensory experiences that unmake foregoing integrative aspect of personhood with discrepancies of differently situated logics and sesitivity together with
      • intermediate (sub) cultural formation for a supportive space: cultural formation for the world of the “disabled” ->    develop several different stages; cultural changes
    • Bethel House in Urakawa
      • Established in 1984 < 1978 at the old Bethel house (Church) by a group of several people who got out of a hospital
      • Roughly 100 members now <NPO.Urakawa Bethel-no-Ie + Welfare Shop etc.
      • Social worker Ikuyoshi Mukaiyachi > Dr. Toshiaki Kawamura
      • 1990~Cognitive Behaviral Therapy
    • Sufferer’s self-study method   :   Tojisha-Kenkuyu
      • Personification of Auditory Hallucinations~ different characters of each type of auditory hallucination;
      • shift of each character due to sufferer’s and his/her interacting others in a supportive space.
      • Characteristics of this space.
      • -try and error approach, others who are also sufferers but may function to do supportive relativization of his/her subjective split experiences ~ laughter.
    • Subculture of the sufferer trying to overcome mental symptoms
      • Disclosure of one’s hallucinations, delusions, obessessions i.e. experience of suffering.
      • Meetings and meetings have priority to meals
      • Semi-therapeutic sessions
      • Related to other interacting systems: SST etc offered in Red-Cross Hosptital
      • Nethertheless risks ~~ a particular type of humor needed cf: K. Nakamura 2010
    • Further issues relevant to the research
      • The role of Social workers
      • Its possible changes due to a change of sub-culture of the sufferers.
      • Spread processes of the sufferer’s self-study method to other parts of Japan (private clinics via psychiatric social workers, care-takers as well as to Korea.
      • Future issues.
    • Significance
      • Validates a new pathway for recovery of sufferers from narrowly framed mental symptoms and develop everyday coping potentials via finding variable processes as observed in the unique space.
      • Comparative researches are needed e.g. via cases in Italy (after Franco Basaglia)
    • Summary and future scope for personhood, ratinality and the senses
      • shamanisitc trans bodily experiences from the perspective of empirical sensory anthropology ( cf: Paul Stoller, 1995 Embodying Colonial Memories)
      • Also with regards to schizophrenic split experiences in the sensory perspective
      • Further accumulation of ethnographic studies on formation and changes of the culture of the disabled via self-help group.
    •  
    • Stages in medical anthropological research
      • Allan Young 2007:
      • III:   Ethnomedicine
    • Background of My Research (1)
      • Indigenous Healing Rituals:
      • -- Culture & Healing, Ethnomedicine< II~III stage (Allan Young)
      • Transformation of Indigenous Healers
      • -- Globalization, Transcultural Psychiatry, bicultural healer-performers,
      • Interwining reflexive
      • Predicaments of Political Tortured Refugees, Their Trauma
      • Personhood, Body, and Split Experience
    • I. Outline: Cultural anthropological approaches to logic/sensibility & reason/emotion
      • Classical & orthodox approaches: cultural variations or socio-culutral construction of folk models and idioms
      • -each culture has its uniquenss
      • - “ primitive” (small-scale socieites) vs civilized :: witchcraft ( the Azande: E.E. Evans-prichard 1937)~ rationality dibate
    • Outline (continued)
      • Changes in mini-paradigms~ coexisting alternative approaches: e.g. Neuroanthropology
      •   Intercultural encounters between   2 or more cultures~ towards network rather than localized sites of encounters ( complexically skewed reflexivity, appropriation) : situated reasoning & symbolic dealing with incongruities; e.g. ritual and play: the Mubti
      • Minds in indigenous peoples as well as in modern scientists. Social and cultural epestemologies (Allan Young)
    • I(2) continued outline
      • Distribution of different “minds,” in the same person: insanity? Multiple personalities? Or the states for a possible integration towards a new personhood. Reason & Emotions
      • Personhood vs personality
      • - mediates or integrates bodily sensations, physical states and thinking, ethonomical reactions -> Embodiment
      • - e.g. transformed forms of emotions via cultural personhood
    • continued outline I(2)
      • Shaministic trance, training to trans sessions.
      • Schizophrenic split personality: hallucinatory senses or sensations (visual or auditory)
      • In both cases, there are usualphysical-sensory processes that unmake an integrated every experiential world
    • I (3) continued outline
      • Inter- or multi-cultural interfaces~ bilingual/multi-lingual, code-switching patterns in differently situated logic & sensibility.
      • Changes of psychiatric therapy sessions : e.g. Ethnopsychiatry; Extension of Morita therapy : modification of the concept of culture
      • E.g. Self-help groups for searching new or combined medical practice inserted in-between meical insitutions, patients, families, and supporting members.
    •  
    • Performers in Trance? One’s soul –self sees one’s dance while dancing Maureen Flemming: Slow Dance + Butoh Oriented Dacne
    • Ohno Kazuo ……..Min Tanaka
    • Australina performing artist Stelarc
    • Hôpital    Avicenne service de psychopathlogie
    • continued I (3)
      • both needs a stable positive group support for not negating unusual sensory experiences that unmake foregoing integrative aspect of personhood with discrepancies of differently situated logics and sesitivity together with
      • intermediate (sub) cultural formation for a supportive space: cultural formation for the world of the “disabled” ->    develop several different stages; cultural changes
    • II: Outline of different approaches in Cultural, Cultural-Meidical ) Anthropology including the issue on Logic and Sensitivity
      • Positivist-biomedical approach
      • Cognitive anthropological approach
      • Interpretive-phenomenological
      • Critical-deconstructive
      • -- integrated approach is important
      • -- even if with some inner-contradictions: OK in the transitional period
    • II: Outline of different approaches in Cultural, Cultural-Meidical ) Anthropology including the issue on Logic and Sensitivity
      • Medical Anthropology has developed several different research orientations in response to its practical applied missions.
      • To take one perspective focusing on epistemological analysis of different medical anthropological paradigms, there have been those orientations ranging from empiricist,-rationalist, cognitive, interpretive, and critical approach.
      • Or, those from the undifferentiated medical interest in anthropology during its founding period, the focus on folk healing, the ethnomedicine model, and the newly appeared focus on efficacy would be recognized, with a historical perspective concerning the development of medical anthropological models.
      • The issue on the recent tendency for the separation of cultural and medical anthropology aside, there have been important interactions between medical/cultural anthropology, sociology, and cross-cultural/transcultural psychiatry;
      • however, the intrinsic focus on “culture” in medical aspects of human suffering and healing practices requires the unique perspective inherent in anthropology.
    • continued outline II
      • Medical Anthropology has developed several different research orientations in response to its practical applied missions.
      • To take one perspective focusing on epistemological analysis of different medical anthropological paradigms, there have been those orientations ranging from empiricist,-rationalist, cognitive, interpretive, and critical approach.
    • continued
      • Or, those from the undifferentiated medical interest in anthropology during its founding period, the focus on folk healing, the ethnomedicine model, and the newly appeared focus on efficacy would be recognized, with a historical perspective concerning the development of medical anthropological models.
    • continued
      • The issue on the recent tendency for the separation of cultural and medical anthropology aside, there have been important interactions between medical/cultural anthropology, sociology, and cross-cultural/transcultural psychiatry;
      • however, the intrinsic focus on “culture” in medical aspects of human suffering and healing practices requires the unique perspective inherent in anthropology.
    • i: Ethnomedical belief vs medical knowledge: what underlies in the evidence based medical approach
      • Illness > folk “ belief ” system vs biomedical “ knowledge ” – emic<etic ->the phenomenological body as appeared in suffering ~existential
      • cross-cultural/comparative orientation within empiricist paradigm – embodied experiences of patients (of different cultural backgrounds) are not approachable -> cultural relativism reconsidered ->   the transcultural phase~ medical pluralism
      • Individualism-rational man idea behind apparent cross-cultural orientation: a set of analytic idioms such as -- health seeking behavior -> the form of socialty ~the social body+the political body ~intersubjective & negotiated
    • ii: the integration of interpretive and critical approach: its implication
      • illness( personal)/ sickness(social relations) cf: disease
      • The issue on locally variable practices that tend to be ignored by critical approach.
      • Dialectics between the personal and the social
      • How to understand different forms of medical (indigenous) knowledge via empirical/experiential :explanatory models/proto- types
      • Semantic network analysis (B.J.Good)
      • Transcultural/Multi-cultural turn: The problem of cultural mediator (medical interpreter)
    • iii: The Interpretive and Critical approach McGill – Keio affiliation[ Examples: recent seminars and symposia in medical anthropology at Keio University]
      • Allan Young ’ s seminars, July, 2007
      • Ellen Corin ’ s seminars, March, 2008
      • Laurence J. Kirmayer ’ s seminars, July, August, 2008+ Feb.2009
      • Margaret Lock ’ s seminars, January, 2009
      • Cf: Karl Heider ’ s seminar, August, 2010
    • 文化医療臨床人類学の新展開 ――人類の論理・感性/精神研究の融合領域におけるその位置
      • ―― アラン・ヤング教授を迎えて「 PTSD 」、「論理と感性、社会的脳」、「先端医療と文化」を考える。 
      • 日時: 2007 年 7 月 29 日(日曜日)    10:00 ~ 18:00
      • 場所: 慶應義塾大学・三田校舎・東館6階 G-SEC LAB  
      •    <研究セミナー>
      • 基調講演 Allan Young (McGill University),  Professor of Cultural and Medical Anthropology 講演題  Changing Perspectives on Mind, Brain, and Empathy: Implications for Understanding the Intersection of Reason and Emotion I. 
      • PTSD の医療人類学 ・江口重幸 ( 東京武蔵野病院・文化精神医学、臨床人類学)( Trauma, Narrative, and 'fonction fabulatrice' of Janet:
    • 京都大学・慶應義塾大学 COE 合同シンポジウム 心・病・文化―医療をめぐる文化と倫理
      • 京都大学 百周年時計台記念館
      • 2009 年 1 月 11 日(日) 12:30-16:30
      • コメンテーター 京都大学教育学研究科  鈴木晶子 教授
      •         慶應義塾大学文学部   宮坂敬造 教授
      • 講演 マーガレット・ロック教授  (カナダ マギル大学 医療人類学)
      •            「生命医学テクノロジーの発達に伴う自己と社会の変容の姿 -- 医療人類学の視点より」                    
      •             The Potential Transformations of Self and Society through   Biomedical Technologies:            Perspective from Medical Anthropology    通訳 北中淳子准教授
      •         (慶應義塾大学文学部 医療人類学)
      •           
    • <文化と医療>再考  人類学と文化精神医学の相互関与性の現在 主催・企画:慶應義塾大学・    相互的感情身体知の文化医療人類学・人間科学研究会    (人文グローバル COE 哲学文化人類学班) 共催:日本文化人類学会関東地区研究懇談会 ・日時: 2 月 25 日(水) 第 I 部/ 15:30 ~ 17:00  第 II 部  18:15 ~ 20:00 ・場所: 慶應義塾大学・三田キャンパス:・東館 4 階 G-SEC セミナー室  アクセス地図   http://www.keio.ac.jp/access.html ・会費:無料・事前登録不要 ・ 問い合わせ連絡先:慶大・人間科学・宮坂敬造  FAX03-5427-1578 <演者> ・ Laurence J.Kirmayer (マッギル大学 文化精神医学)   “ Cultural psychiatry, medical anthropology and the challenges of interdisciplinarity ” ・ 清水透 (慶應義塾大学 ラテン・アメリカ社会史)   「呪医と村人、そして私 ラテン・アメリカ社会史研究から医療民族誌へ、   そして現代医療の諸問題へ」 ・ 波平恵美子 ( お茶の水大学名誉教授 医療人類学)  「日本における文化と医療の研究 医学史から医療人類学まで」 <コメンテーター> ・ 宮地尚子 (一橋大学 文化精神医学・医療人類学) ほか <司会・問題提起> ・ 宮坂敬造 (慶応大学 文化人類学)) ・通訳: Mohacsi Gergely (東京大学  STS 医療人類学ほか
    • III. Brief Sketch on the impact on medical anthropology by actual missions for medical aids for minority-ethnic immigrants, refugees, and needs in developing nations
      • In North America in 1960s, the necessity for medical aids for ethnic minorities and immigrants of variable cultural traditions encouraged practical missions for distributing medical resources for the peoples, and accordingly, the folk belief system and the ethnomedicine model were applied to mediate in practical procedures between medical professions in mission and the peoples ’ health seeking behavior. The then trend became one of the primary movers for differentiating medical anthropology as a newly labeled independent area of study from cultural anthropology per se.
      • In the case of Japan, the interest with using medial anthropology for medical aids and services has been developed in particular in response to the increase of resident workers from abroad in 1900s ( due to the Japanese governmental policy for immigration, largely, those of Japanese extraction from South America), which has resulted from the accelerated globalization process on world-wide. With the recognition of increasing necessity for international medical aids toward developing areas of the world, Japanese contributions also have begun to pursue with committed missions in relation to governmental aids and NPOs ’ orientations toward the medial contribution.
      • The rise of transcultural psychiatry in Japan should also be noted in this regard.
    •  
    •  
    • i: in 1980s & in 1990s
      • Impact of accelerated globalization in 1990s and awareness of “ global health perspective. ” necessity for new forms of medical aids->   the change of theoretical orientations ->postcolonial, postmodern, ethnoscape, etc. focus on reflexive processes in multicultural/hetero-glossia situations. Multi-sited fieldwork.
      • Impact of the change of (cultural anthropological theoretical innovations. cf: M. Fisher vs A.Kuper.
      • Research on advanced medical technology ->research on medicine under the rubric of anthropology of science and technology
    • V: Significant medical anthropological issues: research on Medical experience in-between biomedical cares and cultural illness
      • the issues on the unmediated transplantations of North American (folk) models
      • Self help groups, and supporting groups.
      • -- partnership model / auxiliary model
      • Local variation of the (formative) roll of patient organizations and self-help/supporting groups
      • the importance of an anthropological focus on locally varied socio-cultural orientations and practices which are to be reflected in the variable relationships of medical doctors, cross-cultural patients, and supporting groups.
      • Focus on mediating processes in-between biomedical cares and cultural illness as found in self-help/supporting groups
    • i: part of relevant research
      • the case of alcoholic Anonymous: e.g. Hit Bottom Experience; 12 steps~ recognizing a greater power
      • --the issue on emotions
      • -- the model of alcoholic self by Gregory Bateson to be reconsidered.
      • -- local variations as to the organizational features of self-help/supporting groups, including their consequent role ambiguities
      • -- the base of the latent framework of interaction
      • cf: talking circle. gender-issue.
      • “ appropriation ” of healing rituals/and therapies: reflexivity
      • -- e.g. Naikan therapy etc.
    • VI: “ temporary ” significance of an intermediate approach:
      • The recent situation for practical medical aids in Japan would reveal similarities with that of North America in 1960 partly, but also contain more complicated global issues: global-local + global health
      • to reconsider the relevance of theoretical medical anthropology to the issues on practical medical aids:   an intermediate approach focusing on multicultural medical pluralism via the research on the interacting plural medical systems of knowledge as are observed in developed and developing areas:
      • cf.   Additional practical methodologies such as recent scaling techniques developed in the version upped cognitive anthropology
      • a part of the aspects of uniqueness in the case of recent Japanese socio-cultural experiences in medical aids ->   support groups & inter-group phase ->future impact
    • Medical anthropology: concise view
      •   Medical Anthropology has developed several different research orientations in response to its practical applied missions. To take one perspective focusing on epistemological analysis of different medical anthropological paradigms, there have been those orientations ranging from empiricist,-rationalist, cognitive, interpretive, and critical approach. Or, those from the undifferentiated medical interest in anthropology during its founding period, the focus on folk healing, the ethnomedicine model, and the newly appeared focus on efficacy would be recognized, with a historical perspective concerning the development of medical anthropological models. The issue on the recent tendency for the separation of cultural and medical anthropology aside, there have been important interactions between medical/cultural anthropology, sociology, and cross-cultural/transcultural psychiatry; however, the intrinsic focus on “ culture ” in medical aspects of human suffering and healing practices requires the unique perspective inherent in anthropology.
    • Continued
      • In North America in 1960s, the necessity for medical aids for ethnic minorities and immigrants of variable cultural traditions encouraged practical missions for distributing medical resources for the peoples, and accordingly, the folk belief system and the ethnomedicine model were applied to mediate in practical procedures between medical professions in mission and the peoples ’ health seeking behavior. The then trend became one of the primary movers for differentiating medical anthropology as a newly labeled independent area of study from cultural anthropology per se. In the case of Japan, the interest with using medial anthropology for medical aids and services has been developed in particular in response to the increase of resident workers from abroad in 1900s ( due to the Japanese governmental policy for immigration, largely, those of Japanese extraction from South America), which has resulted from the accelerated globalization process on world-wide. With the recognition of increasing necessity for international medical aids toward developing areas of the world, Japanese contributions also have begun to pursue with committed missions in relation to governmental aids and NPOs ’ orientations toward the medial contribution. The rise of transcultural psychiatry in Japan should also be noted in this regard.
    • Summary and future scope for personhood, ratinality and the senses
      • shamanisitc trans bodily experiences from the perspective of empirical sensory anthropology ( cf: Paul Stoller, 1995 Embodying Colonial Memories)
      • Also with regards to schizophrenic split experiences in the sensory perspective
      • Further accumulation of ethnographic studies on formation and changes of the culture of the disabled via self-help group.
    • --shapes how individuals and families cope with illness --influences the clinician-patient relationship --determines the values that underlie medical decision-making cf: the shift of analytical meaning in the concept of culture
      • At this developing period regarding the recent Japanese situation, accomplishment contrasts conception and accordingly, the intermediate approach that concerns a critical relationship between practically oriented empiricist and critical interpretive approach will be pronounced by evaluating its own dialectical tension.
      • The above recent situation for practical medical aids in Japan would reveal similarities with that of North America in 1960 partly, but also contain more complicated global issues. Given this, I would like to reconsider the relevance of theoretical medical anthropology to the issues on practical medical aids by taking into account a part of the aspects of uniqueness in the case of recent Japanese socio-cultural experiences in medical aids: the issues on the unmediated transplantations of North American (folk) models, by taking the case of alcoholic Anonymous and else, will be dealt with in relevance to patient organization and self-help/supporting groups, as well as to the importance of an anthropological focus on locally varied socio-cultural orientations and practices which are to be reflected in the variable relationships of medical doctors, cross-cultural patients, and supporting groups.
      • The features of the developing processes of Japanese medical aids both within and outside Japan will be beneficial not only for practical accomplishment but also for appropriate productive interaction between theoretical orientation and its applicability in medical anthropology.
    • I: Cultural Relevance to Health care
      • ethnicity, psychopathology & illness behavior
      • cultural diversity and health disparities
      • Culture--accounts for significant disparities in every society
      • --influences the symptoms, course and outcome of disease
      • --determines help-seeking, clinical presentation
    • IV: Sketch on theoretical,clinical variations of transcultural/cross cultural psychiatry with reference to locally based research/clinical groups
      • Montreal: transcultural psychiatry 1956,7 at McGill. Medical anthropology at McGill. Girame
      • Vancouver: Psychiatric hospital, Vancouver Associations for Survivors of Torture
      • Toronto: Canadian Centre for Victims of Torture, St.Johns Hospital
      • London:Centre of Psychiatry Wolfson Institute of Preventive Medicine
      • Paris: Hopital avicenne service de psychopathologie
      • Geneva: Jacque Arpin
    •  
    •