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Henri Ellenberger, Ethno-psychiatrie

Alice Feyeux (English translation)
Traduction de Avril de Goer-de Herve et Eliza Staples
Cet article est une traduction de :
Henri Ellenberger, Ethno-psychiatrie
Ethno-psychiatrie
Henri Ellenberger, Ethno-psychiatrie, Lyon, ENS Éditions, coll. « Sociétés, espaces, temps », 2017, 245 p., Édition critique d'Emmanuel Delile, ISBN : 978-2-84788-931-4.

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Notes de la rédaction

Review translated by Avril de Goer de Herve (ENS de Lyon) and Eliza Staples (Columbia University, Barnard College), as part of the Transatlantic Collaborative Translation Workshop between Barnard College-Columbia University and the École normale supérieure de Lyon. Supervised by Professors Laurie Postlewate (Barnard-Columbia) & Layla Roesler (ENS de Lyon).

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  • 1 Launched in 1929 and edited by Elsevier Masson, the Medico-Surgical Encyclopedia is one of most imp (...)
  • 2 Its main representatives are Wilhelm Wundt (1832-1920) and Abel Miroglio (1895-1978). Wundt sought (...)
  • 3 As Emmanuel Delille notes, Roger Bastide himself distinguishes ethnopsychiatry from his sociology o (...)

1The current edition of Ethnopsychiatry includes the installments that Henri Ellenberger created for the “Treaty on Psychiatry” in the Medical-Surgical Encyclopedia in 1965 and 19671. It also includes documents from the author’s archives, including first drafts and excerpts from his correspondence. Emmanuel Delille proposes here a critical edition of Ethnopsychiatry which highlights “the role of actors and of scientific networks” (p. 10) in the genesis of these texts. This work is one of the first French-language syntheses of ethnopsychiatry, which Ellenberger defines as “the study of mental conditions as a function of ethnic and cultural groups the patients belong to” (p. 119). The discipline of ethnopsychiatry occupies a middle ground between ethnology and psychiatry. It is distinguished from social psychology, which seeks to determine the subconscious processes that guide every individual’s behavior2. Ethnopsychiatry also differs from cultural anthropology, a branch of ethnology (without a medical component) that developed in the 1930s. It also differs from social psychiatry, i.e. “the study of mental illnesses as a function of the social (rather than ethnic) groups that the afflicted persons belong to” (p. 119). While Ellenberger addresses the role of social groups in his investigation, his study remains different from Roger Bastide’s study of the sociology of mental illnesses, as the two authors do not share the same postulates3.

  • 4 This is a people of present-day Russia. “Scythian disease” is mentioned in the treatise Air, Waters (...)
  • 5 Kraepelin, for example, studies the Javanese categories of “latah” and “amok”. The former is a loca (...)
  • 6 Mead Margaret, Mœurs et sexualité en Océanie, Paris, Terre Humaine, 1963 (trans. Georges Chevassus)
  • 7 Ruth Benedict, Patterns of Culture, Boston, Houghton Mifflin, 1934.
  • 8 Transcultural psychiatry is the English translation of “ethnopyschiatrie”. Ellenberger considers th (...)
  • 9 Latest edition (2013) of the American Psychiatry Association's Diagnostic and Statistic Manual of M (...)
  • 10 Berserker fury affected medieval Scandinavian warriors, who during fits of rage, deployed a superna (...)
  • 11 Psychiatrist Shoma Morita made the first clinical description of this condition. This neurosis affe (...)
  • 12 Though Ellenberger distinguishes social psychiatry from ethnopsychiatry, he still maintains that be (...)
  • 13 Among the culturally-specific neuroses identified by Ellenberger, one can consider the “cleaning ne (...)

2Ellenberger finds one of the first forms of ethnopsychiatry to be contained in the Hippocratic Corpus. The “Scythian disease”4 was a diagnosable and recognized form of “transvestism”, rebuked by the Greeks at the time. Medieval and classical literary texts similarly contain references to psychological conditions specific to certain cultures. But, with the development of colonial-era psychiatry in the nineteenth century came the first systematic descriptions of non-Western psychological conditions5. Cultural anthropologists such as Margaret Mead6 and Ruth Benedict7 also provided ethnopsychiatry with key concepts by linking the notion of “base personality” (that is, the shared character shaped by education) with the frequency and types of neuroses and psychoses. Ellenberger was a member of the group for transcultural psychiatric studies8 founded at McGill in 1956 in conjunction with the bi-annual journal, Transcultural Psychiatric Research. This journal assigned a goal that was both theoretical and practical to the field of ethnopsychiatry: analyzing the role of ethnic factors in the origin of mental conditions and completing the existing symptomatology so that psychiatrists working in a population different from their own might avoid errors. Ellenberger’s text develops these two objectives. From a theoretical and general perspective, he first tackles the issue of cultural relativism. According to Ellenberger, there exist cases of “complete madness” (p. 128) – psychological conditions, such as idiocy, advanced dementia, and severe delusions that “all populations” consider as pathological. However, for cases of “partial madness”, the idea of normal and pathological causes sometimes gives way to that of supernatural causes. Furthermore, it is impossible to identify cultural invariants in the attitudes towards and the social statuses of psychological abnormalities. Secondly, there is the issue of culture-specific psychological conditions referred to as “culture-bound syndromes” by the DSM-59. For the author, there only exist local instantiations of universal psychological conditions. The specific attributes of these local instances are explained by the degree of tolerance for these conditions within the group and ceremonialization around them. For example, “Berserker fury”10 and “running amok” are both deemed variations of the same phenomenon: a sudden impulse towards mass murder. Similarly, Ellerberger associates the “taijin kyōfushō”11, a form of neurosis diagnosed in Japan, to psychasthenia and the “need for direction” identified by Janet. The third field of study in ethnopsychiatry investigates the differentiation of mental conditions within a given ethnic group based on gender, social class12, urban or rural living environment, or belonging to a marginalized group (such as a sect). Ethnopsychiatry also focuses on pathogenic cultural factors: in a given culture, which factors favor or suppress the onset of psychological conditions? To answer this question, one must first exclude factors that are not unique to a culture (genetics, climate, nutrition, demographics, etc.). Ethnopsychiatristy can then focus on the psychosocial pressure faced by some groups (such as women13), collective attitudes towards children, and the cultural changes that can cause familial norms and the norms of the outside world to clash. Separating biological factors from cultural factors constitutes the last part of research. Increasing life expectancies, for example, gives rise to an increase in occurrences of new conditions that have both social and biological traits, such as senile dementia.

  • 14 Mauss studies a case of mass psychogenic death. The Mariori (a people of New Zealand) were enslaved (...)
  • 15 The author proposes a limited definition: a mass psychogenic disorder affects anywhere from a dozen (...)
  • 16 Le Bon Gustave, La psychologie des foules, Paris, Alcan, 1895.

3From a practical or clinical point of view, the mental conditions listed by Ellenberger can be divided into three groups: those with known organic causes, those without known organic causes, and cases of mass psychogenic disorders. The first group is of interest to ethnopsychiatry because its symptomatology is shaped by social factors. With regard to drug and poison consumption, cultural factors influence the choice of intoxicant: why that choice is opium in China and alcohol in France calls for study. Ellenberger classifies those conditions without a known organic cause and which have culturally identifiable forms: these include conditions like depression and less widespread conditions, like rapid-onset psychogenic death. With respect to this condition, he invokes the works of Mauss (1926) who demonstrated that psychogenic death could be the result of the violation of a taboo14. Mass psychogenic disorders15 can be broken down into six forms: collective hallucinations and panics, mass hysteria, riots, mass crime, and widespread epidemics of self-harm. With regard to the first of these six forms, Ellenberger revisits the example developed by Gustave Le Bon (1895)16: in 1846, while searching for another vessel, crew members aboard the frigate Belle Poule mistook floating branches for drowning men. Rather than reading this instance as a sign of regression and crowd blindness, as Le Bon did, Ellenberger instead tries to explain this phenomenon by examining social and biological causes: the physical exhaustion of the sailors, a latent depression linked to preconceived notions, various sensory factors, the role of the lookout in the confusion, etc.

  • 17 Douyon reports that his image test series contain voodoo ritual symbols, which blurs the traditiona (...)
  • 18 Freud Sigmund, “Totem et Tabou” [1913], in Œuvres complètes de Freud / Psychanalyse, Volume XI, p.  (...)
  • 19 Delille recalls Devereux uses the term “ethnopsychoanalysis” more than “ethnopsychiatry” and thus d (...)
  • 20 Ellenberger summarizes Devereux’s thoughts thus: “any mental condition in a Mohave person is as a r (...)
  • 21 Among the archives Delille consulted, is a study conducted by Ellenberger of a Mohave man. The man (...)
  • 22 Delille, referring to the foundational works of Edward Saïd, characterizes Orientalism as “a body o (...)
  • 23 Bullard Alice, “Imperial networks and postcolonial independence. The transition from colonial to tr (...)
  • 24 24. At that time it was still represented by authors such as Henri Aubin, who were well established (...)

4In the end, despite having provided detailed documentation, the author hardly addresses the ethnopsychiatric method at all. He does, however, note three difficulties related to its implementation. The first difficulty relates to “the situation of the psychiatrist” confronted with a language and a mentality that are not their own. Besides the fact that emotions are put into words differently in different languages, the patient might not necessarily be accustomed to introspection or reciting their family history. This leads to a second difficulty: psychologists must be able to adapt their role to meet their patients’ expectations. Ellenberger cites the works of Emerson Douyon (1964), a Haitian psychologist whose clients expected him to play the role of a voodoo witch doctor17; unfortunately, however Ellenberger does not detail the methods allowing the adaptation of his routine psychotherapeutic practices to different local contexts. A third difficulty concerns the theoretical side of ethnopsychiatry. Here, the primary data consists of in situ observations by a third party, often an ethnologist, which the psychiatrist must consider with a critical eye. For example, Ellenberger distances himself from what he calls “exotic psychiatry”, which relies on often scientifically weak observations made by colonial physicians. He is also critical of the theories Freud developed in Totem and Taboo18, which are not based on any empirical evidence. Although he mentions among his sources Georges Devereux, another prominent figure in ethnopsychiatry19, Ellenberger nonetheless rejects the universal claims of Devereux’s psychoanalytic approach. Whereas Devereux diagnosed mental conditions amongst indigenous Mohave people as neuroses or Freudian psychoses (1961)20, Ellenberger’s analysis is based on socialization and double personality21. Still, Ellenberger does not escape the very biases that he identifies. One reason for this, among others, is that he remains bound to the results of the very colonial-era psychiatry which he criticizes, and he uses a heavily ethnocentric vocabulary — the author calls many non-Western populations “primitive peoples”. Moreover, many of his sources have an Orientalist influence22. This is what causes Emmanuel Delille to apply the analytical framework of Alice Bullard23 to Ellenberger’s text, which he [Delille] believes belongs to a “transitional context” between exotic psychiatry24 and the emergence of transnational academic resources. The texts “escape the canon of colonial medicine, but do not yet belong to a well established academic discipline.” (p. 12). Nevertheless, the small number of anthropologists present in the McGill research group up until the 1980s leads one to think that ethnopsychiatry still suffers from the lack of an interdisciplinary dialogue, which would provide the discipline with both more material and more reflexivity.

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Notes

1 Launched in 1929 and edited by Elsevier Masson, the Medico-Surgical Encyclopedia is one of most important professional reference works for the entire French-speaking medical field.

2 Its main representatives are Wilhelm Wundt (1832-1920) and Abel Miroglio (1895-1978). Wundt sought to determine general psychological laws which would erase the national and local differences between peoples. Miroglio, however, noted psychological traits specific to Western people based on racial theories, which contributed to his marginalization. His journal Ethno-psychology: journal of peoples’ psychology, which was published in post-war France, did not impact the field greatly.

3 As Emmanuel Delille notes, Roger Bastide himself distinguishes ethnopsychiatry from his sociology of mental conditions. Primarily, because of his aversion for some psychiatrists' non-systematized accounts, more fundamentally, however, he believed that the process of socialization was the explanatory principle that determined the variability of mental conditions and hence acted as a “sociological rule” (p.  280). Yet, Ellenberger does not aim to draw general rules as much as to avoid diagnostic errors resulting from the lack of consideration of cultural and social dimensions of illnesses. Furthermore, Bastide rejects ethnopsychiatrists who view intercultural contact as an unavoidable source of instability and a vector of mental conditions or of a transformation of symptoms. Bastide Roger, Le rêve, la transe et la folie, Paris, Éditions du Seuil, 2003 [1972].

4 This is a people of present-day Russia. “Scythian disease” is mentioned in the treatise Air, Waters, and Places. Observations related to this illness date back to the fifth century B.C. Hippocrates, Des airs, des eaux, des lieux, Œuvres complètes vol. 1, Paris, Javal et Bourdeaux, 1932.

5 Kraepelin, for example, studies the Javanese categories of “latah” and “amok”. The former is a local form of hysteria which primarily afflicts women and is characterized by a person's uncontrolled imitation of the behavior of people around them and a boundless obedience to orders. “Amok” is a male, murderous, fury, which does not cease until the target is defeated. Kraepelin Emil, “Vergleichende Psychiatrie”, Zentralblatt für Nervenheilkunde und Psychiatrie, vol. 11, n° 2, 1904, p.  433-437 and 468-469.

6 Mead Margaret, Mœurs et sexualité en Océanie, Paris, Terre Humaine, 1963 (trans. Georges Chevassus).

7 Ruth Benedict, Patterns of Culture, Boston, Houghton Mifflin, 1934.

8 Transcultural psychiatry is the English translation of “ethnopyschiatrie”. Ellenberger considers the terms synonymous.

9 Latest edition (2013) of the American Psychiatry Association's Diagnostic and Statistic Manual of Mental Disorders.

10 Berserker fury affected medieval Scandinavian warriors, who during fits of rage, deployed a supernatural energy and became “wild beasts”, killing great numbers of foes in a short amount of time.

11 Psychiatrist Shoma Morita made the first clinical description of this condition. This neurosis affects individuals with an excessive fear of offending or inconveniencing others. Morita relates the etiology of the disorder to a common hypochondriac tendency, the taroté, which refers to the patient’s ongoing concern for his health, but also for the slightest actions of those around him. Morita Shoma, Morita therapy and the true nature of anxiety-based disorders (shinkeishitsu), Albany, NY, State University of New York Press, 1998 (trans. Akihisa Kondo).

12 Though Ellenberger distinguishes social psychiatry from ethnopsychiatry, he still maintains that belonging to a social class can be considered as belonging to a “subculture” (p.  155). He relies on studies by Hollingshed and Redlich, who conducted an investigation of all psychiatric cases treated in 1950 in hospitals of New Haven, US. The patients were split into five social classes based on their wealth (a criterion which suggests a questionable view of social class). The higher the social class, the higher the number of treated neuroses. “Patients belonging to higher social classes are preferentially treated with long-term psychotherapy, those of lower social classes with shock therapy or medication” (p. 155). Hollingshead August and Redlich Frederick, Social Class and Mental Illness, New York, Wiley, 1958.

13 Among the culturally-specific neuroses identified by Ellenberger, one can consider the “cleaning neurosis”, of which the most serious form affects Swiss women. This neurosis is characterized by a need to “clean in an irrational or exaggerated way” (p. 199), whatever the housing size. Though the woman is deemed tyrannical by those who are close to her, her husband is quite content with these excesses: “a characteristic trait is the absolute obliviousness of these women: despite deploring this exhausting work, they still consider it a necessary evil and view themselves as victims who sacrifice themselves for their families. Nothing is more typical than their indignation when it is suggested that this sacrifice is useless […]. No condition in German-speaking Switzerland is harder to treat than a cleaning neurosis because the psychotherapist faces not only the illness’ endurance but also the family’s resistance, and above all the full weight of tradition and cultural values” (p. 199-201).

14 Mauss studies a case of mass psychogenic death. The Mariori (a people of New Zealand) were enslaved and forced to violate their taboos by the Maori in 1835. The Mariori died as a result of this invasion. For Mauss, explanations for this “absolute social fact” can be found in psychology, physiology, and sociology. Marcel Mauss, “Effet physique chez l’individu de l’idée de mort suggérée par la collectivité (Australie, Nouvelle Zélande)”, Journal de psychologie normale et pathologique, n° 23, 1926, p. 653-669.

15 The author proposes a limited definition: a mass psychogenic disorder affects anywhere from a dozen up to millions of people individuals. It differs from individual psychosis and is connected to a phenomenon of “mental contagion” (p.  228).

16 Le Bon Gustave, La psychologie des foules, Paris, Alcan, 1895.

17 Douyon reports that his image test series contain voodoo ritual symbols, which blurs the traditional framework of analysis. Moreover, his clients do not permit him to ask questions but rather expect him to actively participate in the “therapy” as would a houngan (a voodoo ceremonial leader): reading palms, deciphering premonitory dreams, and identifying foes. The notions of psychological stages, IQ, or normality are thus rendered meaningless since the majority of patients are unsuited to tests and analysis.

18 Freud Sigmund, “Totem et Tabou” [1913], in Œuvres complètes de Freud / Psychanalyse, Volume XI, p. 189-387, Paris, PUF, 1998.

19 Delille recalls Devereux uses the term “ethnopsychoanalysis” more than “ethnopsychiatry” and thus differentiates himself from his colleagues on the other side of the Atlantic.

20 Ellenberger summarizes Devereux’s thoughts thus: “any mental condition in a Mohave person is as a result of a double diagnosis, one based on indigenous psychiatric conceptions and one based on our usual nosology”. “Indigenous nosology should not be expected to unveil the existence of any mental illnesses specific to a given culture” (p. 135). Devereux Georges, Psychothérapie d’un Indien des plaines, Paris, Aubier-Fayard, 1998 [1951].

21 Among the archives Delille consulted, is a study conducted by Ellenberger of a Mohave man. The man in question, in his sixties, was hospitalized in the Topeka State Hospital for “alcoholic neurosis”: a type of neurosis which usually appears much earlier in an individual’s life. Ellenberger highlights the blind spots of this diagnosis. Interviews, along with participant observation of magico-religious rituals, reveal the patient’s unique socialization as well as the clinical signs of a “double personality” (a diagnostic category coined by Janet). The patient in question claimed to be a Protestant, which conflicts with his belief in a private Indian religion, whose rites are based on peyote consumption. Ellenberger, drawing on botany and psychopharmacology, demonstrates that in the framework of religious rites, peyote could be addictive – as an ethnologist, he is interested in the link between the sacred and the toxic. No longer able to obtain peyote, the patient seems to have turned to alcohol to satisfy his initial addiction.

22 Delille, referring to the foundational works of Edward Saïd, characterizes Orientalism as “a body of doctrines which aims to establish domination over peripheral and heterogeneous people by reducing them to a fictive savant object, the Orient: at once an absolute otherness, distinct from Western countries, and a fiction completely created by them, out of stereotypical representations and stale metaphors based in inferiority (the Orient as a woman, a child, irrationality, flesh more than spirit, etc., taken in hand by the West, seen as male, mature, rational, and spiritual, etc.)”. Kraepelin's study of latah and amok (1904), cited by Ellenberger), is an example of this type of narrative about the Orient. Said Edward, L’orientalisme. L’Orient créé par l’Occident, Paris, Éditions du Seuil, 2005 [1978].

23 Bullard Alice, “Imperial networks and postcolonial independence. The transition from colonial to transcultural psychiatry”, in S. Mahon et M.Vaughan (dir.), Psychiatry and Empire, London, Palgrave MacMillan, 2007, p. 197-219.

24 24. At that time it was still represented by authors such as Henri Aubin, who were well established in both the French and international fields of psychology. See especially: Aubin Henri, Alliez Joseph, “Socio-psychiatrie exotique”, fasc. n° 37730A10, Traité de psychiatrie, Paris, Éditions techniques (Encyclopédie médico-chirurgicale), 1955, p. 1-8

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Alice Feyeux (English translation), « Henri Ellenberger, Ethno-psychiatrie », Lectures [En ligne], Les comptes rendus, mis en ligne le 03 février 2021, consulté le 08 mars 2021. URL : http://journals.openedition.org/lectures/47251 ; DOI : https://doi.org/10.4000/lectures.47251

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Alice Feyeux (English translation)

Alice Feyeux holds an “aggregation” in economics and is a doctoral student at the University of Paris-Dauphine.

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