Abstract
Published over half a century ago by one of psychiatry’s most lucid expositors of ideas, Henri F. Ellenberger’s ‘Ethno-psychiatrie’ (1965–67) was the first French-language treatise dedicated to examining the complicated role of culture in mental health. Ellenberger’s writings on ethnopsychiatry, which appeared as a series of articles in the specialized medical collection Encyclopédie médico-chirurgicale, are as brilliantly synoptic as one would expect from the future author of The Discovery of the Unconscious (Ellenberger, 1970). Like that encyclopaedic work, the book Ethno-psychiatrie teems with detailed description drawn from a wide range of primary sources in the medical and social sciences. Ellenberger – born to missionaries in colonial Rhodesia, trained in medicine and ethnology in France, active in Swiss psychiatric circles and, from 1953, a researcher and clinician in North America – was ideally suited to accomplish such a comprehensive and multilingual undertaking. As early as 1967, reviewers from Paris to Montreal demanded that Ellenberger’s articles be expanded and republished in a more accessible volume. Fifty years later their wish has finally been fulfilled with the publication of Ethno-psychiatrie, a sleek and smartly conceived new edition of Ellenberger’s work that features an extended introduction by Emmanuel Delille.
‘Ethnopsychiatry is the study of mental afflictions in accordance with the ethnic or cultural groups to which patients belong’ (p. 119). With this concise definition, Ellenberger distinguished ethnopsychiatry from related pursuits in the post-war human sciences such as cultural anthropology and social psychiatry. Ever the historian of psychiatric ideas, Ellenberger then surveyed the discipline’s long prehistory, unearthing an ancestry of ethnopsychiatry in ancient Greek medicine, Renaissance travel literature and colonial psychiatry. But Ethno-psychiatrie mainly examines how ethnopsychiatrists have contended with some of the field’s most fertile clinical and theoretical problems, including cultural relativism, collective psychoses, pathogenic cultural influences, cultural specificity in mental illness, and the entanglement of biological and cultural factors. A theme across each of these inquiries was Ellenberger’s recognition of the correlation between rapid cultural transformations and increased rates of mental disturbance. Thus, joined to his enthusiasm for recent developments in ethnopsychiatry was an urgent awareness of the detrimental effects on mental health caused by the enormous increase in excitation, deracination and cultural disintegration characteristic of twentieth-century life.
Emmanuel Delille’s 92-page introduction is a tour de force of contextualization. In lieu of imagining Ellenberger as some sort of solitary pioneer, Delille demonstrates that there is much to be gained from telling the history of ethnopsychiatry as a story of scholarly sociability and circulating knowledge. Marshalling archival sources and a sizeable secondary literature, Delille organizes his wide-ranging setting around one large narrative: there was a 21-year transition (1945–65) from ‘exotic’ colonial psychiatry to ‘academic’ cultural psychiatry, and Ellenberger’s treatise marked the dénouement of that change. Hence, Delille’s introduction is animated by the conviction that, after Ellenberger’s move to North America in 1953, the transnational networks at the Menninger Clinic and McGill University led to a real intellectual and methodological maturation in his thinking. It should be noted that Delille argues for this transition without shirking questions of how colonial discourses and Eurocentric perspectives often persist in post-colonial practices; however, the questions posed are more satisfactory than their answers, which roam widely and transition abruptly from one context to the next. It is also worth noting that those less enthralled with network analyses will at times feel bludgeoned by how often psychiatrists are cast as ‘actors’ and ‘intermediaries’, universities as ‘spaces of communication’, academic disciplines as ‘linked fields’, and knowledge as ‘transversal’ and ‘globally mobilized’. But regardless of one’s views on method, Delille’s many contexts, which he continues to layer in judicious editorial notes throughout Ellenberger’s Ethno-psychiatrie, will prove of interest to historians of psychiatry and the broader human and social sciences.
Following Delille’s substantial introduction and Ellenberger’s original articles, Ethno-psychiatrie adds four appendices of previously unpublished archival material. Most noteworthy are Ellenberger’s lecture notes on a case of peyote addiction and his correspondence with fellow ethnopsychiatrist Georges Devereux. In fact, the Devereux–Ellenberger relationship is a thread running through all three parts of Ethno-psychiatrie. Defining their relationship is a source of constant tension in Delille’s introduction, as he oscillates between advancing a vast network of like-minded academics and his desire to clearly delineate Ellenberger’s didactic aims from Devereux’s psychoanalytic inclinations. Meanwhile their 21-year epistolary exchange (1954–74) reveals that, in addition to finding each other scrupulous readers, they each sought to formulate precise definitions for the nascent discipline. As for the case of a 67-year-old Kickapoo patient suffering from a rare addiction to peyote, Ellenberger’s insistence on the psychiatric importance of popular beliefs, antagonistic acculturation and the enduring rites of a supposedly archaic indigenous religion mirrored themes in Devereux’s own ethnopsychiatry. Moreover, Ellenberger – who recognized in Devereux’s work not just a recuperation of an indigenous mental health system, but a double diagnostic rooted in local and transcultural psychiatric knowledge – turned to Devereux’s Mohave Ethnopsychiatry (1961) at a critical juncture to support his contention that, while symptoms and rates of frequency were continually mediated by cultural factors, the general processes of mental illnesses were fundamentally the same the world over (p. 135).
This book is an important addition to literature on and by the Swiss historian of psychiatry, Henri F. Ellenberger. It represents a renewed interest in him by a new generation of scholars and a growing appreciation for his work on ethnopsychiatry. When, in the early 1990s, Mark Micale (1993) showed Ellenberger to be an exemplar in the cultural history of psychiatric ideas and Elisabeth Roudinesco (1994) read Ellenberger in relation to French Freudianism, they summoned the Swiss psychiatrist to then burgeoning histories of psychiatry and psychoanalysis. Ethno-psychiatrie presents yet another dimension of Ellenberger’s thought and calls for a reappraisal of his eclectic oeuvre. Moreover, with its emphasis on cultural values and local ways of life, Ellenberger’s Ethno-psychiatrie provides real insight into the challenges involved when one takes up the imperative to consider cultural diversity in psychiatric practice. As Ellenberger recognized long ago, ‘the usefulness of ethnopsychiatry is at once of a theoretical and practical order’ (p. 121, original italics).