Abstract
This work, perhaps the first of its type, is a book-length historical and cultural analysis of psychiatry in modern Iran. It is written by a London-based Iranian physician with specialization in medical anthropology.
The central theme is the ‘medicalization’ of Iranian psychiatry, a process that has also occurred in the rest of the world. Depression (or ‘depreshen’ as pronounced by Iranians without translation) came to mean something broad, a general unhappiness, and was treated with drugs, as in the West. In the last half-century, Iran suffered many obvious social reasons for unhappiness: autocratic monarchy, revolution, civil war, terrorism, a brutal 10-year war with Iraq, international isolation and economic limitation, tension with Israel, and nuclear debate with the USA. There has been a translation of these social forces into a psychiatric interpretation of depression, with drug treatment. Besides Prozac and analogous ‘antidepressants’, the author also describes the rise of the diagnosis of attention deficit disorder, and the use of amphetamines.
In short, as in the USA and the West and much of the rest of the world, Iranian psychiatry medicalized social unhappiness and tried to treat it with pills. Perhaps the most interesting observation here is its very banality: Iran, so exotic and ancient and supposedly different from America, did not differ from the West in how psychiatry functioned within its culture.
In telling this story, Behrouzan provides detailed case interviews of doctors with patients, and brings out the nuances of this process. The oral and written history is interesting and well-documented. There is good original research behind much of the book and it is well-written. The author’s approach focuses on how psychiatric ideas migrated from the clinic into Iranian culture, informing how ordinary people and artists think and write about themselves in autobiographies, memoirs and works of fiction. But I suggest that she does not acknowledge how the social sphere informed the medical, namely how her own interpretations are influenced by our current postmodernist, social- constructionist mainstream culture. The work will be useful for those interested in understanding the Iranian psychiatric profession, as well as for anthropology and history students of modern Iranian culture.
However, I found that the overall critique could have gone beyond mainstream viewpoints of modern Western medical anthropology. Medical anthropology tends to focus on the social and cultural context of the medical profession, its views and its practices. Discussion is often rooted in those identified with a certain way of thinking, especially Michel Foucault and allied thinkers, often French or of other Continental European origin. This way of thinking is complex and not fully captured by any single label, although terms like ‘postmodernism’ are relevant. A basic idea in this philosophy involves social constructionism, the view that many (if not all) medical concepts are relative to society and culture, and are more a reflection of power than anything else. This kind of medical anthropology is not without merit, but it often fails to use its own method against itself: What are its own social and cultural assumptions, and how do they allow it to relativize almost all other views?
I observe the impact of this internal ideology in Behrouzan’s primary concern with ‘the positivist hold of biological psychiatry’. She mentions having trained for a while at the most prominent psychiatric hospital in Iran, the University of Tehran’s Ruzbeh hospital. I have also been there many times, as student and lecturer, and know the faculty well. My observation is that many of their views are derived from standard American psychiatric beliefs, especially from the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the biopsychosocial model.
Rather than another standard critique of the medicalization of psychiatry, I would have appreciated analyses that might have been more originally Iranian, on topics that are mentioned only briefly. For instance, Iran is suffused with its literary past, with the psychological genius of its multiple medieval Shakespeare-level poets (Rumi, Hafiz, Khayyam, Saadi, Ferdowsi); Iranian psychiatrists often refer to the insights of these poets in their clinical discussions, and a study of how this poetic cultural lineage interplays with modern psychiatry would therefore be a fascinating topic. Also, the tradition of mysticism (Irfan, Sufism) is strong in Iran, and a major international Sufi leader of the twentieth century, Javad Nurbakhsh (1926–2008), a Master of the Nimatullahi order, was a prominent psychiatrist and head of the Ruzbeh hospital before the 1979 revolution. He later moved to the USA and then England, and had an influence on the spread of Sufism in the West. Although not mentioned in the book, an exploration of his influence on Iranian psychiatry, as well as the influence of psychiatry on his Sufism, would have been enlightening. There are also Iranian psychiatrists in the diaspora, like the novelist Taghi Modaressi (1932–97), who worked as a child psychiatrist in Baltimore and wrote books of fiction, in Farsi and in English, which struggled to describe the same painful cultural unhappiness that afflicted so many Iranians before and after the revolution. These other aspects of Iranian psychiatry, which are unique to Iranian culture, still wait to be explored.