and Clinical Ethnopsychiatry
(Translated from the French by Catherine
In the past ten years, the field of French-speaking
social sciences has witnessed the emergence of a new paradigm: ethnopsychiatry.
Clearly, it had already happened that within ten to twenty years after
the massive arrival of immigrants, Western psychiatry produced a sub-discipline
crossbreeding anthropology and psychiatry. Indeed, comparable research
programs appeared after World War Two, in the 50's and 60's, in the US
and Canada, in the 70's in Britain, Germany and Holland, and are flourishing
today, in Italy, Switzerland, Belgium etc... In the United States, both
empirical and classifying orientations were adopted, sign of the times
or locally inspired: first, Folk Psychiatry, then Transcultural or Cross
Cultural Psychiatry, and Medical Anthropology. In France, yet another
sign of the times or local inspiration, as soon as ethnopsychiatry was
developed in its clinical aspects it became the object of violent conflict,
as if one aimed to force the discipline into a political debate rigged
from the onset - pitting communities against the Republic, culturalism
against universalism. Yet nothing is farther from the spirit of ethnopsychiatry
than this imposed state of war. For almost twenty years, since the creation
of the first ethnopsychiatry clinic at Avicenne Hospital, and for five
years now at the Georges Devereux Center (2),
part of the Psychology department of the University of Paris 8, the discipline
has consistently provided a space for experimenting mediation. Now, in
order to mediate one must first acknowledge misunderstandings, oppositions,
conflicts, good or bad reasons to hold each other in contempt - in other
words: recognize conflict, define it, and then take diplomatic action.
To act according to this philosophy of mediation amounts to putting confidence
in an acceptable peace, in the possibility of learning to live with others.
But the political situation in France doesn't account for everything and
the contradictions inherent to the field itself must be considered, as
well as the personality of the man who introduced these questions: Georges
"Go find a master..."
In the course of my formative years,
I encountered schoolteachers, educators, professors, guides... Towards
them, I experienced admiration or anger - often indifference - before
them, I felt fear or pride; at times they rewarded me; often they scolded
me, sometimes they humiliated me - most often they ignored me and that
was how it should be! Only once did I experience the pain of having a
master. In his presence, I felt suspended, as though any personal thinking
were interrupted. This experience somewhat resembles entering a convent
- in fact for a long time, a very long time, I felt cloistered within
his thinking. I traveled the spaces, theories, beings and yet I remained
confined to the very spot where he had left me since our last meeting.
My ideas followed the strict progression of what he accepted to entrust
me with. I must point out that this wasn't deliberate on his part, rather,
it was a mechanism, a sort of machinery. Actually, I didn't like meeting
with him; I avoided those one on one encounters during which he confidently
purred away... reminiscing, uttering sentences which were sometimes profound,
sometimes merely reasonable, dispensing advice or criticism, which he
gave out generously. Our work meetings were long - lasting four hours,
twelve hours... I would come out crushed. He dislocated me, as one takes
apart a puppet ; he broke my shell as one shells a walnut, he stoned me
like an olive, throwing my naked flesh out to the world... And it was
like a new beginning: I was left with the courage and recklessness of
I was fascinated by his intelligence - the kind of intelligence I prefer,
agile, sharp, loathing boredom above all else, skipping over explanations
without ever becoming sibylline, mystic, or sophistic... Yet he left me
dumbfounded by contradiction... He endlessly spoke of humanity, comprehension,
reason, friendship yet only abstract theories interested him; he stated
that the only true value was mature love within a stable couple and repeatedly
praised the radiant bawdiness of the Mohave Indians; he idealized psychoanalysis,
described it to us as the only true therapy, yet he despised flesh and
blood psychoanalysts whom he considered garrulous show-offs. I met him
in 1969 - he hated Marxists, leftists, protesters, agitators, all those
he referred to as « social negativists », and in fact any thought
remotely inspired by Marxism; yet he consistently behaved as a rebel,
a fundamental anarchist. (3) He owned a
single tie, a plaid tie, which he wore every Saturday afternoon, the day
of his seminar. In private conversations, he described all ethnologists
as jokers - except Marcel Mauss - all psychologists as eccentrics - except
Freud, and only up until 1915. He praised the pursuit of progress yet
claimed that there had been none in the Humanities for the past fifty
years. He sometimes acted as if he were inviting me to share fragments
of his private life, immediately denying me any authentic knowledge of
him. Such was Georges Devereux, my master. Today, I know a master leads
one to the hidden but never reveals it, never points it out, never explains
it - he is the path leading to it... for one cannot all at once be the
container and the content.
I worked with him for ten years - from 1971 to 1981 - first under his
direction, and then more and more with him, like an apprentice: together,
we founded the first ethnopsychiatry journal (Ethnopsychiatrica), we often
discussed together the concrete extensions his teachings should include.
He endlessly complained about not having a laboratory or research funds
for his students, of not receiving attention from administrative authorities.
Yet he carefully avoided all contact with officials of any kind representing
the administration. (4) In the last days
of our relationship, he acted towards me as towards a future heir, asking
me to teach his seminar when he couldn't because his respiratory insufficiency
made it difficult for him to breathe. He insisted that I obtain a course
at the Ecole des Hautes Etudes which I taught for a year in 1977-1978.
At the time, I was too little to know that one doesn't inherit from a
master; one is merely transformed by him! I learnt this to my cost one
day! On a Saturday of 1981, we were four of his students gathered together
to start the first ethnopsychiatry consultation - four clinicians, psychiatrists,
psychologists, with psychoanalytic training. Indeed, we had theoretical
knowledge of what was then already referred to as ethnopsychiatry - the
study of specific manifestations of disorders in certain cultures, the
analysis of traditional treatment systems - but no idea of the real practices
that such knowledge could produce. That same evening, he ended all relations
with me. I like to think that by acting in this way, he was simply taking
once again his true place, that of a master, to guide me one last time;
teaching me to leave: I'd like to keep thinking that, in fact, he wished
to pass on to me the rage to go on. In any case, it is the lesson I think
I learned: I've mostly worked on clinical issues.
The contradictions of theoretical ethnopsychiatry
The ethnopsychiatry which Georges Devereux
taught us was theoretical, descriptive and explanatory. He made out index
cards sorting out thousands of anecdotes of all kinds, field notes, short
clinical observations. This is how he constructed his books; he also taught
in this fashion. His rare lectures - he didn't like giving talks, and
preferred to debate, argue, discuss - were a long list of small observations.
For over thirty years, he had patiently accumulated unusual, contradictory,
paradoxical facts. Though he was always attempting audacious conceptual
breakthroughs, original constructions, his true passion was that of the
scholar, his ambition, knowledge. Yet his theory of complementarism, inspired
by Jordan, Bohr and Heisenberg isn't that of a practitioner of physics
designing experimental set ups to try to capture the electron, but rather
it is that of a creator of general theories of matter. His writings are
peppered with general statements on the nature of beings : humans are
like this; culture is that; the superego is made up of this, stress of
I wish here to examine two fundamental impacts of Georges Devereux's thinking
on psychoanalysis and psychotherapy.
1. The first was to compel the clinician to take into consideration facts
he didn't know about, whose existence he never even suspected, to whom
he therefore gave no importance a priori - for example that one can read
psychological disorders through the lens of specific cultural determinants.
In other words : the statement (number 1) : B, son of A, himself the head
of a Fon lineage of Benin, was driven mad by the voduns because he refused
to take on the ritual responsibility incumbent upon him since his father's
death is as true as the statement (number 2): B was overcome by a profound
melancholic sadness following the death of his father, A, to whom he was
strongly attached by bonds both deep and ambivalent. This first blast
still hasn't been metabolized by the field of clinical psychotherapy which,
up until now, hasn't been able to take it into consideration technically,
forever trying to be rid of the first statement.
2. The second impact is methodological. For Devereux, psychoanalysis creates
the phenomenon it observes.
« The psychoanalytic experiment
not only elicits the behavior which it studies, it actually creates
it - exactly as the opponents of psychoanalysis have told the psychoanalyst
all along, though he refused to listen. » (5)
It is therefore the task of the psychoanalyst
to always create fruitful material, open to elaboration, to new productions,
to life. For, just as a biologist can set up experimental designs which,
taken too far, can destroy the very object of his experiment, a psychoanalyst
is always at risk of creating a clinical situation turning the patient
into a vegetable.(6)
« The behavior so produced also
includes the patient's specific responses to the existence of the therapist
and to the physical and formal setting of the analysis. It includes,
above all, responses to the experience of being analyzed and it is this
experience which is unique and altogether unlike ordinary life experiences.
It is even probable that it is this which elicits transference. »(7)
Thus, as early as 1966, Devereux had
reached crucial methodological formulations regarding psychoanalysis -
formulations in which he attributes the entire responsibility of the process
to the psychoanalyst who provokes, triggers, creates, who, in the end,
generates and interprets his own productions. This also underscores the
responsibility of the therapist and the intellectual dead-ends in which
the interpretation of possible therapeutic failures inevitably get stuck.
Such are the two essential methodological points based on which I will
attempt to describe what ethnopsychiatry has developed into, at least
the ethnopsychiatry we practice at the University of Paris 8.
As I said earlier, as early as 1981,
we seized upon the methodological premisses of ethnopsychiatry in order
to develop new practices. I must point out that, for ten years, Devereux's
seminar was attended by young psychiatrists and psychologists, who were
all faced with new clinical problems that were starting to appear in France.
From then on, ethnopsychiatry was redefined by force of circumstance,
moving beyond its status as a descriptive theory towards the invention
of therapeutic settings for the treatment of immigrant populations. This
ethnopsychiatry was first and foremost a research approach to clinical
work, but it also constituted a theoretical and political experiment.
For, if it prompted us to rethink the practice of psychoanalysis, I believe
it also led us to think in an radically new way about the place we are
willing to give to immigrant populations and their cultures in the modern
societies we are contributing to build.
In fact, I would gladly define the Georges Devereux Center as an experimental
space for mediation between scientific systems of thought, and thought
systems brought with them by immigrant populations. At a time of what
is referred to as globalization, it seems impossible for us to consider
actual social practices - as well as political action, in fact - without
addressing the question of the place we attribute to systems from other
versus language (langue et langage)
But let us return to clinical considerations.
Changes in settings which stem from the questioning of doctrine often
result in fruitful innovations. I can say today that simply introducing
a translator in the psychotherapeutic setting sufficed to turn upside
down the pleasing theoretical construct that was ours at the beginning.
First, the patients' statements were no longer « interpretable »
- or more precisely: the interpretation - and namely psychoanalytic interpretation
- appeared oddly superfluous. Indeed, what place was to be given to slips
of the tongue, or to specific arrangements of signifiers when the primary
urgency first resided in the literal comprehension, then in the necessary
comparison of the systems thus brought together - and first of all the
languages! I claim that the diffidence my psychoanalyst colleagues generally
display towards languages - and not language - stems from the fact that
introducing a second language and its necessary representatives (translators,
family, friends) makes it impossible to « listen », according
to the usual sense we give that word in our profession. An then, we gradually
discovered that it wasn't merely a matter of speaking the language of
the patient, but also of speaking about languages. In the end, this is
a considerable advantage because speaking about languages, publicly discussing
the translation of the patient's and his family's statements ipso facto
turns the patient into an expert, a necessary partner, an ally in an enterprise
of exploration, knowledge and especially of acting on negativity. Indeed,
the mediator's translation, immediately submitted to the patient, becomes
debatable, invites contradiction. He or she can discuss the subtleties,
the intention; comment on the partiality of the translator. For if the
words of the patient become questions about his world, and as such about
the world, these questions, quite understandably, are of interest not
only to the therapist. As soon as they appear, the patients join the debate,
contributing to the translation, to the discussion of etymologies, the
exploration of the thousands of mechanisms at work in the making of possible
statements, the choices allowed by the language and those it prohibits.(8)
From time to time, when the exploration of the meanings of a word became
too problematic, too conflicting, a proverb would appear. "Why does
she say « God blessed me when he gave me this son »? Hasn't
she experienced so many problems because of his illness?" Is this
a mere figure of speech?" "Custom" one might say? The husband
answers: "At home, we often say: el kerd fi 'en ommou gha-zal."
How should this proverb be translated? Probably literally, first: "In
the eyes of its mother, the monkey is a gazelle." And it sounds just
right... For isn't this mother forever praising her drug abusing son who
has been plaguing her for the past five years? Someone in the gathering
explains... Is it the patient, a family member, the therapist, a co-therapist?
What does it matter? Talking about languages can bring everyone to agree;
the meaning of a proverb as well. "The proverb means that in general,
one tends to find only qualities among one's close relations"...
Yes but... How are we to understand it in this case? Does it mean that
she doesn't dare complain about her son, for fear that the words of a
mother might put a curse on him? Or only that she is partial? Does she
wish to ward off fate, she who has suffered so much from a cruel destiny?
Is it merely a complaint worded in a coded form? All this is open to discussion,
commentary, argumentation, initiating reminiscences, attempts at demonstrations
and theoretical constructions.
Treating language as a thing - more precisely as a system of things -
suddenly opens the psychotherapeutic space to real debate in that it henceforth
contains a means for the speakers to reach an agreement, instead of finding
themselves confined yet again within the closed field of dual conflict
where the question is always to determine which of the two better understands
the meaning of what is said. This is why clinical ethnopsychiatry takes
place within a group - a group of therapists who come from different worlds,
who practice multiple languages, a group thus containing a multiplicity
of interpretations. The multiplicity of possible statements creates and
stabilizes a space which can thus avoid degenerating into an arena of
dual confrontation. The innovation of clinical ethnopsychiatry has been
to consider this transformation of the clinical setting as specifically
worthy of interest.
The growing experience we acquired in the handling of translations gradually
led us to adopt languages as a comprehension model, in an attempt to resolve
the contradictions inherited from theoretical ethnopsychiatry. Let me
try to explain in what way. I would first define every language as an
object manufactured by a group which in turn manufactures one by one the
individuals belonging to this group. Indeed, it is clearly absurd to wonder
who created the French language - absurd because the answer is obvious!
The speakers manufacture the language every day - any one of them being
capable of modifying in a durable way a word, an expression, a pronunciation,
a rule of syntax, provided the modification is accepted by the group.
The creation of new expressions by present day second generation North
African immigrants in our suburbs or by rap music groups demonstrates
that the French language isn't manufactured only in the Académie
française but mostly in the streets. And since it is obvious that
language is one of the systems that most strongly contributes to the development
of the individual, one can conclude that the group manufactures an object
which, in turn, manufactures the individuals of the group.
Again, the model of language provides us with a logical, reasonable and
robust solution. There is no difference, from this perspective, between
let's say a Malinke speaker and a French speaker. There is no doubt that
each of them has been "manufactured" by a language, itself manufactured
each day by their group. It is precisely because the Malinke person and
Frenchman are identical that they are both manufactured by a language.
One could also say that the fact that they are both manufactured by a
language proves that they are identical. The problem is that the objects
by which they've been manufactured are different : the Malinke language
isn't the French language. It thus becomes absurd to discuss a possible
opposition between universalism and relativism. This is mere common sense:
the universal nature of man is obvious, it is not worth discussing. If
humans are the same, the objects manufactured by groups of humans are
different. The difference worth studying is located in objects, not in
humans -not in their biology, nor their social structure, nor their psyche.
I will try to demonstrate how this notion solves a series of contradictions
and opens the way to original and effective technical settings.
The question of recovery
This notion also solves the old problem
posed by recovery and the endless question: can one consider recoveries
obtained by cultural therapies as being of the same nature as those obtained
through "scholarly" therapies? What I refer to as "scholarly"
therapies are those psychotherapies claiming to proceed from the scientific
observation of "nature." It goes without saying that I am in
no way taking a stance on their scientific value. The question of recovery
is crucial because if, on the one hand, therapeutic systems are radically
heterogeneous, and, on the other, recoveries obtained by these different
systems were all of the same nature, we would then have to abandon the
claim of theories of psychopathology to a general explanation, both of
disorders and of action upon the disorders. Yet, to think in this way
clearly seems too difficult - professionals' resistances are huge! This
explains why most authors who have attempted conceptualizations in the
field of ethnopsychiatry have always proposed Western-based explanations
of the therapeutic effects of cultural systems, effects which have been
routinely observed. They ascribe the improvements observed in patients
either to "transference" (Roheim), to "suggestion"
(Freud and many psychoanalysts after him), to the "placebo effect",(9)
to "beliefs" (Levi-Strauss) or to "social reorganizations"
(Zempleni, along with many anthropologists). Some, like Devereux, do not
recognize any real effect other than palliative:
« Thus, one cannot consider that
the shaman accomplishes a "psychiatric cure" in the strict
sense of the term; he only provides the patient with what the Chicago
School of Psychoanalysis would call a "corrective affective experience"
which helps him reorganize his defense system but does not allow him
to reach the genuine insight without which there is no real cure. »(10)
Transference, suggestion, placebo effect, belief... these are all "Western"
concepts which make it possible to reject cultural explanations by interpreting
them. Of course, the days are over (yet it wasn't so long ago) when the
thought of "primitive" peoples was considered prelogic,(11)
magical or infantile .(12) But today, interpretation
- be it sociological, structuralist or psychoanalytic - is the principal
instrument used to disqualify theories belonging to groups and communities,
and, consequently, to disqualify their therapeutic practices(13).
Those who from the start deny actors in a system the capacity to totally
account for the system they manage, are doomed to interpret these actors'
theories, their results, the entire system. As a result we have a psychiatrist,
a psychoanalyst, an ethnographer feeling at home everywhere he (or she)
goes. Such a nomad will tend to annex any cultural therapy he approaches,
translating it into ready-made theoretical tokens. Having become an expert,
he won't learn anything of substance about the people with whom he comes
into contact. Isabelle Stengers has perfectly described this problem:
"As I have already emphasized,
only those who see themselves as purely « nomadic », are irreparably
destructive and/or tolerant, those who can no longer be frightened or
distressed by anything; and the group which identifies as such can only
send out experts The psychoanalyst, when he views himself as a «
modern practitioner » also views himself as « nomadic »,
freed from the illusory bonds that attach others. Henceforth, the analyst
can consider himself « at home » wherever he is, since his
practice defines any « territoriality », any sedentary way
of life as open to « analysis »."(14)
So, we must take a stance: do cultural therapies cure patients? Or, even
worse, do they cure them for the "wrong reasons"(15)?
This is the first question we will have to answer seriously. In any event,
it is always in the name of recovery that the Senegalese patient continues
to consult the marabout, the Moroccan to consult the fkih and the patient
from the Limousin the magnetic healer. Since, justifiably, it is by way
of this criteria that patients allow the persistence - and even the development(16)-
of such systems, making it possible for the objects of their worlds to
continue manufacturing new cases, new beings, we must pay attention to
their arguments. The Moroccan has usually experienced that amulets heal;
the Senegalese that sand speaks, and the person from the Limousin that
hands convey a fluid. They don't believe in the healer, as is generally
claimed, they respect the objects of the professional: an amulet, sand,
a fluid - and the mastery he has acquired.
of the validity of cultural theories:
How should we consider the concepts
which organize cultural therapeutic systems? As "representations,"
"beliefs" or genuine theories? If we think of them as "representations,"
we deny them, in effect, any claim to describing objects of the world:
they speak of things, we, of representations; they, of the action of the
fetishes, we, of the belief in the action of the fetishes; they, of the
demands of the dead, we, of mourning feelings; they, of the constraints
imposed by the gods, we, of "paternal complexes" If we could
find a way to respect their claim of describing the world, then we should
consider cultural therapeutic systems as genuine theories. And if theories
they are, it becomes necessary 1) to learn them; 2) to experiment with
them concretely; 3) to compare their clinical efficiency, or at least
their concrete effects, with the efficiency of "scholarly" therapies.
This is a challenge, in as much as these theories often aren't taught
but rather they are transmitted through initiation. Moreover, these theories
are rarely explicit, never presented as systems of ideas. Rather, they
inform the technical actions of the therapist and can only be re-constructed.
Finally, to consider them as genuine systems of thought would require
of those who decide to learn them that they more or less adopt the professional
identity of those who practice them. Yet it is socially impossible for
a Western clinician to take on the identity of a Colombian shaman, a Moroccan
fkih, a Nigerian baba-lawo - not to mention that of a magnetic healer
from the Limousin! Here again, we come up against professional resistances.
This is why, to avoid the problem, most authors(17)
consider cultural theories, as "pre-notions," "fantasies,"
"beliefs" and sometimes even as the survival in adults of infantile
sexual theories.(18) As was often the case,
G. Devereux recognized the problem and expressed himself vividly on the
« This is why we can never be
certain data of primitive "psychiatrists" represent authentic
scientific intuitions or if they are mere fantasies derived from a model
of cultural thinking »(19)
It should be noted that for Devereux,
should the theories of traditional therapists prove to be of interest,
they would be so only in terms of intuition. Thus, he writes further-on
in the same text, referring to the Sedans in Viet Nam :
« ...These are merely people
who are inclined towards speculation, but whose insights remain sterile
in as much as they are not integrated within a scientific context and
are not correlated with other insights of the same order, but only with
Yet cultural theories
are perceived by those who make use of such therapeutic systems as being
as genuine as « scholarly » theories. Patients, and we have
all experienced this, do not oppose the two worlds. Rather, they try to
take advantage of both. Indeed, it is the « scholars » who are
at war, not the clients! At war with each other, in the first place,(21)
but also with those they designate as "charlatans." Again, the
ethnopsychiatrist should follow the users' example when constructing his
concepts, taking seriously cultural theories - approaching them not as
"representations", but as genuine theories the specific rationale
and necessity of which he will have to explicit. In brief, he will have
to explain how the phenomenon apprehended by these theories is apprehended
correctly and how these theories permit an effective grasp of the world.
do about groups?
Ethnopsychiatry needs the concept of
"culture", or at least a concept acknowledging the existence
of groups. French anthropologists and especially sociologists have an
increasing tendency to do without such a concept (often with good reason),
preferring the more vague notions of « worlds » or « universes
». Moreover, the increasingly active processes of globalization of
information, habits, laws, commodities, tend to make this notion seem
out-of-date, perhaps somewhat prematurely obsolete. Yet at the same time,
a series of new elements have emerged reminding us that in psychopathology,
groups cannot be done away with - whether such groups are referred to
as "ethnic groups" or as "communities." Indeed, more
and more frequently "therapists" appear who re-invent "cultural"
treatment systems. For example, a Tahitian Tahua who, in the wake of an
existential crisis, suddenly decides to seek initiation among the New
Zealand Maori and is tattooed there from head to toe;(22)
or a woman healer in a Mali village who organizes (invents? re-invents?)
new rituals to the djinnas claiming all the while that she is merely re-instating
a timeless tradition; (23) or a female nganga,
a healer from Northern Congo, settled in Brazzaville, who creates a new
method of extracting malignancy.(24) And
what of this healer from a social housing development in the northern
suburbs of Paris who reads the cards for the depressed unemployed on the
dole?(25) These people all gather around
them numerous patients. They present and see themselves as "cultural"
therapists. It seems to me that, today, if the social sciences are to
be innovative, they must imperatively conceive of methods allowing for
these « subjects » to be considered as competent and creative,
in no way puppets or robots! For, after all, these people haven't chosen
to be initiated in just any old trade but in the art of healing. Our observations
in ethnopsychiatry have increasingly led us to a somewhat strange hypothesis:
It may be that psychopathology and culture entertain stronger bonds than
was once suspected. For if it turned out that nowadays, in this period
of globalization, it were mostly through an illness - or one of its most
pernicious forms, the obligation to heal others - that "culture"
might suddenly invest a person, then illness - and especially mental illness
- and culture would form a couple more closely linked than ever before,
though such an alliance would remain as mysterious as ever.(26)
First, it must be said that any social science is the science of groups.
Even clinical psychology, based on the study of individual cases, necessarily
leads to the creation of groups - admittedly artificial groups, the only
expert of which is the researcher. Indeed, what social reality might a
group have, for example made up of all the people classified by psychologists
and psychiatrists under the heading of Paranoid Schizophrenia? These are
simply statistical groups, "homogeneous groups of patients,"
people whose only common characteristic is of having been classified in
a given category by professionals. In this case, how could one possibly
construct the truth by way of a real debate taking on the patients as
In the modern world, social groups are often formed in a battle opposing
specific interests to experts. Recent examples: people with AIDS, united
in associations, succeeded in imposing their expertise, thus upsetting
the perspectives and priorities of researchers in the field.(27)
The pressure of gay movements compelled the American Psychiatric Association
to delete homosexuality from the list of mental disorders. Sometimes,
isolated researchers help to constitute such groups through their brilliant
personal efforts. Oliver Sachs, for instance, has succeeded in imposing
the idea that modern research in neurology consists in investigating the
actual experience of patients, who are the only ones capable of describing
the unique strangeness of their world.(28)
Thus, recognition by groups is sought after by an increasing number (though
still to few) of modern researchers in social sciences in order to acquire
partners able to question the validity of their hypotheses.(29)
Ethnopsychiatry can be practiced only in this manner. Indeed, the ethnopsychiatrist
always has a double who incessantly questions him on the legitimacy of
his perspectives, methods and results, namely the healer or the "natural"
therapist of the populations he treats. The good fortune of the ethnopsychiatrist,
his asset, is merely epistemological: among all clinicians, he is the
only one to have a necessary contradictor. We must also remember that
in other universes, groups of "patients" are also often genuine
social groups. For example, in Morocco, the group made up of all those
who have been possessed by a certain djinn is possible and constitutes
a reality of experience. Such a group can be found in certain zaouias
(30) in which the followers can devote themselves
to the 'hadra, the ritual trance.
In other words, the question of ethnopsychiatry necessarily calls forth
actual social groups which, nowadays, have lost the distant, literary
and somewhat imaginary nature conveyed in yesterday's ethnology. We meet
Bambaras, Dogons, Mandingos... every day, in the street, in the subway,
in our offices. Such cohabitation requires managing relations with different
communities, given that, as all groups, these tend to produce representatives.
We are in the urgent need of a theory which will allow us to recognize
and call upon these groups and their representatives. Thus, the ethno
part of the term "ethnopsychiatry" is a reminder to the ethnopsychiatrist
of his own methodological requirement: to appeal to actual constituted
groups and their representatives in order to validate his (or her) propositions
Today, however, there is an added complexity. Sometimes, it turns out
to be concepts constructed by practitioners that end up generating genuine
First example: The description of a neurological syndrome by Gilles de
la Tourette led, several decades later, to the creation of an extremely
active association (especially in the United States), the Tourette Syndrome
Association.(31) Here, the group is defined
by the disease. While keeping close ties with the doctors and neurologists
who created it, the association challenges them incessantly, prompting
them to actively pursue research, propose new etiologic hypotheses, discover
Second example: It is reasonable to consider that Freud's definition of
homosexuality as a "psychic structure" allowed people with homosexual
practices who saw themselves as "deviant," to imagine they were
members of a particular category, then constitute a social group: the
gay movement. Today, the movement questions the experts - psychiatrists,
psychoanalysts, endocrinologists, biologists, who created them - having
designated itself as their unavoidable partner.
Third example: The description by Benjamin, followed by Stoller, of "transsexuals"
gradually brought individuals to first create a social group then a pressure
group requesting surgery from doctors and identity changes from administrative
authorities... Here, the group originally defined by a bio-psychoanalytic
concept - they refer to themselves as Benjaminites, inspired by the name
of their "creator" - has become a pressure group compelling
professionals to adopt new ethical standards, a new moral code, indeed
a new philosophy.
Thus, we must face the evidence: social practices, which are always the
applications of social sciences, generate the creation of new social groups
which in turn question their creators.
Attempts in this field - ethnopsychiatry,
transcultural psychiatry, comparative psychiatry, folk psychiatry - always
started from the acknowledgment of differences, but then got bogged down
in an endeavor to recapture universality. This is what renders them "soft,"
fragile and, of course, questionable. Most of the time, the authors adopt
the hypothesis according to which the psychological or psychopathological
structure is universal, merely "colored" by culture. Jilek,
for example, quite rightly points out that the usual position in "comparative
psychiatry" has been to consider culture as having a pathoplastic
rather than pathogenic influence on psychopathological symptoms.(32)
Some authors, considering the strangeness of pathologies referred to by
Anglo-Saxons as culture bound syndromes, venture a little farther, though
quite timidly. Michael Kenny, for example, proposes the idea that certain
morbid entities, such as smallpox or the measles are unequivocally universal,
whereas the Malaysian latah would be a sort of "social theater".(33)
It remains to be seen, however, in what way a "social theater"
might make up a psychopathology. Georges Devereux was perhaps alone in
noting that this constituted a true epistemological problem calling for
the creation of a full-fledged discipline. Yet it must be said that his
works are replete with the same type of contradictions I have indicated.
For instance: if there is an irreducible specificity to Mohave psychopathology,(34)
through what miracle could psychoanalysis possibly account for it? Indeed,
even reduce it to something already known elsewhere? Unless we consider
this psychopathology to be in no way specific; or rather that its specificity
is nothing but an illusion. Here we find ourselves almost insulting the
Mohave, sympathetically considering them poor theoreticians, barely capable
of naïvely approaching - and only "symbolically" - Freud's
To put an end to this type of contradiction, my proposition is to apply
to therapeutic settings the conception drawn from our experience with
languages and translation. Groups manufacture therapeutic settings; and
it is these therapeutic settings that manufacture, not human beings, of
course - and here they differ from languages - but patients. This proposition
solves a series of problems, creates new ones and entails technical and
First, this proposition is rational, materialistic, and rejects any compromise
with mystico-philosophical positions, in good keeping with rationality.
It has the advantage of being perfectly congruent with what is known about
traditional therapeutic systems. In many African groups, for example,
people don't refer to a person as a treatment specialist but as someone
who has touched things - not knowledge but things, objects. I believe
these systems know - or, more precisely, they postulate - that patients
are manufactured by things, those things that the therapists belonging
to the group have learned to handle. On the other hand, it fits rather
well with traditional theories that have so far been considered mythical
and/or symbolic, according to which humans manufacture fetishes, look
after them, feed them, all the while receiving sustenance from them -
in no way impeding that fetishes in turn manufacture humans.
This proposition makes it possible to once and for all rid ourselves of
those vague, catch-all notions such as "belief" or "conviction"
- notions which can only generate attitudes of tolerance, indeed even
This proposition also makes it possible to understand why people from
non-Western societies expect from a therapist that he (or she) manufacture
them from their own objects, yet are also prone to accepting other types
of manufacturing, agreeing to go along with, in a sense to try out, other
types of patient-manufacturing. We are thereby afforded a new perception
of a curious fact that has ceaselessly bewildered clinicians, namely the
paganism, the sort of spontaneous therapeutic polytheism of patients all
over the world, who never hesitate to straddle the so-called metaphysical
opposition between "natural" and "supernatural," between
"rational" and "irrational," seeking help successively,
sometimes even simultaneously, from a psychiatrist, a psychotherapist,
but also a healer, a charismatic church, etc. Finally, feeble and contradictory
reasoning can thus be avoided, such as the "either, or" argument
- either Western reason or traditional irrationality - as well as the
postmodern logic of juxtaposition, the "why not?" stance - why
not both the psychiatrist and the healer - this vague crossbreeding rightly
criticized by Devereux in his 1968 preface to The Psychotherapy of a Plains
Indian. The very fact that patients so willingly accept the ethnopsychiatric
setting demonstrates that any true therapy should always strive to reach
the level of complexity of which are capable those it is intended to serve.
It also allows us to understand why, when we consider traditional therapeutic
objects, in the course of an ethnopsychiatry consultation, patients willingly
accept to take part in the discussion with us. When we demonstrate some
competence, certain statements can make the entire gathering agree, just
as the discussion around the meaning of a word or a proverb can make everyone
agree. Formulations such as the following: the jnoun throw stones at noon;
or every person has a rab of the opposite sex; or this child spends each
night talking with the spirits which is why he hasn't been able to learn
the language of humans, etc.
But the theoretical implications are considerable:
In terms of psychopathology, according to this proposition, the core of
a person is no longer located inside him (or her), but in a public space,
within the objects invented by the group and manufactured by professionals.
I must make it clear that I am referring to patients and not persons as
In order to account for what ethnopsychiatry brings to light, we need
to change the very object of psychopathology. It would no longer be a
matter of studying symptoms, syndromes, structures, even illnesses, but
of describing and then learning the use of therapeutic objects such as
they are invented and manufactured by human groups. When I speak of objects,
I mean all kinds of objects: theories, prayers, songs, but also things
- plants, statuettes, calabashes, skulls, etc.
And there is no reason to think that what has just been said holds true
only for non-Western groups. On the contrary, I think such a theory is
just as useful with our native patients. In other words we are much closer
to the reality of our clinical work when we consider our patients as "manufactured"
- rather than spontaneous - manufactured by our own theory, of course,
but also by the successive theories of those professionals who inevitably
In a word, the ethnopsychiatry we practice is not relativistic: it is
If ethnopsychiatry is constructivist,
then the patient loses his status as an object, a strange and feeble being
to be probed until interesting elements come to light. It is no longer
possible to "interpret" her functioning with a theory. She becomes
a necessary partner, an indispensable alter ego in a common research enterprise.
Ethnopsychiatry has developed the habit of rethinking with the patient
both his personal suffering - as do talk therapies - as well as the theories
which have informed this suffering, which have, as we have seen, constructed
and elaborated it... To generalize the logic of ethnopsychiatry to all
patients, regardless of their origin, would lead us never to hesitate
in considering them as "constructed" as "cases;" to
postulate that this manufacturing concerns and interests them; and that
they are the privileged recipient of what the theory thinks about them.
Thereby promoted informant, the patient is invited to discuss the observations
of the therapists, to argue their hypotheses, and finally to share the
responsibility of the treatment thereby worked out in common.
Thus conceived, ethnopsychiatry generates an ethical rigour through a
sort of natural process since any information concerning her is necessarily
and systematically submitted to the patient's attention. The obligation
to share interpretations with the patient, the construction of "truth"
in the course of a genuine debate in which she truly participates, are
part of its theoretical postulates and thus of its routine clinical practice.
In fact, such a therapy truly achieves the ideal of psychoanalysis - to
allow the patient to grasp part of what constituted her.
Although Georges Devereux probably would've
disagreed - but can the dead be made to speak? - both technically and
politically with the practice of clinical ethnopsychiatry - I am firmly
convinced that his inspiration has been passed on. His continuous strive
towards scientific rigour and specialization; his never-ending interest
in related disciplines, biology, ethology, physics, what wasn't yet referred
to as cognitive psychology, considered as practices and not results, constitute,
in my opinion, the most innovative aspect of his work. It is for this
reason that we chose to name after him the university centre I have directed
for the past five years. And it is this perspective, which we can qualify
today as materialistic, constructivist and research-oriented that the
ethnopsychiatry I practice attempts to take as far as clinical work will
Finally, to conclude, I would now define
ethnopsychiatry as follows:
1. A clinical discipline taking as its object the analysis of all therapeutic
systems, viewed as systems of objects; all systems without exception
nor hierarchy, those claiming to be "scholarly" as well as
those purporting to belong to a specific collective or community - be
it ethnic, religious, or social. Ethnopsychiatry sets out to describe
these systems, to extract their own rationality and especially to demonstrate
their necessary character. This discipline claims a specific scientific
rigour stemming from the fact that, considering therapeutic systems
as the property of groups - according to the aforementioned formula:
groups manufacture objects which in turn manufacture persons - it seeks
to demonstrate its hypotheses through the development of methods allowing
representatives of these groups to take a stance on their validity.
2. A discipline which sets out to test the concepts of psychiatry, psychoanalysis
and psychology in light of theories belonging to the groups whose therapeutic
systems it studies. It creates situations, imagines settings, invents
methods intended to test these theories in light of the cultural and
clinical realities it observes.
A clinical practice which considers that the processes and results of
points (1) and (2) are of concern primarily to the patients; a practice
interested in engaging in a true debate with them; finally, a practice
deliberately setting up spaces prohibiting on the part of therapists
the practice of insulting(35) patients,
their families or their groups- by this I mean that it isn't satisfied
with simply leaving the respect of this rule up to the moral value of
the therapist, but rather it actively engages in constructing a setting
which concretely precludes such a practice.
Translated from the French by Catherine
Berger L., 1997 - Anthropologie politique des systèmes
de soins magico-religieux. L'exemple des cultes de possession bamanan
au Bèlèdugu (Mali). Mémoire de DEA d'Anthropologie,
sociologie du politique et du développement. Université
Chlyeh A., 1995 - La thérapie syncrétique des Gnaoua marocains.
Thèse de doctorat d'ethnologie, Université de Paris VII.
Clément C., 1980 - "De l'angoisse à la méthode"
par Georges Devereux. Libération du 20 mai 1980, p. 34.
Collignon R., 1989 - "Pour un retour sur les "culture-bound
syndromes" en psychiatrie transculturelle." Santé, Culture,
Health, VI, 2, 149-162.
Devereux G., 1969 - Ethnopsychiatrie des indiens mohave . Tr. fr. : Paris,
Synthelabo, Les empêcheurs de penser en rond, 1996.
Devereux G., 1970 - Essais d'ethnopsychiatrie générale ,
Devereux G., 1972 - Ethnopsychanalyse complémentariste . Paris,
Devereux G., 1980 - De l'angoisse à la méthode dans les
sciences du comportement. Paris, Flammarion.
Dozon P. - 1995 : La cause des prophètes. (politique et religion
en Afrique contemporaine) Paris, Le Seuil.
Foucault M., 1997 - « Il faut défendre la société.
» Cours au Collège de France. 1976. Paris, Gallimard, Seuil.
Freud, Totem et tabou, Paris, Payot, 1968.
Gauchet M., 1985 - Le désenchantement du monde . Paris, Gallimard.
Grunberger B., Dessuant P., 1997 - Narcissisme, christianisme, antisémitisme
; Actes Sud.
Jilek G. , 1982 : Culture "Pathoplastic" or "Pathogenic"?
A key question of Comparative Psychiatry. Curare (Journal of Ethnomedicine
and Transcultural Psychiatry) , Heidelberg, 5: 57-68.
Juillerat B. - 1991 : dipe chasseur. Une mythologie du sujet en Nouvelle
Guinée. Paris, P.U.F.
Levy-Bruhl L. - La mentalité primitive. Paris, P.U.F., réédition.
Nathan T., Hounkpatin L. - 1996 : La parole de la forêt initiale.
Paris, Odile Jacob.
Ortigues M.C., Ortigues E. - Oedipe africain. Paris, Plon, 1966.
Piault C. ed. - Prophétisme et thérapeutique. Albert Atcho
et la communauté de Bregbo. Paris, Hermann, 1975.
Pignarre Ph., 1997 - Qu'est-ce qu'un médicament ? Paris, La Découverte,
Pouillon J. - 1970 : "Malade et médecin : le même et/ou
l'autre. Remarques ethnologiques." - Nouvelle Revue de Psychanalyse,
Pradelle de la Tour C.H. - 1997 - Le crâne qui parle. Ethnopsychanalyse
bamileke . Paris, EPEL.
Pury (de) S., 1998 - Traité du malentendu. Théorie et pratique
de la médiation interculturelle en situation clinique. Paris, Synthélabo,
Les empêcheurs de penser en rond.
Róheim G., 1943 : Origine et fonction de la culture. Paris, Gallimard,
Sacks O. , 1996, Un anthropologue sur Mars. Sept histoires paradoxales
Paris, Le Seuil.
Saura B., 1993 - Politique et religion à Tahiti . Tahiti, Éd.
Stengers I, 1997 - Cosmopolitiques I, La guerre des sciences . Paris,
Paris, La découverte-Synthélabo, les Empêcheurs de
penser en rond, 1996.
Stengers I, 1997 - Cosmopolitiques, tome 7, Pour en finir avec la tolérance.
Paris, La découverte-Synthélabo, les Empêcheurs de
penser en rond.
Stengers I., 1995 - "Le médecin et le charlatan" in T.
Nathan et I. Stengers - 1995 : Médecins et Sorciers, Les empêcheurs
de penser en rond, Paris, Synthélabo.
Tourette (G. de la) - 1885 : "Etude sur une affection nerveuse caractérisée
par l'incoordination motrice accompagnée d'écholalie et
de coprolalie (jumping, latah, myriatchit)" ; Archives de neurologie
, 9, 19-42 et 158-200.
neurologie , 9, 19-42 et 158-200.
(1) Ph D ; Professor of Clinical Psychology and
Psychopathology, Centre Georges Devereux, University of Paris 8
(2) Centre Georges Devereux - Centre Universitaire d'aide psychologique,
Université de Paris 8, 2, rue de la Liberté, 93526 Saint-Denis
cedex 02, France.
(3) "In 1968, he is furious. « My heart was heavy with anguish
and worry for those young people in the process of preparing a unlivable,
totalitarian world for themselves. There wasn't a chance that they would
succeed in establishing their anarchist, idealistic world. » Catherine
Clément: "De l'angoisse à la méthode"
par Georges Deverux. Libération, May 20 1980, p. 34. (Quote translated
from the French by C. Grandsard)
(4) "Georges Devereux remained unknown because he was always a
rebel, first and foremost towards the establishment: he never asked
for anything from anyone, and this is palpable. Where did his strange
genius come from, this sort of burnt sorcerer above himself?" Ibid.,
(5) Devereux, G. From Anxiety to Method in the Behavioral Sciences,
The Hague, Paris, Mouton & Co, 1967, p. 302.
(6) "Bohr and Jordan conclusively proved that, if one seeks to
determine completely the functions of life, one must reach so deeply
into the organism, one must disturb so radically its essential state,
that one abolishes thereby the very phenomenon one seeks to study: Life."
Ibid, pp. 288-289.
(7) Ibid, p. 302
(8) Concerning this matter, see Sybille de Pury, Traité du malentendu.
Théorie et pratique de la médiation interculturelle en
situation clinique. Paris, Synthélabo, Les empêcheurs de
penser en rond, 1998.
(9) See the stimulating discussion of the concept of placebo in Ph.
Pignarre - 1997: Qu'est-ce qu'un médicament ? Paris, La Découverte,
(10) Devereux, Essais d'ethnopsychiatrie générale , Paris,
Gallimard, 1970, p. 18. (Quote translated from the French by C. Grandsard)
(11) Levy-Bruhl L. - La mentalité primitive. Paris, P.U.F., new
edition. In recent psychoanalytic texts, one comes accross arguments
very similar to those of the beginning of the century: "Primitive
man made weapons and tools which he rendered sacred, investing them
with a magical power greater then his own. In the same fashion, he manufactured
idols and fetishes, signifying projections of his narcissism. The idols
represented (and still represent nowadays, to the extent that their
worship still survives, in more or less disguised forms) the virtues
and powers that man would like to possess in an absolute fashion...
thus the idols become a prop of his projected hatred and could be feared."
B. Grunberger, P. Dessuant : Narcissisme, christianisme, antisémitisme
; Actes Sud, 1997. Hence, there is no interest here in the techniques
of fetish makers and users - nor in their philosophy or their construction
of the world - once again reduced to the status of infantile masturbators.
(12) Freud, S. Totem et tabou, Paris, Payot, 1968 (Totem and Taboo).
See also the critique of the Western representation of "primitives"
in M. Gauchet, Le désenchantement du monde. Paris, Gallimard,
(13) See certain present day works representing what one could qualify
as "old style" ethnopsychiatry, an ethnopsychiatry which denies
the specificity of its own approach to the world, which interprets the
actions and, above all, thoughts that it ascribes to those it observes.
In this type of approach, if others do indeed act, they do so guided
by intuition whereby the theories they construct to justify their actions
can only be considered as facts to be observed. Examples: Ortigues M.C.,
Ortigues E. Oedipe africain. Paris, Plon, 1966 or Pradelle de la Tour
C.H., Le crâne qui parle. Ethnopsychiatrie bamileke, Paris, E.P.E.L.,
1997 for Lacanian interpretations; Juillerat B., dipe chasseur. Une
mythologie du sujet en Nouvelle Guinée. Paris, P.U.F., 1991,
for more "classical" psychoanalytic interpretations.
(14) Stengers, Cosmopolitiques, tome 7, Pour en finir avec la tolérance.
Paris, La découverte-Synthélabo, les Empêcheurs
de penser en rond, 1997. (Quote ranslated from the French by C. Grandsard)
(15) I quote here an expression coined by Isabelle Stengers in "Le
médecin et le charlatan" in T. Nathan et I. Stengers, Médecins
et Sorciers, Les empêcheurs de penser en rond, Paris, Synthélabo,
(16) For example, the exponential development in large cities throughout
the world of prayer groups which are genuine traditional therapeutic
organizations adapted to the modern world. See Piault C. ed., Prophétisme
et thérapeutique. Albert Atcho et la communauté de Bregbo.
Paris, Hermann, 1975; Dozon P., La cause des prophètes. (politique
et religion en Afrique contemporaine) Paris, Le Seuil, 1995; Nathan
T., Hounkpatin L., La parole de la forêt initiale. Paris, Odile
(17) With the noteworthy exception of Marcel Mauss.
(18) See G. Ròheim (1943) Origine et fonction de la culture.
(Origin and Funtion of Cuture) Paris, Gallimard, 1967.
(19) Devereux, Ethnopsychanalyse complémentariste . Paris, Flammarion,
1972, p. 252. (Quote translated from the French by C. Grandsard)
(20) Ibid, p. 256.
(21) See I. Stengers, Cosmopolitiques I, La guerre des sciences . Paris,
Paris, La découverte-Synthélabo, les Empêcheurs
de penser en rond, 1996.
(22) Saura, B. Politique et religion à Tahiti . Tahiti, Éd.
(23) Berger, Anthropologie politique des systèmes de soins magico-religieux.
L'exemple des cultes de possession bamanan au Bèlèdugu
(Mali). Mémoire de DEA d'Anthropologie, sociologie du politique
et du développement. Université Paris 8, juin 1997.
(24) Field data collected by Geneviève Nkoussou and Jérôme
(25) Personal observation.
(26) See Pouillon's description of theDangaleat where any calling is
first an affliction. In other words: it is an illness which promotes
the individual to the social position he will hold and qualifies him
for this function. Pouillon J., 1970, "Malade et médecin
: le même et/ou l'autre. Remarques ethnologiques." Nouvelle
Revue de Psychanalyse, 1, 76-98.
(27) It isn't surprising that it is in Foulcault's wake that one finds
the most innovative attempts in including patient associations in research,
for example in the works of Daniel Defert. The recent publication of
Foucault's lectures at the Collège de France provides us with
theoretical leads for reusing « subjugated knowledges ». "By
«subjugated knowledges » I also mean a series of knowledges
that were disqualified as non-conceptual knowledges, as knowledges that
were insufficiently elaborated: naïve knowledges, hierarchically
inferior knowledges, knowledges beneath the level of scholarly or scientific
requirements... it is through the reappearance of these local knowledges
of people, of these disqualified knowledges that a critique was initiated."
[Quote translated from the French by C. Grandsard] Michel Foucault,
Il faut défendre la société. Cours au Collège
de France. 1976. Paris, Gallimard, Seuil, 1997, p.9.
(28) Oliver Sacks, Un anthropologue sur Mars. Sept histoires paradoxales
. (An Anthropologist on Mars) French translation: Paris, Le Seuil, 1996.
(29) I even think it is the only methodology, at least for psychopathology
and psychotherapy, which affords a way of avoiding Popper's criticism
accusing psychoanalysts of producing "non refutable" statements.
(30) Brotherhood also including a therapeutic function, gathered around
the tomb of a saint. See, for instance, A. Chlyeh, La thérapie
syncrétique des Gnaoua marocains. Thèse de doctorat d'ethnologie,
Université de Paris VII, 1995.
(31) The original text : G. de la Tourette, 1885, Etude sur une affection
nerveuse caractérisée par l'incoordination motrice accompagnée
d'écholalie et de coprolalie (jumping, latah, myriatchit), Archives
de neurologie , 9, 19-42 et 158-200.
(32) Jilek G., Culture "Pathoplastic" or "Pathogenic"?
A key question of Comparative Psychiatry. Curare. (Journal of Ethnomedicine
and Transcultural Psychiatry), Heidelberg, 1982, 5: 57-68.
(33) Quoted by Collignon in Pour un retour sur les "culture-bound
syndromes" en psychiatrie transculturelle. Santé, Culture,
Health, VI, 2, 149-162.1989.
(34) Devereux, Ethnopsychiatrie des indiens mohave . French translation:
Paris, Synthelabo, Les empêcheurs de penser en rond, 1996.
(35) I refer to Isabelle Stengers' use of this expression (la pratique
de l'injure) - Seminar, 97/98.
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