Transforming Therapy: Mental Health Practice and Cultural Change in Mexico

Transforming Therapy

Transforming Therapy

Mental Health Practice and Cultural Change in Mexico

Whitney L. Duncan

Vanderbilt University Press

Nashville

© 2018 by Vanderbilt University Press

Nashville, Tennessee 37235

All rights reserved

First printing 2018

This book is printed on acid-free paper.

Manufactured in the United States of America

Library of Congress Cataloging-in-Publication Data

Library of Congress Cataloging-in-Publication Data on file

LC control number 2017055304

LC classification number RC455.4.E8

Dewey classification number 362.196/890097274—dc23

LC record available at lccn.loc.gov/2017055304

ISBN 978-0-8265-2197-2 (cloth)

ISBN 978-0-8265-2198-9 (paperback)

ISBN 978-0-8265-2199-6 (ebook)

This book is the recipient of the Norman L. and Roselea J. Goldberg Prize from Vanderbilt University Press for the best project in the area of medicine.

For my parents, Donnetta Duncan, and Wallace LaMar Duncan, y para AHR

Contents

Acknowledgments

Preface: Convivencias

Introduction

1. Go Where There Is No Path and Leave a Trail

2. Psicoeducación in the Land of Magical Thoughts

3. Prozac and Pura Plática

4. Transnationally Shaped Sentiments

5. Psy-Sociality at La Paz

Conclusion: Transforming Therapy

Notes

References

Index

Acknowledgments

This project has benefitted from the support, guidance, feedback, and patience of so many people. First, I am immensely grateful to those in Oaxaca who have opened their lives and homes to me, displayed enthusiasm for the project, and graciously shared their stories. I would like to specially thank AHR, whose courage humbles me and whose friendship I will always treasure. Many, many thanks also to the Cruz del Sur hospital patients who, often under painful circumstances, took time to speak with me, and to the families in the Mixteca who fed me, housed me, and befriended me. Mil gracias.

Also in Oaxaca, I am grateful to the psychiatrists and administrators at Cruz del Sur, the staff at Servicios de Salud de Oaxaca, and the many independent mental health practitioners and therapists who shared their expertise.

Thanks to Aerin Dunford, Arturo Jarquin, and Candelaria Gómez for their exceptional research assistance and insights. Andrea Belarruti provided translation help, and Santiago Renato Efrain Ramirez Ortiz, Rebeca Aracely Avendaño Méndez, Erica López Alonso, Jenny Hernández, Erich A. Hernández, Josely Germain Cruz Gómez, Norma Vásquez Jiménez, María de Montserrat Ordoñez Narváez, Rosa María Flores Lepe, Luis Adrián Fernández Ortega, Edelmira Pérez Hernández, and Roque Infanzón Mendoza provided research, interview, and transcription assistance.

I am indebted to Paul Hebb and Karen Rasmussen for generously housing me and providing beautiful spaces in which to work in Oaxaca. For friendship, moral support, and constant laughter during fieldwork and beyond, I thank Megan Martin, Shane Dillingham, Karen Rasmussen, and Holly Worthen. Fellow fieldworker Abigail Andrews could always be counted on for fun and stimulating exchanges. John Burch and Carl Owens have been much-appreciated sources of friendship and logistical help. Angelina Trujillo, Marcos Cruz Bautista, and Juan Julian Caballero were excellent Mixtec teachers who graciously invited me into their communities and patiently answered my many questions. The curanderas at the Clínica de Medicina Tradicional were extremely generous with their expertise as well. Thanks also goes to all the members of The Hub Oaxaca who made me feel welcome.

There are many people I wish to acknowledge at the University of California, San Diego, where I was trained as an anthropologist and where the seeds of this project were sown and nurtured. First and foremost, Janis Jenkins has provided immeasurable support throughout my career and has believed in and greatly enriched this project from its inception. Her brave insistence that anthropology must attend to experiences of mental health and illness gave me courage to pursue the questions I do in this book. I am extremely fortunate to have her as a mentor and a friend. Tom Csordas’s mentorship and intellectual legacy have also been very influential to my development as a scholar. Wayne Cornelius, John Haviland, Tom Patterson, Nancy Postero, Steve Parish, Keith McNeal, and Kit Woolard offered invaluable guidance, critiques, and insights. My training as an anthropologist and social scientist was significantly enhanced through my participation in SWYEPT and MMFRP—I thank Janis Jenkins, Tom Csordas, Wayne Cornelius, and David Fitzgerald for those opportunities.

I am extremely grateful to Bridget Haas for her encouragement, close chapter readings, and invaluable feedback throughout every stage of this project, in particular, the book chapter drafting and editing. Our ongoing dialogue and Bridget’s superb ethnographic sensitivity has helped shape so much of what lies in these pages. Allen Tran, too, has been an incisive reader and interlocutor whose work on mental health and subjectivity stimulates my own. I have cherished my friendships and intellectual exchanges with Charlotte Hajer and Ted Gideonse, both of whom helped me learn the importance of close attention to experience, agency, and good writing.

Other anthropology friends and colleagues, including Jess Novak, Heather Spector Hallman, Ana Pimentel Walker, Nofit Itzhak, Sarah Horton, Elizabeth Carpenter-Song, Julia Cassaniti, Jon Yahalom, and Sonya Pritzker, have inspired and challenged me as well. I’m indebted to Kristin Yarris for detailed, incisive comments on early chapter drafts and for thought-provoking discussions about migration and Mexican psychiatry. Peter Guarnaccia, Roberto Lewis-Fernández, and Devon Hinton have provided mentorship and feedback over the years. I thank Neely Myers for introducing me to Vanderbilt University Press and for her anthropological attention to mental illness and recovery.

Colleagues at the University of Northern Colorado welcomed me with open arms and have provided an academic home for me since then. Thanks to Sally McBeth, Britney Kyle, Andy Creekmore, Mike Kimball, Trish Jolly, Ather Zia, and Brooks Pardew. My students at UNC have asked probing questions and have pushed me to think about how anthropologists communicate to undergraduate audiences.

Michael Ames, director of VUP, expertly ushered this manuscript from rough draft to finished product. I am extremely grateful for his encouragement, dedication, and editorial guidance. Joell Smith-Borne, VUP’s managing editor, also helped immensely on the road to publication.

The book was significantly improved by several anonymous manuscript reviewers, who pushed me to think harder and write better. Their detailed and insightful feedback helped sharpen every aspect of this book.

This project would not have been possible without a National Science Foundation grant (Award #1026819) as well as various grants and fellowships from the University of California and the University of Northern Colorado.

Finally, I am tremendously fortunate to have a network of friends and family who have nurtured and challenged me through the years. In particular, I owe a great debt of gratitude to my parents for taking every opportunity to foster my curiosity and for insisting that I pursue my passions. I have kept the memory of my father, Wallace LaMar Duncan, close throughout fieldwork and writing. His discipline, perspicacity, and love of stories have profoundly influenced my life and work. My mother, Donnetta Duncan, has always believed in me, provided unwavering support, and made sure to remind me that it is only as fun as you make it.

Most of all, Joel Johnson’s love, patience, and support—moral, intellectual, emotional—has helped me through every stage and page of this project and continues to inspire me daily. Our life together nourishes and sustains me. Thank you. You and our daughters are everything to me.

Preface

Convivencias

It was Día de los Muertos, and I had gathered cigarettes, wine, fruit-flavored Mentos, and an old photo of my father to add to my friend’s family altar. They had built a double-arch of marigold flowers interspersed with orange, jicama, tomatoes, guayaba, and other fruit, under which lay dozens of family photos, candles, traditional pan de muertos, sugar skulls, cups of coffee on saucers, and more piles of fruit. Over the course of several days, a film formed over the coffee and the insides of the mugs showed rings where the coffee had evaporated, creating the impression that our difuntos (dead) had, indeed, been taking sips when we weren’t looking. Chairs were set up in front of the altar and, in turns, we sat to convivir with our difuntos and with each other. In homes and cemeteries all around us, others were doing the same. How heavy the years since my father had passed away felt upon me, and how deeply I appreciated that convivencia with him and with living friends as I alternately grieved his death and celebrated his life.¹

The Spanish word convivir has multiple meanings: to live in the company of others, to get along with others, to coexist with others, to visit with and interact with others. I view anthropological research and writing as a long process of being-with, or convivencia.² Living in Oaxaca, sharing life with others; returning for briefer visits, seeking to maintain relationships with people and places; listening to recordings of interviews, events, reliving them from a distance, then analyzing them; writing about those with whom I interacted: all of this is part of ethnographic convivencia. Writing this from my home in Colorado, with my Oaxacan friend Amapola’s voice fresh in my ears from a quick phone call, recent emails from Oaxacan research collaborators in my inbox, and a Oaxacan black clay calavera (skull) looking back at me from my desk, I feel acutely the ways in which this convivencia is ongoing, and I consider how to convey it using the written word.

Nine months before that Día de los Muertos, on the second anniversary of my father’s death, I had spent the day alone, save for the dogs, Oscar and Güera, with whom I shared my home. I lit a candle and tried to write, hoping to find my own language of grief. I had been living alone in Oaxaca for exactly one month and still lacked deep friendships. I questioned what I was doing there, whether my whole endeavor was misguided, and wondered if I would reach the point where I could share such moments with others in Oaxaca. On Día de los Muertos, I reflected not only on my father and the time that had passed since I had seen him in the flesh but also on the nature of the relationships I had formed in Oaxaca, for I had gone from writing alone in a room to a convivencia with the living and the dead in front of an altar dedicated to members of multiple friends’ families.

It was in these emotionally laden moments that questions of commensurability (Garcia 2010, 48) came into sharp focus. Some of those moments took place with patients at the psychiatric hospital, who frequently struggled to understand their distress and who sometimes asked me for my advice—requests that deeply humbled me and often left me speechless. I shared with some of them my own mental health–related experiences, for—sometimes to their disappointment—I was not an authority who could provide answers, but someone asking similar questions. Some of these moments took place in the Mixteca region, visiting with friends who told me story after story about loss, worry for migrant relatives, and preoccupation over whether there would be enough food to eat, but who also danced at the evening’s end and insisted I do the same. Some of those moments took place in the women’s support group I joined, where other attendees and I together sought to understand and recover from various losses, conflicts, and distressing feelings we had experienced. In such moments, I considered the possibilities and limits of relating in the context of anthropological study.

The word conmover, which came up in support groups I attended, captures an important part of the experience of ethnographic being-with. Conmover means to be moved, in the sense of provoking an emotional response (as in, her words moved me), and support group participants sometimes reflected by saying they were deeply conmovida or conmovido (emotionally impacted) by the sessions. Their accounts emphasized the con (with) in conmovida, like the con in convivir and convivencia: it was not only that they were moved from a distance, moved by the events to which they were witness, but that they were moved with others. To express being conmovida or conmovido in this context was to express the ways in which emotion is cocreated and coexperienced (Besnier 1990; Irvine 1990; Lutz 1988; Lutz and Abu-Lughod 1990; Rosaldo 1980), how feeling-with is a way of being-with.

Many of the moments in which I felt most conmovida occurred with my friend Amapola.³ It was frequently through the lens of our relationship and interactions that I considered the degree to which I could really understand, and claim to represent, the experiences of others, especially those whose lives are precarious and characterized by extreme structural vulnerability (Quesada et al. 2011). Amapola and I talked a good deal about death—her mother’s and my father’s; a pregnancy loss of mine, which Amapola helped me through and which impacted the course of my research; Amapola’s own future death, which, because she is HIV-positive, she thought about frequently and sought to accept. As a Jehovah’s Witness, she believes paradise awaits us in the next life, a paradise filled with flowers, where there is no disease, no war, and no divisions between people, no borders between countries. That Amapola’s vision of heaven invoked such divisions and borders speaks to their important role in her experience of being-in-the-world. She has been judged, discriminated against, and emotionally and physically abused due to her position as a woman, as a person living with HIV, as a poor Oaxacan, and as a Mexican, and yet she harbors no bitterness: only a desire for connection despite difference, only a powerful drive to speak her story and, in so doing, relate to others.

But no amount of convivencia will change the fact that my very ability to conduct this study reflects deep inequalities and power imbalances. This raises issues concerning the tremendously difficult process of commensurability—of remaining in the face of one another’s unshared vulnerabilities (Garcia 2010, 68), of intimacy created not through sameness of experience but through a being-together, which is, in the end, the very heart of social commensurability (Garcia 2010, 182). The idea of unshared vulnerabilities profoundly resonates when I think about how my mere presence in Oaxaca—and my ability to leave and visit the United States if I had the need—meant I could freely cross a border that thousands of Oaxacans and millions of others have risked their lives to cross. Not only was my presence in Oaxaca a physical reminder of such imbalances but so, too, was my own freedom of movement and the luxury of the work I was conducting. I could walk the streets of Oaxaca unafraid to be seen or questioned regarding my immigration status. I could drive a car legally with my American license; I could see a private doctor; I could conduct a research study. To many Oaxacans, the idea that I had the time and money to pursue an advanced degree and spend my days talking to people rather than using every ounce of energy to put food on the table for my family no doubt seemed like an absurd excess. And not only did I have the legal and financial means to live, drive, and work in Oaxaca, but I was usually welcomed with open arms and extraordinary hospitality.

No degree of feeling conmovida or conveying that sensation in writing will change the fact that Amapola has very little chance of ever obtaining a tourist visa—even if I were to pay for it—to visit me or her other US-based friends, for she cannot possibly prove, as she would be required to do, that she would have no incentive to overstay that visa and remain in the United States. The closer my relationships became with those lacking freedom of movement, the more I understood the weight of the border as a symbolic and actual force of rejection, as a physical manifestation of inequality. One of the ways in which Amapola and I connect, despite our differences in age, ethnicity, nationality, religion, and socioeconomic status, is in our shared bafflement at such divisions, borders, and inequalities, and at the limitations they represent. I do not share many of Amapola’s vulnerabilities, but in our day-to-day exchanges and our interactions during more extreme moments of distress, I think we both felt the power and importance of those divisions receding, if only temporarily.

Oaxacan anthropologist Jaime Martínez Luna writes, In the models that attempt to interpret what we are, you hear the echoes of the monarch’s voice asking us to be quiet so others may speak for us, so others may write for us, so others may live—not us (2010, 19).⁴ Like many anthropologists, I have grappled with how to write with, not write for, how to make writing part of the process of ethnographic convivencia. The present book is, for better or worse, written by me about Oaxacans who were generous enough to open themselves up to me, to be with me, and to convivir. I have sought to write something that at the very least adequately represents their voices as well as the layered experience of conducting fieldwork in a specific place at a specific time with particular individuals, something that conveys a sense of ethnographic being-with. I hope to have done so in an accessible way that some of those who participated in my study might also enjoy reading.

I also hope to have done so in a way that questions the possibility of an authoritative account, instead bringing various voices, approaches, and the often contradictory nature of experience to the fore. In this spirit, I have made particular stylistic decisions, blending writing styles and including personal and poetic accounts, transcript excerpts, ethnographic descriptions, and more traditional academic analysis. While this blend may be jarring at times, I find that—more than a consistent, scholarly voice—it allows me to convey some of the ebb and flow of everyday life, as well as relationships, stories, and struggles to which I was privy, and in which I engaged.

Introduction

Storms, Sustos, and Psychiatrists

The rain poured hard, dripping off the branches into puddles. The night was black save for the lightning, illuminating cloud cover when it struck. Flowers bowed under the weight of water. Rain, clouds, mountains, caves: so vital to stories of Oaxaca. The Mixtecos, pueblo de la lluvia, ñuu savi, people of the rain.¹ In some Mixtec pueblos caves are sites of worship, el culto de la cueva, and have names like yavi kee yuku, Cueva de la Curación, Healing Cave; or we’e dawi, Casa de la Lluvia, Rain House. The Zapotec, Cloud People, Bene Zaa, are named owners—dueños, or xaan—of the hills, water, and land. The Mixe are likely named for the Nahuatl word for rain, mixtlii. Poj ‘Enee, Thunder Wind, is a Mixe protector god of rain and fertility. Where was Poj ‘Enee that night?

A Mixe family ran for cover, leaving on the mountainside branches they had gathered for firewood: no matter now. The cave was dry underfoot, a relief. The family watched the storm from the mouth of the cave, shivering. Slowly, though, the cave began to collapse; they covered their heads and screamed. Struck by a heavy stone, the mother fell to the ground.

I do not know if Antonia, Mauricio, and their other family members carried their mother’s body back to their home during the storm or whether they waited. I do not know what the funeral was like, or whether there was one. Mauricio fell ill first: a mi se me estaba borrando la mente, he said. My mind wasn’t working. It was failing me, and I didn’t want to do anything. No work, no cutting firewood, no housework. I just walked around like a drunk. Soon his sister Antonia became ill as well, began talking to herself, vomiting, having trouble sleeping. She jumped, she danced, she stopped doing her housework, her hospital file says. Mauricio explained, When she gets sick her mind doesn’t work. She doesn’t want to do anything. She wants to go out alone. I imagine Antonia walking the mountain, talking, her eyes cast downward, as they were when we met.

I have replayed the moment that Mauricio described many times, imbued it with the texture of a story although it was told to me in fragments. I have thought about what lay between the lines of transcript, what lay in Antonia’s silence when her brother spoke for her. I have wondered what the two whispered in Mixe, consulting, and I recall their soft tones. I have imagined the curandero (healer) patting Antonia down with basil, rosemary, passing the egg over her body to remove the fright, and I have wondered whether her soul ever returned to her, and whether it ever left.

We met in Oaxaca’s one public psychiatric hospital, Cruz del Sur, over a decade after the fateful storm. At the hospital, Antonia was prescribed psychiatric medications: clonazepam (a benzodiazepine for anxiety, trade name Klonopin), risperidone (an antipsychotic, trade name Risperdal), biperiden (controls side effects of antipsychotics), and valproic acid (an anticonvulsant and mood stabilizer, trade name Depakote). Mauricio pointed to the psychiatrist’s hastily written script. Without medicine, the illness kills us, he told me.

What was the illness, exactly? Espanto, as Mauricio put it. Fright, susto: that’s what Antonia’s curandero had said as well. But the spiritual cleanse the curandero provided only helped a little, Mauricio emphasized. Possibly, he considered, it was from too much thinking, por tanto pensar. Or maybe it was the neighbors’ envy, for despite their tragedy, they were surviving as campesinos (peasants) and we spend our days well, Mauricio said. The psychiatrist said Antonia’s diagnosis was retraso mental (mental retardation). As her brother spoke to me, Antonia sat stiffly in her dress, looking sideways, giggling and covering her mouth when I addressed her. She only spoke a little Spanish, so Mauricio spoke for her, not forcefully but rather tenderly, as an older brother who looks after his younger, ailing sister might.

Antonia’s story, told by Mauricio and relayed by me, is but one that could open this book. Perhaps like any story told in a psychiatric hospital, it begs many questions—questions about family and social life; about vulnerability to social and natural forces; about distress that stretches across the years and unfurls in various forms, some spiritual, some social, some psychiatric; about whose knowledge counts and encounters between ways of knowing. The stone that fell from the cave’s wall brought the rest of the cave with it.

Changing Landscapes of Mental Health

This book is an effort to understand the meanings of mental health in contemporary Mexico. In particular, I focus on the relatively recent growth of Euroamerican-style psychology, psychiatry, and other forms of emotional therapeutics in Oaxaca, amidst a context of extraordinary sociocultural, ethnic, and linguistic diversity, medical pluralism, and social strife.² What impacts are these newly popular psy-services having on the society, and how are they linked to larger historical and sociopolitical currents in Mexico? Are they interacting with, replacing, or merely operating alongside preexisting ideas and forms of care? For what types of issues are Oaxacans seeking such services, and how might they affect Oaxacans’ social interactions and self-understandings?

Transforming Therapy focuses squarely on psy’s dual role as an instrument of sociality, healing, and self-making, and as an instrument of biopolitical governance. I show how psy-globalization—the transnational spread of psychological and psychiatric ways of knowing and working upon the self—articulates with political economic projects, on the one hand, and simultaneously creates therapeutic sites of psy-sociality for commenting upon and contesting such projects and their failures, on the other (Duncan 2017a, 2017b). These sites range from the institutional to the informal, including the public psychiatric hospital, private clinical settings, support groups, and community settings in which people explicitly engage in self-work or mental health care. In these sites, Oaxacans grapple with and seek to recover from the emotional consequences of social problems and breakdowns, such as familial conflict and loss, poverty, violence, and migration, which themselves are often intimately tied to the broader political economy and cultural changes in the context of globalization and modernization.

Transforming Therapy is not a straightforward story of medicalization, psychologization, or subjectification. While psy-globalization and global mental health practice provide new imaginaries and means of self-understanding linked to modern forms of governance, they do not supplant ethnopsychological understandings of the self as socially and morally constituted. Nor do they necessarily displace traditional forms of therapy and medicine, although popular and professional discourse tend to pit the traditional against the modern, culture against mental health. Examining the reciprocal relationships between global trends, local political economy and cultural discourse, expert knowledge, and individual experience, I show how globalizing psy-ideas and therapies are transformative for and transformed by people seeking to transcend demoralization, comment upon and repair social relations, and experiment with new ways of knowing and acting upon the self.

In Oaxaca, the subject of mental health raises issues far beyond psychological wellness and suffering, and provides a lens through which to understand changing sociocultural formations as well as the ways individuals make meaning within them. Indeed, the topic brings up deep ambivalences about what it means to be a person in contemporary Mexico, inspiring reflection on what tradition is or should be—and whether it is possible to be the type of person that the psy-disciplines seek to cultivate. This ambivalence contributes to a larger story about the uses and abuses of culture in Mexico’s practices of governance. Psy-ideas and psy-practices balance precariously on the taut thread of the social fabric, on the tension created by the longing for seemingly opposed forces: change and sameness, modernity and tradition, independence and interdependence. In the flux and interchange between the local and the global, any easy dichotomy between them collapses.

Openings and Closings / Aperturas y Cierres

At the beginning of my study, people often asked me why I had chosen Oaxaca as my fieldsite if I wanted to understand mental health in Mexico. Here, the trope went, people think you have to be crazy to go to a psychologist. I was assured by Oaxacan mental health practitioners and members of the general community alike that there were many mental health problems in Oaxaca, but that they were too stigmatized to discuss openly. People frequently mentioned how behind Oaxaca was in matters of mental health and how wedded Oaxacans were to tradition and pensamiento mágico (magical thinking).

The Mexican, Octavio Paz famously wrote in The Labyrinth of Solitude, is a person who shuts himself away to protect himself: his face is a mask and so is his smile. In his harsh solitude, which is both barbed and courteous, everything serves him as a defense: silence and words, politeness and disdain, irony and resignation. . . . The Mexican is always remote, from the world and from other people. And also from himself (1985, 29). Although it’s now over a half-century old, Paz’s Freudian analysis of Mexican character—rooted in the loss and rejection of the Conquest and borne out as a kind of cultural melancholy and shared inscrutability—bears some resemblance to the way Oaxacans talk about themselves, or about other Oaxacans, at least when the subject of mental health comes up. Like Paz, many noted a need for ritual as a form of self-protection and a predominance of the closed over the open. As one Oaxacan psychologist put it, People live with a lot of fear of being talked about, so they protect themselves too much. It’s a very closed, reserved society. A Oaxacan doctor went so far as to report that the further away you get, the smaller the village, the more conservative and distrusting it is.

Many spoke to me about how Oaxacans tend to be emotionally repressed and resistant to deep exploration of the psyche. Unlike other people, Paz wrote, we believe that opening oneself up is a weakness or betrayal. The Mexican can bend, can bow humbly, can even stoop, but he cannot back down, that is, he cannot allow the outside world to penetrate his privacy. . . . He refuses to emerge from himself, to ‘let himself go’ (1985, 30–32). A Oaxacan friend of mine echoed these descriptions when he said, We limit our emotions. You cover those emotions up and don’t get them out for many reasons. For fear of rejection. He concluded: Expressing the emotional in Oaxaca . . . it’s very rare. Some people opined that such repression was more notable among indigenous Oaxacans: They are more closed, one Oaxacan psychologist insisted. It’s harder for them to talk—or, there’s much more embarrassment. The problem is, there’s still a lot of repression, mostly with women. . . . Therapy is not yet part of their culture.

If such self-reflections are accurate, Oaxaca hardly seems the kind of place where mental health services and emotional therapeutics would thrive. After all, most forms of therapy require us to emerge from ourselves, take off our masks, and disclose our feelings. Psychology, psychiatry, and other forms of mental health practice and emotional care urge us to work on the self, act on the mind with psychopharmaceuticals, and aspire to particular forms of emotional management and self-expression. The psy-related disciplines do create certain types of order, ritual, and tradition, which Paz opined were so important to the Mexican, but they are usually deeply rooted in Euroamerican thought, philosophy, history, and politics (Good 1994; Illouz 2008; Luhrmann 2000; Rose 1998, 2007; Shorter 1998; Young 1995). The idea of mental disorders as mental, as well as the drive to mine the individual psyche, express inner feelings, and build self-esteem, reflects a particular view of the self as an independent entity in need of a particular type