GHCS 300R: Mental Health in Cross-Cultural Perspective
Global Health, Culture, and Society
T/Th 2:30 - 3:45, Candler 120
Fall 2013
*Syllabus is subject to change throughout the semester. All changes will be announced in class and on Blackboard.
Instructor
Lesley Jo Weaver
Email: lweaver@emory.edu
Office hours: Thursdays 1:30-2:20 in Anthropology 218A, or by appointment
Course description
This course critically engages concepts of mental health and illness through an interdisciplinary perspective that draws from psychological and medical anthropology, history, psychology, public health, disability studies, and biology. We will examine various psychiatric conditions across three levels of analysis, beginning at the individual, followed with the community level, and finally in a macro-, socio-political perspective. The class will analyze mental health definitions, treatments, outcomes, advocacy, and nosology in Western and non-Western approaches. While
Western diagnoses–such as schizophrenia, autism, and depression–will be critically examined, students will also engage with concepts of psychopathology broadly as well as culture-specific syndromes. Weekly readings will draw on scholars such as Ethan Watters, Ian Hacking, and Arthur Kleinman. Students will work on a project throughout the semester, culminating in a term paper examining a psychiatric state or condition from each of the three perspectives noted above
(individual, community, global).
Course objectives
● Use a variety of disciplinary literature (i.e. psychology, anthropology, neurology, sociology, biology) to discuss topics related to mental health
● Analyze a mental health issue at the intersection of individual/family, community, and socio-political levels
● Gain familiarity with current debates in the field of Global Mental Health
Texts
Required:
Ethan Watters. (2010). Crazy Like Us: The Globalization of the American Psyche. New
York: Free Press
Diagnostic and Statistical Manual of Mental Disorders V (2013). Full text available online through Emory Libraries.
Recommended:
Ghaemi, S. Nassir, A. Clinicians Guide to Statistics and Epidemiology in Mental Health:
Measuring Truth and Uncertainty, Cambridge University Press, 2009.
Assignments

Class Participation – Please note that class participation counts for an unusually large proportion of your course grade. This is because this course does not simply provide you with “facts” to learn, but rather prompts you to reflect on the subjects we explore. You are expected to understand the facts and concepts, but also to develop a critical assessment of them. Therefore, you must engage in class through close reading of the materials with a critical mind, and actively participate in class discussion. Class attendance is a crucial part of your class participation, but just attending the class sessions will not lead to full credit. The quality of your class participation, your active role in formal class debates, and responses to other students’ papers and presentations will also be assessed.
Blackboard posts - 1-2 pages, due on Tuesdays by classtime
Use one of the prompts below to address the previous week’s readings, pulling in other topics from class as desired. A total of 5 posts must be turned in throughout the semester, meaning all students will complete a response paper for 5 out of the 10 semester weeks between Tuesday,
September 10 until Tuesday, November 19. Prompts may only be used once ; therefore, you will use all of the prompts below one time each. If you have an idea for an alternative prompt that you would like to write about, see me a week before the paper will be turned in to discuss whether it is appropriate. You may only submit one response paper per week. All posts must be turned in on Blackboard by classtime on Tuesdays and will cover the previous week’s readings. If you decide to turn in more than 5 papers (and if you do so, you may reuse the prompts), I will use the top 5 grades for your final grade.
Prompts: In your response paper, indicate which prompt you are using.
a.
Synthesize the week’s readings b.
Find an outside academic reading that is relevant to the course and tie it in to class readings c.
Respond critically, respectfully, and rigorously to another student’s previous post, drawing on readings from the class at any point d.
Write up your group’s position in your assigned debate [due the week after the debate] e.
Write a summary and analysis of an outside event/lecture you attend, drawing on readings we have done or concepts we have discussed in class [please clear the event with me in advance unless I’ve pre-approved it for class]
Module papers - One 5-page paper will be due at the end of each module (Oct 3, Oct 31, Nov
21). The module papers comprise an ongoing semester project that you will synthesize into your final paper and panel presentation. Select a mental health issue (e.g. a particular diagnosis, stressor, intervention, or idiom) with relevance in a setting of interest to you. At the end of each module, you will submit a 5-page paper presenting your issue as a case study of the module concepts. Please work closely with me on these papers; you are strongly encouraged to meet with me at least once per module to discuss your module paper.
Final project - 15-18 page paper, developed by synthesizing the three module papers. Involves analyzing a mental health issue from individual/family, community, and socio-political perspectives. Due December 20 at 8:30am.

Panel Presentations - At mid-semester, you will be grouped into 3-4 person panels based on your chosen mental health topics. You will collectively put together a conference-style panel presentation, including a title and abstract that represents your group’s topics, and present it in the last few days of the course. Each student will have 10 minutes to present their project and take questions.
Grading System
1.
Participation................................................... 20%
2.
Blackboard posts (5)……………………….. 15% (3% each)
3.
Small Module Papers (3)................................ 45% total (15% each)
4.
Final presentation/synthesis paper (1)........... 20% (paper 10%, presentation 10%)
A =
≥ 94%
C = 74 - 76%
A-
B+
=
=
90 - 93%
87 - 89%
C-
D+
=
=
70 - 73%
67 - 69%
B
B-
=
=
84 - 86%
80 - 83%
D
F
=
=
60 - 66%
< 60%
C+ = 77 - 79%
Classroom Environment and Behavior
I encourage lively discussions and classroom exploration as opportunities to further our understandings on issues of culture and mental illness. Every student should come to class prepared to discuss that day’s topic.
Some of the topics in class may be sensitive and/or controversial. All students are expected to be respectful of all opinions, comments, and questions. Discussions are meant to be student-directed and all comments will be listened to and respected; however, students are responsible for ensuring that their comments are appropriate for a classroom environment. If there is any time in which any student feels uncomfortable, offended, or confused by classroom discussions, please bring this to my attention so I can appropriately address the issue.
Students are not allowed to use technology in class, including laptops, tablets, and smartphones phones, unless it is to be used as an assistive technology. Anyone using these devices in the classroom without permission will automatically lose one point on a Blackboard post for each incident.
Attendance and Participation
Students who attend every class during the semester will have their lowest response paper grade dropped. Students are expected to arrive to class on time; persistent tardiness (more than 3 times) will result in deductions from the attendance and participation grade. Participation is worth 20% of your overall grade, meaning if you are not in class and, when in class, not participating, this will strongly affect your final course grade.
E-mail Policy

Please write concise emails and allow at least 48 hours for response. For substantial questions, please talk to me during office hours rather than using e-mail, as it is mutually more beneficial.
Plagiarism and the Honor Code
Full compliance with the University Honor Code is expected. See the website for details: http://college.emory.edu/home/academic/policy/honor_code.html. Many students each year are caught for plagiarism, which can result in a failing grade for the assignment, a failing grade for the whole class, or even more serious consequences. Always make sure in your written work when quoting or paraphrasing material that you indicate the source (including Internet sources).
If you have any questions in this regard, please consult appropriate reference materials, or come and see me.
Some Notes from the Office for Undergraduate Education:
The Office for Undergraduate Education (OUE) central office is located in White Hall 300. Please visit or call
404.727.6069 with questions about academic affairs, concerns or policies. All Emory College of Arts and Sciences policies may be found in the College Catalog: http://college.emory.edu/home/academic/catalog/index.html
For a full list of Religious Holidays can be found here: http://www.religiouslife.emory.edu/pdf/Religious%20Holidays%202013-14.pdf
Important Fall 2013 Dates
August 28: First day of classes
September 4: Add/Drop/Swap ends 11:59pm
September 11:
October 14-15:
October 18:
November 15:
November 28-29:
December 10:
December 11:
December 12-18:
Last day to change S/U or Grading option
Fall Break
Last day for withdrawal without penalty (all students)
Last day for withdrawal without penalty (1st year, Transfer, Oxford ONLY)
Thanksgiving Holiday Break
Last day of classes
Reading Day(s)
Final Exam Period
Academic Advising and Class Deans
If you have any academic concerns or questions about Emory College of Arts and Sciences policies, you should first meet with an OUE academic adviser. If an academic adviser is unavailable to meet with you, you may meet with an
OUE dean during open hours.
OUE Academic Adviser appointments: Visit White Hall 300 or call 404.727.6069
Deans’ Open Hours: http://college.emory.edu/home/administration/office/undergraduate/hours.html
Academic Support
There are a range of resources available to Emory undergraduates designed to enrich each student’s educational experience.
Visit http://college.emory.edu/advising for a list of support programs and appointment directions
Access and Disability Resources
Students with medical/health conditions that might impact academic success should visit Access, Disability Services and Resources (ADSR formerly the Office of Disability Services, ODS) to determine eligibility for appropriate accommodations. Students who receive accommodations must present the Accommodation Letter from ADSR to your professor at the beginning of the semester, or when the letter is received.
Attendance Policies (Absences and Absences from Examinations)

Absences: Although students incur no administrative penalties for a reasonable number of absences from class or laboratory, they should understand that they are responsible for the academic consequences of absence and that instructors may set specific policies about absence for individual courses.
Absences from Examinations: A student who fails to take any required midterm or final examination at the scheduled time may not make up the examination without written permission from a dean in the Office for Undergraduate
Education. Permission will be granted only for illness or other compelling reasons, such as participation in scheduled events off-campus as an official representative of the University. A student who takes any part of a final examination ordinarily will not be allowed to defer or retake that final. Deferred examinations must be taken during the student’s next semester of residence by the last date for deferred examinations in the academic calendar or within twelve months if the student does not re-enroll in the college. Failure to take a deferred examination by the appropriate deadline will result automatically in the grade IF or IU.
Course Schedule
August 29: Introduction, syllabus
1. Watters, Ethan. (2010). “Introduction”.
In Crazy Like Us. New York: Free Press.
2. Grinker, Roy R. (2010). “In retrospect: The five lives of the psychiatric manual.” Nature,
468. 168-170.
3. TED talk playlist “All Kinds of Minds” (Watch talks 1-3 and 5 only) http://www.ted.com/playlists/9/all_kinds_of_minds.html
September 3: Global Mental Health; Intro to Course Case Studies
1. Patel, Vikram. (2010). “Global Mental Health: A new global health field comes of age.”
The Journal of the American Medical Association, 303(19). 1976-1977.
2. Summerfield, D. (2008). "How scientifically valid is the knowledge base of global mental health?" British Medical Journal 336(7651): 992-994.
3. Busfield, Joan. (2012). "Challenging Claims that Mental Illness Has Been Increasing and
Mental Well-Being Declining." Social Science & Medicine 75: 581-588.
September 5: Mental Health Statistics
1. Ghaemi, Nassir. (2009). Chapters 1-3. In
A Clinician’s Guide to Statistics and Epidemiology in Mental Health: Measuring Truth and Uncertainty.
Cambridge: Cambridge University
Press.
2. Daley, Tamara (2002). “The need for cross-cultural research on pervasive developmental disorders.” Transcultural Psychiatry, 39(4). 531-550.
Module 1: Engaging cross-cultural mental health at the individual and interpersonal level
September 10: Family Responses—AUTISM GUEST LECTURE
1. Stein, Catherine H. & Wemmerus, Virginia A. (2001). “Searching for a normal life: Personal accounts of adults with schizophrenia, their parents, and well-siblings.” American
Journal of Community Psychology, 29 (5): 725-746.
2. Marom, Sofi, Munitz, Hanan, Jones, Peter B, Weizman, Haggai, & Hermesh, Haggai.
(2005). “Expressed Emotion: Relevance to rehospitalization in schizophrenia over 7 years.”
Schizophrenia Bulletin, 31(3): 751-758.

3. Nunley, Michael. (1998). The involvement of families in Indian psychiatry. Culture, Medicine and Psychiatry, 22: 317-352.
4. In-class video: Gerald: http://www.youtube.com/watch?v=i6h8Ic-I7R0&feature=relmfu
September 12 Schizophrenia in the Family
1. Watters, Ethan. (2010). “The shifting mask of schizophrenia in Zanzibar.” in Crazy Like
Us: The Globalization of the American Psyche. p 127-186. New York: Free Press.
2. DSM 5 diagnosis of schizophrenia
September 17: DEBATE 1: What Is Normal? [DEPRESSION CASE STUDY]
1. Horowitz, Allan V. & Wakefield, Jerome C. (2007). Chapter 1: The Concept of Depression. In The Loss of Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive
Disorder.
Allan V. Horowitz & Jerome C. Wakefield. p 3-26. Oxford: Oxford University
Press
2. Clements, Paul et al “Cultural Perspectives of Death, Grief, and, Bereavement"
3. DSM Depression: Single Episode
4. DSM Depression: Recurrent
September 19: Explanatory Models
1. Kleinman, Arthur. (1988). Chapter 7: Conflicting Explanatory Models in the Care of the
Chronically Ill. In The Illness Narratives: Suffering, Healing, and the Human Condition .
New York: Basic Books.
2. Patel, Vikram. (1995). Explanatory models of mental illness in Sub-Saharan Africa. Social
Science & Medicine 40(9): 1291-1298.
3. Luhrmann, Tanya (2001) Of Two Minds: An Anthropologist Looks at American Psychiatry. Excerpt; pp. 25-54
September 24: Individual/Familial Traits
1. Good, Byron J. (1997). Studying mental illness in context: Local, global, or universal?
Ethos, 25 (2): 230-248.
2. Tam, S., Tsang, HWH, Yee-Chiu, IP, & Chan, CSC. (2004). Preliminary evidence for the basis of self-concept in Chinese with mental illness. Quality of Life Research, 13(2): 497-
508.
Module paper topic due on Blackboard
September 26: Idioms and Ethnophysiology
1. Kohrt, B., & Hruschka, D. J. (2010). Nepali Concepts of Psychological Trauma: The Role of Idioms of Distress, Ethnopsychology and Ethnophysiology in Alleviating Suffering and
Preventing Stigma. Culture, Medicine, and Psychiatry, 34(2), 322-352.
2. Nichter, M. (1981). "Idioms of distress: alternatives in the expression of psychosocial distress: a case study from South India." Culture, Medicine and Psychiatry 5(4): 379-408.
October 1: Wrap-up Module 1 (Jeopardy!)
Module 2: Engaging cross-cultural mental health at the community level

October 3: Culturally-Specific Values—AUTISM GUEST LECTURE
1. Shaked, Michal (2005) The social trajectory of illness: Autism in the ultraorthodox community of Israel. Social Science & Medicine, 61: 2190-2200
2. DSM autism: http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=94
3. Love, David A. (2012). Is Jesse Jackson Jr doing a disservice to his constituents? The
Grio, August 14. http://thegrio.com/2012/08/14/is-jesse-jackson-jr-doing-a-disservice-to-his-constituents/
- First module paper due
October 8: Resilience and Coping
1. Watters, Ethan. (2010). Chapter 1: The wave that brought PTSD to Sri Lanka. in Crazy
Like Us: The Globalization of the American Psyche. p.65-126. New York: Free Press.
2. DSM Post-Traumatic Stress Syndrome
- In class video: Returned: Child Soldiers of Nepal's Maoist Army
October 10: Treatment and Healing—Dr. Peter Brown guest lecture
1.
Patel V., Weiss, H., et al. (2010). Effectiveness of an Intervention Led by Lay Health
Counsellors for Depressive and Anxiety Disorders in Primary Care in Goa, India: A Cluster Randomised Controlled Trial. The Lancet 376(9758): 2086-2095.
2.
Patel, V. (2012). TED Talk: Mental Health for All, By All. http://www.ted.com/talks/vikram_patel_mental_health_for_all_by_involving_all.html
3.
Levi-Strauss, Claude. The Sorcerer and his Magic.
Fall Break: October 15
Over the break, please read the pieces for our Oct 22 class debate!
October 17: Culture-Bound Syndromes
1. Watters, Ethan. (2010). Chapter 1: The rise of anorexia in Hong Kong. in Crazy Like Us:
The Globalization of the American Psyche. p. 2-64. New York: Free Press.
2. Rebhun, L. (2004). Culture-Bound Syndromes. In Carol Ember and Melvin Ember, eds.
Encyclopedia of Medical Anthropology. p. 319-327. New York: Kluwer Academic/Premium
Publishers.
October 22: DEBATE 2: Universality versus Cultural Particularity of Psychiatric Suffering
1. Canino, G., & Alegria, M. (2008). Psychiatric diagnosis - is it universal or relative to culture? Journal of Child Psychology & Psychiatry & Allied Disciplines, 49(3), 237-250.
2. Samuel, Douglas B. (2012). Assessing personality in the DSM-5: The utility of Bipolar constructs. Journal of Personality Assessment, 93(4): 390-397.
3. Rousseau, Cécile, Measham, Toby, & Bathiche-Suidan, Marie. (2008). DSM IV, culture and child psychiatry. Journal of the Canadian Academy of Child and Adolescent Psychiatry,
17(2): 69-75.
October 24: Comparing Mental Illness Across Cultures DEPRESSION CASE STUDY
1. Miller, Joan. (1997). The interdependence of interpretive ethnographic and quantitative psychological methodologies in cultural psychology. Ethos, 25(2): 164-176.
2. Read one of the following (assigned)

o Cardozo, B. L., Talley, L., Burton, A., & Crawford, C. (2004). Karenni refugees living in Thai–Burmese border camps: traumatic experiences, mental health outcomes, and social functioning. Social Science & Medicine, 58 (12), 2637-2644. o Betancourt, T. S., Bass, J., Borisova, I., Neugebauer, R., Speelman, L., Onyango, G., et al. (2009). Assessing local instrument reliability and validity: a field-based example from northern Uganda. Social Psychiatry and Psychiatric Epidemiology, 44 (8),
685-692. o Jayawickreme, E., Jayawickreme, N., & Goonasekere, M. (2012). Using focus group methodology to adapt measurement scales and explore questions of wellbeing and mental health: the case of Sri Lanka. Intervention, 10 (2), 156-167. o Weaver, LJ, and B Kaiser. (in press). Developing and testing locally-derived mental health scales: Examples from India and Haiti. Field Methods.
October 29: Wrap-up Module 2 (Jeopardy!)
Module 3: Engaging cross-cultural mental health at the socio-political level
October 31: Political-Economic Motives in Diagnosis—DEPRESSION CASE STUDY
1.
Watters, Ethan. (2010). Chapter 4: The mega-marketing of depression in Japan. in Crazy
Like Us: The Globalization of the American Psyche . p 187-248. New York: Free Press.
2.
Ecks, Setfan and Soumita Basu. 2009. The Unlicensed Lives of Antidepressants in India:
Generic Drugs, Unqualified Practitioners, and Floating Prescriptions. Transcultural Psychiatry 46(1): 86-106.
-Second module paper due
November 5: The Politics of Biological Psychiatry
1. Valenstein, Elliot S. (1988). Chapter 2: Discoveries of psychotherapeutic drugs & Chapter
3: Theories of drug action and biochemical causes of mental disorder. in Blaming the Brain:
The Truth About Drugs and Mental Health. p. 9-94. New York: The Free Press.
November 7: Access to Care
1. Saxena, S., Thornicroft, G., Knapp, M., & Whiteford, H. (2007). Resources for mental health: scarcity, inequity, and inefficiency. Lancet, 370(9590), 878-889.
2. Belkin et al. (2011). Scaling up for bottom billion: “5 x 5" implementation of community mental health care in low-income regions. Psychiatric Services, 62(12): 1494-1502.
November 12: Drivers of Mental Illness—Dr. Michelle Parsons guest lecture
1.
Singer, Merrill. 1992. Why does Juan Garcia have a drinking problem? Medical Anthropology.
2.
Skim readings for Nov 19 (we will have in-class debate group prep on this day)
-Two questions for Watters due on BB
November 14: Ethan Watters Guest Lecture: Debates in Global Mental Health
1. Global mental health and its discontents (blog post): http://somatosphere.net/2012/07/global-mental-health-and-its-discontents.html

2. Watters, Ethan. (2010). Conclusion: The global economic crisis and the future of mental illness. in Crazy Like Us: The Globalization of the American Psyche. p 249-256. New York:
Free Press.
November 19: DEBATE 3: Mental Healthcare in Non-Western Settings: Hegemony or Best
Practices?
Re-read September 3th readings, plus these four very short pieces:
1. Fernando, S. (2011). A 'global' mental health program or markets for Big Pharma? Open
Mind Sept - Oct: 22.
2. Salie, M. et al. Unpublished letter to the editor of Nature .
3. Patel, V. (2000). The need for treatment evidence for common mental disorders in developing countries. Psychological Medicine 30: 743-746.
4. Hanlon, Charlotte, et al. (2010). Ethical and Professional Challenges in Mental Health
Care in Low- and Middle-Income Countries. International Review of Psychiatry 22(3): 245-
251.

Panel title and abstract due
November 21: Media Representations and Stigma AUTISM GUEST LECTURE
1. Garland-Thomson, Rosemarie. (2000). Seeing the disabled: Visual rhetorics of disability in popular photography. in The New Disability History American Perspectives Eds. P.
Longmore and L. Umansky. New York University Press, 2000: 335-74.
2. Owen, Patricia R. (2012). Portrayals of schizophrenia by entertainment media: A content analysis of contemporary movies. Psychiatric Services, 63(7): 655-659. DOI:
10.1176/appi.ps.201100371
3. Park, Jun-Hyun, Choi, Young-Min, Kim, Bongseog, Lee, Dong-Woo, & Gim, Min-Sook.
(2012). Use of the terms “schizophrenia” and “schizophrenic” in the South Korean news media: A content analysis of newspapers and news programs in the last 10 years. Psychiatry Investigation, 9(1): 17-24. DOI: 10.4306/pi.2012.9.1.17.
November 26: Class cancelled!
- Third module paper due by class time.
Thanksgiving Break: November 28
December 3: Panel presentations
December 5: Panel presentations
December 10: Panel presentations and recap
1. Harris et al, J.H. A proposal to classify happiness as a psychiatric disorder. Br J Psychiatry. 1993 Apr; 162:539-42.
Final paper due Friday, December 20 at 8:30am