| This ethnography traces solitary and mutually participated in rites of passage undertaken by individuals whose lives were temporarily bound together in the sequestered universe of psychopathology, and in its functional analogue, the field site of the inpatient psychiatric unit. Turner's model of ritual process and his construct of "liminality" as a crucial threshold stage, "betwixt and between" endings and beginnings, provides the theoretical and analytic foundation for deconstructing and linking mental illness, psychiatry and the author's field experiences (1969). The social, cultural, political and economic settings in which perceptions of and responses to mentally ill individuals, and the institutionalized structures of incarceration evolved, and the fundamentally unchanging ideologies and agendas that have kept "the different" locked in limbo, from the fifteenth century to the present, are reviewed. The history of the anthropology/psychiatry alliance, psychiatry's commitment to biomedicine and chemotherapy, and anthropology's intradisciplinary diversity and the formation of "medical anthropology," "critical medical anthropology" and "clinically applied anthropology" are contextually juxtaposed with macro changes in American society. The structure, function, personnel and "healing rituals" of the inpatient unit, and the ways in which its person, place and time warp reinforce and perpetuate pathology are discussed. Contradictory theories related to the timeless enigma of madness, its etiology, chronicity and outcomes are contrasted with literary constructs and experiential accounts of mental illness. For the patients, the unit replicates and buttresses their status as "liminal personae," permanently cast in the role of pariah, and exiled to the lowest realms and statuses of social life.; The synergism of my expanded privileges, escalating involvement with and ultimate "entrapment" (Schwartz 1964) by the patients was a determinant of changes in my directions, affiliations and objectives, and of my irrevocably altered views of the mentally ill, psychiatry's practices and practitioners, and of self. Several multidimensional case histories of patients whom I had interviewed, illustrate the failings of psychiatry's therapeutic ministrations and indicate that there is an extant void in patient follow up services which anthropologists have the appropriate training and qualifications to fill.; For me, passage through the limbo of the psychiatric unit was a true odyssey into "the heart of darkness--a strange land with occult practices" (Tyler 1986: 121). It represented a threshold crossed, and marked endings--and beginnings. My "findings" suggest that those who have chosen to practice an "anthropology of affliction" (Farmer 1988a: 80), can and will find needs and places to which they can contribute to those areas that have been an enduring focus of anthropological inquiry--human health and human life. |
