Developing a Social and Epistemological History of Psychiatric Epidemiology through a Case Study (Senegal) and international network – SEHPE

1)Multi-scalar, multi-method historical-anthropological case-study of the social uses and conceptual characteristics of epidemiology in global health initiatives around the psychoses, depression and epilepsy, in Senegal. Psychiatric epidemiology will be examined not as produced in Western academia, but as practically produced or resisted in specific localities. Rather than a linear history of the diffusion of expertise and standards, we posit local-global (“glocal”) processes: globalization shaped by the circulation and aggregation of local practices; global policies or programs achieved only through interaction with local actors. To grasp the ‘global’, we combine levels of analysis; trace circulation of experts, policies, tools, standards, etc.; observe their local reception. We use archives, artifact analysis, interviews, and observation including with actors usually left out of history (e.g. patients, families, local communities, research subjects), artifacts (computers, logbooks, standardized tools, gifts…) local and regional policies and practices (e.g. the transition from post-colonial research to nation-state controlled health research) and the interaction between different scales. This local epidemiological history is related to the reconfiguration of health governance in the post World War II period. Finally, we treat epidemiology not simply as techniques to empirically describe things, but as practices that do things (Bauer 2000), or make facts through statistical processing, combining scales of intervention, contextually interpreting information, and valuing certain data over others.
2)To promote international histories of psychiatric epidemiology, a workshop will build common methodology for reasoned comparisons of local case studies.
3)To promote exchanges between with practicing epidemiologists and 4) disseminate findings in medical anthropology, history, epidemiology and interdisciplinary venues, we will encourage publication within the network.

Forthcoming

Forthcomng

Forthcoming

This project aims to contribute basic social science foundations for a social and epistemological history of psychiatric epidemiology. Unlike general epidemiology, psychiatric epidemiology is virtually unstudied as a historical or anthropological object, a situation attributable to three characteristics: (1) its late consolidation compared to other epidemiology; (3) its problematic object – mental illness, mental health – which, in the absence of biomarkers, is relatively refractory to objectification and standardization; (3) its highly variable social usages due not only to its conceptual instability, but also to contextual differences (low vs high-income countries, post-colonial histories, public health cultures, ).
We hypothesize that this differentiated history was shaped through two regimes of knowledge and action: international health and development (1960 – mid-1980s, for mental health) and globalization of health (ca. mid-1980s-present). In the first period, focus on epidemics, mortality and disability from tropical diseases eclipsed mental health concerns. Yet WHO and researchers promoted psychiatric epidemiology, partly to demonstrate the universality of psychiatric categories. In the second period, international health care development gave way to the primacy of research, pharmaceutical marketing and neo-liberal models. International bodies like WHO were replaced by private-public partnerships. These transformations influence and are in turn affected by the development and scaling up of psychiatric epidemiology studies, strengthened by the globalization of diagnostic systems (e.g. DSM).

Two research components will explore these hypotheses:
(1) a historical and anthropological case-study (Senegal, 1960-2012) with the objective of examining the development, social uses and conceptual characteristics of psychiatric epidemiology. This case’s interest lies in a unique post-Independence psychiatric tradition, the “Fann School”, influenced by anthropology and French psychoanalysis and founded by a French neuropsychiatrist. Despite the “mistrust of numbers” built into French psychiatry (Henckes 2010), Fann collaborated on mental health and epilepsy aspects of development surveys. With global health, however, the epidemiology of epilepsy developed locally, but not so quantitative study of mental illness.
Data will be collected through archival research, oral histories and observations of actors (research scientists, agents and participants; members of public health agencies, NGOs, multilateral organizations, the pharmaceutical and research industries). These include psychiatrists and epidemiologists whose work spanned both regimes in Senegal. Data will be managed with nVivo qualitative data software. Analysis will include tracing multidirectional connections between networks of individuals and organizations though which psychiatric epidemiology has been constructed (or not), and examining local practices and actors’ meanings constitutive of the field. Logistical aid and office space for the case study will be provided by the Dakar IRD unit at the Centre Régional de Recherche Clinique (CRCF)
(2) The promotion of an interdisciplinary, international network of scholars researching the history of psychiatric epidemiology. The network, founded by the PI in 2010, will be fostered through a post-doctoral position and 3-day workshop, in partnership with historian and epidemiologist G. Oppenheimer (Columbia University Center for the History and Ethics of Public Health).
Project deliverables include presentation of results to academic bodies and practitioners in epidemiology and public health (France, Senegal), articles in scientific journals, an edited volume (English) and published French translation. Most importantly the project will innovate through a new subfield at the intersection of anthropology, history and social studies of science and a case study that should become an exemplar for research within that subfield.