Transforming Therapy: Mental Health Practice and Cultural Change in Mexico by Whitney L. Duncan (review)

Thoughtfully written and carefully researched, this rich ethnography studies the changing landscapes of mental health in Mexico, specifically the “relatively recent growth of Euroamerican-style psychology, psychiatry, and other forms of emotional therapeutics in Oaxaca” (2). Known for its ethnic and linguistic diversity, this southern state of Mexico is also marked by social and economic inequality, political discord, and marginalization of indigenous populations (18). In this context of social change, the author affirms, psy––mental health services and therapeutic practices––has taken hold. Investigating how transnational forms of mental and emotional health care are implemented and transformed, Duncan shows how psy-globalization—the spread of ‘Western’ ways of knowing and working on the self––are part of therapeutic practices that have been adapted and transformed by local populations.

Each chapter links detailed fieldwork experiences, practices, and concepts to show the tensions between these transformative processes at the local and global levels. The first two chapters aim to “explore how therapeutic practices and ideologies generate cultural conflicts as they define the ways modern citizens should know and act upon themselves” (28). Chapter 1, for example, describes in great detail a psychiatric conference held at a hotel in Oaxaca City and contrasts two different events. The first featured a ‘Western’-themed presentation that featured waiters dressed as cowboys. This presentation was also ‘Western’ in the sense that in it, “psychiatrists were engaged in a global endeavor to detect, diagnose, and treat mental disorder.” The second was a less flashy panel that engaged in conversations about understanding community mental health practices, complicating the understanding of patient treatment practices at the local level.

Chapter 2 explores the roles governmental, institutional, and other broader social structures play in defining and producing meaning about mental health practices in local populations. Psicoeducación, an official governmental practice that educates and informs populations about mental health resources, is not limited to clinical settings but spread through religious organizations, schools, and local media. Duncan argues that psicoeducación is an effort to move local cultures from ‘magical thinking’ and ‘traditional’ health practices into modernity. Chapter 3 presents the daily interactions between patients and practitioners, a study of the funding challenges faced by the staff of one psychiatric hospital, and the stories of patients and their families to “illustrate how the very processes of globalization and modernization that facilitate the spread of psy also contribute to the suffering that drives people to seek out psy services to begin with” (92). This chapter uses patient interviews to show the important role familial and social structures serve in supporting an individual’s treatment.

Chapter 4 looks at the intersections of political and economic stressors related to “poverty-induced migration” and mental health services. This chapter is particularly interesting because Duncan also focuses on the mental health of non-migrant families and individuals. Duncan suggests that the emotions and distress felt by “migrant-sending communities must be conceptualized as transnational: rooted in sociopolitical developments, emotional experiences, and movements occurring on both sides of the border and beyond” (121). Finally, Chapter 5 examines the function of mental health groups like Neuróticos Anónimos. Organizations like these generate “spaces for the cultivation of social connection and trust, for socialization in particular ways of knowing the self, and for grappling with forms of suffering rooted in social and familial worlds” (149).

As Duncan demonstrates throughout the study, social, economic, and political strife and conflicts faced by local communities (for example migration and domestic violence) are “directly connected to the very global, political and economic processes that initially facilitate the spread” of mental health practices (184). Engaging and candid, this ethnography brings local mental health practices together with psy-globalization to illustrate the tensions and contradictions between institutional power, ideological differences, and local practices. This monograph will be of interest to those who wish to deepen their understanding of local interpretations of health care and those...