SOAN 045D

THE TRIUMPH OF THE THERAPEUTIC

Spring semester 2006

Instructors: Tom Elverson, Steve Piker

Wed afternoon, 1:15-4:00, SCI 104

In middle class American society, the last half of the 20th century has witnessed the rise to cultural importance of a psychotherapeutic ethos, manifestations of which are that vast numbers of Americans are seeking therapy or allied forms of counseling and support; a flourishing psychotherapy and counseling industry has arisen in response to this; and Americans increasingly phrase issues such as...social relationships and personal well being in psychotherapeutic terms. This course looks at this phenomenon from the perspectives of ethnomedicine and social history: How does the content of this new ethos respond to issues of personal well being(and its opposite)that in all cultures are phrased by ethnomedical systems? Why is this happening in our American world now? Therapeutic fads, and the claims of the therapy industry, will be critically evaluated. Upon completion of this course, you should be equipped to think and converse and write usefully about the following: Most Americans who, in seeking therapy, profess distress are among the most privileged, pampered, protected, and affluent people who have ever walked the face of the earth. Just what the hell is actually going on here?

TABLE OF CONTENTS OF THIS SYLLABUS

1) Introductions

II) Overview of the course

III) Readings

IV) Class procedures

V) Course requirements

VI) Schedule of class meetings

VII Paper assignment

VIII) Final exam

IX) Terms and concepts

I) Introductions

Tom Elverson is a therapist and an educator. He is a 1975 graduate of Swarthmore, with a major in English Literature. He has worked as a special education teacher, counselor, psychologist and Dean in the Wallingford-Swarthmore School District for twenty five years. In addition, he has maintained a private psychological practice for almost thirty years. Following the 911 disaster in 2001, tom volunteered as a crisis worker in New Y ork City for a number of weeks. He counseled and consulted with business people who survived the collapse of the twin towers. For the past two years, Tom has worked in the Deans' and Presidents' offices at Swarthmore. He has taught other courses over the years at Swarthmore, but this is his first course with his mentor and friend, Steve Piker.

Steve Piker is an anthropologist. Earlier in his career, he did field work in a Thai rice farming village, where he lived for two years with his spouse and - for the second of these years - also with his infant son, Josh. The field work focused, inter alia, on popular religion, which in Thailand is Theravada Buddhism. that's where Steve's anthropological interest in the issues of this course originated; because in Thailand, as in so many traditional cultures, the issues of well being and its opposite receive a largely religious phrasing. More recently, Steve has worked with religious conversion in the United States. He has been teaching anthropology at Swarthmore for longer than you folks have been alive, and for the past several years he has also served as foreign study adviser at Swarthmore.

What you can expect of Tom and Steve........ You can expect them to be informal, friendly, always welcoming of your contributions(including suggestions about the course), responsive to your questions, and accessible. Tom and Steve will be glad to see you in their offices, either during office hours or by appointment, and will be glad to hear from you by e-mail as well.

What Tom and Steve expect of you........ The specifics of what this course calls upon you to do are set forth below. Generally, they expect you to be unfailingly considerate of your fellow students in the work that we will be doing together this semester. They expect you to produce your work for this course in the manner set forth in the syllabus. They expect you to be punctual in the production of your work, and to make sure that you get to class on time. They expect you not to hesitate to be in touch with them out of class whenever you are disposed to do so. They expect you to be adults.

Tom Elverson

Parrish West # 153, telvers1@swrthmore.edu

Office hours by appointment, m-F, 8:30-4:30

Steve Piker

Kolhberg 244

Office hours: TTh 9-11, or by appointment

610 328 8111, spiker1@swarthmore.edu

II) Overview of the Course

For any culture, its ethnomedical system contains its understanding and experience of the nexus of issues, health/illness/healing. Ethnomedical systems typically articulate major parts of cultures' understandings of what it means to be well and badly off. Please n.b., for many cultures 'system' may actually be something of a misnomer here, because the domain denoted by 'ethnomedical system' is not necessarily bounded and unified and integrated. It may be pluralistic and internally disjunctive, especially in plural cultures like the modern US. And.....we can name, severally, the different 'parts' or 'systems' of a culture, e.g., the kinship system, the religious system, the political system, subsistence practices, the ethnomedical system. But in the lived experience of natives, where one 'system' leaves off and another begins is often impossible to say. And, as with all cultural 'systems', the contents of ethnomedical systems vary endlessly from culture to culture and, within any culture, the contents may change over time.

Psychotherapy and its hinterlands have, especially in the past half century, become major parts of the American ethnomedical system. Correlatively, psychotherapy has come to have a real big role in our understandings of what it means to be well off and badly off, and how to maximize the former and minimize the latter.

Issue 1(first two weeks). To introduce the concept of ethnomedical system , and cross cultural variability in same. This will show that what different cultures include and exclude in 'well off' and 'badly off'' is highly variable. We will do this by looking at two cultures that construct this in ways vastly different from contemporary middle class US. This will include proposing definitions of 'disease' and 'illness.'

Issue 2(week 3). What does this course intend by 'the therapeutic'? '...a belief that feelings are sacred and that salvation lies in self-esteem, that happiness is the ultimate goal and that psychological healing(psychotherapy and its hinterlands)is the means(thereto).' Such a therapeutic ethos was clearly visible in the US in the last half of the 19th century. By the last half of the twentieth century, 'An almost slavish devotion to psychological health and emotional problems(had come to dominate)our culture.' A major part of this is that large parts of the human experiential or emotional spectrum have come to be medicalized.

Issue 3(remainder of the course). How and why did the therapeutic ethos rise to such importance in our culture? There are(at least)two very different ways to come this question: A) The way that the therapist and his or her patients or clients see it, viz., the mental and emotional problems posited by the therapeutic ethos are real, they are properly seen as health issues, and therapy validly promises to alleviate or remove these problems. B) Alternately(and without necessarily specifically pronouncing upon (A)(, just above), this is a social historical question, and progress toward an answer will involve constructing a social historical narrative of the affinities that aligned changing American groups and their interests with various expressions of the therapeutic ethos. This course is devoted to an exploration of (B).

a) (Week 4). We will look at one master social historical narrative account(Moskowitz)of this process, to get tuned in to what doing social history involves.

b) (Rest of the course). We will look more specifically at a number of specific episodes(e.g., post traumatic stress disorder, satanic panic, the recovery movement, the depression industry, cultural hysterias, making psychotherapy scientific)which comprise important parts of the overall social historical process.

III) Readings

We will be reading the following:

1) Allan Young. THE HARMONY OF ILLUSIONS. INVENTING POST TRAUMATIC STRESS DISORDER

2) Nathan and Snedeker. SATAN'S SILENCE. RITUAL ABUSE AND THE MAKING OF A MODERN AMERICAN WITCH HUNT

3) Wendy Kaminer. I'M DYSFUNCTIONAL, YOU'RE DYSFUNCTIONAL.

4) Dennis Healy. THE ANTI DEPRESSANT ERA

5) Peter Kramer. LISTENING TO PROZAC

6) Elaine Showalter. HYSTORIES.

7) Kirk and Kutchins. MAKING US CRAZY

8) Richard Katz. BOILING ENERGY. COMMUNITY HEALING AMONG THE KALIHARI KUNG

9) Marina Roseman. HEALING SOUNDS OF THE MALAYSIAN RIN FOREST

10) Warren Sussman. " 'Personality' and the making of 20th century American culture"

11) Phillip Rieff. THE TRIUMPH OF THE THERAPEUTIC(concluding chapter)

12) Jerome Frank. PERSUASION AND HEALING(APA Presidential address)

13) Steven Piker. "Be a victim. Psychocultural perspectives of victimhood in modern America."

14) Gananath Obeyesekere. "Buddhism, depression, and the work of culture in Sri Lanka"

15) Tom Wolfe. "The 'me' generation"

(1,24,5,,6,7, 8,9)are available for purchase in the College book store, as well as on general reserve in McCabe. (3) is available from amazon.com, as well as on general reserve in McCabe. Xeroxed copies of the remainder will be made available to each member of the class. You are not required to buy any books for this course.

IV) Class Procedures.

The class will meet Wednesday afternoon 1:15-4:00, in SCI 32. Our class meetings will be given over to a mixture of discussion, group oral reports, buzz groups, and lecture. Informality will be our watchword. Participation on the part of all members of the class is strongly encouraged. We'll plan on having a ten minute break, with refreshment, about mid way through our scheduled class periods.

And, our scheduled class periods will not provide sufficient time to discuss as fully as we want everything we may wish to discuss. Tom and Steve will be available in their offices, and via e-mail, for further discussion. In addition, Tom and Steve will be available to have dinner in the dining hall one eve per week with interested members of the class. We will plan on doing this Monday eve, beginning second Monday of the semester, in private dining room 6 in Sharples. Tom and Steve will plan to be there from about 5:30/5:45-7:00, or later if conversation continues. Each and all, please feel free to drift in and out as schedules and inclinations permit. Informality will be out watch word. For members of the class not on the board plan, your dinners will be paid for. We can discuss whatever we want at these sessions. It occurs to Tom and Steve that the following could be a good continuing discussion topic: If the therapeutic ethos has risen to great importance in middle class America, it is reasonable to hypothesize that it has risen in importance in the Swarthmore College tribe corner of middle class America. This is, or should be, an empirical question. How might one go about seeking a sound answer to this question? Specifically, can we devise a program of feasible research which promises to shed useful light on this?

And.......from time to time, Tom and/or Steve will be sending out all class e-mails, to comment further on what has transpired in class or to flag issues and questions for upcoming meetings, or whatever. You are responsible for being familiar with the content of these e-mails.

And......e-mail can otherwise facilitate out of class communication among ourselves. Specifically, members of the class are encouraged to do all class e-mails if and when they come upon something - e.g., an article or book or personal experience or movie or something from another course or comments on in-class proceedings - that promises to be of interest to the class. A convenient way to do this is to send your e-mail to Tom or Steve, and he or he will all class e-mail it tout suite. Anything that you feel prompted by The Inner Light to share with the rest of us, it's open season.

V) Course Requirements

A) Required work(ungraded): Group reports and buzz groups. To be discussed and assigned in class on a week by week basis. 'Episode of mental illness' report(please see week 1, Schedule of class meetings, VI, below).

B) Required work(graded): Paper and final exam(VII and VIII, below)

C) Class attendance is required. Unexcused absence(s) will result in a grade penalty. The reason for this is that much of each class will be devoted to us working with and helping each other. This is integral to the course, and your full participation in it is a requirement of the course. Extra curricular activities which conflict with our class time will not provide bases for excused absences.

D) Paper and final exam will weight equally in computation of your course grade. Grade penalties for late submission of required work, and for not participating in a group report. Your grade can be helped, but not harmed, by class participation. This is a main way in which we help each other, and enrich and enlarge our learning experiences.

E) Getting to class on time is required. One or two minutes past 1:15 the door will be closed, and later arrivers will not be let in. This will eventuate in an unexcused absence, entailing a grade penalty. Ditto for returning late from break.

VI) Schedule of Class Meetings

Please n.b., readings are correlated with the topic(s) of the week. It is important that you do the assigned reading for the week BEFORE the class meeting for that week. Class discussions will be predicated upon this. And, the amount of reading varies considerably by week. Therefore, for those weeks for which there is not so much reading, it's a good idea to read ahead.

18 January. INTRODUCTION. THE CONCEPT OF ETHNOMEDICINE; DISEASE ILLNESS DISCRIMINATION; REVIEW OF COURSE PROCEDURES.

A) Please bring to class(or e-mail to Tom or Steve)a brief - one and a half or two pages - account of an episode of mental illness which is known to you. It can be real(e.g., from the life of someone you know or know of, or from your own life), or fictional(e.g., from a book or movie or play). Do this off the top of your head. Don't spend more than a half hour or so on it(if you spend as much as forty minutes, we won't look upon it as a serious breach of faith).

B) We will devote some of our class time to a buzz group exercise. For this, the class will be divided into groups of four to five students, and each group will be asked to discuss for about fifteen minutes the ethnographic vignettes, right below, with reference to the questions and issues which follow them. Then each group will summarize the gist of its discussion to the full class.

An ethnographic vignette.....

In the Thai rice village of Baan Oi(sugar cane village)in which Steve lived and did field work for a couple of years, an elderly woman came down with the following symptoms: stomach pains, sometimes acute; vomiting; appetite loss; weight loss; lethargy; disorientation. She was bed ridden and cared for by members of her household.

Her family asked a local healer - an herbalist and 'ghost doctor' - to see what he could do about the lady's affliction. He determined that the source of the affliction was a particularly feared type of ghost, who gets into the victim's abdominal cavity and eats away the victim's insides. By way of treatment, the healer performed at bedside a couple of rituals for the afflicted lady: a 'soul binding' ritual, intended to insure that her soul would remain with her and not flee, and/or restore it to her if it had already fled; and a ghost exorcism. Over a period of a few weeks, both rituals were performed for the afflicted lady a few times. The symptoms did not abate. In fact, by the time Steve left the village a couple of months later, they appeared to have worsened.

Another ethnographic vignette......

In an Appalachian Pentacostal congregation, some members at services for worship from time to time handle poisonous snakes. This is understood by congregants as a test of the strength and purity of one's faith, and congregants find scriptural justification for this belief and the corresponding practice("They shall take up serpents...", Mark XVI,17,18). On one such occasion, a snake handler was bitten by the poisonous snake that he had draped around his neck and shoulders. Non-Pentacostal visitors at the religious meeting at which this occurred urged the snake bite victim(who immediately began to exhibit the symptoms of poisonous snake bite)to go right away to the nearest hospital. But the snake bite victim refused to do so; and, in so doing, was supported by his co-religionists. He insisted that this was not a hospital matter. Rather, he vowed, the snake bite was the will of God; and in fact God, through this event, was testing his faith. It was, therefore, his religious duty to leave his affliction and its outcome in the hands of God, and not to treat it as a medical problem.

Members of the class are asked to address the following:

1) Are either or both of these afflictions diseases?

2) With these two cases in mind, please attempt to propose a general definition of disease.

Readings: No readings specifically assigned for this week. Get started on the Katz and Roseman for week 2.

25 January. WHAT IS AN ETHNOMEDICAL SYSTEM?

Readings: Katz and Roseman.

Two group reports:

A) For the !Kung(Katz), of what does their trance dancing consist? Why do they do it? Specifically, what 'goods', states of well being, is the trance dancing thought to foster? Compare and/or contrast this !Kung conception of healing with the conception of healing embodied by modern Western biomedicine.

B) For the Temiar(Roseman), ditto for their healing practices.

1 February. THE THERAPEUTIC ETHOS

Reading: Sussman, Rieff, Frank, Wolfe

Group report: Perspectives on the rise of cultural celebration of pre-occupation with the self

8 February. THE THERAPEUTIC ETHOS IN SOCIAL HISTORICAL PERSPECTIVE

Reading: Moskowitz

Group report: A la Moskowitz, the attractions to Americans of the therapeutic etho9s, and its costs

15 February. POST TRAUMATIC STRESS DISORDER: THE SOCIAL HISTORY OF A PSYCHIATRIC SYNDROME

Reading: Young

Group report: The historical vicissitudes of traumatic memory

22 February. PTSD(continued)

Reading: Young

Group report: The reality of PTSD in the lives of patients: illness and disease

1 March THE RECOVERY MOVEMENT

Reading: Kaminer, Piker

Group report: who is recovering from what, and how? the manufacture and marketing of malaise.

8 March. SPRING BREAK

15 March. MENTAL ILLNESS. THE DEPLOYMENT OF HOSPITAL RESOURCES IN THE SERVICE OF THE THERAPEUTIC ETHOS

Nowhere is the institutionalization of biomedicine more evident than in hospitals Nowhere is the medicalization of large parts of the human emotional and experiential spectrum more evident than in the mental hospital. For this week,the class period will be devoted to a visit to Friends psychiatric Hospital in NE Philadelphia.

22 March. SATANIC PANIC

Reading: Nathan and Snedeker

Group report: the involvement of psychotherapy in the satanic panic)and allied phenomenoa)of the 1980s

29 March. A PHARMACEUTICAL TRIUMPH? THE CHEMICAL ASSAULT ON DEPRESSION

Reading: Kramer, Obeyesekere

Group report: Is depression a disease? If so, of what does it consist?

5 April. HOW DEPRESSION BECAME BIG BUSINESS

Reading: Healy

Group report: How depression became big business: Medical science, the pharmaceutical industry, the insurance industry, and psychiatry

12 April. MAKING PSYCHOTHERAPY SCIENTIFIC. THE DSM

Reading: Kirk and Kutchins

Group report: Good vs. bad(or bogus)science, in the service of psychotherapy

19 April. CULTURAL HYSTERIAS

Reading: Showalter

Group report:: Why do we have hystories?

26 April. WRAP UP

VII) Paper assignment

The therapeutic ethos has become an important part of the ethnomedical system of the modern US, and the previous paragraph clearly applies to the therapeutic ethos.

For your paper, you re asked to compare and/or contrast the therapeutic ethos in these respects with the ethnomedical system of one of the cultures depicted in one of the books, below.

Plese n.b., A) More than one student can write on the same culture and use the same book. When this happens, you are expected to work out book sharing arrangements. And those of you who are working on the same culture are encouraged to discuss what you are thinking and doing with each other. B) Each of these books is hel by (at least) one of the trico libraries. If, however, the book you want to use is not available to you, switch to another book. Unavailability of book will not provide an acceptable excuse for a late paper. C) These several books are not just about the ethnomedical systems of the cultures they depict. It is part of your responsibility to extract a description of your culture's ethnomedical system from your book, and then to use it in the compare and/or contrast exercise mentioned in the previous paragraph.

Nine or ten pages, double spaced. Due last day of exam period.

1) Paul Brodwin. MEDICINE AND MORALITY IN HAITI

2) Gladys Reichard. NAVAJO ELIGION(Navajo are American Indians, SW US, four corners region)

3) Arthur Kleinman. SOCIAL ORIGINS OF DISTRESS AND DISEASE: DEPRESSION, NEURASTHENIA, AND PAIN IN MODERN CHILA

4) Reo Fortune. SORCERERS OF DOBU(Dobu is a small island in Melanesia)

5) E.E. Evans-Pritchard. WITCHCRAFT, ORACLES, AND MAGIC AMONG THE AZANDE.(the Azande are a Nilotic culture)

6) Jeanne Favret-Saada. DEADLY WORDS: WITCHCRAFT IN THE BOCAGE(Normandy, France)

7) Bruce Kapferer. A CELEBRATION OF DEMONS(Sri Lanka)

8) Nancy Ammerman. BIBLE BELIEVERS FUNDAMENTALISTS IN THE MODERN WORLD(USA)

9) Horacio Fabrega and D. Silver. ILLNESS AND SHAMANISTIC HEALING IN ZINACANTAN(Mexico)

10) Emiko Ohnuki-Tiernay. ILLNESS AND HEALING AMONG THE SAKHALIN AINU: A SYMBOLIC INTERPRETATION(The Ainu are a japanese aboriginal population, who inhabit the Northern islands in the Japan Island chain, including Sakhalin)

11) Frank Speck. PENOBSCOT SHAMANISM(Penobscot are American Indians, Maine and the Canadian Maritimes)

12) Arthur Rubel, Carl W. O'Nell, and Rolando Collado-Ardon. SUSTO. A FOLK ILLNESS(Mexico)

13) Clyde Kluckhohn. NAVAJO WITCHCRAFT

VIII) Final Exam

At the start of our three hours exam period during finals week at the end of the semester, three from the list of questions, below, will be specified for you to answer. Completed exams will be due three hours later. Each essay should be about 700-800 words.

Further.......

A) You are encouraged to prepare your essays in advance, and review your preparation with Tom and Steve.

B) Members of the class are encouraged to work together in small groups(2-4 students)in preparing the exam essays. Groups that do so may, with permission of the instructors, submit a single exam for the group.

C) Grade boost: If you submit more essays than the three required, and if the average grade for the 'more' is at least as good as the average grade for the three you are required to do, this will improve your exam grade(unless you already have a grade of A for the three required essays, in which case it doesn't get any better than that).

Exam questions.

1) The ethnomedical systems of the !Kung and the Temiar embody conceptions of what it means for a person to be well off and badly off. So also jdoes the therapeutic ethos, an important part of th ethnomedical system of the modern US. For either the !kung or the Temiar, compare and/or contrast the contents of these conceptions with the contents of the conceptions of the therapeutic ethos. And compare and/or contrast as well the respective means embraced by the two healing systems for attainment(and maintenance)of wellbeing, and alleviation or prevention of its opposite.

2) Kramer and Healy each provide extended discussions of depression as a psychiatric syndrome. Image that Healy is asked to write an evaluation of Kramer's LISTENING TO PROZAC. Imagine, further, that you are Healy. Now, from your knowledge of Healy's book, write the evaluation of LISTENING TO PROZAC.

3) As our materials illustrate, the therapeutic ethos has risen to great importance in main stream middle class American culture. Swarthmore College is an educational institution, most of whose students, staff, and faculty are drawn from main stream middle class American culture. the conjunction of these circumstances makes it sensible to hypothesize that the therapeutic ethos is prominent and important at Swarthmore College. Is it? If so, how does it manifest itself? If not, why do you suppose that Swarthmore College has somehow managed to avoid it?

4) the mythos of biomedicine posits, inter alia, that its healing practices are grounded in applied medical science and, derivatively, that the establishment of diagnostic categories, or what qualifies as a disease, expresses the reliable application of valid medical science. However, inspection of the actual history of biomedicine shows that delineation of disease often involves negotiation, and that cultural factors extraneous to medical science figure prominently in such negotiations. This is especially evident in the mental health field and the branch of medicine known as psychiatry. From Kirk and Kutchins, you are asked to select onbe or two instances of such negotiation, and elucidate how non-scientific cultural factors can shape the definition of disease.

5) Moskowitz provides us with a magisterial social historical treatment, covering much of two centuries, of the rise to cultural importance in the USA of the therapeutic ethos. Healy for depression, Young for PTSD, Nathan and Snedeker for satanic panic, and Showalter for hystories have each adopted an approach that is in important part social historical. Each, in other words, is attempting a social historical analysis of a specific part of the therapeutic ethos. You are asked to pi8ck any one of the books produced by these authors, and compare and/or contrast its manner of treating the therapeutic ethos social historically with Moskowitz' social historical approach.

6) the effectiveness of psychotherapy - all of it, and/or any particular part of it - has for decades been a vexed issue. In the paper of his that we have read, Jerome Frank addresses this issue. What relevance does his treatment of this issue have for the multitude of psychotherapies that dot our cultural landscape and, especially, for the psychiatry of DSM IV?

7) The DSM posits that mental problems often are diseases for which proper medical treatment promises cure or alleviation. Friends Psychiatric Hospital is a residential institution that purports to provide medical treatment for such problems. Presumably, each - the book and the institution - embody conceptions of disease and preferred treatments of same. Do these respective conceptions agree? If yes, in what important respects? If not, in what ways do they part company? Please n.b., it is assumed that the Kirk and Kutchins volume is your source for knowing about the DSM.

8) You are asked to make up a question which frames an issue that is important to the subject matter of our course, and then to answer the question.

IX) Terms and concepts

1) Elective affinity.

We are indebted to the great German sociologist, Max Weber(active late 19th, early 20th centuries) for the elective affinity way of conceptualizing social historical process.

"With Marx, (Weber)...shares the sociological approach to ideas: they are powerless in history unless they are fused with material interests; and with Nietzsche, he is deeply concerned with the importance of ideas for psychic reactions"(Hans Gerth and C. Wright Mills, editors, FROM MAX WEBER, 1958).

For Weber, however, each of these emphases is part of a more inclusive, and more dynamic, perspective. "Ideas, selected and reinterpreted form (an)...original doctrine, (may)...gain an affinity with the interests of certain members of special strata; if they do not, they are abandoned.... (In other words), Both the ideas and their publics are seen as independent; by a selective process elements in both find their affinities." (IBID)

Weber's best known application of the elective affinity conceptual method for understanding social history is to be found in his, THE PROTESTANT ETHIC AND THE SPIRIT OF CAPITALISM. In part.......In some regions of 16th and 17th century Europe a tradesman stratum - socially not highly esteemed, low regard for itself, no possibility for changing livelihood, already caught up in the Reformation - came into contact with the Calvinist branch of radical ascetic Protestantism which, in part, was plausibly understood by members of this stratum newly to place the highest religious valuation on constructive work in and on the world. In other words, the new doctrine placed the highest cultural value upon a previously despised mode of livelihood. Members of this stratum embraced the new doctrine, but selectively so, highlighting those parts(or those among competing interpretations) which 'fit' their material interests, their already established and inescapable life ways(e.g., making a living as tradesmen). As a result of the embrace, members of the tradesman stratum come to sacralize their work, to view it as a religious vocation, and - therefore - to imbue it with a new motivational zeal, new as regards both content and intensity. This in turn transformed their every day lives in many fundamental respects and, inter alia, led to a level of mercenary gain theretofore unknown within this stratum.

Throughout this semester, we plan to take this elective affinity approach to the rise of the therapeutic ethos in the US in the past half century or so: We will look at the ideas embodied by various parts of this ethos, and we will look at the 'interests' of groups of Americans(a la Weber, 'interests' understood in terms of the social situations of the actors), and we will try to grasp why and how some of these therapeutic ideas, on the one hand, and some of these groups of actors, on the other hand, came to experience powerful mutual affinities; why, in other words, they embraced and, having embraced, how the embrace remade the lives of the actors.

If there is a master concept for this course, the concept is elective affinity.

2) Emic and etic

These funny sounding paired terms refer to two different perspectives on the same thing, the perspective of the insider(native)and of the outsider(researcher, e.g., anthropologist). They come from descriptive linguistics, where the 'same thing' is a speech sound. For any speech sound, phonetics describes the sound in physical terms. Only a trained linguist can successfully do phonetics, and a linguist's phonetic representation of speech would be incomprehensible to a native speaker. Phoinemics, on the other hand, treats what makes the sound(s) uniquely meaningful to native speakers. Whereas phonetics has nothing whatsoever to do with the speaker's understanding of his or her speech, phonemics is grounded expressly in the speaker's understanding of what his or her speech means, it embodies the speaker's perspective on his or her own speech.

Analogously, recall the sick lady in the first of week one's ethnographic vignettes. the emic, native, perspective on her situation says that she is afflicted by ghost possession, an should be treated accordingly. An etic perspective on the same situation which would be sensible to us and is grounded in biomedicine would say she is afflicted by a serious gastro intestinal disorder, would name the disorder, interpret its etiology, and recommend a very different kind of treatment. Or, to allude to 'natives' who will be important to us this semester - e.g., therapists, patients - their emic take on the therapeutic ethos is often that it has arisen in response to real medical problems and that it reliably promises relief from same(the fact that this native 'take' is often draped in the trappings of science makes it no less emic for our purposes). Whereas this course will be flogging an etic social historical uperspective the same phenomenon, the therapeutic ethos, which is vastly different from the native, emic perspective on same.

For either or both of the cases mentioned in the previous paragraph, one might further ask, 'Well, which of the two very different, and perhaps disagreeing, perspectives is correct?' Almost always, for the anthropologist, this is not a useful question, we shouldn't waste time on it. Thus, I expect that most of anthropologist don't accept that, e.g., ghosts and demons exist. But it is not part of our anthropological calling to treat native beliefs(and practices rationalized by them)as empirical propositions to be tested according to the procedures and criteria of Western science. Rather, it's our job, first, fully and accurately and contextually to describe the usages which are important in the lives of the natives we are learning about; and, second, to try to figure out why, in the context of these lives, these usages are compellingly sensible to natives.

And, it is increasingly commonplace, as literacy becomes established in even remote parts of the third world, for natives to read studies of them produced by outsiders. Often, these studies contain etic perspectives on native lives and culture. Sometimes native readers criticize these etic perspectives on the grounds that, as natives, they know the significance of the usages of their own cultures; and if their native knowledge disagrees with the outsiders' knowledge, then the outsiders are ipso facto wrong. What about this? The point to remember is this: Emic and etic are disjunctive frames of reference. The validity of an etic perspective is properly judged in terms of the frame of reference which generates it. Of course, if we don't think that a frame of reference is worthwhile, then we won't be interested in any of the perspectives it generates. Thus, modern chemists don't have much time for anything that comes from alchemy.

And, much of anthropology treats the meaningfulness to natives of local, everyday life. If one wishes, as anthropologists often do, to develop etic perspectives on local life, it is imperative that one first learn and describe satisfactorily the emic perspective on the same local, everyday life. Thus, in this course, we wish to develop etic social historical perspectives on the therapeutic ethos. In the service of this goal, we will, therefore, properly devote alot of time and attention to getting our minds around the emic, ntive perspectives on the same things.

3) Etiology, disease vector.

E.G., the medicos want to establish the etiology of diseases, how diseases arise. Successful establishment of the etiology of a disease involves identifying the disease vectors, the contributing causes of the disease. Development of effective treatments and/or preventions is supposed by biomedicine to presuppose the establishment of valid -please see( 4,)just below - etiologies. Just for biomedicine, disease vectors can be very specific and precise(e.g., a specific pathogen, a specific gene, a specific type of trauma)or very general(e.g., life style. For a snoot full of the latter, take a gander at the NYT four part, 9-12 January, series on diabetes). The general disease vector is often, conceptually, vague and messy, which means inter alia not amenable to reliable - please see(4), just below - measurement. This does not, however, make it any less real or important than the specific disease vector.

Healing systems of the cultures of the world all posit etiologies of whatever it is they purport to heal(and/or prevent). These etiologies refer ,inter alia, to ghost possession, pathogens, sorcery victimization(e.g., the evil eye), heredity, trauma, menstruating women, early life psychological traumas, the will of God, ingested substances, Karma, anomie, social disharmony.

4) Validity and reliability

Validity pertains to the correctness of knowledge or ideas. Judgments of the validity of knowledge or ideas are always made within the frame of reference which generated the knowledge or the ideas, which frames of reference rest, finally, on untestable assumptions. It follows, therefore, that, e.g., disagreements as to the validity of an idea or bit of knowledge can only usefully and fruitfully be discussed within the frame of reference, by people who agree on the untestable assumptions. Thus, the Book of Genesis contains an account of the origins of the universe, and of the origins and nature of life on earth; and so also do the sciences of astrophysics and evolution. These are disagreeing accounts. Because the respective accounts are grounded in disjunctive frames of reference, the disagreement cannot be usefully adjudicated by the respective partisans.

Reliability pertains to procedures for measurement. A measurement procedure is reliable if repeated applications of it to the same thing produce the same results.

Thus, within the frame of reference of science, the theory of gravitation comprises valid knowledge of the physical universe; and, properly designed and constructed scales enable reliable measurement of some of the predicted effects of gravitation.

A good deal of psychotherapy purports to be scientific. Re this, we will ask, inter alia, within the frame of reference of science, how valid is the knowledge which supposedly grounds the therapy? And how reliable are the measurement procedures - e.g., diagnostic techniques - which supposedly measure what the therapy purports to treat?

5) Native. We are all natives. We differ from each other according to what culture(s) and sub culture(s) we are natives of.

"It rains on both the just and the unjust fella......

But it rains mainly on the just, because the unjust has stolen his umbrella"