The Making of Psychotherapists: An Anthropological Analysis by James Davies

Author:James Davies
Language: eng
Format: epub

Chapter Seven Illness Aetiologies and the Susceptibilities of Training

I opened the last chapter by noting that to fathom the psychodynamic concept of aetiology we must look to the specific socio-historical conditions out of which it arose. Emphasising how this concept is psycho-centric, I then illustrated through our case study how trainees learn to use such aetiological understanding to guide their clinical interpretations and actions. In this chapter, by contrasting psychodynamic aetiology with aetiologies found in other healing systems studied by anthropologists, I shall not only locate the psychoanalytic conception within a wider scheme of aetiologic-al classification, but also illustrate that the psychoanalytic notion of aetiology constitutes one basis for the practitioner's conviction that psychodynamic therapy has something to offer any patient in emotional distress.

My second aim in this chapter is to note that as the theory and practice of psychotherapy is transmitted in the social space of the institute, the covert pressures of this space bend trainees' subjectivities toward a posture of receptiveness. In other words, we will see how such receptiveness is nurtured by the various institutional stressors to which trainees are subject, stressors disposing novices to submit to the guidance and instruction of seniors.

Classification of Illness Aetiologies

Having in our possession the conceptual and empirical data of the last chapter, we are now in a stronger position to place psychoanalytic aetiology within a wider system of classification. The classific-atory system I would like to discuss is not an indigenous nosology (i.e. one created by the therapeutic community), since it is founded on anthropological rather than psychotherapeutic principles. However, as I offer it here to better understand, or more clearly translate, an aetiological outlook that practitioners embodied as a core disposition, for the purposes of my central argument its contrivance seems justified.

To understand psychoanalytic aetiology in relation to other aeti-ological systems let me first review some existing anthropological literature pertinent to this subject. Not only will this enable us to set psychotherapy down within a broader context, but it will also help us to illuminate through contrast and comparison the exact kind of aetiology psychoanalytic therapy embraces.

Anthropological & Ethnomedical Studies

In surveying the ethnomedical literature on illness aetiologies one thing immediately arrests our attention: such systems look to orthodoxy (the concepts the practitioner holds) rather than orthopraxy (the practice the practitioner undertakes) for the basis of classification. Since the early work of W. H. R. Rivers (1924) this criterion has served to clarify the aetiological idiosyncrasies of diverse healing systems. However, this 'concept-centred' emphasis has led to a depreciation of praxis or clinical activity as an equally useful criterion by which different aetiologies might be classified and ordered.130 In what follows I hope to show why omitting to take praxis into account constitutes an oversight, one which for our purposes warrants rectification. Before I do this, I shall first look at some concept-centred classifications, paying especial attention to Young's dichotomous classification of 'externalising' and 'internalising' systems.

Aetiology Taxonomies

The first classificatory system I shall discuss is from Seijas (1973), which classified non-Western aetiologies into 'supernatural' and 'non-supernatural'.

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