The culture of mental health in a changing Oaxaca

This dissertation examines the causes and consequences of the recent growth in Euroamerican mental health practice in Oaxaca, one of Mexico's poorest and most ethnically diverse states with a thriving tradition of indigenous medicine. Based on 18 months of fieldwork in Oaxaca City and the Mixteca region, I explore how and why mental health services have grown so dramatically; what they consist of and what discourses they promote; for what problems they are being utilized; and what impacts they are having in the region. In so doing, I advance a number of central claims. First and most broadly, I argue that Oaxaca is experiencing a shift in its culture of mental health, one in which globalizing conceptions and practices are taking hold and impacting understandings of illness, self, and social relations. Social problems such as migration and violence are increasingly dealt with in the clinical setting as matters of mental health, and concepts such as trauma, stress, self-esteem, and self-expression are gaining traction throughout the state. Secondly, I argue that mental health professionals themselves are integral to these broader shifts. As conduits of the global attempting to mold the local, practitioners' enterprise goes well beyond the provision of treatment: I show how they are actively attempting to foment culture change in the region. Representations of `culture'--which practitioners view as incompatible with mental health and with modern forms of subjectivity--are central to this project. Finally, community members do not merely absorb these globalizing concepts; rather, they actively engage with and alter them on the ground. Thus the expansion of Euroamerican mental health practice is not simply a homogenizing process, but one in which globalizing concepts articulate with local meaning systems to generate novel social practices, experiences, and self- understandings. As a fine-grained ethnographic analysis of social and cultural change, the dissertation (1) advances social scientific theory on the reciprocal relationships between global trends, cultural discourse, professional practice, and individual experience; (2) provides qualitative data on health ideologies, disparities, and access to treatment in marginalized communities; and (3) contributes to anthropological and cross-disciplinary scholarship on culture, mental health, and globalizatio