Culture, Medicine, and Psychiatry

, Volume 41, Issue 4, pp 499–540 | Cite as

Family Life and Social Medicine: Discourses and Discontents Surrounding Puebla’s Psychiatric Care

  • Kathryn Law Hale
Original Paper


Drawing on clinical data from 15 months of on-site participant observation in the only public psychiatric hospital in the state of Puebla, Mexico, this article advances our understanding of globalization in relation to psychiatry. I challenge the construction of psychiatry as only treating the individual patient and provide grounded doctor-patient-family member interaction in a Mexican psychiatric clinic in order to review what happens when doctors cannot interact with patients as atomized individuals even though in theory they are trained to think of patients that way. Challenged by severe structural constraints and bolstered by lessons from other nations’ efforts at deinstitutionalization, psychiatrists in Puebla push to keep patients out of the inpatient wards and in their respective communities. To this end, psychiatrists call upon co-present kin who are identified both as the customer and part of the caretaking system outside the clinic. This modification to the visit structure changes the dynamic and content of clinical visits while doctors seamlessly respond to unspoken beliefs and values that are central to local life, ultimately showing that efforts to define a “global psychiatry” informed by global policy will fail because it cannot exist in a uniform way—interpersonal interaction and personal experience matters.


Psychiatry Mexico Globalization Doctor–patient interaction Family-oriented care 



This research project was supported by the National Science Foundation (Grant# DGE-0707424) and summer research grants from the UCLA Department of Anthropology and the UCLA-FPR Center for Culture, Brain, Development, and Mental Health. First and foremost, I thank the patients, family members, psychiatrists, psychologist, and psychiatric residents who participated in my project. I am also indebted to Dra. Lara, Dra. Baez, Dra. Herrera, and other staff members at el Hospital Psiquiátrico Dr. Rafael Serrano who welcomed me into their facility and their daily lives. Moreover, I wish to thank my advisors (Thomas Weisner, Elizabeth Bromley, Linda Garro, Steven López, and Elinor Ochs) for their mentorship and feedback, and Dr. Aguilar, who became an honorary adviser during my time in Puebla. These ideas were presented in an earlier, abbreviated format at the 2014 American Anthropological Association annual meeting as part of a panel entitled “Psyche and Brain in the 21st Century.” This piece also benefited from feedback from two anonymous reviewers, members of the Center for Culture and Health lab group at UCLA, the UCLA Mind, Medicine, and Culture group, and one-on-one discussion with Jena Barchas-Lichtenstein, Keziah Conrad, Whitney Duncan, and Scarlett Eisenhauer. Having acknowledged these sources of support, all errors and omissions are my own.


This study was funded by the National Science Foundation Graduate Research Fellowship Program (Grant# DGE-0707424) and summer research Grants from the UCLA Department of Anthropology and the UCLA-FPR Center for Culture, Brain, Development, and Mental Health.

Compliance with Ethical Standards

Conflict of interest

Kathryn Hale declares that she has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. IRB approval was obtained from the Institutional Review Boards (IRB) at both the University of California, Los Angeles and el Hospital Psiquiátrico Dr. Rafael Serrano in Puebla prior to start of data collection.

Informed Consent

Informed consent was obtained from all individual participants included in this study.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of AnthropologyUniversity of California, Los Angeles (UCLA)Los AngelesUSA

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