Nervous conditions: cultural difference, political rifts, and mental health care in Israel
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Based on fourteen months of ethnographic fieldwork conducted in Israel between 2013 and 2016, this dissertation examines how clinicians and patients deal with the issues of cultural difference and diversity in Israel’s mental health care settings, which are increasingly called upon to practice “cultural competence.” In 2010s, the Israeli Ministry of Health started to design and execute policy measures intended to target inter-group health disparities and introduce cultural competence in health care institutions. Although modest in scope, these policies are also emblematic of the much larger tectonic shifts that have been reshaping Israeli society over the last three decades, including a neoliberal restructuring of Israeli economy and a decline of the secular Ashkenazi hegemony in political and cultural spheres. In this context, the Ministry of Health measures may be understood as a reaction of a particular segment of the Israeli political elite to the new realities and as an attempt to address mounting public anxieties, while also working within the existing neoliberal and largely non-pluralist political-economic framework. The specific discourses of the cultural competence policies construe culture as a property of individual patients that individual clinicians and institutions should learn to accommodate, without attending to structural or political considerations. And yet, the actual implementation of the governmental agenda in the sphere of cultural competence training is almost never a mere passive reflection of the official discourses: While echoing some of the essentializing and implicitly hierarchical rhetoric of the official policies, the training also smuggles in quietly subversive approaches to cultural difference and recognition. The impact of this training on actual clinical practice is, unsurprisingly, very limited, and clinicians themselves rarely find the discourses of “cultural competence” resonant or relevant. At the same time, they are constantly engaged in complex moral reasoning and ethical decision-making over the nature and limits of empathy and recognition in the face of cultural alterity and political difference. This dissertation contributes to an interdisciplinary literature on the so-called “psy” or psychological disciplines (psychiatry, psychology, psychoanalysis etc.) by proposing an approach that is informed by the anthropology of ethics and morality.