To the Editor: In a column in the November issue, "Efforts to Support Special-Needs Soldiers Serving in the Israel Defense Forces," Bodner and colleagues (1) claimed that "providing treatment and support to special-needs populations can decrease psychopathology and suicide rates." Their argument is based on a case study of MACAM (the acronym for the title in Hebrew of the Center for the Advancement of Special Populations). MACAM is a unique program for "special populations" recruited into the Israeli army. Bodner and colleagues' column draws heavily on my own work, which explores what I term "institutional ethnopsychology" in Israel (2).
My use of the term ethnopsychology follows its use by Gaines (3), which should be distinguished from its more common usage in psychological literature as folk psychology (see Lillard ). As I apply it, "institutional ethnopsychology" refers to rehabilitation programs that are directed at managing selected ethno-class groups. In contrast, the psychological rationale for ethnopsychological models is fused with popular wisdom and cultural beliefs about social difference. Standard ethnopsychological programs treat sociocultural attributes "as cognitive, emotional, behavioural and structural characteristics of the individual … abstracted from the individual's social, economic, cultural and political context" (2). The models are normally applied by teachers, social workers, youth counselors, and others rather than by psychologists or psychiatrists. However, by focusing on an individual's disorders and pathologies, the models obscure the role of socioeconomic, cultural, and political forces in shaping social difference and hierarchies.
My article showed how culturally ingrained beliefs about the Mizrahi population (Jews of Middle Eastern and North African origin) are integrated into the therapeutic discourse and the logic of practice applied in the MACAM program (1). In my case, over 95% of MACAM participants were of Mizrahi origin and from disadvantaged neighborhoods. My analysis of ethnopsychology in the MACAM program thus referred to a set of beliefs about soldiers rather than to literal descriptions of the soldiers' condition. As presented in the column by Bodner and colleagues, my analysis has been substantially misread and misinterpreted, with these authors depicting MACAM soldiers as a group of random individuals suffering from mental disorders rather than a distinct ethno-class group suffering from social exclusion and marginalization.
Bodner and colleagues' omission of the soldiers' ethnicity from their text is particularly striking given that their subject—suicide rates among special populations—has been closely linked to ethnicity (5). This blind spot raises interesting and relevant issues for readers of Psychiatric Services. One issue is the relevance of class, ethnicity, and social context to suicide rates. A second is the denial of ethnicity in a national therapeutic discourse and the resulting therapies. Third, ethnicity's absence provides an intriguing case of what happens when knowledge crosses disciplinary boundaries. In this instance, salient sociopolitical dimensions were filtered out. These issues hint at how much my work has been distorted in the transition. The impact of such issues on theory and practice deserve, I believe, further attention in Psychiatric Services.
Dr. Mizrachi is with the Department of Sociology and Anthropology, Tel Aviv University, Israel.
1.Bodner E, Iancu I, Sarel A, et al: Efforts to support special-needs soldiers serving in the Israeli Defense Forces. Psychiatric Services 58:1396—1398, 20072.Mizrachi N: "From badness to sickness": the role of ethnopsychology in shaping ethnic hierarchies in Israel. Social Identities 10:219—243, 20043.Gaines AD: From DSM-I to III-R; voices of self, mastery and other: a cultural constructivist reading of US psychiatric classification. Social Science and Medicine 1:3-24, 19924.Lillard A: Ethnopsychologies: cultural variations in theories of mind. Psychological Bulletin 1:3—32, 19985.Spicer RS, Miller TR: Suicide acts in 8 states: incidence and case fatality rates by demographics and method. American Journal of Public Health 12:1885—1891, 2000