Moujan Mirdamadi

Investigations into antagonistic political emotions have typically included a concern with expressions and actions related to particular emotions, such as hatred, anger, fear, and ressentiment, or examining how seemingly positive or apolitical emotions can become antagonistic on the political stage. Yet one of the ways in which antagonistic politics plays out is through imposing controls and restrictions on the spaces containing the expressions and experiences of emotions. Focusing on online social spaces as such a container, we examine how antagonistic politics play out within and through such spaces. Using the case of the 2019 protests in Iran when access to the internet was blocked across the nation as a means of oppressing revolt, we examine dynamics of political antagonism online. We highlight the affordances of online communities as a “holding space” for various emotions and affects that arise in response to state violence and oppression, and we consider some ways in which online spaces foster new possibilities for political empowerment and collective action.

Important pillars of Iranian culture and the current social makeup of Iran are detailed as shaping the background against which experiences of depression take on a uniquely cultural form and meaning. Shi’ism as the official religion in Iran, the place of Persian literature in the collective consciousness, and historical turning points such as the Islamic Revolution and the Iran-Iraq war form the foundations of the current sociocultural context of the country. Within this culture, the status of sadness and dysphoria as valued emotions is examined and together with a brief history of psychiatric pedagogy and practice in the country, helps to arrive at the culturally unique conceptions of depression in Iran. The elements examined in this chapter form the basis of the cross-cultural analysis that follows.

Somatisation as an aspect of cultural variation in mental disorders has been widely studied. Less has been offered by way of explaining how culture influences presentation with somatic symptoms. Acknowledging the embodied experience of depression as a universal part of the disorder, a range of different bodily symptoms in depression are examined, including fatigue, lack of energy and perception of body as heavy and leaden. Situating these universal experiences within a cultural context with particular conceptions regarding health and illness, the higher emphasis on some of the somatic symptoms such as pain is accounted for. While the meaning and significance attached to somatic symptoms may be culturally determined, these nonetheless ought to be understood as instances of disturbances of embodiment, itself a universal part of experience of depression.

Some of the cross-cultural variations in symptoms and experiences of depression are those seen in the personal domains of relationship and which arise due to the spilling over of the perceived lack of empathy prevalent in social relationships. Iranian depressed patients, unlike those in the UK, do not complain of feelings of guilt and instead complain of feeling aggressive towards others; rather than feeling lonely in depression, they seek to isolate themselves from others. Using Sartre’s phenomenology of being-with-others and emotions, the breakdown of interpersonal bond in the Iranian cultural context is examined. By situating the phenomenological considerations within the sociocultural context an understanding of variations in experiences of depression in light of cultural conceptions is given.

Within Iranian culture awareness of death is encouraged and woven into everyday understanding of life and lived experiences. This death-conscious culture can be traced in religious belief system, works of literature old and new, and dominant discourse pushed through by the political establishment. This element of the culture can account for variations in manifestations of certain depressive symptoms, the different emphasis placed on them, and different ways of encountering them. Iranians commonly complain about a sense of meaninglessness and absurdity in depression which can be accounted for by appeal to the death-conscious culture and the cultural conceptions of life. Similarly, this culture can account for manifestations of suicidal ideation and ‘passive suicide’ as a response to one’s religious duty to protect and preserve one’s life. It is also shown how a death-conscious culture has phenomenologically important effect on a common symptom of depression, namely loss of hope.

Psychiatric science defines depression with a fixed set of symptom manifestations, presumed to be universal across cultures, while different studies have documented the presence of variation in manifestations and experiences of depression. The role of culture, as a system of beliefs and values that impacts individuals’ experiences of and encounters with depression, however, has been largely overlooked in the literature. Noting the importance of first-person accounts of depression, the phenomenological framework for understanding the role of culture in shaping experiences of depression is introduced. Through a phenomenologically informed cross-cultural comparison of experiences of depression between Iran and the UK, it is hoped that a plausible account of the cultural shaping of depression can be given. The chapter includes details of aims and methodology of the study and offers a summary of chapters and arguments that follow.

Broad implications of the study for psychiatry and phenomenology are outlined. Findings of the study bring under question the claim to universality of psychiatry as a science, consequently casting doubt on psychiatric practice with universal diagnostic criteria and methods at its heart. Similarly, it is argued that phenomenological investigations are made more complete and informative if they adopt a culturally sensitive outlook. In this sense an individual ought to be viewed as always situated within a sociocultural context that gives her experiences meaning and significance.

Disturbances to interpersonal relationships are an important part of experiences of depression and in Iran, as a collectivist culture, this importance is seen ever more clearly. Focusing on the tensions in the social sphere of relationships and using Heidegger’s phenomenology, the conflict felt between an individual with depression and her society’s misunderstanding of the nature of the illness is highlighted. Using the first-person accounts, it is shown how a misconception of the illness and the resulting stigmatisation of depression affects a depressed person’s experiences of the illness and her space of possibilities in seeking help for the disorder. The conflict between one and her society is experienced as a lack of empathy, which colours the depressed person’s experience of interpersonal relationships.

As a complex disorder that encompasses a wide range of physical, cognitive and emotional symptoms, depression gives rise to experiences that are often difficult to express. Due to this complexity, and especially in a cross-cultural study, sensitivity to metaphorical expressions and narratives of depression are important. Using the cognitive-linguistic framework for metaphors, universal and cultural metaphors of depression are examined. While universal metaphors of depression, rooted in the embodied experience of the disorder highlight what is unique to depression itself, cultural metaphors bring to attention the culturally unique modes of understanding, interpreting and experiencing depression that merit further investigation. Metaphors of colour and water, used by Iranians, signal a cultural understanding of the self and the world in depression, traceable to Persian literature and religious conceptions.

The preceding chapters offer case studies of instances where cultural conceptions are shown to play a role in how a phenomenon is experienced and communicated. Here the aim is to offer a theoretical sketch for understanding culture, experiences and narratives as inherently inseparable. Bourdieu’s theory of the habitus and field is used to argue for this inseparability. Using this account, an objection is made to the notion of idiom of distress for its lack of explanatory power. The broad use of the notion in the literature, and the theoretical account offered, together demonstrate the notion’s lack of explanatory power thus limiting its use to other points of concern such as highlighting the importance of culture in intervention methods.

This paper offers a phenomenologically informed critique of the post-traumatic stress disorder (PTSD) model of trauma in cross-cultural contexts. Using the case of the Iranian political lifeworld, where the psychiatric discourse of trauma in delineations of various heterogenous experiences of distress is dominant, I demonstrate how trauma can be conceptualized and experienced as temporally extended and collectively shared—contrary to the paradigmatic understanding. First, the PTSD model of trauma as seen in the _Diagnostic and Statistical Manual of Mental Disorders_ (DSM) is examined, where I highlight how the model fails to recognize the importance of sociocultural environments in bringing about states of psychological (ill)health. Second, using first-person accounts by Iranians, I examine how trauma finds meaning and significance within a particular sociocultural setting. Third, by revisiting the notion of continuous traumatic stress (CTS) as a feature of the social environment, I show how a re-coupling of environments and individuals within them can offer a more complete understanding of trauma and the distressing and/or pathological states it may give rise to. Highlighting the common threads with growing interest in enactive and extended approaches in philosophy of psychiatry, I therefore argue for the recognition of the socioculturally constructed conceptions of trauma in shaping experiences and responses to it.

This paper offers a phenomenologically informed critique of the post-traumatic stress disorder (PTSD) model of trauma in cross-cultural contexts. Using the case of the Iranian political lifeworld, where the psychiatric discourse of trauma in delineations of various heterogenous experiences of distress is dominant, I demonstrate how trauma can be conceptualized and experienced as temporally extended and collectively shared—contrary to the paradigmatic understanding. First, the PTSD model of trauma as seen in the Diagnostic and Statistical Manual of Mental Disorders (DSM) is examined, where I highlight how the model fails to recognize the importance of sociocultural environments in bringing about states of psychological (ill)health. Second, using first-person accounts by Iranians, I examine how trauma finds meaning and significance within a particular sociocultural setting. Third, by revisiting the notion of continuous traumatic stress (CTS) as a feature of the social environment, I show how a re-coupling of environments and individuals within them can offer a more complete understanding of trauma and the distressing and/or pathological states it may give rise to. Highlighting the common threads with growing interest in enactive and extended approaches in philosophy of psychiatry, I therefore argue for the recognition of the socioculturally constructed conceptions of trauma in shaping experiences and responses to it.

This book is an investigation into cultural variations in experiences of depression. With the aid of empirical data, and with a phenomenological outlook, the analyses presented aim to give a comparative account of the significance of culture in shaping cross-cultural variations, as seen in Iran and the UK. Through analysis of elements of Iranian culture such as literature and folk theories, and important pillars of current social make-up of the country like experience of Iran-Iraq war, the Islamic revolution and its dominant religious discourse, variations in conceptions, experiences and narratives of depression are accounted for. Some of the themes explored include discussions of particular symptoms of depression such as guilt, hopelessness, loss of meaning and somatic symptoms; social stigmas and help-seeking behaviours; changes in relations with others; and metaphors used to convey experiences of depression. The findings of the empirical data examined challenge the universalist approach to psychiatry as science and practice, as well as theoretical notions like idioms of distress that aim to account for cross-cultural variations of mental illness. Instead, it is claimed that a better understanding of the workings of mental illness is achieved by situating individuals and their experience in a meaning-making sociocultural context.