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In our age of massive public protests, roiling college campuses, fascistic governments, and simmering wars around the world, coming on the heels of a still-fresh pandemic that took the lives of millions and disrupted many more, is it any wonder that we are in the grip of an age of anxiety? How do we understand so-called pathological and everyday forms of worry and the role of pharmaceutical and wellness industries in alleviating or exacerbating local and global dis-ease? Allen Tran's masterful A Life of Worry: Politics, Mental Health, and Vietnam's Age of Anxiety provides incisive answers to these and other questions that go far beyond its specific context of Vietnam's Ho Chi Minh City and its original mission, which was to answer a different ethnographic puzzle—of why rapid progress and change, even for the better, can be challenging and disorienting to handle. The book is at once concise, rich, and deeply thought-provoking, showcasing some of the best that sociocultural medical and psychological anthropology have to offer. In just 142 pages (notes included) helpfully divided into three sections (definitions, clinical manifestations, and extra-clinical interactions), A Life of Worry accomplishes what few monographs can do. First, it introduces readers to key concepts and theories in anthropology, including theories of selfhood and subjectivity, the phenomenology and politics of morality/ethics, medicalization, mental health, and psychologization. Second, it provides a vivid picture of a specific ethnographic context and locale, namely, Ho Chi Minh City's rising middle class in Vietnam's quickly transforming sociopolitical and economic context of the early 21st century, and the impacts and implications of these transformations on urban Vietnamese experiences of selfhood, belonging, and health-seeking. Third, the monograph thereby also illuminates facets of human experience and social practice—particularly that of "anxiety" under neoliberalizing conditions—beyond the specific context of Vietnam. The thrust of Tran's argument is that anxiety is not just an emotional state or existential condition, nor reducible to a pathological symptom or a biochemical process; rather, anxiety is fundamentally a social practice that creates and sustains social relationships — "something we do and perform in addition to feel and experience" (6–7). This argument allows Tran to make a further key move that advances the aims of medical and psychological anthropology, namely, to make a programmatic call, in the conclusion, for further comparative study of anxiety and anxiety disorders as socially productive practices in other places or times. Tran's own ethnographic study of worry is thus an exemplary model. He draws on and pithily summarizes key arguments from a range of theorists such as Kierkegaard, Freud, and Foucault, as well as on contemporary medical and psychological anthropologists and on recent ethnographies of Vietnam and of mental health and emotion, to powerfully reveal the impact of neoliberal, (post)colonial, and capitalist technologies of governance and self on experiences of psychiatric care and illness, at both individual and structural levels in contemporary Vietnam. Another of the many strengths of A Life of Worry is the way that the ethnography ripened over time, as Tran revisited the field and his insights over the course of more than a decade. This allowed him to experiment with different methodologies that he helpfully discusses throughout the monograph, and, no less importantly, to trace processes of change while revising arguments he advanced in earlier scholarly publications. For example, rather than claim that "sentiment" (as an other-focused social orientation) has been replaced by "emotion" (as an inward-looking, psychologizing orientation), Tran proposes a more nuanced relation between these different regimes of selfhood, morality, and sociality, linked to changing economic conditions and modes of governance, yet not determined wholesale by them. Over time, he has moved from simply trying to "identify the range of emotions that epitomizes the contemporary moment," to instead discover and illuminate how "the very concept of emotion itself is indicative of an emergent subjectivity" (29). Relatedly, he traces changing forms of engagement with biomedical treatments such as psychopharmaceuticals and psychotherapy that appear to generate new forms of sociality that he shows are not apolitical, and that trouble linear models of the globalization of (mental) health, as though therapeutic modalities simply are exported from the so-called West to the so-called Rest. In so doing, and deftly depicting both clinical interactions and person-centered narratives of interlocutors who did not seek formal therapeutic treatment, A Life of Worry also troubles the hoary concepts of modernity and tradition and the ways that these figure in people's romantic lives and desires. Importantly, Tran's insights and contributions both grow from and further develop psychodynamic approaches to our study of emotions and affective (dis)orders (e.g., the shift from neurasthenia to major depressive disorder MDD and generalized anxiety disorder GAD in Vietnam and what this tells us about lay and professional approaches to and assumptions about the self, morality, and normality). A Life of Worry thus sheds light on the ways in which a person's presumed internal self-processes or innermost feelings are entwined in dynamic interaction with one's sociopolitical and cultural contexts, including discourses about these experiences that in turn shape and constrain the range of desires and perceived possibilities for a given self. What makes Tran's theoretical claims especially compelling and accessible is his ability to mobilize concrete examples based on longitudinal person-centered interviews with interlocutors, as well as on more limited observations of clinical interactions and interviews with (harried and sometimes frustrated) therapists who bemoan what they describe as their clients' misguided and even ignorant expectations. His critiques are ever-subtle, insightful, and smart. Having assigned the monograph in an anthropology of mental health seminar that attracted both graduate and advanced undergraduate students, and in a psychological anthropology course for advanced undergraduates majoring in a variety of health and social sciences fields, I can unequivocally recommend it. Students across fields appreciated Tran's clear, elegant writing that helped them become acquainted with theoretically dense concepts, as well as with our field's bread and butter concerns regarding lived experience and critical phenomenology, structural inequalities, and selfhood and subjectification in relation to governance regimes and therapeutic modalities such as cognitive behavioral therapy. Particularly powerful were the ways that students came to see their own lives and struggles with school, family, peers, psychopharmaceuticals, and/or therapy in new ways, including to "reconceptualize modern anxiety," in some students' words, "as a product of today's sociopolitical climate," rather than merely a set of individually bound symptoms, and to see "critiques of psychotherapy as also critiques of society itself." In short, A Life of Worry illuminates for readers how nuanced and ambivalent experience and aspirations for development or becoming "modern" truly are, as well as provides them with a set of conceptual tools to revisit what they thought they knew about human psychology, choice, love, care, politics, and wellbeing, by highlighting and illuminating how fundamentally relational selves are. Save for a few repeated passages, it is a brilliant read from beginning to end, introducing audiences to key figures in medical and psychological anthropology and extending the fields' reach far beyond, in that the monograph is at once accessible, innovative, and agenda-setting without foreclosing possibilities for what forms future research may take. It is sure to appeal to a wide range of scholars and students, including those interested in medical and psychological anthropology, cultural theory and politics, Vietnam and Asian studies, global mental health, and the health sciences and helping professions more generally.
Merav Shohet (Tue,) studied this question.