Book Review
Transcultural Psychiatry
Schizophrenia, Culture, and Subjectivity. The Edge of Experience. Janis Hunter Jenkins, Robert John Barrett, editors. Cambridge (UK): Cambridge University Press; 2004. 357 p. US$85.00.
Reviewer
rating*: Good
Review by:Frank Frantisek Engelsmann, PhD, CSc
Montreal, Quebec
This book’s editors, professors of psychiatry and anthropology at Case Western Reserve University and the University of Adelaide, respectively, were both postdoctoral fellows in the Department of Social Medicine at Harvard. Their clinical and ethnographic studies on culture and mental health prepared them for the challenging task of integrating the volume’s contributions, which show alternative conceptual frameworks related to culture and schizophrenia and illustrate how family and community assistance help professional interventions. Schizophrenia has been recognized in a wide range of cultures and remains one of the most serious, yet still elusive, psychiatric disorders. As Arthur Kleinman observes in his Preface, showing how schizophrenia has as much to do with society as with biology is one of the book’s main achievements.
The volume’s 3 parts contain 13 chapters. Contributions in the first part address themes of culture, self, and experience. The second part presents 4 approaches to understanding schizophrenia—the ethnographic, the sociolinguistic, the clinical, and the historical. The third part focuses on subjectivity and emotion. Coeditor Janis Jenkins views schizophrenia as a paradigm case for understanding fundamental human processes and capacities (see p 29). She examines particular processes of self, emotion, social engagement, and cultural orientation in the complex phenomena of the illness. A contributing author, Kim Hopper, questions the durability of the WHO findings of a distinct advantage in schizophrenia course and outcome in developing countries. Methodological problems of the WHO international collaborative studies include attrition, groupings, outcome measures, and diagnostic ambiguities. Coeditor Robert J Barrett analyzes ethnographic and clinical findings among the Iban in Borneo, focusing on Schneider’s first-rank symptoms in a cross-cultural context. They are essential for comparative inquiry, although their cross-cultural frequency in patients with schizophrenia varies considerably. Interestingly, questions about auditory hallucinations translate with ease from English to Iban, whereas problems with thinking (for example, thought insertion and withdrawal) make little cultural sense in the Iban context.
Ellen Corin, Rangaswami Thara, and Ramchandran Padmavati write about signifiers of early psychosis and subjective experience among people with schizophrenia in the cultural context of South India. Drawing on advances in 2 distinct fields of inquiry—psychological anthropology and French psychoanalysis (see p 112)—these investigators view culture as paradoxical, multilayered, and contradictory. They elucidate how culture mediates psychotic experience and shapes its evolution. Their analysis of narratives reveals the subtle phenomena of altered feelings and relationships, including social withdrawal, linked to Hindu renunciation. Another author, Rod Lucas, explores the implications of a schizophrenia diagnosis for patients’ daily lives, in his interesting fieldwork with 50 participants living in their own homes in an Australian capital city.
Part 2 of the volume contains the report by Byron Good and MA Subandi on experiences of psychosis in Java. Their research of acute, recurrent psychosis was carried out in Yogyakarta, the centre of classical Javanese culture in Indonesia. These authors conclude that the study of acute, recurrent psychotic disorders requires approaches that differ from those used to study more chronic thought disorders. In another chapter, James Wilce, inspired by linguistic anthropology, uncovers aspects of the relations among Bengali culture, language, and interactive style. Using videotape and audiotape recordings, he demonstrates that what is called “madness” in Bangladesh is shaped by metacommunicative pressures and cultural sensibilities touching gender and the esthetics of behaviour. Esperanza Diaz, Alberto Fergusson, and John Strauss inform the reader about innovative care for the homeless mentally ill in Bogota, Colombia. Jonathan Sadowsky describes symptoms linked to colonialism in terms of the content and the context of delusions observed in Southwest Nigeria between 1945 and 1960.
Chapters in Part 3 explore schizophrenia’s emotional dimension. Juli McGruder describes 3 Zanzibar families having 5 persons diagnosed with schizophrenia. Her study analyzes the illness course and its impact on the families’ emotional environment. Calm reserve is valued social behaviour; hatred, anger, grief, and love are often concealed. Lack of assertiveness is not regarded as a sign of low self-esteem but, rather, as one of healthy self-respect. This study shows that elements of “expressed emotion” can be identified across cultures (see p 279). Also in Part 3, Sue Estroff presents excerpts from poetry and other literature written by persons with schizophrenia, as well as by those who care for them, that reveal some of the sociopolitical aspects of mental illness in North America. In the last 2 chapters, Ann Kring and Marja Germans concentrate on the subjective experience of emotion in schizophrenia, and Louis Sass discusses negative symptoms, including such diminished behaviour or expression as apathy and lack of social communication.
Enriched by the discipline of anthropology, this volume offers social science research findings to clinicians, thereby enhancing our understanding of the interaction between culture and schizophrenia. Exploring and discussing the complex subjective experience of schizophrenia and psychosis is not easy, and it is demanding to read some of these chapters. Brief biographic vignettes from the 20 contributors help readers to better understand their work and position. This book will interest psychiatrists, psychologists, anthropologists, and other mental health clinicians and scientists.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
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