by Tanya Luhrmann and Jocelyn Marrow, co-authors of Our Most Troubling Madness: Case Studies in Schizophrenia across Cultures
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Anisha, Veena, Priyanka, Madhu, Sita, and Sunita are Indian women diagnosed with schizophrenia. In Our Most Troubling Madness: Case Studies in Schizophrenia across Cultures, we show that despite their struggles, they succeed in fulfilling valued social roles in their families and communities in urban and rural locations across North and South India. They are proud of being responsible members of their social world. To be sure, some are less successful than others. But all remain optimistic that they might reach their life goals at some point in the future. Most of them have family who tolerate their odd behave as long as they can cook and care for their parents or their children.
In contrast, the life histories of John, Violet, Zaney, and Meg are bleaker. While none of the Indian women in our case studies knew their diagnosis, all four of these citizens of highly developed economies with state-of-the-art mental health care feel defined and limited by the label. To them, “schizophrenia” is a judgment that they are defective persons with little hope for a normal life. This is true even though they had been exposed to mental health activism asserting exactly the opposite. The good life in the United States and the United Kingdom—employment, financial self-sufficiency, and care of children and spouse—was unrealized and seemed unrealizable. They felt defeated.
Case studies of these ten lives, plus others from Ghana, Romania, and Thailand, provide intimate accounts of the social and cultural contexts in which persons with psychotic disorders live. They give depth to earlier, replicated findings of the World Health Organization that the course and outcomes for schizophrenia are different across the world, with some of the best results coming from India.
With a commitment to engaged anthropology, Our Most Troubling Madness examines the lives of those with psychotic disorders to suggest how we might redeem U.S. mental health services that do harm while they do good. Most importantly, we argue that creating a society in which those with psychosis may flourish involves altering our approach to psychosis. Downplaying the importance of diagnosis, respecting the experience of psychosis, allowing individuals to engage with voices, and focusing on interpersonal behavior in social settings, are tasks we may undertake to make our own culture more benign for those with psychosis.
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T. M. Luhrmann is Professor of Anthropology at Stanford University. She is the author of When God Talks Back, Of Two Minds, and Persuasions of the Witch’s Craft.
Jocelyn Marrow is a cultural anthropologist and Senior Study Director at Westat in Rockville, Maryland.