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Schizophrenia has long puzzled researchers in the fields of psychiatric medicine and anthropology. Why is it that the rates of developing schizophrenia—long the poster child for the biomedical model of psychiatric illness—are low in some countries and higher in others? And why do migrants to Western countries find that they are at higher risk for this disease after they arrive? T. M. Luhrmann and Jocelyn Marrow argue that the root causes of schizophrenia are not only biological, but also sociocultural.
This book gives an intimate, personal account of those living with serious psychotic disorder in the United States, India, Africa, and Southeast Asia. It introduces the notion that social defeat—the physical or symbolic defeat of one person by another—is a core mechanism in the increased risk for psychotic illness. Furthermore, “care-as-usual” treatment as it occurs in the United States actually increases the likelihood of social defeat, while “care-as-usual” treatment in a country like India diminishes it.
List of Illustrations
Foreword - Kim Hopper
Introduction - T. M. Luhrmann
1. “I’m Schizophrenic!”: How Diagnosis Can Change Identity in the United States - T. M. Luhrmann 2. Diagnostic Neutrality in Psychiatric Treatment in North India - Amy June Sousa
3. Vulnerable Transitions in a World of Kin: In the Shadow of Good Wifeliness in North India - Jocelyn Marrow
4. Work and Respect in Chennai - Giulia Mazza
5. Racism and Immigration: An African-Caribbean Woman in London - Johanne Eliacin
6. Voices That Are More Benign: The Experience of Auditory Hallucinations in Chennai - T. M. Luhrmann and R. Padmavati
7. Demonic Voices: One Man’s Experience of God, Witches, and Psychosis in Accra, Ghana - Damien Droney
8. Madness Experienced as Faith: Temple Healing in North India - Anubha Sood
9. Faith Interpreted as Madness: Religion, Poverty, and Psychiatry in the Life of a Romanian Woman - Jack R. Friedman 10. The Culture of the Institutional Circuit in the United States - T. M. Luhrmann
11. Return to Baseline: A Woman with Acute-Onset, Non-affective Remitting Psychosis in Thailand - Julia Cassaniti
12. A Fragile Recovery in the United States - Neely A. L. Myers
Conclusion - Jocelyn Marrow and T. M. Luhrmann
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.
“These case studies reveal the humanity and resilience of people living with psychotic disorders. Luhrmann and Marrow have collated perceptive and sensitive sketches of the lives of people with psychosis. The material reveals not only how culture shapes the content of delusions and hallucinations, but also how different societies respond to those with psychosis. Just as a prism can refract light into its component wavelengths, psychotic disorders can unexpectedly reveal the influence of cultural factors on the spectrum of thinking and cognition.”—John McGrath, Queensland Brain Institute, The University of Queensland, Australia
“Our Most Troubling Madness is a rich, detailed, textured account of how schizophrenia presents cross-culturally. In several case studies, the contributors lay out in compelling detail how these sufferers conceive of themselves and are conceived of by others, making clear that there are more and less toxic ways to respond to schizophrenia, and that the cultural context gives shape to the illness. The authors not only tell these stories but also draw important lessons for those who suffer with, or help those who suffer with, these sometimes devastating illnesses. A must-read for anyone interested in the presentation of serious mental illness across very different cultures.”—Elyn R. Saks, University of Southern California; author of The Center Cannot Hold: My Journey through Madness
“An opportune and highly accessible volume of case studies. This excellent collection offers a valuable set of rich descriptions of the everyday experience of persons who live with schizophrenia. The volume is fascinating and should be essential reading across the social and medical sciences alike.”—Janis H. Jenkins, University of California, San Diego; author of Extraordinary Conditions: Culture and Experience in Mental Illness