CLINICAL HANDBOOK OF SCHIZOPHRENIA

550 VII. POLICY, LEGAL, AND SOCIAL ISSUESAllopathy has its strength in a strong “scientific” evidence base, created through laboratorydata and collective strength of documented individual case studies. Teachings oftraditional medicine are based on documents that conceptualize physical and mental illnessin general terms. The texts do not abound in descriptive pathology or psychopathology.They describe physical ailments, thinking, feeling and actions, personality traits,and syndromes of mental illness (including insanity) in general terms. The metaphors correspondto the current descriptions of schizophrenia and bipolar disorder. Such similescorrespond to similar descriptions in Greek medicine.The task of studying schizophrenia across cultures therefore poses formidable challengesin terms of how to explain and to standardize findings within cross-cultural contexts.Although a substantial body of literature now addresses this topic, a frequent criticismis that using evidence-based techniques for this purpose may not be the most validstandard for assessment of the issue.“Traditional Care”Treatments in the system of traditional health care tend to be a mixture of religion, mysticism,and rational healing. Treatment methods include rituals, use of somatic treatments,and drugs that have to be inhaled, ingested, or massaged into the head, hair, or skin. Acommon principle used in traditional care involves identification of a causal entity, and areversal of the identified cause is believed to induce cure. This is the basis for exorcism incultures where possession by an external entity is believed to be the cause of psychosis. Asubgroup of traditional healers subscribe to the thought that strong fear or severe loss inducesinsanity. They believe that the dysfunction caused by exposure to such fear can bereversed by a second exposure to an identical stimulus. Hence, exposure to wild animalsor inducing pain in other forms is believed to be a cure for insanity. Popular past practicesof confinement to a cellar, solitary confinement in a room without sanitation or ventilation,whipping the patient, or blood letting from the skull at a point near the temporal regionhave now been abandoned.Leaders, or the hierarchically higher class of society, often counsel individuals andthe public at large on religious norms and social customs, and provide psychosocial counseling.In several cultures, religious and faith healers have helped people with psychologicaland psychosocial problems. Faith healers differ from practitioners of traditional medicinein that they claim to cure the illness through occult and magical practices. Acommon factor in such healing practices is a strong and unchallenged mutual belief andsocial approval of healers, who have strong personalities and usually deliver the serviceswithout seeking monetary compensation. Anecdotal reports of physical or sexual abuseby such healers have not been verified.The literature documents that, in some cultures, the socially conscientious and therich provided food and medicine to the sick and the needy. However, the seriously mentallyill were viewed inauspiciously, and the society was often encouraged to renouncethem. Violent and unreasonably aggressive patients were considered unworthy of treatment.The theorists often blamed the family or the celestial influences as factors causingthe illnesses.It is of note that the practice of contemporary psychiatry does not differ in differentcultures across the globe, but in the developing world, psychiatrists are constantly facedwith the issue of educating persons with mental illness about the nature of the illness, andthe notion of the illness being a biological entity with phenomenological manifestationsthat are related to cultural norms. Practitioners of Western medicine in developing countriesare required to spend long hours dispelling the myths and misconceptions about