Recovery From Schizophrenia: Psychiatry And Political Economy

162 SCHIZOPHRENIA IN THE THIRD WORLDbehavior or stigmatized by her illness, because her hallucinations of ghosts arecredible supernatural events and she is innocently suffering the magicalconsequences of the wrong-doing of others. The communal healing activities leadto a dramatic reversal of Maria’s course of alienation from family and community.In the West, a psychotic episode is likely to lead to increased alienation. In thecase of Maria, conflict resolution and social reintegration are central to herrecovery and result from the folk diagnosis and treatment of her symptoms. 58THE FOLK DIAGNOSIS OF PSYCHOSISThroughout the non-industrial world, the features of psychosis are likely to begiven a supernatural explanation. The Shona of southern Rhodesia, for example,believe visual and auditory hallucinations to be real and sent by spirits. 59 In Dakar,Senegal:one can have hallucinations without being thought to be sick. A magicalexplanation is usually resorted to and native specialists are consulted. Thereis no rejection or alienation by society. The patient remains integratedwithin his group. As a result, the level of anxiety is low… 60The psychiatrist who gives this report claims that 90 per cent of the acutepsychoses in Dakar are cured because the patient’s delusions and hallucinationshave an obvious culturally relevant content, and he or she is not rejected by thegroup.Similarly, in the slums of San Juan, Puerto Rico:If an individual reports hallucinations, it clearly indicates to the believer inspiritualism that he is being visited by spirits who manifest themselvesvisually and audibly. If he has delusions…his thoughts are being distorted byinterfering bad spirits, or through development of his psychic facultiesspirits have informed him of the true enemies in his environment.Incoherent ramblings, and cryptic verbalizations indicate that he isundergoing a test, an experiment engineered by the spirits. If he wandersaimlessly through the neighborhood, he is being pursued by ambulatoryspirits who are tormenting him unmercifully. 61In many cases where a supernatural explanation for psychotic features is used, thelabel “crazy” or “insane” may never be applied. I once remarked to a Siouxmental health worker from the Pine Ridge Reservation in South Dakota thatmost Americans who heard voices would be diagnosed as suffering frompsychosis. Her response was simple. “That’s terrible.”