Recovery From Schizophrenia: Psychiatry And Political Economy

164 SCHIZOPHRENIA IN THE THIRD WORLDthere are local conditions restricting the development of brief psychoses socommon elsewhere in the Third World, then one must assume that the reasonthere are so few acute cases in Dr Westermeyer’s Lao sample is that they are notconsidered by the villagers to be baa. Interestingly, the severely psychotic baaindividuals in Laos are not exiled or assassinated but continue to receive food,shelter, clothing and humane care and are restrained and incarcerated only as longas their violent behavior requires. 68 It is apparent that labeling is an importantissue only insofar as it affects management. As we shall see in the next example, itis the concept of illness that lies behind the label that is also critical in determiningcare and treatment.Four East African societiesAnthropologist Robert Edgerton, describing attitudes to psychosis amongtribesmen of four East African pastoral and farming societies, confirms thatviolence and destructiveness are emphasized in descriptions of psychosis (kichaa)and hallucinations are virtually never mentioned. 69 Most commonly reportedfeatures of psychosis include murder, assault, arson, abuse, stealing and nakedness.The pastoralists whose homesteads are more widely dispersed and who are morefree to move away from disagreeable circumstances are less concerned than thefarmers about the social disruption caused by people suffering from psychosis. 70The intriguing conclusion of Edgerton’s survey is that the tribal view of the causeof psychosis determines not only the manner of treatment but also the level ofoptimism about recovery. 71 The Pokot of northwest Kenya and the Sebei ofsoutheast Uganda have a naturalistic conception of the cause of psychosis. Theyimplicate a worm in the frontal portion of the brain and are very pessimisticabout the possibilities of cure. The Kamba of south-central Kenya and the Heheof southwest Tanzania, on the other hand, attribute the cause of psychosis towitchcraft or stress and are optimistic about curing such disorders. The two tribesthat are most unsure about their respective theories of causation, the Pokot andthe Hehe, also tend to be more ambivalent about the curability of the condition.The Kamba and the Hehe, holding a supernatural theory for the cause ofpsychosis, favor the use of tranquilizing herbs and ritual in treatment. Thepessimistic Sebei and Pokot, with the naturalistic belief system, are much moreinclined to treat people with psychotic disorders harshly, as illustrated by theremarks of a Pokot shaman: “I am able to cure mads. I order the patient tied andplaced upon the ground. I then take a large rock and pound the patient on thehead for a long time. This calms them and they are better.” 72 The Pokot andSebei recommend that people suffering from psychosis should be tied up forever,allowed to starve, driven away to die or killed outright.