Recovery From Schizophrenia: Psychiatry And Political Economy

168 SCHIZOPHRENIA IN THE THIRD WORLDGROUP PARTICIPATIONThe process of curing in pre-industrial societies, it is clear, is very much acommunal phenomenon tending not only to reintegrate the deviant individualinto the group but also to reaffirm the solidarity of the community. Thus, theN’jayei secret society of the Mende tribe in Sierra Leone, which aims to treatmental illness by applying sanctions to those who are presumed to havecommitted a breach of social rules, provides members with a mechanism forsocial reintegration and, simultaneously, reinforces the integrity and standards ofthe culture. 92 Such a dual process of unification of the group and integration ofthe individual is seen to result from the great public healing ceremonies of theZuni medicine societies 93 or from the intense communal involvement anddramatic grandeur of a Navajo healing ceremony. The Navajo patient, relativesand other participants alike take medicine and submit to ritual procedures in asymbolic recognition that illness is a problem for the community as a whole. 94Nancy Waxler, in her research on people suffering from psychosis in Sri Lanka,was impressed with the way in which the intense community involvement intreating mental illness prevents the patient from developing secondary symptomsfrom alienation and stigma and results in the sick person being reintegrated intosociety. She writes:Mental illness is basically a problem of and for the family, not the sickperson. Thus we find among the Sinhalese that almost all treatment ofmental illness involves groups meeting with groups. When a mad person isbelieved to have been possessed by a demon the whole family, their relativesand neighbours, sometimes the whole village, join together to plan, carryout and pay for the appropriate exorcism ceremony. The sick person isusually the central focus, but often only as the vehicle for the demon, andduring some parts of these ceremonies the patient is largely ignored. 95The importance of this process of social reintegration is confirmed by data fromthe two WHO outcome studies. In both the developed and developing worlds,social isolation was found to be one of the strongest predictors of poor outcomein schizophrenia. 96 Several other researchers have found this factor to beimportant in the genesis and outcome of schizophrenia. 97SOCIAL CONSENSUSThere is some anthropological evidence that broad group participation in healingnot only aids the reintegration of the patient but is also a necessary and powerfullyeffective element in the treatment of emotional illness. The French anthropologistClaude Levi-Strauss, for example, analyzed the effectiveness of a highly respectedKwakiutl shaman from British Columbia who was skeptical of his own healingpowers. Levi-Strauss concluded that the shaman was effective despite his cynicism