Madness in Zanzibar: "schizophrenia" in three families in the "developing" world
ABSTRACT Thesis (Ph.D.)--University of Washington, 1999 Transnational studies of schizophrenia that detected a differential prognosis for persons in developed versus developing countries and established the influence of family emotional environment on relapse, as well as the perceived efficacy of traditional treatment of mental illness, prompted this ethnographic study of five persons diagnosed with schizophrenia in three families in Zanzibar, Tanzania. Heeding recent advice on the necessity of particularizing ethnographic accounts by situating them in multiple contexts, I first describe local notions of the self, emotion and conflict in the family, then recount the history of institutional psychiatry on the islands, with attention to economic and political forces. Primary Islamic texts, political discourses and popular television programs are examined to describe the variety of local ideas about the natural, supernatural and preternatural world, and about the sources and appropriate treatment of madness. In the next three chapters I describe identified patients and their families with reference to: disease accounts in medical records; relevant political phenomena surrounding incidents of disturbed behavior; subjective perspectives on illness and identity; expression of emotion in the family; performance of work and other tasks; social rules and rule violation; and interaction of ideologies in shaping responses to the patients' illnesses. This organization of analysis allows not only a comparison between ethnographic material and extant hypotheses purported to explain the finding of a less debilitating form of schizophrenia in the third world, but also facilitates an interrogation of that finding itself. The analysis makes use of a critical approach to medical anthropology and problematizes the application of biomedical psychiatry in third world communities.