Madness in Zanzibar: "schizophrenia" in three families in the "developing" world
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.
Available from: Nigel Cox
- "Fernando attributes this to the greater social nature of identity in the culture. Similarly, McGruder (1999) describes the emergence of high-expressed emotion among mentally distressed Tanzanians following PERMITTED USE DISCLAIMER (Wiley CTA, section C, submitted version) This is the pre-peer reviewed version of the following article: Poles apart: does the export of mental health expertise from the Global North to the Global South represent a neutral relocation of knowledge and practice?, which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/1467-9566.12230/abstract 9 exposure to Western psychiatry; this occurred within a culture in which 'not speaking' was the more common response to stress. "
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ABSTRACT: The World Health Organization's Mental Health Action Plan 2013-2020 identifies actions for all member states to alleviate the global burden of mental ill health, including an obligation for mental healthcare to be delivered in a 'culturally appropriate' manner. In this article we argue that such a requirement is problematic, not least because such pronouncements remain framed by the normative prepositions of Western medical and psychological practice and their associated ethical, legal and institutional standpoints. As such, when striving to export Western mental health expertise, different paradigms for evidence will be necessary to deliver locally meaningful interventions to low and middle income countries. Our discussion highlights a number of philosophical concerns regarding methodologies for future research practice, including those relating to representation and exclusion in the guise of epistemic injury, presumptive methodologies arising from Western notions of selfhood, and related ethical issues.
© 2015 The Authors. Sociology of Health & Illness © 2015 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.
Available from: Steve Harrist
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ABSTRACT: Recently, a number of distinguished critics have raised fundamental questions about the knowledge claims and practices of the mental health professions. We review a few of these critiques concerning such matters as pathologizing normal experiences and reactions to events and spreading not only our brain disease conception of mental illness but our Western “symptom repertoire” as well around the globe in a detrimental manner. It is striking that for the most part these critics have almost nothing to say about genuine alternatives to the problems and cultural deficits they identify. We suggest that work done by theoretical psychologists and others working in a similar vein in recent years might help both sharpen the analysis of these dilemmas and contribute something valuable to envisioning alternative therapeutic and cultural pathways of a better sort.
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