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Interpretations of schizophrenia
... ILLNESS AS NARRATIVE In discussing the concept of illness, we begin by describing what we believe has been a broad view that has been generally accepted historically and cross-culturally. Prototypically, illness has been defined as a construct used to explain certain nonvolitional, maladaptive patterns of distress and/or behavior that impair an individual's capacity to function (Barrett, 1988). However, such a definition barely starts to convey the rich complex of meanings and perspectives associated with this phenomenon that can, but need not be viewed reductionistically. ...
... In discussing the concept of illness, we begin by describing what we believe has been a broad view that has been generally accepted historically and cross-culturally. Prototypically, illness has been defined as a construct used to explain certain nonvolitional, maladaptive patterns of distress and/or behavior that impair an individual's capacity to function (Barrett, 1988). However, such a definition barely starts to convey the rich complex of meanings and perspectives associated with this phenomenon that can, but need not be viewed reductionistically. ...
This article examines and clarifies controversies about the concept of illness in the field of family therapy. We contend that illness, as traditionally understood in all cultures, is a relational, transactional concept that is highly congruent with core principles of present-day family theories. Family therapists need not buy into a biotechnical, reductionistic reframing of illness as disease. Rather, it is more appropriate to conceptualize and work with illness as a narrative placed in a biopsychosocial context. Such a narrative includes how shared responsibility for coping and for finding solutions can take place, without becoming involved in disputes about causal models.
... Divergent cosmologies notwithstanding, schizophrenia and depression (or their semantic equivalents) cause suffering and distress in north Europe as they do in the farther reaches of India. nuanced and subtle anthropological work has pointed out several problems with the universal aspirations of the transcultural psychiatric project: the culturally constructed nature of psychiatric categories (Barrett, 1988(Barrett, , 1996; the problems of applying these categories around the globe (Kleinman, 1977(Kleinman, , 1987; the varied symptomatic expression of major conditions (Barrett, 2004;Jenkins and Barrett, 2004); and the divergent values and epistemologies that inform the assessment and understanding of psychological and behavioral deviance (Jenkins, 1988;Al-Issa, 1995). ...
Psychiatrists encounter persons from diverse cultures who profess experiences (e.g., communicating with spirits) that evoke
intuitions of abnormality. This view might not be shared with the person or her/his cultural peers, raising questions concerning
the justification of such intuitions. This article explores three positions relevant to the process of justification. The
relativist position transfers powers of judgment to the subject’s peers yet neglects individual values and operates with a
discredited holistic view of culture. The clinical-ethnographic position remedies this by suspending judgment subject to understanding
the individual in a sociocultural context yet finds objections with the universalist-scientific position: objective standards
exist and could justify intuitions of abnormality cross-culturally. This article argues that the claim to objectivity is value-laden,
reflecting instead a brand of normality and relationship to reality further upheld through epistemological utility and valued
technological progress. In conclusion, it is suggested that the clinical-ethnographic position takes personal values and context
seriously, both of which are crucial for responsible clinical practice.
This volume brings together a number of the foremost scholars - anthropologists, psychiatrists, psychologists, and historians - studying schizophrenia, its subjective dimensions, and the cultural processes through which these are experienced. Based on research undertaken in Australia, Bangladesh, Borneo, Canada, Colombia, India, Indonesia, Nigeria, the United States and Zanzibar, it also incorporates a critical analysis of World Health Organization cross-cultural findings. Contributors share an interest in subjective and interpretive aspects of illness, but all work with a concept of schizophrenia that addresses its biological dimensions. The volume is of interest to scholars in the social and human sciences for the theoretical attention given to the relationship between culture and subjectivity. Multidisciplinary in design, it is written in a style accessible to a diverse readership, including undergraduate students. It is of practical relevance not only to psychiatrists, but also to all mental health professionals.
This volume brings together a number of the foremost scholars - anthropologists, psychiatrists, psychologists, and historians - studying schizophrenia, its subjective dimensions, and the cultural processes through which these are experienced. Based on research undertaken in Australia, Bangladesh, Borneo, Canada, Colombia, India, Indonesia, Nigeria, the United States and Zanzibar, it also incorporates a critical analysis of World Health Organization cross-cultural findings. Contributors share an interest in subjective and interpretive aspects of illness, but all work with a concept of schizophrenia that addresses its biological dimensions. The volume is of interest to scholars in the social and human sciences for the theoretical attention given to the relationship between culture and subjectivity. Multidisciplinary in design, it is written in a style accessible to a diverse readership, including undergraduate students. It is of practical relevance not only to psychiatrists, but also to all mental health professionals.
This volume brings together a number of the foremost scholars - anthropologists, psychiatrists, psychologists, and historians - studying schizophrenia, its subjective dimensions, and the cultural processes through which these are experienced. Based on research undertaken in Australia, Bangladesh, Borneo, Canada, Colombia, India, Indonesia, Nigeria, the United States and Zanzibar, it also incorporates a critical analysis of World Health Organization cross-cultural findings. Contributors share an interest in subjective and interpretive aspects of illness, but all work with a concept of schizophrenia that addresses its biological dimensions. The volume is of interest to scholars in the social and human sciences for the theoretical attention given to the relationship between culture and subjectivity. Multidisciplinary in design, it is written in a style accessible to a diverse readership, including undergraduate students. It is of practical relevance not only to psychiatrists, but also to all mental health professionals.
This volume brings together a number of the foremost scholars - anthropologists, psychiatrists, psychologists, and historians - studying schizophrenia, its subjective dimensions, and the cultural processes through which these are experienced. Based on research undertaken in Australia, Bangladesh, Borneo, Canada, Colombia, India, Indonesia, Nigeria, the United States and Zanzibar, it also incorporates a critical analysis of World Health Organization cross-cultural findings. Contributors share an interest in subjective and interpretive aspects of illness, but all work with a concept of schizophrenia that addresses its biological dimensions. The volume is of interest to scholars in the social and human sciences for the theoretical attention given to the relationship between culture and subjectivity. Multidisciplinary in design, it is written in a style accessible to a diverse readership, including undergraduate students. It is of practical relevance not only to psychiatrists, but also to all mental health professionals.
This volume brings together a number of the foremost scholars - anthropologists, psychiatrists, psychologists, and historians - studying schizophrenia, its subjective dimensions, and the cultural processes through which these are experienced. Based on research undertaken in Australia, Bangladesh, Borneo, Canada, Colombia, India, Indonesia, Nigeria, the United States and Zanzibar, it also incorporates a critical analysis of World Health Organization cross-cultural findings. Contributors share an interest in subjective and interpretive aspects of illness, but all work with a concept of schizophrenia that addresses its biological dimensions. The volume is of interest to scholars in the social and human sciences for the theoretical attention given to the relationship between culture and subjectivity. Multidisciplinary in design, it is written in a style accessible to a diverse readership, including undergraduate students. It is of practical relevance not only to psychiatrists, but also to all mental health professionals.
This volume brings together a number of the foremost scholars - anthropologists, psychiatrists, psychologists, and historians - studying schizophrenia, its subjective dimensions, and the cultural processes through which these are experienced. Based on research undertaken in Australia, Bangladesh, Borneo, Canada, Colombia, India, Indonesia, Nigeria, the United States and Zanzibar, it also incorporates a critical analysis of World Health Organization cross-cultural findings. Contributors share an interest in subjective and interpretive aspects of illness, but all work with a concept of schizophrenia that addresses its biological dimensions. The volume is of interest to scholars in the social and human sciences for the theoretical attention given to the relationship between culture and subjectivity. Multidisciplinary in design, it is written in a style accessible to a diverse readership, including undergraduate students. It is of practical relevance not only to psychiatrists, but also to all mental health professionals.
This volume brings together a number of the foremost scholars - anthropologists, psychiatrists, psychologists, and historians - studying schizophrenia, its subjective dimensions, and the cultural processes through which these are experienced. Based on research undertaken in Australia, Bangladesh, Borneo, Canada, Colombia, India, Indonesia, Nigeria, the United States and Zanzibar, it also incorporates a critical analysis of World Health Organization cross-cultural findings. Contributors share an interest in subjective and interpretive aspects of illness, but all work with a concept of schizophrenia that addresses its biological dimensions. The volume is of interest to scholars in the social and human sciences for the theoretical attention given to the relationship between culture and subjectivity. Multidisciplinary in design, it is written in a style accessible to a diverse readership, including undergraduate students. It is of practical relevance not only to psychiatrists, but also to all mental health professionals.
This volume brings together a number of the foremost scholars - anthropologists, psychiatrists, psychologists, and historians - studying schizophrenia, its subjective dimensions, and the cultural processes through which these are experienced. Based on research undertaken in Australia, Bangladesh, Borneo, Canada, Colombia, India, Indonesia, Nigeria, the United States and Zanzibar, it also incorporates a critical analysis of World Health Organization cross-cultural findings. Contributors share an interest in subjective and interpretive aspects of illness, but all work with a concept of schizophrenia that addresses its biological dimensions. The volume is of interest to scholars in the social and human sciences for the theoretical attention given to the relationship between culture and subjectivity. Multidisciplinary in design, it is written in a style accessible to a diverse readership, including undergraduate students. It is of practical relevance not only to psychiatrists, but also to all mental health professionals.
This volume brings together a number of the foremost scholars - anthropologists, psychiatrists, psychologists, and historians - studying schizophrenia, its subjective dimensions, and the cultural processes through which these are experienced. Based on research undertaken in Australia, Bangladesh, Borneo, Canada, Colombia, India, Indonesia, Nigeria, the United States and Zanzibar, it also incorporates a critical analysis of World Health Organization cross-cultural findings. Contributors share an interest in subjective and interpretive aspects of illness, but all work with a concept of schizophrenia that addresses its biological dimensions. The volume is of interest to scholars in the social and human sciences for the theoretical attention given to the relationship between culture and subjectivity. Multidisciplinary in design, it is written in a style accessible to a diverse readership, including undergraduate students. It is of practical relevance not only to psychiatrists, but also to all mental health professionals.
Alterations in self-experience are increasingly attended to as relevant and important aspects of schizophrenia, and psychosis more broadly, through a burgeoning self-disorders (SD) literature. At the same time, issues of self, subject, and subjectivity within schizophrenia-spectrum illnesses have also gained attention from researchers across the social sciences and humanities, and from ethnographic research especially. This paper examines the subjective experience of disruptions in self-identity within a cohort of first episode psychosis (FEP) service users, critically engaging with the SD literature and bringing it into conversation with social sciences and humanities scholarship on self and schizophrenia. Drawing findings from an ongoing ethnographic study of young peoples’ experiences with psychosis, we explore meanings of mental distress relating to psychotic episodes and attend to issues of self, identity, and subjectivity. We critique the division between “normal” and “pathological” self-experience that is endorsed within the SD literature, arguing against the notion that fragmentation of self-experience in schizophrenia-spectrum illnesses is indicative of psychopathology. We highlight how experiences categorized as psychosis are also important and complete aspects of one’s social world and inner life and explore the ways in which at least some aspects of disruptions of self-identity stem from clinical situations themselves—in particular, from asymmetries of power within the mental health system. Relating our findings to feminist, postcolonial, and disability studies’ approaches to the “self,” we emphasize the complex interplay between interpersonal, cultural, and structural aspects of self-experience within FEP.
Since the 1990s, suicide in recession-plagued Japan has soared, and rates of depression have both increased and received greater public attention. In a nation that has traditionally been uncomfortable addressing mental illness, what factors have allowed for the rising medicalization of depression and suicide? Investigating these profound changes from historical, clinical, and sociolegal perspectives, Depression in Japan explores how depression has become a national disease and entered the Japanese lexicon, how psychiatry has responded to the nation's ailing social order, and how, in a remarkable transformation, psychiatry has overcome the longstanding resistance to its intrusion in Japanese life. Questioning claims made by Japanese psychiatrists that depression hardly existed in premodern Japan, Junko Kitanaka shows that Japanese medicine did indeed have a language for talking about depression which was conceived of as an illness where psychological suffering was intimately connected to physiological and social distress. The author looks at how Japanese psychiatrists now use the discourse of depression to persuade patients that they are victims of biological and social forces beyond their control; analyzes how this language has been adopted in legal discourse surrounding "overwork suicide"; and considers how, in contrast to the West, this language curiously emphasizes the suffering of men rather than women. Examining patients' narratives, Kitanaka demonstrates how psychiatry constructs a gendering of depression, one that is closely tied to local politics and questions of legitimate social suffering. Drawing upon extensive research in psychiatric institutions in Tokyo and the surrounding region, Depression in Japan uncovers the emergence of psychiatry as a force for social transformation in Japan.
A handbook on recent advancements and the state of the art in array processing and sensor Networks Handbook on Array Processing and Sensor Networks provides readers with a collection of tutorial articles contributed by world-renowned experts on recent advancements and the state of the art in array processing and sensor networks. Focusing on fundamental principles as well as applications, the handbook provides exhaustive coverage of: wavelets; spatial spectrum estimation; MIMO radio propagation; robustness issues in sensor array processing; wireless communications and sensing in multi-path environments using multi-antenna transceivers; implicit training and array processing for digital communications systems; unitary design of radar waveform diversity sets; acoustic array processing for speech enhancement; acoustic beamforming for hearing aid applications; undetermined blind source separation using acoustic arrays; array processing in astronomy; digital 3D/4D ultrasound imaging technology; self-localization of sensor networks; multi-target tracking and classification in collaborative sensor networks via sequential Monte Carlo; energy-efficient decentralized estimation; sensor data fusion with application to multi-target tracking; distributed algorithms in sensor networks; cooperative communications; distributed source coding; network coding for sensor networks; information-theoretic studies of wireless networks; distributed adaptive learning mechanisms; routing for statistical inference in sensor networks; spectrum estimation in cognitive radios; nonparametric techniques for pedestrian tracking in wireless local area networks; signal processing and networking via the theory of global games; biochemical transport modeling, estimation, and detection in realistic environments; and security and privacy for sensor networks. Handbook on Array Processing and Sensor Networks is the first book of its kind and will appeal to researchers, professors, and graduate students in array processing, sensor networks, advanced signal processing, and networking.
Although medicalization is a concept that has been widely taken up and used by medical anthropologists, it was sociologists who first coined the term and put it into circulation. One of the abiding interests of sociologists concerned with modernization and its effects, particularly those who followed in the legacy of Emile Durkheim and Talcott Parsons, has been to show how social order is produced and sustained in contemporary society. In this vein the sociologist Irving Zola (1972) argued in the early 1970s that medicine had become a major institution of social control, replacing the more “traditional” institutions of religion and law, resulting in the “medicalizing” of many aspects of daily life in the name of health. Zola’s publication, in which he makes it clear that he is by no means totally opposed to the process he highlights, gave birth to a genre of research in which the cumbersome word medicalization—“to make medical”—was adopted as a key concept.
It can be argued that medical ...
This volume brings together a number of the foremost scholars - anthropologists, psychiatrists, psychologists, and historians - studying schizophrenia, its subjective dimensions, and the cultural processes through which these are experienced. Based on research undertaken in Australia, Bangladesh, Borneo, Canada, Colombia, India, Indonesia, Nigeria, the United States and Zanzibar, it also incorporates a critical analysis of World Health Organization cross-cultural findings. Contributors share an interest in subjective and interpretive aspects of illness, but all work with a concept of schizophrenia that addresses its biological dimensions. The volume is of interest to scholars in the social and human sciences for the theoretical attention given to the relationship between culture and subjectivity. Multidisciplinary in design, it is written in a style accessible to a diverse readership, including undergraduate students. It is of practical relevance not only to psychiatrists, but also to all mental health professionals.
Greater geographical latitude was found to be positively associated with multiple sclerosis rates in the United States and Italy. Latitude was found to be positively correlated with schizophrenia rates in Italy. Temperature was negatively correlated with multiple sclerosis in the United States. The exploratory variable of amount of sunlight was inversely related to multiple sclerosis in the United States and inversely related to schizophrenia in Italy. Other exploratory findings were schizophrenia correlating positively with precipitation and negatively with elevation in the United States; schizophrenia rates positively correlating with esophageal cancer rates in Italy and in the United States; and multiple sclerosis rates correlating negatively with influenza rates in the United States. The present research examined the inter- relationship of schizophrenia rates, multiple sclerosis rates, temperature and geographical latitude. This research had two principal purposes, one pertaining to multiple sclerosis and the other more central to the interests of the present authors and pertaining to both multiple sclerosis and schizophrenia. It has long been very well established that multiple sclerosis rates are higher in locations with greater latitude, both in the northern and southern hemispheres (McAlpine et al, 1972). Although the authors of these studies have stressed latitude rather than temperature, there seems to be little rationale provided for the position that latitude is more important than tem- perature. The present study included both latitude and temperature. The second purpose was to relate both 1. California School of Professional Psychology, Fresno, California 93721.
Amidst the progress being made in the various (sub-)disciplines of the behavioural and brain sciences a somewhat neglected subject is the problem of how everything fits into one world and, derivatively, how the relation between different levels of discourse should be understood and to what extent different levels, domains, approaches, or disciplines are autonomous or dependent. In this paper I critically review the most recent proposals to specify the nature of interdiscourse relations, focusing on the concept of supervenience. Ideally supervenience is a relation between different discourses which has all the advantages of reduction, but without its disadvantages. I apply the more abstract considerations to two concrete cases: schizophrenia and colour. Usually an interlevel or interdiscourse relation is seen as asymmetrical: the overlaying discourse depends on the underlying discourse (and not vice versa), where the out- or un-spoken assumption is that the ultimate underlying discourse is physical. Instead I argue that scientific categories referred to in interdiscourse relations are, ultimately, dependent on common sense categories and common sense normative criteria. It is the manifest categories and common sense ideas about what is reasonable and what is right that determine the relevant categorisations at the deeper, underlying levels. I suggest that the implications of this are not merely methodological or epistemological.
The concept of hope is important for illness and healing. In psychiatry, the opposite, ‘hopelessness’ has clinical importance, because it is linked to depression and suicide. However, the clinical notion conceals the moral dimensions of the concept. By presenting anthropological data on psychiatric practices related to chronic mental illness, the author shows that hope with its western theological origins plays an important role in daily psychiatric practices. Hope has different meanings and functions for staff and patients. These are related to cultural ideas about a person, illness, social relationships, life and death. The analysis underlines the cultural construction of western psychiatry. The usual meanings of hope have to be modified because some meanings do not always have favourable effects on the course of the illness.
The question ofhow social response 1 to schizophrenic illness 2 varies across cultures has long been of interest to anthropologists (Carin). A principal issue is whether social responses are mediated primarily by culture or by the severity of individual psychopathology. In support of the latter position, Murphy (1982:70) has argued that there seems to be little that is distinctively cultural in the attitudes and actions directed toward the mentally ill .... There is apparently a common range of possible responses to the mentally ill person, and the portion of the range brought to bear regarding a particular person is determined more by the nature of his or her behavior than by a preexisting cultural set to respond in a uniform way to whatever is labelled mental illness.
The WHO cross-cultural studies of schizophrenia exemplify both the achievements and the pitfalls of large-scale psychiatric epidemiology. Their logistical and technical advances have been justly celebrated; the consistent—and unexpected—finding of better outcome in the developing than in the developed world continues to vex analysts. At the same time, anthropological critics have not been shy about pointing up the limitations and blind spots of such research. Criticisms range from charges of ethnocentrism and category errors in the psychiatric research enterprise itself especially the inapplicability of its disease taxonomy to some non-Western cultures, to translation difficulties, the suspect and “thin” quality of questionnaire-generated accounts of illness, disregard for variant understandings of the “self,” and the naïveté of treating culture as a set of variables. Not all of these objections, I argue, are well-founded; some more properly reflect persisting instabilities in anthropological theory. This critical commentary all but ignores the striking epidemiological findings in the West that dispute the received wisdom of chronicity as the natural trajectory of schizophrenia. A natural alliance awaits realization between clinicians—newly alerted to ill-understood factors affecting course and outcome—and fieldworkers—bent on close ethnographic analysis of the configurations and roles of beliefs, work, kin-based support, the uses of public space, and “the natives”‘ own understanding of what ails them.
This article examines and clarifies controversies about the concept of illness in the field of family therapy. We contend that illness, as traditionally understood in all cultures, is a relational, transactional concept that is highly congruent with core principles of present-day family theories. Family therapists need not buy into a biotechnical, reductionistic reframing of illness as disease. Rather, it is more appropriate to conceptualize and work with illness as a narrative placed in a biopsychosocial context. Such a narrative includes how shared responsibility for coping and for finding solutions can take place, without becoming involved in disputes about causal models.
Over the last ten years a new approach to psychiatric knowledge has developed under the influence of social anthropology. Its origins, assumptions, methods, achievements, and limitations are reviewed.
Culture influences the experience and expression of distress from its inception. While Western psychiatry has identified several universal patterns of distress, there are significant geographical variations in the prevalence, symptomatology, course and outcome of psychiatric illness. Indirect evidence suggests that cultural differences in the recognition, labelling and interpretation of deviant behaviour affect the outcome of major psychiatric disorders as well as milder forms of distress. Emotion theory and the cultural concept of the person provide links between social and cognitive processes that contribute to the natural history of emotional distress. However, many current studies of ethnopsychology confound psychology (mechanisms of behaviour) and meta-psychology (theories of the self). Further advances in understanding the impact of culture on distress depend on the development of psychological and social theory that is neither ethnocentric nor naive about the wellsprings of action. Three arenas for further study are identified: (1) the handling of the gap between experience and expression; (2) the labelling of deviant behaviour and distress as voluntary or accidental; and, (3) the interpretation of symptoms as symbols or as meaningless events. Attention to these themes can guide re-thinking the assumptions of Western psychological and social theory.
Many a psychiatrist has said that he did not want to burden himself with a philosophy and that this science had nothing to do with philosophy. But the exclusion of philosophy would nevertheless be disastrous for psychiatry: firstly, if we are not clearly conscious of our philosophy we shall mix it up with our scientific thinking quite unawares and bring about a scientific and philosophic confusion. Secondly, since in psychopathology in particular the scientific knowledge is not all of one kind, we have to distinguish the different modes of knowing and clarify our methods, the meaning and validity of our statements and the criteria of tests- and all this calls for philosophic logic ... To sum up: If anyone thinks he can exclude philosophy and leave it aside as useless, he will be eventually defeated by it in some obscure form or another.
In Modern Western cultures, conceptual models of mental illness are interwoven with value systems of individualism, agency, internal locus of control, and fear of dependency. These values have translated into psychological theory and practice, affected families' relationships with the professional, legal, and consumer communities and have often exacerbated family burden. Culturally patterned attributions of individual accountability also affect family-patient interactions and may have an effect on relapse and prognosis. The family and consumer movements are discussed in terms of their orientations, services, social impact, and influence on epistemology, particularly with reference to the different effects of protective paternalism and individualistic autonomy. Questions are raised regarding cultural values and differential prognoses in modern and developing countries and whether the process of recovery may be shaped by different cultural introjects. It is suggested that the era of family and consumer empowerment may be heuristic in discovering parameters of mental illness and potential for recovery, and ideas are offered for future cross-cultural research.
This article reviews the literature on culture and schizophrenia, the aetiology of schizophrenia, and service evaluations about how it is best managed. It examines how schizophrenia affects and manifests itself in individuals from different cultures, whilst assessing the extent to which migration, as a process, plays a role. Furthermore, it considers the impact that cultural background has on diagnostic practices. The authors argue that a holistic approach needs to be taken in order to understand and respond effectively to ethnic inequalities in service access, experience, and outcome. One cannot solely look through the lens of culture but, rather, one needs to analyse how culture interlinks with internal and structural factors such as race, levels of integration, socio-economic status, and social capital. Effective diagnosis and treatment therefore needs to take into account the individual self and history, together with the psychosocial realities.
For the past decade, the dopamine hypothesis of schizophrenia has been the predominant biochemical theory of schizophrenia. Despite the extensive study of tissue samples obtained from schizophrenics, indirect pharmacological evidence still provides the major support for the hypothesis. Direct support is either uncompelling or has not been widely replicated. The dopamine hypothesis is limited in theoretical scope and in the range of schizophrenic patients to which it applies. No comprehensive biological scheme has yet been proposed to draw together the genetic, environmental, and clinical features of schizophrenia. Recent refinements of the dopamine hypothesis may aid in the delineation of biologically homogeneous subgroups. Positive symptoms (e.g., hallucinations, delusions) and negative symptomatology (e.g., affective flattening, social withdrawal) may result from different pathophysiological processes. Schizophrenia research might benefit from an increased attention to neurophysiological adaptations.
Seemingly the definition of ‘mental health’ presents few difficulties. According to a widespread general conception, human existence is a physical as well as a psychological existence, based on the equally well-known division of human existence into body and soul. The body is that part of us which is visible. It is the physician who concerns himself with the health of the body. If the organs of the body are in good condition, which as a rule can be deduced from the usually clear results of scientifically oriented examinations, then a state of physical health appears to be achieved. The soul is said to be that ‘thing in us’ which is nonvisible, which is immaterial. The soul contains all that which is left of us when we remove in thought — the purely physical elements from our existence. What remains is, for instance, our interests, our longings, our happiness, our sorrow. Our life! Perhaps our destiny. To the domain of our soul belong likewise all the ties we have with others. All these aspects I have just mentioned form together that which is nonphysical in the medical sense. It must be noted, however, that the psychic functions here indicated and many others which could be added to this list cannot do without the human body. What is our sorrow if it cannot express itself through our body? What are relationships between people if those people are not physical? But let me stop worrying about this just now, at the very beginning of my paper. Body and soul — it is a wellknown and generally accepted distinction. Equally accepted is the distinction between physical and mental health. Today I wish to talk about mental health and not about the functioning of physical organs.
In this paper I will look at psychiatric illness from a biomedical as well as from an ethnomedical perspective. Several themes will be emphasized throughout the discussion. In thinking about medical problems generally, and psychiatric ones specifically, I have found it useful to distinguish between purely physical (i.e., neurophysiologic, neurochemical) factors as opposed to symbolic factors, namely psychological and social factors consisting of behaviors, feelings, etc. of the person. I have employed the terms disease and illness to designate these two sets of factors respectively. I will posit that psychiatric illness is a psychosocial “entity” which is extended in time and space. This means (1) that the domain of personal experience (e.g., self definition, attitudes toward others, emotions, etc.) and that of social activity (e.g., role functioning, social relations) together form the substance of psychiatric illness and (2) that the illness duration in time and space is critically influenced by these social-psychological factors. Furhermore, I have assumed that an individual’s theory of illness and of self, which impact on one another and are complementary, strongly influence how an underlying psychiatric disease condition expresses itself psychosocially or in psychiatric illness generally.
Health and disease are cardinal concepts of the biomedical sciences and technologies. Though the models of health and disease may vary, these concepts play a defining role, indicating what should and what should not be the objects of medical concern. The concepts are ambiguous, operating both as explanatory and evaluatory notions. They describe states of affairs, factual conditions, while at the same time judging them to be good or bad. Health and disease are normative as well as descriptive. This dual role is core to their ambiguity and is the focus of this paper. In this paper I shall examine first the concept of health; second, the concept of disease; and third, I will draw some general conclusions concerning the interplay of evaluation and explanation in the concepts of health and disease.
• Six sets of operational criteria for diagnosing schizophrenia were applied to a systematically ascertained twin series by raters who were blind to zygosity and to the psychiatric status of the co-twin. Assuming a multifactorial/threshold model of transmission, twin correlations in liability and, where possible, approximate broad heritabilities were calculated for each criterion. All definitions resulted in significant monozygotic twin correlations. The highest heritabilities (of approximately 0.8) were given by the Research Diagnostic Criteria and by the categories "probable" plus "definite" schizophrenia according to the criteria of Feighner et al. In contrast, Schneider's first-rank symptoms defined a form of schizophrenia with a heritability of 0 and, together with the criteria of Carpenter et al and Taylor et al, proved to be excessively restrictive, identifying fewer than half of the probands as schizophrenic.
• Computed tomographic (CT) scans of 28 chronic schizophrenic patients, 15 chronic schizoaffective patients, and 19 patients with bipolar affective disorder were compared on three measures: ventricular size, sulcal prominence (cortical atrophy), and cerebellar atrophy. Because the patients with bipolar disorder were older, measures were adjusted by controlling for age statistically or excluding patients over age 50 years. After age correction, there were no significant differences across diagnostic groups. Each group contained some subjects with enlarged ventricles, sulcal prominence, and/or cerebellar atrophy. The similarity of CT scan results across the three groups argues against ascribing these abnormalities to any one psychiatric disorder or to a specific drug effect. Sampling effects and the possibility of differential causes of the findings in the different diagnostic groups must be considered. Examination of the correlations of these three CT scan measures found them to be significantly related to each other. Age correlated with all measures when patients over age 50 years were included in the analysis, but not for patients aged 50 years and younger.
• Present clinical and research methods of differential diagnosis of schizophrenia and affective psychoses rely very heavily on presenting symptoms and signs, especially in acute psychosis. We have reviewed studies bearing on this issue, including studies of the phenomenology of psychotic illness, outcome, family history, response to treatment with lithium carbonate, and cross-national and historical diagnostic comparisons. We conclude that most so-called schizophrenic symptoms, taken alone and in cross section, have remarkably little, if any, demonstrated validity in determining diagnosis, prognosis, or treatment response in psychosis. In the United States, particularly, overreliance on such symptoms alone results in overdiagnosis of schizophrenia and underdiagnosis of affective illnesses, particularly mania. This compromises both clinical treatment and research.
The Strange Case of Dr Jekyll and Mr Hyde / Robert Louis Stevenson Note: The University of Adelaide Library eBooks @ Adelaide.
Present clinical and research methods of differential diagnosis of schizophrenia and affective psychoses rely very heavily on presenting symptoms and signs, especially in acute psychosis. We have reviewed studies bearing on this issue, including studies of the phenomenology of psychotic illness, outcome, family history, response to treatment with lithium carbonate, and cross-national and historical diagnostic comparisons. We conclude that most so-called schizophrenic symptoms, taken alone and in cross section, have remarkably little, if any, demonstrated validity in determining diagnosis, prognosis, or treatment response in psychosis. In the United States, particularly, overreliance on such symptoms alone results in overdiagnosis of schizophrenia and underdiagnosis of affective illnesses, particularly mania. This compromises both clinical treatment and research.
We now have evidence that the prognosis for schizophrenia is much better in nonindustrial than in industrial societies. This paper reports on a 5-year follow-up of schizophrenic patients living in the peasant society of Sri Lanka and shows that social adjustment and clinical state of a sample of first admission schizophrenic patients examined at the end of 5 years are remarkably good. Further, the 5-year outcome for these patients is consistent with WHO's samples followed in Nigeria and India, for example, and consistently different from outcome for schizophrenic patients followed in industrial societies such as Denmark, U.S.A., U.K., and U.S.S.R. Further, we have shown for the Sri Lanka schizophrenics that good outcome cannot be explained by artifacts of sampling or diagnostic methods, by type of treatment, or by the family's willingness to tolerate deviance. Instead, to explain cultural differences in prognosis, we propose a theoretical alternative to the medical model of disease, social labeling theory, that attributes good prognosis to cultural factors such as the traditional system of beliefs, structure of the treatment system, and family norms. In modern industrial societies, expectations and beliefs about mental illness and the operation of the treatment system serve largely to alienate schizophrenic patients from their normal roles and thus to prolong illness. In contrast, beliefs and practices in nonindustrial societies encourage short term illness and quick return to normality. Cultural differences in prognosis, then, may be the result of culturally based self-fulfilling prophecies.
The phenomenological criteria of prominent Anglo-American researchers on certain so-called passivity experiences, sense deceptions and delusional phenomena, reflecting their interpretations of Kurt Schneider's first rank symptoms of schizophrenia, are examined. In this way the frequent discrepancies and difficulties in deliminiting the clinical boundaries of these phenomena more clearly come to light.
Contrary to Singer's contention that the features of depressive disorders do not exhibit significant cross-cultural differences, the author uses material from field research in Taiwan and data from recent anthropological and clinical investigations to support the opposite view that such differences exist and are a function of the cultural shaping of normative and deviant behavior. Somatization amongst Chinese depressives is used as an illustration. This discrepancy reflects substantial changes in the nature of more recent cross-cultural studies by anthropologists and psychiatrists, changes which are giving rise to a new cross-cultural approach to psychiatric issues. Some features and implications of that approach are described.
There is doubt whether schizophrenia, the most common and most devastating serious mental illness, existed much more than 200 years ago. Many authors who have written recently on the history of schizophrenia suggest that it is a disease that first appeared towards the end of the eighteenth century and rapidly increased in prevalence throughout the nineteenth. Cooper & Sartorius (1977) ask “Why are good descriptions of what can now be recognized as chronic schizophrenia so scarce in European medieval and earlier literature?” and they associate schizophrenia with industrialisation. Torrey (1980) argues that although descriptions of madness, including hallucinations and delusions, date to ancient times, schizophrenia as we know it with an onset in early adulthood and progressive deterioration, is not described. He associates schizophrenia with civilisation, and proposes an infectious cause. Hare (1979, 1982) supports this hypothesis, providing detailed evidence for a real increase in hospitalised psychiatric patients who most probably had schizophrenia in the last century (Hare, 1983), and also states that there are no good earlier descriptions of schizophrenia.
Many psychiatrists assume that schizophrenia has existed in its current form throughout history, but recently it has been suggested that schizophrenia, far from being an ancient disorder, is of recent origin and is linked to the spread of civilization. In part this is based on the rarity of historical accounts of schizophrenia in comparison with other mental illnesses. In this article we present evidence that a substantial number of clinical descriptions resembling modern conceptions of schizophrenia exist throughout history. In addition, we discuss reasons why historical descriptions of schizophrenia may be relatively uncommon while the illness itself may have been common in the past.
Morbidity risks for mental illness were determined in 750 first-degree relatives of chronic schizophrenic and normal control probands. Psychiatric disorders that were more frequent in relatives of schizophrenic probands than in relatives of normal control probands were chronic schizophrenia (5.8% versus 0.6%), schizotypal personality disorder (definite, 14.6% versus 2.1%; probable, 12.1% versus 6.5%), and paranoid personality disorder (7.3% versus 2.3%). The data suggest that schizotypal and paranoid personality disorders are genetically related to schizophrenia. The implications for schizophrenia research are discussed.
This report examines the risk for psychiatric illness in 723 first-degree relatives of schizophrenics and 1,056 first-degree relatives of matched surgical control patients. Diagnoses in patients and relatives were made "blind" to one another, using DSM-III criteria. Information on relatives was obtained from personal interview and/or hospital records. Results were analyzed using two levels of diagnostic certainty and with or without relatives on whom only hospital records were obtained. In all analyses, the risk for schizophrenia was significantly greater (at least 18-fold) in the relatives of schizophrenics v controls. Evidence was also found for an increased risk in relatives of schizophrenics for schizoaffective disorder, paranoid disorder, and atypical psychosis but not for unipolar disorder, anxiety disorder, or alcoholism. As defined by DSM-III, schizophrenia is a familial disorder; however, the increased risk for psychotic illness in relatives of schizophrenics does not appear to be confined to schizophrenia alone.
The role of genetic predisposition in schizophrenia is undoubted but some of the data on family concordance cannot be explained on the basis of genes alone: for instance, the concordance rate is higher in same-sex than in different-sex dizygotic-twin and sibling pairs and in same-sex dizygotic twins than in same-sex sibling pairs. The findings can be understood if disease expression is also a function of physical proximity to an affected individual, as is suggested by the fact that the anomalous findings occur within primary but not secondary family relationships. There is some familial and epidemiological evidence to support the hypothesis of transmission from affected to nonaffected individuals. Schizophrenia could be due to a virus which is transmitted predominantly from schizophrenic patients to genetically-predisposed individuals, perhaps in some cases with a latency of approximately six months.
Assessed the evidence for and against the view that insanity was increasing in Britain during the 2nd half of the 19th century. The author considers the arguments used by the nosocomialists to support their view that the obvious increase in numbers of ascertained insane did not necessarily imply an increase in the incidence of insanity. Two possible reasons are considered as to why the "first-admission" rate to asylums increased during the last 4 decades of the 19th century. The first is that the incidence of insanity increased without any diminution in the severity of the condition. The second is that the increase was due to the admission of increasingly milder cases. During the past decade or two, a great deal of research has suggested an association of schizophrenia with pathological changes in the brain; and 2 etiological hypotheses of a strictly environmental type have been posited, one implicating a dietary factor and the other an infective (viral) factor. The historical evidence, which the author suggests indicates a change in the incidence of a schizophrenic-like disorder in Britain during the 19th century, is compatible with a somatic cause and may be considered as lending support to the etiological hypotheses, particularly the infective one. (76 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The author reviews the results of twin studies of schizophrenia from the perspective of recent advances in our understanding of the twin method and of the transmission of schizophrenia. The evidence suggests that twin studies of schizophrenia are not likely to be substantially biased by the greater similarity in social environment of identical versus fraternal twins. Raw concordance figures from twin studies of schizophrenia are quite variable. When models to estimate the etiologic importance of genetic factors are applied to these figures, the results from all studies are similar. According to these models, genetic factors are as etiologically important in schizophrenia as in such medical conditions as diabetes and hypertension. Twin studies of schizophrenia probably provide a valid measure of the major etiologic role genetic factors play in schizophrenia.
Six sets of operational criteria for diagnosing schizophrenia were applied to a systematically ascertained twin series by raters who were blind to zygosity and to the psychiatric status of the co-twin. Assuming a multifactorial/threshold model of transmission, twin correlations in liability and, where possible, approximate broad heritabilities were calculated for each criterion. All definitions resulted in significant monozygotic twin correlations. The highest heritabilities (of approximately 0.8) were given by the Research Diagnostic Criteria and by the categories "probable" plus "definite" schizophrenia according to the criteria of Feighner et al. In contrast, Schneider's first-rank symptoms defined a form of schizophrenia with a heritability of 0 and, together with the criteria of Carpenter et al and Taylor et al, proved to be excessively restrictive, identifying fewer than half of the probands as schizophrenic.
To determine whether genetic influences in schizophrenia are related to the symptoms specified by diagnostic criteria, the case histories of 151 pairs of monozygotic twins from five twin studies of schizophrenia were rated for positive and negative symptoms. Concordance rates in monozygotic twins were significantly higher when probands had a greater number of negative symptoms; no evidence of a similar relationship was found for positive symptoms. The data indicate that negative symptoms may be characteristic of schizophrenia in which there is a greater genetic component. The results have important implications for determining diagnostic criteria and understanding the pathogenesis of schizophrenia.
The authors present a 16-year update on schizophrenia in the National Academy of Sciences-National Research Council (NAS-NRC) Twin Registry. As of October 1981, a recorded diagnosis of schizophrenia was equally common in monozygotic and dizygotic twins. However, probandwise concordance for schizophrenia was significantly greater in monozygotic (30.9%) than in dizygotic (6.5%) twins. Biases in zygosity determination, diagnosis, or ascertainment could not plausibly explain these results. Correction for selection effects in construction of the registry produced concordance rates for schizophrenia approaching those found in previous studies. According to registry data, genetic factors appear at least as important in the etiology of schizophrenia as in several common medical conditions, including diabetes and hypertension. Results from the NAS-NRC Twin Registry support the etiologic importance of genetic factors in schizophrenia.