What follows is a short and relatively free-wheeling post penned (very loosely) in response to Greg Downey’s recent and very much more scholarly web-essay. Given that I’ve never taken even a single anthropology class, I feel relatively unqualified to discuss the broader cross-cultural literature on psychosis and culture; taking a more familiar route, then, I much more modestly aim to highlight a few key implications (or extensions) of Greg’s musings in the context of culture and psychosis in the US.
(1) Culture and perception
As Greg notes, not only patterns of “ideational and elaborate delusions” but also the kind and type of hallucinations vary across cultures. I probably define psychotic hallucinations in a less traditional way than many folks—i.e. not simply as “perceptions in the absence of stimuli” but rather as pre-attentive changes that are subjectively “perceived” as occurring within a given sensory modality and subsequently elaborated as more clearly modal experiences—but to me this preliminary data on cultural variation suggests that culture may in fact play a significant role in the distribution and/or localization not just of classical hallucinations but diffuse and/or horizonal pre-modal experiential changes as well. (Arguably such cultural and individual structuring also extends to the experiential form of delusions.) At least in my own experience, the so-called delusional mood or atmosphere that ubiquitously precedes more clear-cut delusional elaborations rigorously resists specification. I’m not at all sure that everyone is equally self-conscious of the (forced but inevitable) movement to specification but for me it has always involved not only intention and effort but has also tended to follow the implicit demands of specific personal and cultural narratives. (As Anna says in Rachel’s article, she wanted to hear the bust of Plato speak–as would any budding student of philosophy–and the force of that desire surely played a large role in her perception of Plato’s “hallucinated” speech qua speech.)
(2) Delusional (Meta)narratives and “Cultures of Psychosis”
Although the putative “autism” of the schizophrenic continues to circulate in certain circles, one of the most fascinating aspects of the alternative mental health and Mad Pride movement(s) is their elaboration of group identities around shared psychotic form(s) and/or content. Thus various activist colleagues of mine (including Will Hall) have begun elaborating on what could be called “indigenous” cultures of psychosis (/”extreme states”) with a focus on urban shamanism, “new consciousness,” and the reiteration and resignification of various symptoms as (meaningful) spiritual voices, visions, awakenings, astral projections, and soul travelling.
What effect such “new” narratives and metanarratives may be having on the phenomenology of psychosis is unclear, but the possibilities are fascinating. Beyond the simple power of the group, the implications of the communal reappropriation and elaboration of experiences that were previously treated as fundamentally and irreducibly individual—by definition non-shared—may be profound.
( Dave Harper’s highly recommended work on paranoia and/in cultures of surveillance proceeds along roughly parallel lines and highlights yet another area that I’d love to see psychiatric anthropologists explore.)
(3) Bizarre vs non-Bizarre Delusions
A final (related) question concerns whether or not the putative bizarreness of certain classic schizophrenic delusions is “real” or, again, ‘merely’ a cultural artifact. By this I do not simply mean, following the DSM-IV, that a given delusion is bizarre if and only if members of the same culture deem it so, but rather want to propose that the very “bizarreness” of (at least some) psychotic thinking may in fact be a product of the cultural isolation of certain claims and experiences and the systematic abrogation of the development and elaboration of these experiences as shared (and, perhaps more importantly, potentially sharable)—at least within a diffuse minority. Similarly, we might wonder if Rumke’s so-called praecox feeling—that fast and intuitive certainty of the “madness” of the psychotic other—might also be a sign not of clinical insight but rather of the success of our long-standing cultural negation of certain (perhaps realtively heterotopic) forms of difference.
Rümke, C. (1941/1990). The nuclear symptom of schizophrenia and the praecox feeling. History of Psychiatry, 1:331–341.