Transcultural Psychiatry

Article excerpt

Transcultural Psychiatry Schizophrenia, Culture, and Subjectivity. The Edge of Experience. Janis Hunter Jenkins, Robert John Barrett, editors. Cambridge (UK): Cambridge University Press; 2004. 357 p. US$85.00.

Reviewer rating: Good

This book's editors, professors of psychiatry and anthropology at Case Western Reserve University and the University of Adelaide, respectively, were both postdoctoral fellows in the Department of Social Medicine at Harvard. Their clinical and ethnographic studies on culture and mental health prepared them for the challenging task of integrating the volume's contributions, which show alternative conceptual frameworks related to culture and schizophrenia and illustrate how family and community assistance help professional interventions. Schizophrenia has been recognized in a wide range of cultures and remains one of the most serious, yet still elusive, psychiatric disorders. As Arthur Kleinman observes in his Preface, showing how schizophrenia has as much to do with society as with biology is one of the book's main achievements.

The volume's 3 parts contain 13 chapters. Contributions in the first part address themes of culture, self, and experience. The second part presents 4 approaches to understanding schizophrenia-the ethnographic, the sociolinguistic, the clinical, and the historical. The third part focuses on subjectivity and emotion. Coeditor Janis Jenkins views schizophrenia as a paradigm case for understanding fundamental human processes and capacities (see p 29). She examines particular processes of self, emotion, social engagement, and cultural orientation in the complex phenomena of the illness. A contributing author, Kim Hopper, questions the durability of the WHO findings of a distinct advantage in schizophrenia course and outcome in developing countries. Methodological problems of the WHO international collaborative studies include attrition, groupings, outcome measures, and diagnostic ambiguities. Coeditor Robert J Barrett analyzes ethnographic and clinical findings among the Iban in Borneo, focusing on Schneider's first-rank symptoms in a cross-cultural context. They are essential for comparative inquiry, although their cross-cultural frequency in patients with schizophrenia varies considerably. Interestingly, questions about auditory hallucinations translate with ease from English to Iban, whereas problems with thinking (for example, thought insertion and withdrawal) make little cultural sense in the Iban context.

Ellen Corin, Rangaswami Thara, and Ramchandran Padmavati write about signifiers of early psychosis and subjective experience among people with schizophrenia in the cultural context of South India. Drawing on advances in 2 distinct fields of inquirypsychological anthropology and French psychoanalysis (see p 112)-these investigators view culture as paradoxical, multilayered, and contradictory. They elucidate how culture mediates psychotic experience and shapes its evolution. Their analysis of narratives reveals the subtle phenomena of altered feelings and relationships, including social withdrawal, linked to Hindu renunciation. …