Imaginary Social Worlds: A Cultural Approach

By John L. Caughey | Go to book overview

Chapter 6
Social Relations in Hallucinations and Delusions

A step beyond the realms of everyday imaginary experience lie the fantastic worlds of "madness." In our society, these hallucinatory and delusionary worlds are typically associated with various kinds of psychotics, particularly "paranoid schizophrenics." These abnormal imaginary systems have been traditionally interpreted through the psychiatric paradigm.

In American society, the basic test through which judgments of madness are made is the psychiatric interview or mental status examination.1 The procedures followed on the ward I studied appear to be typical.2 Here we find a special kind of social interaction in which a person in the role of psychiatrist questions a prospective patient. In some cases the patient has come voluntarily because of subjective distress. In most cases the prospective patient claims to be well, and arrives more or less unwillingly at the instigation of others such as relatives, neighbors, or the police. From a cultural perspective, people are brought to the ward because they have violated cultural rules about appropriate behavior. They have engaged in social deviance that has proved annoying to others. In a few cases people have threatened or attacked others. Much more often they have done nothing violent but have performed actions that strike other people as inappropriate or bizarre.

In the mental status examination, the psychiatrist seeks to determine if the person is mentally disturbed and to establish the proper diagnosis. If the psychiatrist suspects psychosis, he will be particularly concerned about whether the patient has hallucina-

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