As noted by Robert Whitaker in his book Anatomy of an Epidemic, the World Health Organization reported that the prognosis for someone experiencing psychosis is far better in developing countries than in industrialized countries. Mr. Whitaker and others posit that this is due to the treatment models used in the developing world, as well as to debility and chronicity caused by psychiatric drugs themselves. I think this is undoubtedly true.
A number of other reasons for the disparity in outcome have been suggested. Some have put forward the idea that there has been a rush by consumers to apply for this disability money, leading to an increase in apparent chronicity. While this is quite possible, I doubt that this alone explains the large gap in outcomes. Other researchers have suggested that family and community support networks are often stronger in developing countries and that there is perhaps more tolerance and acceptance of people with psychotic tendencies.
Traditional Perceptions of “Mental Illness”
I think it’s also important to explore traditional tribal and village based models of helping people experiencing psychosis and examinewhy they may be effective. Is there something we are missing about how altered and psychotic states have been perceived and treated in indigenous societies? In traditional societies, psychosis is often seen in a spiritual context. Instead of defining the experience as due to an underlying flaw or biological illness, psychosis and altered states have often been understood as a spiritual awakening, or as part of a supernatural process.
In the West, we describe psychosis and schizophrenia in terms of positive (auditory and visual hallucinations, delusions, thought distortions) and negative (anhedonia, dysthymia, catatonia) traits. Scientific explanations have centered around describing brain abnormalities as well as neurotransmitter alterations. Treatment is primarily centered around taking antipsychotic major tranquilizers such as Risperdal and Zyprexa.
In traditional societies, complex supernatural narratives are often used as explanatory models for psychosis. In the Hmong culture, psychotic experiences are caused by spiritual entities (dab neeb). Often those who experience psychosis will go on to be seen as spiritual intermediaries, or shamans who can help heal community members.
Native American tribes such as the Navajo often perceive psychosis as a type of spiritual possession. Elaborate rituals involving singing, praying, herbs and ritual objects are used to exorcise and combat evil entities.
In many traditional societies the process of psychosis is often initiated and invited through drumming, chanting, prayer, fasting and meditation. The Akamba of Kenya can be possessed by the spirits of ancestors, or aimu, in ecstatic rituals. In Ecuador, the Quichua Indians use plant hallucinogens such as ayahuasca and then invite spirit animals such as jaguars to take over their mind. In this state they often perform elaborate healing rituals for community members in emotional and physical distress. And amongst certain Native American tribes, there is a pervasive belief in “Ghost sickness”, a term used to describe symptoms of weakness, dizziness, fainting, anxiety, hallucinations, confusion, and loss of appetite from the action of evil forces.
Explaining these forms of altered states in spiritual terms is often seen as unscientific, and lacking proof. Modern mental health treatments are seen as based in scientific research and as having been vetted for validity, efficacy, and safety. Superstitious folk healing is seen as ineffective, or worse, dangerous.
Traditional Healing as Community Based Care
But I return again to the WHO study that shows far worse outcomes for those experiencing schizophrenia in industrialized countries than in societies that don’t use drug medicine, or indeed rely or superstitious folk healing. Do these traditional societies know something we don’t?
There are two ways I look at it. One could see the experience of supernatural intercession as the cause of psychosis, literally. Perhaps there is a complex spiritual cosmology that can lead to dramatic changes in sense and perception. And perhaps there are certain individuals (healers, shamans) that have a greater capacity for working in that realm, interceding and helping regulate consciousness towards greater harmony and well-being. This has been accepted practice throughout the world for millennia. Certainly western science, at least according to the WHO, has not demonstrated a greater template for healing people going through psychosis.
And one could look at it metaphorically. The elaborate rituals, the use of herbs and sacred objects, the incorporation of the community and tribe; all help in the process of bringing sense and coherence, as well as a deeply felt source of loving support to helping a person navigate the depths of confusion and distress found in psychosis.
At a core level, I think community-level care and support forms the basis for healing. Folk ceremonies and healing rituals help in the process of reintegration. They externalize the psychosis as something coming “from without” and not as an intrinsic defect or permanent biological abnormality. The process of ritual and intercession by a shaman or a healer creates the template for processing and giving meaning to altered states. The community helps to provide a context within which to reintegrate after a “healing”. Whether the experience is literal or metaphorical, the template for managing altered states and psychosis provides a level of care that is often lacking in our modern Western system.
The mental health system in place in the developing world is primarily a white European male construct. Often people from other cultures and backgrounds feel deeply uncomfortable being labeled with a mental illness, and uncomfortable with the therapy modalities (drugs and psychotherapy) offered. When we look closely at the modern mental health programs in developed countries, we see that the treatments offered are leading to worsening symptoms and deepening chronicity.
In our desire to look for alternatives that work, we are obliged to examine why prognosis in developing countries is far better. One easily overlooked aspect is the role of traditional perceptions and treatment of what has come to be known as psychosis. These forms of “illness” have long been known as a sacred part of the human experience and continue to be in parts of the world that have not yet ben assimilated into the modern psychiatric system of mental health care.
This was originally written by Jon Keyes and published here at Mad in America, a site devoted to exploring alternatives to psychiatry.