Our Most Troubling Madness

This book examines the way schizophrenia is shaped by its social context: how life is lived with this madness in different settings, and what it is about those settings that alters the course of the illness, its outcome, and even the structure of its symptoms. Until recently, schizophrenia was perhaps our best example—our poster child—for the “bio-bio-bio” model of psychiatric illness: genetic cause, brain alteration, pharmacologic treatment. We now have direct epidemiological evidence that people are more likely to fall ill with schizophrenia in some social settings than in others, and more likely to recover in some social settings than in others. Something about the social world gets under the skin. This book presents twelve case studies written by psychiatric anthropologists that help to illustrate some of the variability in the social experience of schizophrenia and that illustrate the main hypotheses about the different experience of schizophrenia in the west and outside the west--and in particular, why schizophrenia seems to have a more benign course and outcome in India. We argue that above all it is the experience of “social defeat” that increases the risk and burden of schizophrenia, and that opportunities for social defeat are more abundant in the modern west. There is a new role for anthropology in the science of schizophrenia. Psychiatric science has learned—epidemiologically, empirically, quantitatively—that our social world makes a difference. But the highly structured, specific-variable analytic methods of standard psychiatric science cannot tell us what it is about culture that has that impact. The careful observation enabled by rich ethnography allows us to see in more detail what kinds of social and cultural features may make a difference to a life lived with schizophrenia. And if we understand culture’s impact more deeply, we believe that we may improve the way we reach out to help those who struggle with our most troubling madness.