Schizophrenia among Afro-Caribbeans.
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Biomedical subjects
Publications and source records attributed to R Littlewood.
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The notion of 'pathology' presumes an experiential and socially embedded frame of reference which is at variance with some recent attempts to understand the procedures and subject matter of psychiatry. Psychiatric theories remain bound by individual and historical contingencies whose compelling urgency obfuscates the inter-relationship of phenomenon, social context, response, and explanatory model.
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Over the last ten years a new approach to psychiatric knowledge has developed under the influence of social anthropology. Its origins, assumptions, methods, achievements, and limitations are reviewed.
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Whilst the common analytical distinction between 'naturalistic' and 'personalistic' paradigms of medical knowledge has some immediate heuristic value and may indeed closely resemble the explicit schema elaborated by informants, interpretation of the semantics of bush medicine and madness in Creole Trinidad suggests that the two types of knowledge are not incompatible, nor mutually exclusive, nor distinct. The vices of ganja and rum use may be interpreted within the hot-cold classification of bush medicine but, like other vices and like the more 'intrapersonal' categories of pressure, grinding, studiation and tabanka, they may be understood as leading to madness. A common idiom of opposition and catharsis unites them, providing a higher level of analytical generality manifest in a range of local social institutions, and one rooted in post-colonial Afro-Caribbean experience and ideology.
The cradle of modern ophthalmology was the Joseph's Academy which still stands in Vienna's ninth district. History records some famous names from the academic lineage which flourished there in the nineteenth century, but few people have heard of Joseph Barth, who became the first professor of ophthalmology in 1773. A biography of Joseph Barth is presented.
Cultural explanations of psychopathology in the West have rarely employed models derived by anthropologists for small-scale non-literate communities. Some general features of those ritual patterns usually classed as 'culture-bound syndromes' are applicable to Western neurosis. Such reactions articulate both personal predicament and public concerns, usually core structural oppositions between age groups or the sexes. They gain their power by relying on certain unquestionable assumptions which, although beyond everyday jural relationships, articulate such relationships. In the case of Western reactions, such 'mystical sanction' is provided by biomedicine. Theoretical paradigms emphasize either the individual pragmatic or expressive aspects, or social homeostasis.
While depressive reactions appear to be universal, until recently they have seldom been described outside Europe, probably because of their lack of exotic salience, but also because they are seldom identified locally as distinct entities. Where it occurs, such an identification reflects a local preference for the articulation of individual psychological notions, rather than universal moral imperatives. While the symptoms of reactive depression are recognized in rural Trinidad as a common experience, but not especially remarked, they are also identified by Afro-Caribbeans as a specific state, Tabanka, following the loss of a sexual partner to another. Tabanka is characterized by lassitude, anorexia, insomnia, feelings of worthlessness, anger, a loss of interest in work and other activities and, especially, by a preoccupation with the faithless one. It is said to be most common among married men and among the upwardly socially mobile, and to lead to heavy drinking and occasionally madness or suicide. The precipitation of Tabanka provokes hilarity rather than moral indignation, and its humour articulates an egalitarian and individualistic working-class attitude to marriage and social mobility. In contrast, Trinidadians of Asian or Venezuelan origin emphasize moral notions of honour and shame.