Revue Ethnopsy : 2000 – N° 1 : The actuality of schizophrenia.

Editorial : An ethnopsychiatry of schizophrenia ? By : Tobie Nathan, Isabelle Stengers et Philippe Andréa

Abstract : This article is made up of two parts : the first is a methodological discussion, the second adresses the issue of schizophrenia. Regarding methodology, the authors first show how data stemming from transcultural psychiatry and ethnopsychiatry were slow to penetrate the psyciatric corpus, until their explicit appearance in the latest edition of the DSM. Despite psychiatry’s effort to confine these data within a sort of exotic enclave, such as the culture bound syndrome category, the authors show in what way recent developments suggest how these anthropological data could radically alter psychiatry in the coming years. Based on an analysis of Georges Devereux’s position on schizophrenia, who perceived the disorder as  » culturally induced « , the authors make a theoretical proposition. In the debate opposing conquering chemiotherapy and psychotherapies in danger of being shelved as  » soulful supplements « , ethnopsychiatry could constitute a third way, focusing its interest on the problem of recovery rather than illness. The authors conclude by offering a kind of program dedicated to taking seriously the  » content  » of what patients say about their recovery and the worlds they face, instead of disqualifying them from the onset with notions such as ignorance, belief or representation.

Key words : Ethnopsychiatry, schizophrenia, culture bound syndromes, recovery.

Schizophrenia, an ethnic psychosis, or schizophrenia without tears. By George Devereux

Abstract : Using numerous examples, the author develops the concept of ethnic disorder. He offers an original and innovative definition of schizophrenia. He shows how schizophrenia is a psychosis found exclusively in contemporary Western society and in what way it is produced by the latter.  » The patient who takes on the mask of schizophrenia demonstrates conformity, for being schizophrenic is the proper way of being crazy in our society.  » Indeed, the schizophrenic symptomatology is related to behaviors held in high regard in our societies : detachment, reserve, hyperactivity, sex lives devoid of affect, fragmentation, partial commitment, dereism, the blurring of boundaries between real and imaginary, infantilism, fixation, regression, and depersonalization.

Key words : Schizophrenia, ethnic disorder, acculturation.

Incitant coordination. A clinical hypothesis about the onset of schizophrenia By Henri Grivois

Abstract : The author reviews the normal sensorimotor processes which bond human beings with one another while remaining imperceptible to consciousness and the disturbance of which may be the basis of psychosis. In the course of incipient psychosis, patients are affected both in their personal experience and in their public position : they feel dispossessed of their own selves to the benefit of other individuals. They also feel they have power over others by assisting or hindering them in their gestures. This gestural perplexity can grow into a feeling of personal annihilation. Yet nothing guides patients to the simple notion of incitant coordination. The feeling of  » centrality  » is a constant element in such clinical situations and imposes interpretation.

Key words : Psychosis, motor coordination, basic phenomenon

The issue of early diagnosis of schizophrenia By Robert Barrett

Abstract : Schizophrenia is a notion that must be done away with. The emergence of the category of schizophrenia is linked to that of psychiatric state institutions, which does not mean, however, that it is a fiction or fabrication. The author discusses Kraepelin’s position and the concept of degeneration. He outlines his ethnological observations among the Iban of Borneo and the work of an Australian team offering treatment to patients from the very first signs of early psychosis in order to avoid the evolution towards chronic illness.

Key words : Schizophrenia, early psychosis, ethnology, prevention

Is early diagnosis of schizophrenia possible and if so desirable ? By Henri Grivois

Abstract : The notion of schizophrenia has spread in a disorderly manner. The term is out of place within the context of a first psychotic episode, as it should describe the end of a process (in no way unavoidable) and not its blind beginning. Reviewing the history of psychiatry, the author opposes incipient psychosis and beginning schizophrenia. By using the term « schizophrenia » from the onset, the clinician assigns himself a quasi-divine role as an expert in predestination. The attitude of the clinician, who always has the feeling of arriving too late, can in fact accelerate the switch to « centrality » and its irreversibility. According to the author, incipient psychosis is an accident and is impossible to prevent ; however, it requires a specific clinical approach.

Key words : Schizophrenia, incipient psychosis, history, clinical issues.

The psychiatrist as handyman : thoughts on the psychiatric setting. By Sylvia Fernandez-Katz

Abstract : What is the relationship between biological psychiatry and dynamic psychiatry today ? Psychoactive drugs have changed the classification of mental disorders and psychotherapies have become secondary options. The author describes the day to day psychiatric setting using the methodological tools of symmetrical anthropology. Psychoactive drugs would thus not be pure chemical products but specific orderings of non-humans and humans. Chemotherapy might in the end be considered as psychotherapy. She offers a new research setting centered on the patient and puts forth hypotheses which might explain cases of pathologies resistant to psychoactive drug treatment.

Key words : Biological psychiatry, dynamic psychiatry, psychoactive drugs, clinical issues

The one and only or the hesitation of a young (ethno)psychatrist By Danièle Pierre

Abstract : This article recounts the therapy of a young Moroccan man, suffering from a schizo-paranoid type of pathology, treated by the author, a Belgian psychiatrist. The author dwells more specifically on the use of cultural knowledge in the interpretation of the young patients dreams. She deliberately analyzes her own countertransference, namely in the difficulty she experienced in attributing true value to cultural interpretations such as possession by a jinn. In the process, she questions her own references stemming from traditional psychiatry.

Key words : Schizophrenia, ethnopsychiatry, interpretation of dreams, possession by a jinn

Bouya Omar : the saint and the birds of prey By Olivier Ralet

Abstract : The author, interested in Muslim popular cultures, went to Bouya Omar, the main location for the treatment of possession in the Marrakech area whose activities have already been studied by a Moroccan ethnographer. The place resembles the idea we might have of a nineteenth century psychiatric asylum : dying men and women, haggard, emaciated people, some of them in chains. The author wonders what reasons might explain this situation and whether it might be possible to intervene.

Key words : Possession, Morocco, brotherhood, psychiatry

Fragments of three « Lilat » and their figures By Olivier Ralet

Abstract : The author followed three figures of a Moroccan religious brotherhood, the Hamadcha. The first, Abdelghani, lives in the in dewar of Beni Ouarad, where Sidi Ahmed Dghughi – the holy servant of Sidi Ali ben Hamduch- is buried. He tends the zawiya and belongs to a group of musicians who celebrate rituals intended to call forth the spirits and make them speak. A descendant of the founder of the brotherhood, he has inherited his Baraka. The second, Sharifa, is the daughter of Lalla Aicha, considered the queen of the jnoon, the one who frightens and the one who soothes. The author describes several ceremonies, as well as the role of the saints and the jnoon. The third figure, a spirit called « child of the forest » possesses Said, and the author describes his trance episodes and his role in the ceremonies.

Key words : Trance, brotherhood, spirits, Morocco

The rebel’s legacy. The role of Georges Devereux in the birth of clinical ethnopsychiatry in France. By Tobie Nathan

Abstract : The author first explores the characteristics of France’s psychological and psychiatric treatment of immigrant populations. He notes that, in immigration countries, the massive arrival of immigrants has always led to the appearance of disciplines bridging anthropology and psychopathology. After a vivid description of Georges Devereux, his way of thinking and teaching, he shows how ethnopsychiatry, by directing certain theoretical questions towards psychiatry and psychoanalysis, has allowed the development of a specific therapeutic setting characterized by all forms of translation. He explains how this type of practice also paved the way for a new conctructivistic conceptualization of therapy. In the final part of his article, the author offers to define ethnopsychiatry as a clinical discipline taking as its object the study of all therapeutic systems, viewed as systems of objects ; all therapeutic systems, without exception nor hierarchy, whether they claim to be  » scholarly  » or to belong to a specific collective or community – ethnic, religious or social. He also defines it as a practice which considers that therapists’ theories are of concern primarily to patients ; a practice interested in engaging the latter in a contradictory debate.

Key words : Ethnopsychiatry, psychotherapy, translation, constructivism.