Roland Littlewood

Psychiatric diagnosis and racial bias: empirical and interpretative approaches.

Understanding of psychiatric illness among Britains Black and ethnic minority population has shifted from an emphasis on cultural difference to one on racism within psychiatric theory and practice. In spite of this apparent turn, the explanations put forward remain within an empirical framework of methodological individualism, reflecting the background and training of British psychiatrists themselves. How racism may be actually demonstrated in individual clinical practice remains elusive. The standard hypotheses are examined here through a conventional clinical vignette study: this suggests medical education does not in itself now involve any specific racist psychiatric assumptions. Fuller understanding of the exercise of social power within this particular domain requires not only more complex interactive studies, preferably derived from a variety of clinical and social contexts, but a more developed interpretation of psychiatric practice and ideology within the social system.

Stigmatization of severe mental illness in India: Against the simple industrialization hypothesis

Background: Major international studies on course and outcome of schizophrenia suggest a better prognosis in the rural world and in low-income nations. Industrialization is thought to result in increased stigma for mental illness, which in turn is thought to worsen prognosis. The lack of an ethnographically derived and cross-culturally valid measure of stigma has hampered investigation. The present study deploys such a scale and examines stigmatizing attitudes towards the severely mentally ill among rural and urban community dwellers in India. Aim: To test the hypothesis that there are fewer stigmatizing attitudes towards the mentally ill amongst rural compared to urban community dwellers in India. Materials and Methods: An ethnographically derived and vignette-based stigmatization scale was administered to a general community sample comprising two rural and one urban site in India. Responses were analyzed using univariate and multivariate statistical methods. Result: Rural Indians showed significantly higher stigma scores, especially those with a manual occupation. The overall pattern of differences between rural and urban samples suggests that the former deploy a punitive model towards the severely mentally ill, while the urban group expressed a liberal view of severe mental illness. Urban Indians showed a strong link between stigma and not wishing to work with a mentally ill individual, whereas no such link existed for rural Indians. Conclusion: This is the first study, using an ethnographically derived stigmatization scale, to report increased stigma amongst a rural Indian population. Findings from this study do not fully support the industrialization hypothesis to explain better outcome of severe mental illness in low-income nations. The lack of a link between stigma and work attitudes may partly explain this phenomenon.

Cultural experience of depression among white Britons in London

Cultural pluralism that characterises many major urban centres, especially London, underscores needs for research in cultural psychiatry to identify distinctive needs for mental health services and clinical treatment. Such questions motivated development of this study of the cultural experience and meaning of depression amongst white Britons in London, involving development of a British EMIC interview for depression by adapting an earlier version of the EMIC used in Bangalore, India. Steps in the process involved historical and ethnographic study of depression, and extensive pilot testing. This report focuses on the experience of depression with reference to patterns of distress and its meaning with reference to perceived causes. A wide range of contradictory, overlapping and linked explanations, consistent with reports from previous studies of Indian and other non-Western cultures, were notable among white Britons, whose illness concepts are likely to appear as diverse and inconsistent to an outside observer as findings from research in South Asia may be for a Western medical anthropologist. Furthermore, somatic idioms of depression, although not spontaneously reported, were frequently reported when specifically probed, raising questions about the distinctiveness of depressive and somatoform disorders as discrete diagnostic headings. The range of perceived causes are reviewed, considering the relationship between coded categories and narrative accounts that specify the interrelationship of categories in a causal web. The discussion considers the utility of the EMIC for cultural study and reflections on methodological issues arising in its adaptation and use that may help other researchers wishing to apply the framework and use the tools of cultural epidemiology.

Psychiatric illness among British Afro-Caribbeans.

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The voice of God

Prayer and verbally answered prayer would seem to offer powerful evidence in relation to the question of human agency. Forty members of an English Pentecostal group completed a questionnaire on prayer: 25 reported an answering voice from God, 15 of them hearing Him aloud. The latter groups were interviewed and characteristics of phenomenology and context elicited. The voice of God cannot be held to be ipso facto pathological and many reported its utility in situations of doubt or difficulty.

The effectiveness of words: Religion and healing among the Lubavitch of Stamford Hill

Testimonials of miraculous healing offered by Lubavitch Hasidim evoke images of exile and restitution which derive from Kabbalistic texts. Mediated practically through the person of the Rebbe, these testimonials articulate both immediate affliction and ultimate meaning, physical embodiment as well as symbolic representation, each constituting the other. Both Kabbalah and medical anthropology attempt to transcend not dissimilar epistemological dualisms: those characteristic of monotheism and contemporary science. Yet the ‘lower root’ of Kabbalah affirms a material reality known through immediate sensory experience which recalls the rationale of biomedicine.

The psychology of prayer and the development of the Prayer Experience Questionnaire

To date, prayer has been a largely neglected area in the social sciences. This paper describes four main areas which have been addressed in relation to prayer: the effect of prayer on empirical processes, prayer and coping, the development of praying, and the neurobiology of prayer. After pointing out that the receptive side of prayer has largely been ignored by social scientists, it goes on to describe the development of a new prayer experience questionnaire—the Prayer Experience Questionnaire. This questionnaire examines the frequency and content of prayer alongside eliciting an in-depth phenomenological description of the prayers encounter with the sacred. Data among a sample are presented and demonstrate the utility of the measure. The potential use of the measure is discussed.

Clinical findings in three cases of zombification

1The current United Nations intervention has again focused attention on a phenomenon regarded as exotic and improbable by the media, yet one which is taken by most Haitians as empirically verifiable. Along with the related religious practice of vodu, it has been implausibly related by US physicians to the current epidemic of AIDS in Haiti. 2 Haitian medical practitioners regard zombification as the consequence of poisoning; the clergy as the product of sorcery. Zombis are frequently recognised by the local population, and estimates of their number are of the order of up to a thousand new cases per year (L P Mars, personal communication). Zombification is a crime under the Haitian Penal Code (Article 246) where it is considered as murder although the zombified individual is still alive. Local interpretation is that either by poisoning or sorcery, a young person suddenly and inexplicably becomes ill, is subsequently recognised by their family as dead, placed in a tomb, stolen by a boko (sorcerer) in the next few days, and secretly returned to life and activity but not to full awareness and agency. 3,4

Religion and psychosis: A common evolutionary trajectory?

In this article we propose that schizophrenia and religious cognition engage cognate mental modules in the over-attribution of agency and the overextension of theory of mind. We argue similarities and differences between assumptions of ultrahuman agents with omniscient minds and certain ‘‘pathological’’ forms of thinking in schizophrenia: thought insertion, withdrawal and broadcasting, and delusions of reference. In everyday religious cognition agency detection and theory of mind modules function ‘‘normally,’’ whereas in schizophrenia both modules are impaired. It is suggested that religion and schizophrenia have perhaps had a related evolutionary trajectory.

Did Christianity lead to schizophrenia? Psychosis, psychology and self reference

Both geographically and historically, schizophrenia may have emerged from a psychosis that was more florid, affective, labile, shorter lived and with a better prognosis. It is conjectured that this has occurred with a reflexive self-consciousness in Western and globalising societies, a development whose roots lie in Christianity. Every theology also presents a psychology. Six novel aspects of Christianity may be significant for the emergence of schizophrenia—an omniscient deity, a decontexualised self, ambiguous agency, a downplaying of immediate sensory data, and a scrutiny of the self and its reconstitution in conversion.