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Insanity, Difference, and Cross-Cultural Psychiatry

© Jessica Powers

Over the years, psychiatrists, medical doctors and scholars have debated the cause of psychiatric disorders. Is madness caused by the nature of modern "civilization," which makes life stressful and, at times, unbearable? Is madness a result of genetics? Or, as many anti-psychiatry advocates would argue, is the "madness" of certain people simply the way we perceive people who are different, who don't conform to our social standards of "normal"? This latter theory suggests that society "labels" these individuals as insane when, in fact, they are simply a reproach to our ordered system of sameness, to our system of spitting out people who are more or less alike even though we believe there are huge differences.

There is probably truth to all of these approaches. The causes of psychiatric disorders do not need to be perceived as an "either/or" but rather a "both/and" proposition.

And all of these theories are complicated when they occur in a cross-cultural situation. The idea that madness might have been caused by colonialism (modernization), the fact that madness could be caused by genetic factors, and the truth that colonial officials perceived Africans as "mad" simply because they were "different" than Europeans were all factors in colonial psychiatry practice.

Diagnosing mental illness in Africa posed some real problems for colonial officials. For one thing, they had trouble figuring out what a "normal" African was. Because a "normal" African was so confusing and foreign to them, they had already pathologized the entire continent. So how did they then distinguish between a "normal" pathological African and a "mentally ill" pathological African? Ah, the knots we tie ourselves up in just to maintain our ideas about how the world works!

One theory common among psychiatrists and colonial officials in East Africa, according to Megan Vaughan, was the idea that Africans had two different kinds of schizophrenia. "Normal" "African" delusions were based on the culture of Africans themselves. So if they thought they were a lion or were paranoid that their wife was committing adultery, they were exhibiting a normal form of "African" schizophrenia. But if they engaged in delusions that encroached upon European culture, then they were seen as having a "European" type of schizophrenia.

If it was difficult normally to diagnose madness, imagine how difficult it would be for a psychiatrist who was trying to diagnose it for a population "whose normal behavior he usually regarded as 'alien', to say the least," says Vaughan (102).

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