According to a recent article in the British Journal of Psychiatry, summarized here, psychological anthropologist Tanya Luhrmann and her team interviewed people with schizophrenia in the US, Ghana, and India about their experience of hearing voices. While all heard voices, the kinds of voices they heard and how they related to these voices were quite different. In the US, people heard voices that were threatening, often telling them to do bad things, and reminding them that they had sick brains. Illness did not factor into either Ghananian or India self-understanding of their voices, which tended to be either religious or playful, respectively.
The ways that culture shapes how people experience mental illness is what philosopher Ian Hacking calls “looping effects.” Human categories, he argues, are not purely natural, Platonic kinds—there is no such thing as a human category that is not influence (looped back on) by systems of meanings. That is, the way people experience not only mental illness, but gender, race, class, is to a degree, shaped by cultural interpretations of what that category means. This is not to say that there is not a biological component to mental illness. But, as Luhrmann explains in the article,
“The work by anthropologists who work on psychiatric illness teaches us that these illnesses shift in small but important ways in different social worlds. Psychiatric scientists tend not to look at cultural variation. Someone should, because it’s important, and it can teach us something about psychiatric illness.”
But it is important to recognize that culture is not an essential feature of a given region, but rather a dynamic system meanings and practices that change over time, often in relation to political events. In The Protest Psychosis, cultural historian Jonathan Metzl has shown how schizophrenia in particular came to be understood as a “dangerous” disease in American society during the 1960s. Prior to this, people with schizophrenia were seen as harmless, and the prototypical image was of the young white artistic type who could add color to parlor conversation. But during the Civil Rights movement, the “angry black man” not only became a cultural trope, but a pathologized one. Black men could not always be arrested for demonstrations, but they could often be diagnosed as schizophrenic and locked away. The evidence of pathology? The angry protesting itself.
Whether it is schizophrenia, bipolar, anxiety, PTSD, cultural and historical research can help us to better understand not only mental illness, but how we as a society can make lives more livable for those who experience them not only through psychobio treatments, but through cultural work.