Abstract
In this chapter, in line with interdisciplinary theorising in relation to other dissociative-presentations, we invoke narrative as the central “device” able to weave together trauma-related fragmented psychotic-experience, enabling greater toleration of associated painful affect. Conversely where narrative falters or the gap between lived and culturally narrated or prescribed experience becomes too great, dissociation–psychosis may ensue. Within this model we are able to build in dynamic and structural factors relating to the situation in Timor-Leste. Obversely from the perspective of self, a fragmented psyche is a mind in search of form, which we link to the notable cultural pathoplasticity of dissociative states. Cultural symbols in Timor-Leste are not secularised, and the linking of psychotic-symptoms to unseen spiritual or cosmological dramas, both reflects and communicates internal experience, in a containing manner. In this way psychotic symptoms are taken as meaningful by the community, although they may be simultaneously or strategically understood as a response to trauma, loss and adversity, alongside such extramundane attributions. Ethnography further suggests East Timorese culture to preference performance over exegesis, and in so far as psychotic symptoms are taken as meaningful, culture in turn provides a performative-template for fragmented self-experience to be moulded by. As such psychotic-symptoms may be more organised than at initially apparent. The ability of the community to hold and elaborate meaning of psychotic-symptoms, is also argued to provide a holding-frame for mental and social reintegration, after periods of acute distress and fragmentation, for the afflicted individual. Indeed, in so far that psychotic-symptoms may index unseen traditional cultural realities, now threatened by forces of acculturation, but validated by the community, a further potent organising influence is found.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
Involving “excision of the labia and clitoris followed by almost complete infibulation: intentional occlusion of the vulva entailing obliteration of the vaginal meatus” (Boddy 1988, 5).
- 2.
Boddy (1988) makes clear the woman’s solution can only work if the possessing other remains Other. There can be no utility in framing the possessing spirit as a projection of disowned self-experience, for this would contravene the idealised pure-feminine self that is preserved through possession, and would also be felt as an attack on kin-relations, through which the self is reciprocally interlinked (see also Sect. 5.2.1). The aim therefore is not psychic-integration, as espoused by Western therapists, although there can be ongoing communication and exchange with the possessing entity (see also Sect. 5.1.2).
- 3.
The neuroscientist Antonio Damasio, observed “that individuals whose affective capacities were impaired also experienced cognitive impairment…rationality cannot be properly distinguished from emotions” (West 2007, 92).
- 4.
Ignoring, for now, theories of psychogenic contribution to physical disease causation, and while accepting the links between physical disease and socioeconomic status.
- 5.
- 6.
This was not necessarily, as Leff (1988) suggests in his analysis of some traditional cultures, because of a limited emotional lexicon. Tetum provided for a complex emotional range of expression, with meaning often created through the compounding of body-part words with adjoined adjectives (Avram 2008—e.g. laran kanik = inside broken = broken heart). As one native speaker put it to linguist Taylor-Leech (2008, 166) “I love Tetum-Terik. I am discovering more and more every day of its intricacies.” Clearly however language evolves in accordance with the needs of the people using it and East Timorese ritually governed, sociocentric selves (see Sect. 1.7.2, Footnote 32) likely have less need for making subtle differentiations in internal mental states, where preferred emphasis is on relationships and meaning. Nonetheless Indonesian or Portuguese loan words could be used where necessary, particularly for technical translations of Western psychiatric terminology (such as for depression and specific psychotic symptomatology) although some may have resisted the use of loan words, especially Indonesian ones, on account of its imperialistic connotative significance (Taylor-Leech 2008).
- 7.
While individuals in the West may be subject to the wider forces of social exclusion, acute gestures of self-harm are still recognised and responded to by the community and public service providers.
- 8.
Such cultural templates are part of a small repertoire of cultural resources available to the individual experiencing states of extreme mental fragmentation, functioning as an opposing “organising” influence, even if from the perspective of the observer, this is not at first apparent.
- 9.
According to an earlier focus group the East Timorese community acknowledged there might be occasional instances in which people simulate bulak with various motives (Graves 2003, 18) and indeed one participant had pertinently contented that some “people pretended to be crazy because they are drunk”. At one level this in fact supports our concept of bulak as a culturally category to “act into” (cf. Pearce 2007; see Sect. 1.7.1). It also highlights there is likely to be a spectrum of presentations according to greater or lesser degrees of actual or apparent agency, which itself may be more or less consciously accessible.
- 10.
A similar performance analysis has been made for dissociative experiences in Western medical settings, as manifest in the medical dramas involving patients with conversation symptoms taking centre stage and weaving a complex plot between patient, doctor and family, even if the “actors” are not always consciously party to the dramatic ironies, “uncovered” by later historical and cultural commentators (Ellenberger 1981; Littlewood and Lipsedge 1987).
- 11.
Here we might again invoke Segal’s idea of “symbolic equation” (see Sect. 3.1.2), as in such instances, there is clearly a conflation between representation and reality.
- 12.
Another reading of Adriano’s (Sect. 1.4.2—Case BP1) assertion that he “had been witness to the murder of family and/or friends”—later retracted and denied by his family—might be at the allegorical level (but experienced as concrete and real—Sects. 3.1.2 and 4.2.1) standing for his sense of wounding of Timor as a whole, although of course other explanations such as the sealing over of dissociated memory and the downplaying of trauma by his family need to be seriously considered (see Sect. 2.3.4).
- 13.
A neo-Marxist perspective, would of course suggest such developments to be far from incidental (even if not consciously conspiratorial) but rather part of the wider logic of late capitalist, neo-colonialism.
- 14.
Indeed an earlier scoping study using community focus groups and surveys had surprisingly identified “problems with the brain” as the most frequently cited explanation for mental illness—this was contrary to our experience in the field in which this was only rarely described as an explanation (an understandable exception being the elderly lady with apparent dementia secondary to head-injury: Sects. 1.4.3 and 2.3.4—Table 2.1—Case CP4). While certainly of value, the study was linked to the setting up of the new East Timor Mental Health Service, partly funded by overseas aid, with leadership by Western mental health professionals. This scoping study was also participated in with an expectation of “psychoeducation” and as such these findings almost certainly partly reflected “demand characteristics” of the study (cf. Kagee 2004; see Sect. 1.6).
References
Adams, T. 1996. Kitwood’s Approach to Dementia and Dementia Care: A Critical but Appreciative Review. Journal of Advanced Nursing 23(5): 948–953. doi:10.1046/j.1365-2648.1996.10613.x.
Aditjondro, George J. 2000. Ninjas, Nanggalas, monuments and Mossad manuals: An anthropology of Indonesian state terror in East Timor. In Death squad: The anthropology of state terror, ed. Jeffrey A. Sluka, 158–88. University of Pennsylvania Press.
Are Psychotic Roles Hazardous to an Actor’s Health? | PopEater.com. 2011. PopEater. Accessed Dec 13, 2014. http://www.popeater.com/2010/12/31/disturbing-movie-roles-health-effects/.
Avram, Andrei A. 2008. An overview of reduplication and compounding in Tetun Dili. Revue Roumaine de Linguistique 53(4): 427–448.
Boddy, J. 1988. Spirits and selves in Northern Sudan: The cultural therapeutics of possession and trance. American Ethnologist 15(1): 4–27.
Boddy, J. 1994. Spirit possession revisited: Beyond instrumentality. Annual Review of Anthropology 23: 407–434.
Boscarino, J.A. 1995. Post-traumatic stress and associated disorders among Vietnam veterans: The significance of combat exposure and social support. Journal of Traumatic Stress 8(2): 317–336.
Burnham, John, and Queenie Harris. 1995. Emerging ethnicity—a tale of three cultures. In Meeting the needs of ethnic minority children: Including refugee, black and mixed parentage children: A hanbook for professionals, 2nd rd., eds. Kedar Nath Dwivedi and Ved P. Varma. London: Jessica Kingsley Publishers.
Dallos, Rudi, and Arlene, Vetere. 2009. Systemic therapy and attachment narratives. UK: Taylor & Francis.
Dawkins, Richard. 1989. The selfish gene. Oxford: Oxford University Press.
Deeley, Peter Q. 2003. Social, cognitive, and neural constraints on subjectivity and agency: Implications for dissociative identity disorder. Philosophy, Psychiatry, and Psychology 10(2): 161–167. doi:10.1353/ppp.2003.0095.
de Jong, Joop T., and Ria Reis. 2010. Kiyang-Yang, a West-African postwar idiom of distress. Culture, Medicine and Psychiatry 34(2): 301–321. doi:10.1007/s11013-010-9178-7.
Durand, F. 2009. Recurring crises in Timor-Leste failed state or country in search of a project? Lusotopie 16(2): 65–81.
Ellenberger, Henri F. 1981. The discovery of the unconscious: The history and evolution of dynamic psychiatry. Basic Books.
Gleaves, D.H. 1996. The sociocognitive model of dissociative identity disorder: A reexamination of the evidence. Psychological Bulletin 120: 42–59.
Gone, Joseph P. 2013. Redressing first nations historical Trauma: Theorizing mechanisms for indigenous culture as mental health treatment. Transcultural Psychiatry 50(5): 683–706. doi:10.1177/1363461513487669.
Graves, Jenni. 2003. Knowledge, attitudes and responses to mental illness. Democratic Republic of East Timor: East Timor national mental health project, Ministry of Health.
Guinness, E A. 1992. Relationship between the neuroses and brief reactive psychosis: Descriptive case studies in Africa. The British Journal of Psychiatry. Supplement 16: 12–23.
Handelman, Don. 1968. Shamanizing on an empty stomach. American Anthropologist 70(2): 353–356. New Series.
Hicks, David. 1984. A maternal religion: The role of women in Tetum Myth and Ritual. Monograph Series of Southeast Asia. Northern Illinois University, Center for Southeast Asian Studies.
Hicks, D. 2004. Tetum ghosts and kin: Fertility and gender in East Timor. 2nd edn. USA: Waveland Pr Inc.
Hollan, Douglas. 2000. Culture and dissociation in Toraja. Transcultural Psychiatry 37(4): 545–559. doi:10.1177/136346150003700404.
Holmes, Jeremy. 1999. Defensive and creative uses of narrative in psychotherapy: An attachment perspective. In Healing stories: Narrative in psychiatry and psychotherapy, eds. Glenn Roberts, and Jeremy Holmes, 49–68. Oxford, UK: Oxford University Press.
Hopper, Kim. 1991. Some old questions for the new cross-cultural psychiatry. Medical Anthropology Quarterly 5(4): 299–330. New Series.
Igwe, Ezinne, and Ikechukwu Erojikwe. 2014. Beyond the stage-psychosis and transport in selected performances. Global Journal of Arts Humanities and Social Sciences 2(9): 79–90.
Jackson, Murray, and Paul, Williams. 1994. Unimaginable storms: A Search for meaning in psychosis. London: Karnac Books.
Jones, Elsa. 1993. Family Systems Therapy: Developments in the Milan-Systemic Therapies. Wiley-Blackwell.
Kirmayer, Laurence J. 1994. Pacing the void: Social and cultural dimensions of dissociation. In Dissociation: Culture, mind, and body, ed. David Spiegel, 91–122.
Kirmayer, L.J. 1996. Confusion of the senses: Implications of ethnocultural variations in somatoform and dissociative disorders for PTSD. In Ethnocultural aspects of posttraumatic stress disorder: Issues, research, and clinical applications, eds. Anthony J. Marsella, Matthew J. Friedman, Ellen T. Gerrity, and Raymond M. Scurfield, 131–163. Washington, DC: American Psychological Association.
Kitwood, Tom, and Kathleen Bredin. 1992. Towards a theory of dementia care: Personhood and well-being. Ageing and Society 12(03): 269. doi:10.1017/S0144686X0000502X.
Kohen, Arnold S. 2001. The Catholic Church and the Independence of East Timor. In Bitter flowers, sweet flowers: East Timor, Indonesia, and the world community, eds. Richard Tanter, Mark Selden, and Stephen Rosskamm Shalom, 43–51. Lanham, Maryland: Rowman & Littlefield.
Leff, Julian. 1988. Psychiatry around the globe: A transcultural view. London: Gaskell.
Linington, Mark. 2010. In bits: Hearing the fragmented narratives of people who experience psychosis. In Telling stories? Attachment based approach to the treatment of psychosis, ed. Sarah Benamer, 113–124. London: Karnac Books.
Liotti, Giovanni, and Andrew, Gumley. 2008. An attachment perspective on schizophrenia: The role of disorganized attachment, dissociation and mentalization. In Psychosis, trauma and dissociation: Emerging perspectives on severe psychopathology, eds. Andrew Moskowitz, Ingo Schäfer, and Martin Justin Dorahy, 3769–4287. Chichester, West Sussex, UK: Wiley (Kindle file).
Littlewood, Roland. 1990. How universal is something we can call “Therapy”? Some implications of non-western healing systems for intercultural work. Journal of Interprofessional Care 5(2): 49–65. doi:10.3109/13561829009043447.
Littlewood, R. 2002. Pathologies of the west: An anthropology of mental illness in Europe and America. NY: Continuum International Publishing Group.
Littlewood, R. 2006. Pathology and identity: The work of mother earth in Trinidad. Cambridge: Cambridge University Press.
Littlewood, Roland, and Simon Dein. 2013. Did Christianity lead to schizophrenia? Psychosis, psychology and self reference. Transcultural Psychiatry 50(3): 397–420. doi:10.1177/1363461513489681.
Littlewood, Roland, and Maurice Lipsedge. 1987. The butterfly and the serpent: Culture, psychopathology and biomedicine. Culture, Medicine and Psychiatry 11(3): 289–335.
Lucas, Rod. 2004. In and out of culture: Ethnographic means to interpreting schizophrenia. In Schizophrenia, culture, and subjectivity: The edge of experience, eds. Janis Hunter Jenkins and Robert J. Barrett, 146–163. Cambridge, UK: Cambridge University Press.
Moskowitz, Andrew. 2008. Association and dissociation in the historical concept of schizophrenia. In Psychosis, trauma and dissociation: Emerging perspectives on severe psychopathology, eds. Andrew Moskowitz, Ingo Schäfer, and Martin Justin Dorahy, 1475–1903. Chichester, West Sussex, UK: Wiley-Blackwell (Kindle file).
Obeyesekere, G. 1984. Medusa’s hair: An essay on personal symbols and religious experience. Chicago, London: University of Chicago Press (Kindle file).
Obeyesekere, Gananath. 1990. The work of culture: Symbolic transformation in psychoanalysis and anthropology. Chicago: University of Chicago Press.
Pearce, W. Barnett. 1994. Interpersonal communication: Making social worlds. New York, NY: Harper-Collins.
Pearce, W.B. 2005. The coordinated management of meaning (CMM). In Theorizing about intercultural communication, ed. William Gudykunst, 35–54. Thousand Oaks, CA: Sage.
Pearce, W.B. 2007. Making social worlds: A communication perspective. Oxford, UK: Blackwell.
Pestalozzi, Julia. 2003. The symbolic and concrete: Psychotic adolescents in psychoanalytic psychotherapy. The International Journal of Psychoanalysis 84(3): 733–753. doi:10.1516/G6AC-WEHN-EBWM-5VD9.
Pierre, Bourdieu. 1992. The logic of practice (trans: Richard Nice). Stanford, California: Stanford University Press.
Sabat, Steven R. 2006. Mind, meaning, and personhood in dementia: The effects of positioning. In Dementia: Mind, meaning, and the person, eds. Julian C. Hughes, Stephen J. Louw, and Steven R. Sabat. Oxford: Oxford University Press.
Scambary, James, Hippolito Da, Gama, and Joao, Barreto. 2006. A survey of gangs and youth groups in Dili, Timor-Leste. AusAID. http://researchbank.swinburne.edu.au/vital/access/manager/Repository/swin:15937.
Seligman, Rebecca. 2005. Distress, dissociation, and embodied experience: Reconsidering the pathways to mediumship and mental health. Ethos 33(1): 71–99.
Seligman, Rebecca, and Laurence J. Kirmayer. 2008. Dissociative experience and cultural neuroscience: Narrative, metaphor and mechanism. Culture, Medicine and Psychiatry 32(1): 31–64.
Silove, Derrick, and Zachary Steel. 2006. Understanding Community psychosocial needs after disasters: Implications for mental health services. Journal of Postgraduate Medicine 52(2): 121.
Silverman, Julian. 1967. Shamans and Acute Schizophrenia. American Anthropologist 69(1): 21–31. doi:10.1525/aa.1967.69.1.02a00030.
Sontag, Susan. 1988. Illness as metaphor and AIDS and its metaphors. NY: Farrar, Straus & Giroux.
Taylor-Leech, Kerry. 2008. Language and identity in East Timor: The discourses of nation building. Language Problems and Language Planning 32(2): 153–180. doi:10.1075/lplp.32.1.04tay.
Thompson, Jennifer Jo, Cheryl Ritenbaugh, and Mark Nichter. 2009. Reconsidering the placebo response from a broad anthropological perspective. Culture, Medicine and Psychiatry 33(1): 112–152. doi:10.1007/s11013-008-9122-2.
Toome, Emily. 2012. “Filling Wounds with Salt”: The pathologisation of trauma in Timor-Leste. In Local-Global, traversing customary community and modern nation-formation in Timor-Leste, ed. Damian Grenfell, vol. 11, 24–30.
Traube, Elizabeth G. 1986. Cosmology and social life: Ritual exchange among the Mambai of East Timor. Chicago: University of Chicago Press.
Traube, E.G. 2007. Unpaid wages: Local narratives and the imagination of the nation. The Asia Pacific Journal of Anthropology 8(1): 9–25. doi:10.1080/14442210601161724
Ugarte, Eduardo. 1992. Running amok: The “demoniacal impulse”. Asian Studies Review 16(1): 182–189.
Watzlawick, Paul, Janet Beavin Bavelas, and Don D. Jackson. 2011. Pragmatics of human communication: A study of interactional patterns. USA: W. W. Norton & Company Pathologies and Paradoxes.
West, Marcus. 2007. Feeling, being, and the sense of self: A new perspective on identity, affect, and narcissistic disorders. UK: Karnac Books.
Wilce, James M. Jr. 2004. To “speak Beautifully” in Bangladesh: Subjectivity as Pāgalāmi’. In Schizophrenia, culture, and subjectivity: The edge of experience, eds. Janis Hunter Jenkins and Robert J. Barrett, 196–218. Cambridge, UK: Cambridge University Press.
Wilson, David Sloan, and Edward O. Wilson. 2008. Evolution “for the Good of the Group”: The process known as group selection was once accepted unthinkingly, then was widely discredited; It’s time for a more discriminating assessment. American Scientist, 380–389.
Worsley, Peter. 1987. Trumpet shall sound: A study of ‘Cargo’ cults in Melanesia, 2nd ed. New York: Schocken.
Xiao, Zeping, Heqin Yan, Zhen Wang, M.D. Xu, Zheng Zou, M.D. Chen, M.D. Zhang, Colin A. Ross, and Benjamin B. Keyes. 2006. Trauma and dissociation in China. American Journal of Psychiatry 163(8): 1388–1391. doi:10.1176/appi.ajp.163.8.1388.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Rodger, J., Steel, Z. (2016). Narrative Dimensions of Dissociative-Psychosis. In: Between Trauma and the Sacred. Cultural Studies of Science and Medicine . Springer, Cham. https://doi.org/10.1007/978-3-319-24424-2_4
Download citation
DOI: https://doi.org/10.1007/978-3-319-24424-2_4
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-24422-8
Online ISBN: 978-3-319-24424-2
eBook Packages: Social SciencesSocial Sciences (R0)