Our Most Troubling Madness

Case Studies in Schizophrenia Across Cultures

Schizophrenia has long puzzled researchers in the fields of psychiatric medicine and anthropology.  Why is it that the rates of developing schizophrenia—long the poster child for the biomedical model of psychiatric illness—are low in some countries and higher in others? And why do migrants to Western countries find that they are at higher risk for this disease after they arrive? T. M. Luhrmann and Jocelyn Marrow argue that the root causes of schizophrenia are not only biological, but also sociocultural.

Case studies of ten lives, plus others from Ghana, Romania, and Thailand, provide intimate accounts of the social and cultural contexts in which persons with psychotic disorders live. They give depth to earlier, replicated findings of the World Health Organization that the course and outcomes for schizophrenia are different across the world, with some of the best results coming from India.

With a commitment to engaged anthropology, Our Most Troubling Madness examines the lives of those with psychotic disorders to suggest how we might redeem U.S. mental health services that do harm while they do good. Most importantly, we argue that creating a society in which those with psychosis may flourish involves altering our approach to psychosis. Downplaying the importance of diagnosis, respecting the experience of psychosis, allowing individuals to engage with voices, and focusing on interpersonal behavior in social settings, are tasks we may undertake to make our own culture more benign for those with psychosis.