Worlds of Psychotic People: Wanderers, Bricoleurs and Strategists (Theory and Practice in Medical Anthropology)

277 Pages·2004·1.26 MB·English

by  Els van Dongen

Worlds of Psychotic People
Is there any truth in the old idea that psychotic people have access to a world of
meaning which remains locked to others?
Worlds of Psychotic People brings a fresh twenty-first century voice to the
lives of those with serious psychological disorders, focusing on the way in which
psychiatric patients experience their subjective worlds. Based on ethnographic
research gathered at the psychiatric hospital of Saint Anthony’s in the
Netherlands over a period of five years, it seeks to describe from the perspective
of the mental patient some of the fears and hopes that mark an individual’s
encounter with the reality of a clinical mental ward.
Balancing details from patient interviews and observation with the author’s
theoretical insights into clinical psychiatric practice, Worlds of Psychotic People
considers such dilemmas as: how do psychotics struggle to express subjectivity
in an atmosphere designed to restrain demonstrative emotion? How do they
maintain personal integrity within a completely ordered regime? How do the
distinctive symptoms displayed by many psychotic and schizophrenic patients—
including disordered speech, the experiencing of words as physical sensations,
and fear of touch—interact with the demands of standard therapeutic procedure?
Introducing the concept of the psychotic patient as a wanderer through culture,
creating a ‘bricolage’ reality from materials at hand, Els van Dongen aims to
open up the often secretive exchanges that take place between therapists and
patients, and to seek new meanings and interpretations from these for use within
the therapeutic endeavour.
Els van Dongen is a highly respected authority on psychiatric illness and
treatment. A senior staff member at the Medical Anthropology unit of the
University of Amsterdam, she is co-editor of the book Health for All, All in
Health: European Experiences on Health Care for Migrants (2000), the author
of many books and articles about mental illness and editor of the journal
Medische Antropologie.
Theory and Practice in Medical Anthropology and
International Health
A series edited by Susan M.DiGiacomo, University of Massachusetts, Amherst
Editorial Board
H.Kris Heggenhougen
Harvard University, Cambridge, Massachusetts
Daniel E.Moerman
University of Michigan, Dearborn
R.Brooke Thomas
University of Massachusetts, Amherst
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Gordon, Xòchitl Herrera, Judith Justice, Montasser Kamal, Charles Leslie,
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Worlds of Psychotic People: Wanderers, ‘Bricoleurs’ and Strategists
Els van Dongen
Worlds of Psychotic People
Wanderers, ‘Bricoleurs’ and
Strategists
Els van Dongen
LONDON AND NEW YORK
First published 1994 by Rozenberg Publishers
Rozengracht 176A, 1016 NK Amsterdam
First published in English 2004 by Routledge
11 New Fetter Lane, London EC4P 4EE
Simultaneously published in the USA and Canada
by Routledge
29 West 35th Street, New York, NY 10001
Routledge is an imprint of the Taylor & Francis Group
This edition published in the Taylor & Francis e-Library, 2005.
“To purchase your own copy of this or any of Taylor & Francis or Routledge’s collection
of thousands of eBooks please go to www.eBookstore.tandf.co.uk.”
© 2004 Els van Dongen
All rights reserved. No part of this book may be reprinted or
reproduced or utilised in any form or by any electronic,
mechanical, or other means, now known or hereafter invented,
including photocopying and recording, or in any information
storage or retrieval system, without permission in writing from
the publishers.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the
British Library
Library of Congress Cataloging in Publication Data
Dongen, Els van.
Worlds of psychotic people: wanderers, ‘bricoleurs’ and
strategists/Els van Dongen.
p. cm.
Includes bibliographical references and index.
I. Psychiatric hospital patients—Netherlands—Case studies.
I. Title.
RC450.N4D66 2004
362.2′1′09492–dc21 2002068147
ISBN 0-203-50625-1 Master e-book ISBN
ISBN 0-203-34570-3 (Adobe eReader Format)
ISBN 0-415-30390-7 (Print Edition)
Contents
Acknowledgements viii
1 Introduction 1
Defining the problem 4
Research at Saint Anthony’s 6
Structure of the book 11
2 The quest for reality and the work with culture: when 12
psychiatrists and anthropologists explore psychosis
Therapeutic approaches of reality and interaction with psychotic 12
patients
The work of culture and the work with culture 20
3 Shaping the context of the speech events: models of therapists 29
and patients
How psychosis is explained 29
How patients experience hospital admission 34
The battle for reality 39
4 Hope and hopelessness, healthy and sick parts 47
Short-term residence and the story of hope 48
Long-term residence and the story of hopelessness 62
5 Hiding in talk 73
Topics that are out of bounds 74
How patients and therapists set about their conversations 76
‘Will you try again to get me out of here?’ 85
Silence and vocalization 98
6 Revealing in talk 1 13
vii
Roles and disruptions 1 16
Making out-of-bounds topics discussable 1 30
Reality transformations and reality constructions 1 38
7 Living in two worlds 1 49
Conversations with Vincent 1 50
‘I am different’ 1 52
Vincent in ‘cosmos life’ 1 58
‘Isn’t life too costly to get by without begging?’ 1 61
Reality has two faces 1 67
8 The precarious world of psychotic people 1 73
Emperor Ming and the enemy 1 74
‘I watch people passing by’ 1 86
9 Life and death 1 98
‘You just see yourself dying, shriveling up’ 2 00
‘I’m being murdered: I have to die!’ 2 05
The world within the body 2 07
The world and the body 2 10
The body in the world 2 14
10 Conclusion: psychotic discourse revisited 2 19
In retrospect 2 19
Inconsistencies and dilemmas in the therapeutic relation 2 24
Psychosis, psychiatry and culture 2 30
Notes 2 34
References 2 46
Index 2 59
Acknowledgements
Many intense experiences crowded the years that it took me to cover the subject
matter of my book. It brought me into contact with people who displayed
remarkable patience and persistent humor in dealing with a multitude of
difficulties, and yet persevered to communicate with each other in most
impressive ways.
Writing a book is seldom a solitary task. In this instance it reflects not only a
synthesis of countless discussions held with individuals and groups from within
and outside the subject area, but also the highly personalized accounts lived and
retold by the individuals whose conversations constitute the core of this book. I
want to thank all the assistants and patients whose substantial and concrete
contributions I must humbly acknowledge. The warmth with which they received
me as an outsider, the patience I was shown and their constructive criticism
played a major role in the success of the research. For obvious reasons, I cannot
name them.
I wish to express my sincere thanks to all my colleagues who offered
suggestions and critiques during my fieldwork and writing, especially Arie de
Ruijter and Beke Harms. The Netherlands Scientific Organization (NWO) must
be mentioned. They financially supported the research and the translation of my
work. Oswald Gibson, my editor, supported me and made my writings
‘readable’; thank you, Ossie. I also thank Julene Knox, the editor at Routledge,
for her support and understanding, and Susan DiGiacomo, the editor of the series
for her patience and valuable comments.
When rewriting the book, I was tempted to eliminate references to some
theoretical approaches that now seem outdated. However, on reflection I decided
to retain them because they constitute the background—or, in anthropological
terms, the context—of my work and that of therapists at the time of my
fieldwork.
I would not have been able to complete this book without the enormous
support from my family, and I dedicate it to them.
Els van Dongen
Chapter 1
Introduction
Fifty years ago the youngsters in our street played a somewhat dubious but
exciting game. In a large house on the corner a crazy woman lived alone. She
obviously preferred to keep to herself, she looked strange and she mumbled
words that we did not understand—all of which terrified and enthralled us. Our
constant taunting was meant to entice her from her house, and not even the
intervention of parents had the power to stop us. The climax of the game was
reached when she came out to protest at our constant pestering. Marbles and
balls were abandoned on the sidewalk as we scattered behind trees in the gardens
and listened to her with pounding hearts. Her angry words have faded into memory,
but they never failed to enchant. We had come under the spell of the lunacy that
dwelt on the corner of the block.
I remembered this children’s game some years ago when the psychotic
patients of Saint Anthony’s, a psychiatric hospital in the Netherlands, played a
similar game with me. They would challenge and tease me, and the climax was
reached when I became ‘furious’ and said things that excited them, as they
laughed and scattered to their rooms.
Curiosity about the world of insanity transcends all boundaries: for centuries
philosophers, historians, psychotics, psychiatrists, anthropologists and
psychologists have discussed and described it. Speculation about the realm of
psychosis takes diverse forms, and a recurrent idea is that if only we could come
to know it, we would gain an understanding of the basic and recondite processes
of the human mind. Sometimes there is a spontaneous assumption that psychotic
cognition and discourse possess a wealth of significance that far outstrips
ordinary thought and speech. Psychotic people are thought to have access to a
world of meaning that remains locked to others, even though this approach to the
psychotic world order frequently amounts to no more than ‘the old Platonic theme
of inspired delirium’ (Foucault 1966:71). Mental aberration continues to
fascinate, but there is a corresponding interest that has its origin in society’s
desire to control psychotics and obviate the dangers that they represent. From
this perspective, psychosis has also been described and analyzed in many ways.
Conventional wisdom holds that the more we know about psychosis, the better we
can control and reduce its visible risings. The dual message of concern and
interest emphasizes the ambiguous nature of society’s response to people who