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The relatively frequent occurrence of rapid onset and very brief,
but often florid, psychotic states, with periodic recurrence,
alongside relatively low rates of PTSD and chronic psychosis, were
unexpected findings from the 2004 East Timor Mental Health Study,
conducted in the context of the country's recently won independence
and in the wake of the atrocities endured in the protracted fight
for sovereignty. Further unanticipated was the frequent association
of recurrence with the time of the new moon (fulan lotuk) and other
times or places of sacred (lulik) or associated cultural
significance. The perceived violation of culturally sacrosanct
lulik obligations often also appeared to foreshadow the initial
onset of such patterns of distress. Significant episodes of trauma
and loss appeared a hidden feature of affected individuals
histories, which we argue have become symbolically entwined with
local cultural understandings of ritual obligation, sacredness, and
taboo. This volume develops a dynamic but contextualized
multi-level formulation of psychosis and psychotic-symptoms, able
to incorporate a range of factors from the biological, through the
sociocultural, to the political. The work is truly
interdisciplinary drawing on both the quantitative and qualitative
findings of our own study but further supported through local
ethnography and broader anthropological enquiry into the outcomes
of psychosis in non-Western settings; psychoanalysis and
psychoanalytic anthropology; evidence and theory exploring links
between trauma, dissociation and psychosis; and novel
culturally-adaptable psychosocial focused interventions for
psychosis. We situate both evidence and theorising in wider
epistemological and political context, including in relation to the
movement for Global Mental Health. Culturally patterned
presentations of brief remitting-relapsing psychosis are ultimately
conceived as the trade-off between competing fragmentary and
synthetic forces: the former in part secondary to the lasting and
deleterious effects of overwhelming loss, trauma and adversity; the
latter emboldened by cultural meaning and social response in the
context of broad ecological pressures demanding survival and
resilience.
The relatively frequent occurrence of rapid onset and very brief,
but often florid, psychotic states, with periodic recurrence,
alongside relatively low rates of PTSD and chronic psychosis, were
unexpected findings from the 2004 East Timor Mental Health Study,
conducted in the context of the country's recently won independence
and in the wake of the atrocities endured in the protracted fight
for sovereignty. Further unanticipated was the frequent association
of recurrence with the time of the new moon (fulan lotuk) and other
times or places of sacred (lulik) or associated cultural
significance. The perceived violation of culturally sacrosanct
lulik obligations often also appeared to foreshadow the initial
onset of such patterns of distress. Significant episodes of trauma
and loss appeared a hidden feature of affected individuals
histories, which we argue have become symbolically entwined with
local cultural understandings of ritual obligation, sacredness, and
taboo. This volume develops a dynamic but contextualized
multi-level formulation of psychosis and psychotic-symptoms, able
to incorporate a range of factors from the biological, through the
sociocultural, to the political. The work is truly
interdisciplinary drawing on both the quantitative and qualitative
findings of our own study but further supported through local
ethnography and broader anthropological enquiry into the outcomes
of psychosis in non-Western settings; psychoanalysis and
psychoanalytic anthropology; evidence and theory exploring links
between trauma, dissociation and psychosis; and novel
culturally-adaptable psychosocial focused interventions for
psychosis. We situate both evidence and theorising in wider
epistemological and political context, including in relation to the
movement for Global Mental Health. Culturally patterned
presentations of brief remitting-relapsing psychosis are ultimately
conceived as the trade-off between competing fragmentary and
synthetic forces: the former in part secondary to the lasting and
deleterious effects of overwhelming loss, trauma and adversity; the
latter emboldened by cultural meaning and social response in the
context of broad ecological pressures demanding survival and
resilience.
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