Professional Documents
Culture Documents
R. Brooke Thomas
U.iv .... iry of M..SlICbn ...... Ambo.." On Psychiatric Observation
IntematiolUll Aclvillory Board and Anthropological Understanding
Gt!org< Annt'i4KQs. Ham Bot:r. r~r~ Brown. Xocitill (AJltPt<da. D~h(JrDh
Go"'on. ,'(o<hillllcTT<I"a. Jurillh Jr.lJlla. Mo~rfJ1J'" Kamal
o aria L<Jllc, ShIT/<)' U"ricn/xJum . Marg<P'<r Loclt. s<rha Lo.,.
Mark Niehrer. DrmCdn Pcricrs,". n,omas Ou. Nancy S<hcpcr.Hughu, Merrill Singer
Founding Editor
Ubbef Crandon-Malamud'
Volume 2
Forbidden Narratives: Translated by
Critical Autobiography as Sodal Science Susan M. DiGiacomo and John Bates
K8thryn Church
Volume 3
AnQhropology and Intemational Health: Foreword by Arthur M. Kleinman
AaLan Ca&e Studlcl$
Mark Nichter and Mimi Nichter
Volume 4
The Anthropology of Infectious DiseaGo:
International Hoallh PerupoctiveG
Edited by Mama C. Inhom and Pater J. Brown
el Routledge
Scc the b:llc!< of lhi.s book roC' Qiher hd~ in ThC()ty IlntJ Pr;:u:lict' in Medic:.1 Anthropology .md Intern;,· ! \. Tay!o< 6. F..<IIIdI (; ro"P
Ii"",,! Health. LONDON AND NEW YORK
Copyright © 2000 OPA (Overseas Publishers Association) N.V. Pub-
lished by license under the Routledge
Martinez-Hernaez, Angel
What's behind the symptom? ; on psychiatric observation and
anthropological understanding. - (Theory and practice in
medica! anthropology and international health; v. 6 -
JSSN 1068-3291)
1.Symptomatology 2.Medical anthropology 3.Psychiatry
l.Title
616' .047
ISBN 90-5702-6]2-0
CONTENTS
1 What is behind the symptom'? ....... .... ..... ........ ... ........................ ........ . 1
PART ONE: ON PSYCHIATRIC OBSERVATION ...
2 The dream of a biomedical psychiatry .. ...... ............. .... ... ....... .. ........ 21
3 Kraepelin versus Freud: A retrospective .. ...... ........... ....... .. .............. 39
4 Neo-Kraepelinism: Nosologies .. .. ...................... .. ........ .. .. ... .... ... ...... 65
5 Neo-Kraepelinism: Epidemiologies ....... .......................... ............ .... 89
6 The limits of psychiatric observation ........ ... ........ ....... ................... 113
Epi logue: Open work ... ...... ..... ... .............. ....... ........ .. .... ... ......... .. ... ......... 245
References .......... ... ........ ........................ ... .............. ..... ....... .. ... ..... .......... 251
Index ................... .. ... ....... ....... .... ... ..... ................... ... ..... ... .... ................. . 273
INTRODUCTION TO THE SERIES
If health is silence, then this book is about speech, the meaning of complaint,
the voice of illness. It is also about the clinical gaze, that peculiar form of
scrutiny which lays down the conditions for medical and psychiatric
knowledge.
In the context of Western science, the symptom has been an undisputed
redoubt of biomedicine. Although medical and psychiatric manuals have
differentiated between signs as observed by the professional and symptoms
as expressed by the sufferer, symptoms have generally been regarded as
physical manifestations, natural realities that acquire meaning only through
medical interpretation. The voice of the sufferer is thus silenced. Deprived
of legitimacy, the sufferer's words are associated with crror and ignorance.
However, in recent years, this traditional perception of symptoms has
been challenged. For at least the past two decades, such specialities as medical
and psychiatric anthropology have advanced into new ethnographic territories:
symptoms, illnCl'S, the body and suffering. Kluckhohn's characterization of
anthropology as an intellectual poaching license, taken up by Clifford Geertz
in "'Blurred Genres" (1983, p.21), has become unexpectedly relevant in the
terrain of illness and its forms of expression. As a result, anthropology has
been able to mobilize its well-known sensitivity to lay and local discourses
against the naturalism of totalizing biomedical interpretations. 'This book is
another move in this game of confrontations and poaching activities.
Followiogchapter 1, the book isdivided ioto two parts addressing different
ways of viewing symptoms: as organic manifestations and as symbolic
constructions.
In the fIrSt part, I develop a critique of the perception of symptoms as
simple pathophysiological phenomena, focusing in particular on the
hegemonic paradigm of contemporary psychiatry: neo-Kraepelinism. The
aim of this section is, then, not to review various psychiatric trends and their
ways of conceptualizing symptoms, but to examine in depth onc particular
1
.xii PTr!face Preface xiii
trend and one particular conceptualization. This does nol prevent me. however.
I Taylor (UNAM-Mexico), Joan Prac, Juanjo Pujadasand Oriol Romanf(Rovira
from malcing a brief foray into classical psychoanalysis as a counterpoint to i Virgili University) and Thllio Seppilli (Univer~ity of Perugia)-read and
Kraepelinism. Nor does it mean that my critique is limited to psychiatry; commented on part or the whole of the manuscript. They too deserve my
much or it is also applicable to biomedicine in general . thanks.
fn the second pan. I approach symptoms as symbolic and cultural forms Susan DiGiacomo's invaluable help is worthy of special mention. She is
of expression. Here also my elTons are reslricted to one parlicular theoretical not only responsible for the English translation of this book, togelher with
doma in; !hat of an interpretive or hermeneutic psychiatric anthropology. I John Bates, but is also a valiant scholar who knows how to speak the tru!h to
support this approach wi!h my own ethnographic data as well as an incursion academic power and reveal its mystifications.
into the field of semiotics. I would also like to thank my colleagues from the Departments of
My purpose here is to envision symptoms as an open process. a Anthropology of the University of Barcelona and of the Rovira i Virgili
communicative act. the result of a creali ve interplay of values and discourses. University for their support. I am grateful to the Departmenl of Anthropology
everyday experience, local knowledge and forms of oppression . It is an of the University of California at Berkeley for welcoming me as a visiting
attempt LO return to symptoms !heir meaningful dimension, to rescue their scholar in 1996, when I rewrote several chapters of this book. I also
oft-denied semiotic and cultural nature. Nevertheless. alongSide this general acknowledge my gratitude to Nancy Scheper-Hughes for facilitating my stay
aim there arc other, more specific ones. [ hope to show that contemporary in the department, and particularly to Stanley Brandes for his salloir jaire as
psychiatry treats winks as twitches; that this approach places serious an advisor.
limitations on both clinical practice and epidemiology: that there is a less I should also mention the Department of Psychiatry of the University of
positivist and more efficient way of perceiving symptoms: that symptoms Barcelona and the Clinical Section of Barcelona-Department of
can also be ethnographic objectS: and that Bar!hes. Foucault and Peirce are Psychoanalysis (Uni1Jersity of Paris VIII), where I learned much of what I
mistaken in their approach to symptoms because they fail to take into account know about psychiatry and psychoanalysis.
the human sender of the message. r could point out several others, but I The mental health care facilities in Barcelona where I did the ethnographic
leave this task to the readers' critical judgment. fieldwork that is the source of the case examples used in Chapters 1, 10 and
Many people have helped to bring this book to completion either directly 11 should nOl go unmentioned: the Hospital Clinic of Barcelona. the InstaULO
or indire<:tly, academically and/or personally. First of all, I would like to Frenopatico, ARI and the Cencer for Psychosocial Rehabil itaLion for chronic
thank the twO people who were my supervisors when. in November 1994, I psychotics of the ARAPDIS Foundation.
publicly presented an earlier version of this book as a doctoral disscrtation Likewise, I am grateful to all my informantS. Although at first it was not
in the Department of Anthropology of the University of Barcelona: namely. easy for me to develop emparhic relations with them, I believe that, with
Professors Claudio Esleva Fabregat and Josep Maria Comelles. In many time, I became a familiar character in !heir daily lives. Proof of this came
conversations both formal and inrormal, the first has shared with me the rich one day when a new patient arrived at the center for psychosocial
harvest of a professional lifetime, a wealth of insight from which I have rehabilitation, the ARl, where I was carrying out my fieldwork . Seeing the
benefited, I suspect, much more than [ am consciously aware. The second familiarity with which the others treated me, he asked, "Have you been here
has been a demanding critic. an excellent friend and a generous teacher. long?" I replied that I was an anthropologist, and explained that I was doing
I am aJso grateful for critical comments, help and inspiration from Ioan research and was very interested in what they residents did and thought. To
Frigole, Joan Bestard, Jose Lufs Garda, Marcial Gondar, Joan Obiols and my surprise he shot back, "Is that so! And how long have you been feeling
Ignasi Terrades. The first was my tutor. while !he rest were members of the like this?"
examining board of my doctoral dissertation. Other scholars-Carole My research was possible thanks to funding provided by lhe Programa
Browner (UCLA), Marfa J. Bux6 (University of Barcelona), Dolors Comas Sectorial de Formaci6n de Projesorado Universi.J.ario y Personallnvesligador
(Roviri i Virgili University), Jesus Contreras (University of Barcelona), (Program for the Training of University Teachers and Researchers) of the
Aurora Gonulez (Universidad Aul6noma de Barcelona), Carl Kendall Spanish Ministry of Education and Science (reference AP92 40978896) and
(Tulane University), Arthur Kleinman (Harvard University), Lluls Mallart by the Direcci6 General de Recerca de La GeneralicaI de Catalunya (Research
(Uni versi ly 0 r Paris X), Eduardo Menendez (CIES AS-Mexico), Rafael Perez Office of the Autonomous Government of Catalonia; reference
xiv Prefoct:
and tbus to include tbem in Ihe consultable record of whal mnn hali said (1973.
p.39).
245
246 What s Behind the Symptom? Epilog~: Open Worlc 247
ing. In the case of symptoms, however, the author is present, and while she anguish that it causcs. Patients describe what they feel, relate their symp-
speaks, complains or otherwise e:K.presses her suffering, she dynamically toms and tell the story of their affliction. From all this information the pro-
conSU1Jcts and reconstructs her statements with a communicative purpose. fessional salvages only a few facts on which to base a diagnosis. This salvage
I have already pointed Out that for most mental disorders, organic etiolo- operation involves convening "Oh. my God! Life has no meaning since my
gies remain hypothetical. Given this situation, what the palient says is of husband died" into "feelings of despair." If in the telling the patient's story
primary imporlance for defining such diagnosLic criteria as "auditory hallu- seems to wander from the subject-UOf course my daughter's grown up
cinations" or "feelings of hopelessness"-a whole range of phenomena ac- now and wants to live by herself'-tbe professional may listen patiently for
cessible only through the patient's speech. In contrast to the observational a bit. but finally asks, "Do you feel tired in the mornings? Have you lost
capacity of biomedicine, with its technological ability to penetrate the uni- weight receDtlyT The patient gets the point. and tries to be more focused .
verse of [he organs, contemporary psychiatry is limited to dealing more with Once again the psychiatrist may interrupt with more questions: "Have you
symptoms than with physical signs. On many occasions, for instance in 1M's ever thought about suicide?" "Have you ever thought that life just wasn't
hermetic narrative, signs become indistinguishable from speech itself, be- worth living?" "Do you sleep well at night?" The patient responds to these
cause manifestations of psychosis such as "delusions" or "disorganized questions. but generally in biographical and moral terms. Again the clinician
speech" present not as biological evidence, but emerge from the speaker's tries to narrow it down to "How long have you been feeling like this?" or
vcry words . "Are you taking any medication?"-thus converting the story into an inven-
But the maller does not end here . If we add to these limitations tory of facts reshaped in terms of diagnostic criteria.
Canguilhem's observation that symptoms and signs are rarely superimposed Situations similar to the ODe outlined above have been defined by Brown
(1966, p. 61), the problem gets worse. For example, as Canguilhem himself (1993) as the opposition between the patient who tells a story (his or her
points oul any good urologist knows that a patient who complains of "my own). and the psychiatrist who follows the story as he would a mystery, in
kidneys'" is someone who has nothing in his kidneys, because for the pa- search of clues and evidence (p. 25.5). At frrst this idea seems suggestive.
tient kidneys are "a muscular and cutaneous territory." not organs (1966. p. Think of the traces of pipe tobacco smoke still floating in the air, the mud on
61) . Of course, if the tcchnological means exist to produce physical signs. the shoes of Mr. X, the microscopic piece of Persian carpet which gives
whatever patients say about their kidneys will become less important, be- Sherlock Holmes a vital piece of infonnation for solving the case. In an
cause the clinician will have something observable and measurable to rely apparently similar fashion, the clinician untangles the patient's tale, not to
on. Psychiatry, by contrast. is almost completely limited to the domain of the talee pleasure in it but to convert it into a language of facts: "low energy,"
patien/ 's utterances. to "my kidneys hurt" or "1 hear voices" constructed in a "insomnia." and "poor appetite," but also "feelings of hopelessness," "low
narrative of afiliction. At this point the paths diverge: psychiatry can either self-esteem," etc. Symptoms are raised to the same level ofreification as the
treat symptoms as physical signs reified to make them manageable within a mudstained shoes or the pipe smoke in a process of inference through which
universalist paradigm; or it can recognize that symptoms are not signs and what the patient says is transformed into the logic ofreal facts--traces. clues.
therefore require interpretation. natural signS-Whose meaning depends on the logical and conceptual pro-
Neo-Kraepelinism opted for the first of these two possibilities. This in- cesses of the receiver of the message. In this way the autochthonous mean-
volves a political commitment having to do with the corporate and socioeco- ing vanishes because it is inexpert. ignorant of the true code by which facts
nomic interests of the profession, at the cost of treating winks as twilChes. acquire meaning: loss of weight, feelings of hopelessness, poor appetite,
The clinical relation required by neo-Kraepelinism (and also by biomedi- thoughts of suicide and insomnia as manifestations of' depression.
cine in general) bctween professional and patient is rather odd from an eth- However. clinical procedure and criminal investigation are net entirely
nographic point of view. The clinician takes the position that Lacan neatly similar. Like Holmes, the psychiatrist also wants to find out "whodunit," but
captured as the "subject who supposedly knows" (1973, p. 240). In perfect has the advantage of a ready-made classification. In addition, the signs of
oppOSition to this, patients "do not know," and when they feel unwell, they interest to a psychiatrist are natural and universaJizable, while the detective
tUfn to the profeSSional in search of relief, both for their malaise and for the has to confront a potentially infinite variety of individual situations because
248 Whal:S Behind lhe Symptom? Epi1ogu~: Open Won: 249
human will has intervened. a "motive" which is clearly the intention of an the art critic or literary critic, although a symptom is not Las MenifUls, nor a
author. This is why. despite Brown's suggestive "Psychiatric Intake as a s
complaint Finnegan Wake. There is no need to seek aesthetic meaning in
Mystery Story", the analogy of the clinician and the detective is only appar- symptoms, although some anthropologists have tried this approach (Good,
enl, and in fact inverse: the clinician naturalizes the semiosic. while the de- 1994; Devisch, 1991). In any case. aesthetics-a dogmatic science, as We-
tective reads hwnan will into footprints and physical evidence. ber characterized it-goes in search of meanings that have little to do with
The problem of disguising symptoms as physical signs is no trivial mat- our purposes. These digressions aside, however. the response to a work of
ter, but one of fundamental practical importance. If an Iranian woman's com- art is not so very different from the response to a symptom. Interpretive
plaint of heart distress is understood by the clinician to mean only physical antltropology seeks in the symptom an intention other than its own, develop-
sensations, it is a clear misreading. If this same hypothetical clinician con- ing conjectures that must be validate<! by the message of the work. TIle work
tinually modifies the treatment because his schizophrenic patients complain and its author therefore take center stage rei alive to a priori elic categories
unceasingl y about their nerves, there is a fai lure of interpretati on and a com- modifiable, as Pike cautions us, by fieldwork. The pigmentation, texture, or
munication problem. The list of examples is as long as that of possible worlds other physical aspects of the symptom-as-paintiDg are simply not of interest.,
of affliction, and we do not have to deny the existence of literal meanings and the elhDographer goes straight to the interpret3.1iOD of "the said." Therapy
that allow a degree of understanding in order to see that widely divergent is not a possibility; yet., curiously, this contemplative stance yields a kind of
meanings can make the situation untenable. application. not an uncritically pragmatic one. but a resource which emerges
Although in different cases the nuances vary, the processes are always from the emnographic process itself: it reveals the native meaning of symp-
the same: the conversion of symptoms into physical signs; the suppression toms.
of authorship; avoidance of the message; and the meaningful incenlion of the In the clinical interview above, in which the patient spoke of the burden
complaint. In short, the intention of the reader comes to dominate. limiting of grief she has carried since the death oCher husband, theciinician read into
the symptom to his own interpretation. The semiosic has become physical, a her story a palhological meaning largely alien to the ethnographer's task.
natural phenomenon thaI acquires meaning only insofar as the receiver of Only some of the messages contained in her words caught his interest, par-
the message constructs it. The resulting model is unidirectional, with inter- ticularly those which furnished the basis for a diagnosis. What is important
pretation moving from the clinician to the patient or, more accurately, from for the ethnographer is precisely wh3.1 the cliniCian discards as irrelevant.:
the professional to the disease itself. The only variability of any significance the meaning of death and loss iD a specific cultural cODtext, the structures of
here is produced by clinical inference: will the diagnosis be anxiety or de- kinship that give rise to certain tensions between mother and daughter, the
pression? spiritual entre3.1y implicit in her "'Oh my God!" What interests the ethnogra-
Nonetheless, symptoms can be understood in another way, as they were pher are the cultural meanings evoked by the narrative, shared meanings of
in psychoanalysis and in the phenomenological-existential school 0[ psy- the sort transmitted by a wink, the hierarchies of meaning expressed in a
chiatry. An interpretive ethnography of symptoms and affiiction also plays cultural code; the individual psychology oflbe winker (or the sufferer) is not
an important and distinctive role here. Because it has no interest in establish- the issue here. At this point, the ethnographer goes beyond the infonnant, as
ing pathological meanings, it bypasses the debate about whether the causes the cJ inician does with the patient, i Dsearch of knowledge thal is Dot limited
of mental illness are moral, social, psychological or biological. This is sim- only to the individual's experience, but with the important difference that in
ply not its problem, or at least. not its main preoccupation. Its aim is to ethnography this does not produce a conflict between naturalist approaches
understand affliction or, in Geertz'S terms, (0 gain access to (and record) the and semiosic realities. It is difficult to imagine an ethnographer trying to
responses given by others. discern meaningful intention in red spots on the skin, because physical signs,
Interpretive ethnography, in contrast to neo-Kraepelinism, focuses its at- in and of themselves, do Dot communicate anything. This is not to say, how-
tention on recovering the autochthonous meaning of symptoms, both literal ever, that patients, observing their spOts, may not subsequently use them to
and symbolic. The aim here is not therapy but understanding symptoms construct symptoms that are fully semiosic. Here it is possible to carry out
through their context. In this there is a certain similarity to the approach of the ethnographic task of investigating the meaning of the spots for the sur-
250 What s Behind the Symptom.'
Cerer as a representative of a cultural tradition or social group that shares
certain ideas aboUI such occurrences. The aim then becomes an understand-
ing of the terms in which the natural can become the object of a particular
cultural construction, without losing sight of the fact that "the said" is said
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. INDEX
273
lntkx /ntkx 275
274
Dreams 40. 41. 44-47. 49-50, 51. 59. Geerl2.. Clifford lIi. 3. 5-7.9-11.14-15 . L New Haven Study 89-90
86, 138, 151. 234. 243 29.159.196.204,229,243.248 New mcdieo! semiotics 178.187.191-
Goffman. Ervin 30. 134. 138-141. 158. Latah 14.57.64 (0. 23).116.121.123. 199.203
211.236 134. 159
E Golden era of social epidemiology 90 l.bi-Strauss. Claude J 55-156. 175- o
Good. B}'I"On 2.3. 5. 17 (n. I). 28.29. 176 (n. 2. 3 and 4). 206
Eco, Umberto 17 (n . 5). 177. 179. 185. Oedipus complex 3-4.4.7.48,91.224.
31 (n.8), 67. SO. 89.144,150-157.
188-190.191. 194. 197.205.206.
208. 225. 238
159.160. 161,162.163.165.166. M 225
170.174, 199.203.204.207.210.
Elecl1oconvulsive therapy (ECTj Mal d'oUo 12-15.231 p
249
21- 22.30,33.209 Mal de pelea 14
Embodiment paradigm 3. 132. 157. Meaning-centered approach 3,132. Paresis 23
163, 164.176 (no Ie 5) H
159, 161, 163, 166. 167 Patbogenicity/patboplasticity 58·59,
Etlmobotany 146 (n.7) Medical anthropology 84.106-108,119,120,121,250
Heallh-<:are syslem 157. 158. 165
Elbnosciencc 134. 142-145 Henle-K1>cb paradigm 23. 25 and clinically applied anthropology Peitce. Cbarles Sanders ltii. 17 (n.5).
Exogamy 48 2-3.17 (n.I). 166 125,177.178, ISO. 184, 185-188.
Explanatory Models (EMs) 157-158. and aitical interpretive perspective 190.191. 193.194.196. 197. 198.
162-163.165-166.196.231 (n. I) 2-3. 174 200 (0. 3-1). 203. 205. 206
Experience ncar/experience distant and aitico! medieai anthropology Placebo effc<:t 37 (n.5)
14- I 5. 18 (n. 18) 3, 166-167. 168-175. Positivist medicine 23, 30,31. 181
Exprcssod Emotion (EE) 101 [dioms of distress 132. 163. 149 lU1d critically applied medical Positron Emission Tomogtllpby (PET)
Olness Semantic Network 132, 152- lIDthropology 3 21
F 153.154.155-156.163.174.199 and clinical/critical debate 2-3. Psychoanalysis xii, xiii. 5, 17 (n.7),
Intcrn.ttionaJ Classificalion of 170-171 33-34,35,36.37 (n.13). 39-51. 61-
Fabrega. Horacio 14- 75. 81 . 82. 86 Disc3Scs OCD) 32. 37 (n . J 4). 68. and Gramsci 29. 167, 171.172.175 63 (DOtes), 67. 68, 69. 74, 86 (n.3).
(n .5). 102. 143-145 90.94.109.121.123 . 124 (n.1)
91.131.151-152,184. 189, 190.
Fox possesion 18 (n.18), 147- 149 and bermeDeutics xv. 2-3. 132. 147- 200 (n.2). 223. 224. 225. 243. 248
Foucault. Micbcl xii. 22-23. 30.36 149,150-164,203.204.207,209,
K 243. 244 (n. 3)
Psychoanalytic anthropology 40, 91.
(n.2). 59-60.167.178, ISO-182.
131. 134-138.145-146 (n_4-6).243
185,194 Kleinman. Arlhur xii. ltV-lIvi, 2. 3 • 6. and man;ism 3, 156-157.166-175.
Psychosurgery 33. 31 (n.ll)
Fralc:e. Charles 142-144 11 (n.3) . 18 (n. 19). 27, 29. 35. 37 and pbenomenology lIvi, 17 (0.3).
Freud. Sigmund xiv. xvi,S. 34, 40-51 . (n.5). 38 (n.16). 85. 86 (n .5). 89. 149. 157. 163-164
54. 59 . 60. 61-63 (notes). 86. 95. 97. 101. 110. 112 (n .2). 120. Midtown Manhattan Study 89-90 R
134.135.131.138.151.157. ISQ. 157- 163. 165. 166. 168. 170. Modelo M&lico Hegcm6nico
Ricoeur, Paul 3. 7-8. 17 (n.II). 40.61
206.224 . 243 194. 196. 197.203.204.205.206. (Hegemonic Medical Model) 29
(n.5), 62 (n.9. 10. 14), 125. 164.
and Kraepelin 39-64 210 Monomania 31
195,201 (n.IO). 206-207. 229. 238
KOTO 14.57.64 (n. 23). liS, 120,121.
G N
123.159
Kraepclin. Em il II vi. 39-40, 51-61, 63-
s
Gadamcr. Hans-Georg 3. 164 64 (noles) 65-67,69.71-72, 74. Neo-Kraepelinism :0.65-87,89-112.
116,130.136,150.163,204,209, SIlUSsurC, Ferdinand de 177. 178-180.
Galician culture 12- I 4 77. 78. 87 (0.6). 89. 91 . lOS. 106,
210,215.237,244.245,246,248 184, 185.186.188. 203,205. 206
a sombra 14 109.112(n.3). 123. 136.215.
Nervios 14. 171-173, 208-232. 242. Scheper-Hughes, Nancy mi. 2.3,37
millora 12. 14 236. 242
250 (n.8),164, 167,168.171-174.203,
o enganido 14 and Freud 39-64
Neuroleptics 21. 209 211
Ii
il
I:
:1
276 /mkz lmio: 277 iI
and Int.:rno.tional Study of
II
Schi7..ophrenia 14. 17 (n.3). 28. 32.36 and sign xi. ~v. 4·5,23, 32.35 , 36
(n. I). 50, 52·54. 55 . 56, 57 , 59. (n.2). 61. 65. 84, 108·1<19. 112 Scbizopbrenia (lSOS) 109
63 (n, 17), 74,75.76.82, 108. (n.3). 114-115, 118. 121. 125. and Present Stale Examination !
114, 149. 154, 208·232, 235 130,137.139· 141,142·145.152. (PSE) 92. 93, 103·104, 109. 110
and epidemiology 89. 90,92·)05. 154·156.160·161. 168·170, 170. :1
108·109 173.181. 182·185.186·187.188, y
and narralives 215·226 189.190, 191. 193, 194. 197.
I
and prognosis 52, 53. 93·95. 95· 198·199.200 (n .2), 204. 205. Young, Allan 18 (n.15). 60. 66. 67, 69.
103 209,210,235·236, 237. 244, 141,165·166,169
and symptomatology Il. 52·54, 55, 245.246. 247.248. 250
56. 66, 82. 103·105 and text xv, 7. 44-47. 132. 150.
Social suppor·slress·discase par~digm 155, 189,193, 194,195.197.
26.37 (n.6) 203.204.205.207,208.210. I'
Somalaalio('l 105·107
Structuralism 8. 17 (n. 9), 156. 175·
213.215.217.229·230. 235,
238 . 240,241 . 242, 243
iI
176 (note 3).177.185.188
Suslo 14. 115, 116. 159 T
Symptom II
and aesthetics 156, 203.240.241.
249
Taussig, Miehacl2. 157. 168·171 , 172, !I
1·74.204 :!
and biograpby 7, 39-40. 42. 43, 44. Topopbobia 43
47. 54·56,183,203,215·226. Trait.:mcnt moral 30, 37 (n.9)
247 Thrner. Victor 3. 150·152. 153. 159 :i
and economic·politics xv. 2.3. 168· and dominant ritual symboL~ 150.
175.203 152. 153.208.230
:I I
and c;.;perience xii. xv, xvi . 42. 43. and psycboanalysis 151·152 II
94.107.108.115. 121. 122. 123. I!
132. 148, 152, 154. 155, 156.
157.160·164.174·175.190, 194.
v .i
1