CULTURE AND MADNESS Some now a
thoughts on difficult/ in social adaptation by J. Ola Ojesina, who Psychiatric Social Worker in one of the Greater London Boroughs
it is often a problem to distinguish between actual psychiatric illness and behaviour which is unfamiliar, but conventional in the person's own society. This includes customs such as seeing visions, hearing voices and belief in magic. Not knowing the cultural context of what seems to be bizarre behaviour could cause misunderstanding, and the setting up of In- and OutGroups. An Out-Group would consist of those who come from different cultures from the host community. But there need not be trouble if the newcomer is quick to adjust to the environment, or the In-Group is tolerant. In many parts of Africa, it is still widely believed that if one finds a hair or nail of an enemy, or even a piece of material he has worn, that this can be used to kill or at least injure him. In this kind of thinking, there is a magical denial of the usual concepts of causality, and of space and time relationships. But cultural complexity may make it difficult to be sure where normal belief ends and psychosis begins. Two cases may illustrate this. I arrived in England one November, and went as a student nurse to a psychiatric hospital, where there were already two others from Nigeria. A few days before Christmas, another batch of four arrived. Previous to our there had not been any group, Nigerians working in psychiatric hospitals in this area. Before very long, we became popular, not only in the hospital where we worked, but in the city, the churches and the local press. There had been lamaicans working in the community already, but their culture, language and dress was not really different from that of English people. We didn't find it easy to adjust to our new environment, but tried to do so by imitating our fellow workers. We were very keen to fit in as well as possible, but one of us couldn't adapt to the new environment. When we
in the sitting-room
English nurse asked our name* friendly way. We all introduced ourselves, but this young man said: "You should call me Napoleon." 0Ur English friends roared with laughter not understanding that this was h'5
nickname at home, and that we a" have names of this sort in sport. Bu( the misunderstanding had begun. Next evening, after a hard days at work, we found ourselves looking of the television?we had no relatives friends to visit, and none of the nurse5 who lived outside had invited us to a their homes. But also watching was wb? student nurse, friendly English then took us to visit a pub for the first time. There, he asked us all if we wer? married. When it came to "Nap?(' leon's" turn, he said he had four wiveS' He said this with dignity, and withoU1 ulterior motive. His religi015 any allowed polygamy, and in his own cul' ture it is a status symbol to hav? several wives, as well as economic independence. But our ho*1 knew nothing of this, and the ne^s flashed round the hospital, making "Napoleon" the centre of some sUS' picion. We told him to stop this be' a" haviour, because it was resulting in which had even bekinds of
known outside the hospital. B^ "Napoleon" couldn't adapt himself the new way of life in which he placed; he felt his environment W&s hostile, so that he must attack it. The problem came to a head ofle day when "Napoleon" kissed a Since the story of his four wives and other unusual behaviour had been cir' culating in the hospital, many female nurses had been intrigued with himTo some extent, this was just to make fun of him, but "Napoleon" though he was really popular, and that all the girls were genuinely interested in hit*1. About a week later he was asked tests, bf some
he refused to co-operate. He was regarded as mentally ill, and was ad'
resign and seek treatment, or to Nigeria. In fact, after ?eaving the hospital, he took a course Plumbing at London. He completed ft's successfully and is now back home. The second case was of a Nigerian ?vernment scholar, who came over j ,? a College here, and lived in approved ?? back
After the first year, he began aPpear withdrawn, and was less able 0 communicate with others. He was to accept joking, although his Jess and appearance encouraged it. uddenly, he felt he was being perseand that cars were following about. These were not only being ,riven by the students and tutors of i116 College who joked with him, but all kinds of other people?even old adies. At times, he deliberately went ?ut to see whether he was being folo\ved, and he was sure this was being ?ne so that he would be provoked into
He stopped going
believed that if he went into certain ectures, other students would be pre-
ented from concentrating on their 0rk through being preoccupied with
him. He had been engaged at home, but it had been broken off, and he would change the subject whenever this was mentioned to him. In fact, he was a person of inadequate and insecure personality, who developed a severe psychiatric ill-
watching to a girl
Most of us who come to this country hope to learn something of its way of life, and to adopt those features of it which may be useful to us in developing our own country. This implies a readiness to change certain norms and behaviour patterns, and some of us, such as "Napoleon", seem unable to deal with these novel situations?at least at the beginning. These variations may be due to different childhood experiences. But clearly, deviance due to cultural differences can be differentiated from actual psychiatric illness, although that illness must be influenced by the patient's cultural experience. Those who come from overseas should never be thought of only from the point of view of the alien culture in which they happen to be at the moment.