Toward an Applied Neuroanthropology of Psychosis: The interplay of Culture, Brains, and Experience

About the author

Neely  Anne Laurenzo Myers is an assistant professor at Southern Methodist University.  She received her PhD from the University of Chicago’s department of Comparative Human Development in 2009.  Dr. Myers specializes in psychiatric anthropology and applied neuroanthropology with interests in mental health especially among underserved populations.

Applied Neuroanthropology of Psychosis

The purpose of applying neuroanthropology to psychosis or to mental health more generally is really to understand the interplay between one’s culture, neurodevelopment, and life experiences.  This case study examines how everyday experiences can be integrated into neurodevelopment and lead to psychosis in certain contexts.  Applied neuroanthropology can make improvements on the current recommendations for psychotic disorders by understanding how neurodevelopment during certain life stages and relevant life experiences can interact to affect biologically vulnerable individuals.  Hopefully, new treatments and interventions can be developed to treat people earlier in the course of their psychotic disorder as people in the west typically have a lower rate of recovery than patients in non-western countries.  Another distinct advantage of neuroanthropology is that it can look at psychotic disorders cross-culturally.  By doing so it becomes clear that psychotic disorders do not mean the same thing to people everywhere.  They are experienced quite differently and understandably treated with different approaches.

Introducing Psychosis

While you may not know someone with any type of psychotic disorder it effects around 1% of the global population and even more people experience more mild psychotic episodes at some point in their life.  Psychosis is severely disabling in that the person loses touch with reality, they have delusions, and sensory hallucinations.  You are probably most familiar with the idea that these people hear voices in their head and may talk to those voices.  The voices can vary in who and what they are saying but it can be very frightening.  The patient, family, and friends may become afraid.  The experience is different for every person because everyone has a different brain and for this reason the illness can be very isolating.  I’ve personally seen what psychotic illness can do to a person and their loved ones and it is incredibly devastating and life altering.  Part of this may have to do with the way we view and treat this type of mental illness in this country.  The other symptoms essentially changes the person’s personality and further isolate them from any existing close relationships they had left.  These symptoms include loss of emotional response, little motivation, socially withdrawing, and cognitive problems which can all easily interfere with seeking or adhering to treatment.

This clip summarizes the symptoms of schizophrenia and their impact on the patient and family.

Summary of the Case Study

Dr. Myers spent time at a clinic for psychiatric disabilities in New York where she used a mixed methods approach, including participant observation and interviews, to understand the experiences of a patient named Leroy.  Leroy was in his thirties and had been diagnosed with schizoaffective disorder.  People with schizoaffective disorder frequently have the symptoms of schizophrenia with the symptoms of a mood disorder like depression.  Leroy was also an alcoholic and a felon.  Dr. Myers believed that his neurodevelopment may have been effected by institutional participation and led to the development of his psychotic events.  She detailed his history with psychotic events as well as his beliefs surrounding them.  He had had at least two mild psychotic events as a child.  His Aunt had explained to him that he may be hearing spirits and also told him a story about his birth and that his grandmother thought he might be susceptible to such things.  He seemed to accept this explanation and didn’t have problems for a while because his aunt put something in his water to help.  He explained these ideas to his doctors but they dismissed it completely.  When he was incarcerated he eventually became paranoid.  At some point he ended up serving eighty days in solitary confinement because of disobedience.  His psychotic problems became constant at this point.  He began hearing voices, talked back to the voices, became fixated on things he read in a bible, and ended up being taken to a psychiatric treatment center.  In the center they treated him with anti-psychotics but he felt he was denied the chance to truly face his illness because of this.

Psychotic Disorders: A Neuroscience Perspective

It really isn’t clear what causes Schizophrenia or any of the related psychotic disorders.  The models range from genetic to epigenetic to purely environmental.  The reason for this is that they can see some evidence of the disease in some patient’s brain such as a changing of certain structures or pathways but can’t definitively say it causes the disease.  They can only say it is probably part of the disease.  At this point a mix of genetic predisposition and environmental factors seem like the best explanation.  What has been suggested is that people with Schizophrenia may be biologically susceptible to social stresses and that as these build up they are unable to withstand it and develop psychotic symptoms.  Another idea suggests that is completely normal to experience mild psychotic events during certain stages of neurodevelopment but it only becomes pathological in these supposed biologically susceptible people.  Other models suggest that the reason psychotic symptoms become evident during the young adult years is because of the multitude of social stressors associated with life changes and certain susceptible people cannot handle that and develop psychotic disorders.  Something else that is clear that Leroy was an example of is that certain contexts raise the risk of psychotic illness.  These contexts include urban environments, social disadvantage, adverse life events, and poverty which can all cause prolonged stress.  Which brings us to the last possible explanation which is allostatic overload.  This model suggests that psychotic disorders may result from neural changes due to allostatic overload but specifically due to inflammatory cytokines and glucocorticoids and their effects on the brain.  The cause and mechanism for schizophrenia has yet to be discovered but it is likely a combination of these explanations which include genetic and environmental causes.

Toward an Applied Neuroanthropology of Psychosis

Neroanthropology can be used to better understand how experience is incorporated into neurodevelopment to alter pathways or structures that lead to psychosis.  In Leroy’s case certain episodes in his life (solitary confinement) led to the exacerbation of an underlying issue.  He also came from a disadvantaged background and had previous mild psychotic episodes with certain beliefs about them.  Could this information have been used to intervene and prevent full blown schizoaffective disorder?  We don’t know.  However, continuing applied neuroanthropological research into psychotic illness can provide the insight to answer those kinds of questions.  It can also help us to understand the stages of development, at-risk populations, and biological vulnerabilities that need intervention and what that intervention should look like.  Research experiences like this case study also make it clear that to dismiss the beliefs an individual holds about their illness can be a mistake.  A person’s cultural beliefs surrounding their illness can end up being a vital tool in fighting psychotic disorders.  In the U.S. this could lead to cognitive behavioral therapy as a resource for people who want to try something with or instead of traditional anti-psychotics.

A new form of Cognitive Behavioral Therapy (Facing the voices) to complement anti-psychotics.

9 thoughts on “Toward an Applied Neuroanthropology of Psychosis: The interplay of Culture, Brains, and Experience”

  1. Meyers’ article has me conflicted. I recognize the need for a better understanding of how lived experiences effect psychosis later on in life. In this sense, there is a real need to examine society’s role in doling out structural violence. I also think neuroanthropologic research into psychosis might be applied to the debate surrounding gun violence and mass tragedies. In my opinion, this is less a gun issue and more a mental health issue. However, I also think that identifying “biologically vulnerable” individuals might be misunderstood as predicting, or limiting, a person’s potential or labeling them with a stigma associated to a disease they do not yet have. I wonder if research of this type with increase or decrease the stigmatization of mental health.

    In both the Meyers’ article and the chapter by Finley, I see this idea that Heywood articulated in the article we talked about last week. Lived experiences are important and can change our neurology and our response to events in the future. For Heywood, this meant the inability to “get in the zone” and participate in immersive play. For Meyers, this meant developing psychosis. For Finley, this meant PTSD. Traumatic experiences take a toll on the body and the brain. I felt that Finley did a good job articulating what trauma is. Like Meyers, Finley speaks of genetic predispositions and epigenetic factors as increasing the risk of experiencing PTSD. I thought the resulting model Finley proposed was very clear and concise. I do think that with so many soldiers coming back from combat there does still need to be some type of criteria from which to judge their mental and physical condition just for practicality’s sake. After all, the medicalization of PTSD has had a positive effect for those affected by the disorder by labeling the problem as something that can be treated and, perhaps most importantly, something that is not the fault of the individual.

    I was reading the article “Does seeking safety reduce PTSD symptoms in women receiving physical disability compensation?” by Melissa L. Anderson and Lisa M. Najavits and was instantly reminded of Finley’s perspective that traumas snowball. The more traumas you have the more likely you are to experience PTSD. Anderson and Najavits takes this a step forward by looking at women with physical disability, which is one of those factors that increases the risk of PTSD because it marginalizes the person economically and socially. Trauma might directly instigate PTSD and the physical disability at the same time. Finally, those with PTSD are at an increased risk for physical disability. Anderson and Najavits took 353 female subjects that had been diagnosed with PTSD and substance use disorder (SUD) and randomly grouped them into two groups. One group was subjected to the partial-dose treatment of Seeking Safety (SS) therapy while the other was subjected to Women’s Health Education (WHE) therapy. SS involves psychoeducation and teaching coping skills in a group setting. WHE is very similar but does not focus on overcoming the fallout and effects of past trauma.

    First, women were further categorized as physically disabled or nondisabled (ND). Secondly, PTSD was classified using the Clinician-Administered PTSD Scale (CAPS) first as a baseline and then at 1 week, 3 months, 6 months, and 12 months. The results show that women with disabilities saw an improvement in their PTSD condition when treated with SS but not WHE. Those women without disabilities saw an improvement in the PTSD when treated with either therapy system. Anderson and Najavits concluded that for women with physical disabilities, trauma needs to be addressed. I do feel that the intricate relationship between trauma and disability still needs to be parsed out. Still, it is important to show that even with the homogeneic approach that clinical diagnosis of PTSD may bring, there are steps being taken to treat the variance.

  2. I found this article and the description of Leroy’s time in jail to be profoundly moving. Let me just say that I find our country’s jail system to be absolutely horrible. Deplorable. Inhumane. In the jail systems there is no sympathy towards the fragile state of the inmates minds, and the conditions of some of the institutes invariably lead to psychotic outbreaks. One of my close family members was sentenced to jail, and what the jail did to him makes me extremely enraged. My family member has a history of mental disorders and behavior problems, and invariably he was put in solitary and “protective custody.” While it may have physically protected him, it mentally crippled him. He began to have psychotic breaks, becoming paranoid as he imagined the guards were all against him and hearing voices that were telling him to kill himself. He wasn’t allowed to make outside calls, even when he went to the medical ward for self-inflicted wounds or when the guards had a dog attack him. There is no decent mental hospital in our state, and even if there was it would take months to get transferred, all the while suffering severe psychotic breaks. Instead of trying to help the inmates better themselves and be successful, prison leads to depravity. Even if an inmate gets out of prison, they have their time in jail haunting them as they struggle to find any job, let alone a decent one. Depression ensues, and there is high likelihood that the “criminal,” as they are forever known, will turn back to a life of crime because there are no other visible options of supporting themselves. I believe that our legal, jail, and mental health systems all need a huge overhaul.

    1. Looking at this post again, I find that I am still emotionally moved by this article. It is very easy to imagine becoming psychotic and hearing voices if you are in an isolated cell for months on end. However, I feel that this link might not be quite so bad if our culture did not have such a negative connotation for any kind of mental disorders. Humans are social animals, so it seems natural that an isolated human will try to create his own social atmosphere, even if it is in his mind. This technique could actually be an adaptive mechanism if it keeps his mind off of his situation and brings him happiness. However, the social stigma that accompanies disorders of the mind inhibits any benefits that this mechanism might hold.

  3. Janis Jenkins and colleagues have studied schizophrenia in Mexican-American families and found better functioning than in Anglo-American families. It seems that levels of negative “expressed emotion” are higher in Anglo families and this has an effect on the sufferer. Also in Mexican-American families, the sufferer is more fully integrated in the family and play an important role in the household. I believe that the culture surrounding the sufferer is a key determinant to the functioning of the individual. CULTURE COUNTS

  4. Coming from a psychobiological perspective, the more anthropological look at schizophrenia . The therapy video brought a lot of what researchers in different fields have been trying to get at for a while, at least according to one theory about schizophrenia where the sensory modalities and other parts of the brain cannot easily communicate and are often attributed to an outside source (Shean 2004). The avatar seems to work particularly well because it gives a face to something that people can’t confront, which works on a social level as well as a cognitive one.

    Shean, G. D. (2004) Understanding and treating schizophrenia: Contemporary research, theory,
    and practice. 3-37, 99-195.

  5. I found this article fascinating because I was to integrate a lot of information information learned from other classes. I found the section of the article discussing oxidative stress to be particularly interesting because it makes so much sense with regards to the nature of the brain. The brain is already highly susceptible to oxidative stress due to the sheer amount of molecular oxygen that it uses, the low baseline levels of cellular antioxidants, and the method by which brain cells produce energy. I had never thought of culture or life events as being able to cause such stress on a cellular level. The effects of these factors combined with a genetic susceptibility or predisposition could be HUGE. There was an article recently that claims that schizophrenia is a combination of 7 or so different genes. I wonder how epigenetic factors like oxidative stress could influence that.
    Great review!

  6. On a second look, Meyers’s article has a lot in common with notions of embodiment with emotion as the mediator. Meyers is interested in how experience can affect people’s neurology, eventually flipping a switch in a susceptible mind that cannot be turned off. In the narratives Meyers presents, the confusion, fear, and anger are palpable. Are traumas that stem from structural violence, like extended solitary confinement, similar in effect to the traumas of war? What I mean to ask is this: how different are these “switched-on” psychoses from PTSD? Are they different? We tend to think of mental illnesses that have a strong genetic component as inevitable, unlike PTSD which is often portrayed as strictly circumstantial. Maybe mental illnesses like schizophrenia are not as inevitable as they seem. I’m still a bit unsure of what Meyers’ research really means for people who face a good amount of structural violence on a daily basis. Being more humane in the treatment and discipline of inmates is one thing (may be even a manageable thing), but how should we approach the larger apparatus that is everyday life? Some people escape their everyday through drug use, legal and illegal. This “escapism” can explain some of motivation behind informed people acting against their health or the law. I have no doubt that a bunch of research has been done on the connections between PTSD/psychosis and drug use. What I would find most interesting is to have someone pinpoint what came first, the mental illness or the drug use, and then compare outcomes of each process. Is there a pattern there or is the subject matter too idiosyncratic?

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