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.
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.