Of Spirits and Madness: An American Psychiatrist in Africa - Hardcover

Linde, Paul R.

3.74

100 ratings by Goodreads

9780071367349: Of Spirits and Madness: An American Psychiatrist in Africa

Hardcover

ISBN 10: 0071367349 ISBN 13: 9780071367349

Publisher: McGraw-Hill Inc.,US, 2001

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Notwithstanding four years of medical school and an eight-year residency, a psychiatrist really learns his trade from his patients. After five years of practicing in San Francisco, including stints in the emergency room and the city jail, Paul Linde thought he had seen it all. When his pediatrician wife decided she wanted to practice medicine in Africa for a while, he went along for the ride, not expecting that the experience would transform his life. Of Spirits and Madness is Linde's account of his year spent practicing psychiatry at Zimbabwe's Harare Central Hospital. With compassion, good humor, and growing insight he describes his patients and their demons and difficulties. We meet Winston Chivero, who injures himself by sticking needles and nails into his leg in order to protect his community from a bewitchment; Sister Pagomo, a Shona nurse suffering from kufungisisa, or "thinking too much"; Esther Mawena, who tries to kill herself after her husband gives her AIDS; Samuel Rugare, a 28-year-old laborer driven mad by too much mbanje, or cannabis; and many others. Overwhelmed at first by the press of suffering humanity waiting patiently in his clinic to see him, Linde gradually comes to understand how mental illness cuts across cultures. He also sees the devastation it can cause in a country where psychosis is severely stigmatized as a contagious spiritual illness caused by witchcraft. Most of all he is left with many important lessons from his patients who endure poverty and illness with incredible patience and spiritual dignity.

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Review:

"Linde's descriptions, far from clinical, are full of delightful observations, pointed political reflections, sensitivity to his hospital colleagues, and the diverse cultural needs of his patients. This fascinating and entertaining book should be required reading for anyone (especially in the medical profession) interested in the politics and personal stories of the cultural divide." - Publishers Weekly

From the Back Cover:

In 1993, psychiatrist Paul Linde took off on an African adventure. After five years of working on the front lines of psychiatry, in the emergency rooms and city jails of San Francisco, Dr. Linde thought he had seen it all. But little had prepared him for the madness and mystery he found at Harare Central Hospital in Zimbabwe, where dozens of new patients flooded through the doors every week, each one a fresh lesson in psychosis, culture-clash, and compassion.

Written in the spirit of Oliver Sacks, Of Spirits and Madness takes us on an adventure into medicine and the mind. With sensitivity, good humor, and growing insight, Linde tells the stories of his patients, their demons and their difficulties. We meet Winston Chivero, a self-mutilator who sticks needles and nails into his shin and blames the wounds on witchcraft; Sister Pagomo, a nurse's aide who suffers from kufungisisa, the ailment of "thinking too much"; Esther Mawena, a demoralized young woman who tries to kill herself after her husband infects her with the virus that causes AIDS; Samuel Rugare, a farm laborer driven to mbanje madness after smoking too much cannabis; and many others. In each of these cases, Linde acts as a doctor-detective in the nebulous world of psychiatry. He invites the reader in on the challenge of solving psychiatric puzzles. With limited information, he embarks each time on a process of scrambling, asking dozens of questions through an interpreter, with the clock ticking. And all the while, as Linde is sorting through possible diagnoses and psychotropic medications (and negotiating tea-times, elaborate greeting rituals, and other cultural quirks of the Shona people), he is haunted by the desire to unearth a case of true bewitchment.

While psychiatrists are used to working on the boundary between visible and invisible worlds, in Zimbabwe Linde must struggle with the beliefs of a people who attribute psychotic symptoms to ancestor bewitchment. In his search for answers, Linde becomes a practitioner of the "new cross-cultural psychiatry," with his long-held assumptions about the nature of psychosis turned upside-down. In this vivid portrait of life and work in remote Africa, Linde presents a wry and inspiring tale of medicine at the crossroads of two cultures.

"One of the beauties of practicing psychiatry in Zimbabwe was that there was no way to prepare for what you might see on any given day. I liked that spontaneity, the challenge of making a reasonable decision on the spot, keeping everyone safe, getting the patient to the right place, starting treatment as soon as possible, if need be. That is why I had been drawn to the practice of emergency psychiatry in San Francisco. Like a Vegas casino, the psych ER is open 24/7 and takes all comers. The emergency psychiatrists there are like blackjack dealers��punch in, punch out. I am not an adrenaline junkie, but I tEND to be distractible, absent-minded, and unable to plan things in advance, except with a great deal of effort. I may suffer from a bit of a disability, I guess, but my in-the-moment nature also makes me open to what the world throws at me."
��Paul Linde [from Chapter 5]

In a true African adventure, emergency-room psychiatrist and expatriate Dr. Paul Linde takes over the helm at the dusty and overcrowded Harare Central Hospital in Zimbabwe, where dozens of patients present him with new and daunting challenges every day. From a mind-boggling case of factitious disorder in which a young man treats his own leg like a pin-cushion��to the case of a woman suffering from kufungisisa, the strange ailment of "thinking too much," the patients at Harare walk the line between the visible and invisible worlds, their culture filled with witches and magical rituals. A gifted storyteller, Linde tells the tales of his patients, their demons and their difficulties, with compassion and good humor. Here is a vivid portrait of work and life in remote Africa, where witchcraft still reigns and psychosis is severely stigmatized as a contagious spiritual illness. In the style of Oliver Sacks, Linde takes us with him on this incredible adventure to present a wry and inspiring tale of medicine at the crossroads of two cultures.

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