Of Spirits & Madness: An American Psychiatrist in Africa

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

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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From the Publisher:

OF SPIRITS AND MADNESS
An American Psychiatrist in Africa
By Paul R. Linde

Following his pediatrician wife to Africa, Dr. Paul Linde found himself working in Zimbabwe’s capital as an attending psychiatrist at Harare Central Hospital. Relaxed from months of travel and enjoying limited expectations, he was startled right from the start - shocked by his workload, confounded at the conditions and confused by the beliefs of his patients. Slowly, Linde discovered an unseen realm of spirits lurking in the madness.

OF SPIRITS AND MADNESS: AN AMERICAN PSYCHIATRIST IN AFRICA is a literary debut and scientific memoir that recalls a year in the life of a doctor trying to cure (as best as he could) hundreds of Zimbabweans suffering from mental illness, his task made more difficult by a system stricken with poverty and adversity. Linde’s learning curve about Shona culture climbed steeply; he learned through trial and error how to best handle his patients using a skillful blend of Western remedies and appealing to their belief system of spirits, witchcraft and animism.

Many of Linde’s patients were caught in the throes of the supernatural. The nurses explained to him about n’anga and profita, shamans of Shona culture, who are believed to be able to cast out evil or angry spirits and cure anxieties and depression. Seeing a psychiatrist was regarded as a patient’s last option. Linde had to walk a fine line, filtering through patients’ symptoms and learning to clarify their origins, while interpreting the “spirits.” His patients suffered in part from the larger problems inherent within Zimbabwean society: poverty, AIDS, unemployment, misogyny, domestic violence, tropical diseases, malnutrition, unchecked psychoses, depression, kugungisisa (“to think too much”) and more.

This book is arranged in clever fashion: each chapter tells the story of a different patient and shows Linde’s personal transformation as he comes to understand the Zimbabwean spirit world. In several instances he reaches tragic medical impasses that speak of the chasms between the applications of Western medicine and Zimbabwean culture and sociology.

Linde’s final chapter demonstrates how his worldview is genuinely transformed as he learnes to think like an African – “to see how the day goes.” As he prepares to leave Zimbabwe, he befriends patient Wonder Kasimonje and begins a process which, eventually, successfully relieves Wonder’s symptoms of depression. After Linde returns to America, he grapples with an array of problems ranging from marital to professional to existential. By way of regular letters that he receives from Wonder, Linde continues to better understand the African mindset. In spite of Zimbabwe’s devastated economy and blossoming AIDS crisis, Wonder thrives and repeatedly gives thanks to the spirits that have renewed his optimism and granted him a new life. Here, Linde finally comes to grips with his own spirituality. Wonder’s (and his fellow Zimbabwean’s) steadfast patience and strong belief systems, which took Linde so long to understand in Harare, makes Linde’s life in the West seem numbingly void in comparison. His experience in Zimbabwe, he realizes, has changed him forever.

A thought-provoking debut about the nature of madness and one man’s foray into the Zimbabwean culture and “outer-mind,” OF SPIRITS AND MADNESS tells of a psychiatrist who comes to recognize the spirits in his own life.

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 dealers­­punch 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-cushion­­to 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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