Culture and Madness

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 Inand 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 group, there had not been any 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