Culture and Psychopathology

The Anthropology of Mental Illness

by Georgi Onchev (Author)
©2019 Monographs 184 Pages


The book sets itself the ambitious task of exploring the relationship between human culture and the phenomenon of mental illness, that which has embarrassed, fascinated, and challenged educated minds throughout the centuries. Various manifestations of this phenomenon are examined in specific cultural contexts, presented with notable competence, and illustrated with memorable descriptions of clinical cases. (…) The book and its author have many merits—the capacity to present a highly specialized subject in an intelligible, absorbing, and simultaneously profound manner; respectable erudition and academic self-discipline; and the notable skill of handling different domains of knowledge, among others. The most remarkable quality, however, is the author’s concern both for the reader—who is carefully led into quite unknown and still frightening territory—as well as for his protagonists, the mentally ill. All told, I believe that this book will be of interest not just to students of psychiatry, psychology, and anthropology, but also to a broader circle of readers who are excited by the wretched and admirable destiny of being human.
Haralan Alexandrov

Table Of Contents

  • Cover
  • Title Page
  • Copyright Page
  • Dedication Page
  • Foreword to the Bulgarian Edition
  • About the author
  • About the book
  • Citability of the eBook
  • Contents
  • 1 Introduction: Heritage and Phenomena
  • 2 Culture: Essence and Dimensions
  • 2.1 Elusiveness in Culture
  • 2.2 Cultural Axes
  • 3 Cultural Context at Home: the Bulgarian Odysseus
  • 3.1 Antinomies of the Bulgarian Mentality
  • 3.2 Traumatic Memory and an “Optimistic Theory”
  • 4 Psychopathology: Essence and Manifestation
  • 4.1 The Syndrome
  • Anxiety
  • Depression
  • Mania
  • Acute psychosis
  • Chronic psychosis
  • Delirium
  • Dementia
  • 4.2 Diagnosis and Case Formulation
  • 5 The Culture-Psychopathology Relationship
  • 5.1 Historical Steps of Interweaving
  • 5.2 Symptom Formation
  • 6 Mysticism and Psychopathology
  • 6.1 Religion and Psychopathology
  • 6.2 The Paranormal and Psychopathology
  • 7 Spirit Possession States
  • 7.1 Clinical Cases from Pemba Island
  • 7.2 Bulgarian Analogues of Possession
  • 8 Schizophrenia and Culture
  • 8.1 Epidemiology
  • 8.2 Clinical Picture
  • 8.3 Course and Outcome
  • 9 Affective Disorder, Anxiety, and Culture
  • 9.1 Depression and Anxiety
  • 9.2 Somatization and Dissociation
  • 10 Abnormal Behaviors and Culture
  • 10.1 Alcohol and Drugs
  • 10.2 Personality and Behavioral Pathologies
  • 11 Culture Specific Syndromes
  • 12 Treatment and Culture
  • 13 Epilogue: After Tomorrow
  • List of Figures
  • List of Tables
  • References

1 Introduction: Heritage and Phenomena

Where do we come from? What are we? Where are we going?

P. Gauguin

Over 6 million years ago pre-humans and pre-chimpanzees separated and took different roads of evolution, which remained relatively slow until some 11,000 years ago. Modern homo sapiens appeared around 60,000 years ago, and 20,000 years later the Neanderthal man had already started believing in the supernatural, and thus coping with his fears. Still, it would take another 25,000 more years before Cro-Magnons sewed clothing, made tools, painted, and played—thus creating the ritual foundation of culture.90 11,000 years before the present, a transition began from hunting and gathering to farming and settlement, and this occurred at the earliest within the valleys of civilization’s great rivers: the Nile, Jordan, Tigris, and Euphrates, all along the so-called Fertile Crescent which stretches between Egypt and Mesopotamia (from the Greek, meaning “between the rivers”).47 Later, encounters with non-threatening strangers were tolerated, and history gained momentum. Food production began 9,000 years ago and the first metal tools were made before some 7,000 years, while the first writings and state administrations appeared around 5,400 years ago (3400 BCE), along the Nile and in Mesopotamia, followed shortly by settlements in China, Mexico, the Andes, and Madagascar. All of them were traditional communities: communes, tribes, chiefdoms, and states. The concentration of many people in one place and cattle-breeding resulted in the transmission of microorganisms from animals to humans, and the advent of infectious diseases. In communities larger than tribes, not all people knew each other, so the need for a common sign of recognition arose to prevent unnecessary killing off arose. Thereby, shared rituals and ideologies emerged. These communities were ruled by a chief and their assistants, prototypes of the future bureaucrats—this was a universal model as late as the modern 18th century, when changes were brought on by the Industrial Revolution, public health care, and signs of democracy.

War, “the lethal custom of mankind”,50 has accompanied it throughout history. Probably the most striking feature of human development is its endless violence and ferocity. The main causes for fighting were hunger and territorial ←11 | 12→struggles for hunting land, especially in the “no man’s” ones between separate tribal communities. Fortified cities started being built around 5500 BCE, and around 4000 BCE the horse was domesticated, although it would not be until two millennia later that heavier breeds were selected and used for riding into war or pulling supplies. The wheel was invented around 3000 BCE; the two-wheeled cart—approximately 700 years later. The first civilizational separation between settled farmers and nomadic cattle breeders led to the dark epoch of unceasing raids carried out by nomads against city-states between 2000 and 1500 BCE, and necessitated their defense. After 1500 BCE, human civilizations were already totally militarized, and the power of each kingdom, chiefdom, or empire was measured by its fighting strength. For millennia in succession, nomadic raids of settled communities have shaped history, forming the basis of the migration factors156 for people. In the Fertile Crescent, continuous bloodshed marked the 13-centuries-long domination of Assyria, ending only after the demolition of its capital Nineveh in the 7th century BCE.

The population growth and inhabitation of the steppes, mainly by nomads, caused a struggle for resources which has since become one of the major engines of history—along with successive challenges and responses leading to civilizations’ rise, development, decay, or clashing with one another.206 Theocratic empires such as Rome and Babylon justified their violence and transformed it into a code of behavior. In the Old Testament, the extermination of everyone that does not belong to the chosen people is heroized, with Joshua himself having slaughtered 31 kings and all the inhabitants of 400 towns while conquering the Canaan land. Between the 4th and 14th centuries of the new era, such conflicts became permanent and bloody. Genghis Khan massacred around 40 million Chinese people in order to clear territories as pasture for his herds.50 After the 14th century great wars occurred on average every 50 years, with subsequent and lasting treaties which established the state of affairs in peacetime. Just two generations later, this state would change, e.g., a country developing more quickly in economic and demographic terms, now no longer in concord with the situation allotted to it by the previous treaty, signed when it was weak and poor. Besides the two world wars of the 20th century, there were at least five more big wars with a worldwide scope, including the Thirty Years’ War, the Seven Years’ War, and the Napoleonic Wars. The creation of modern nation states in the 18th and 19th centuries would stimulate further militarism.

There have existed constantly militant cultures, possessed by “constructive paranoia”,47 like some tribes in New Guinea, the Aztecs, the Mayans, and the Incas. In patrilocal societies, with extended families rearing children as a unit, wars were waged not through large-scale battles or by following any rules, but ←12 | 13→with tactics very much like those of guerilla warfare. The abandonment or killing of frail elderly people in order to spare the burden of care, is still common in many cultures. In the Kaulong tribe of New Britain, there is a custom to ritually strangulate widows,47 which is accepted by the victims without resistance. Human sacrifice rituals have been known in almost all cultures throughout history, including the First Bulgarian kingdom before the state conversion to Christianity. The forefather of monotheism, Abraham, did not hesitate at all in cutting his son Isaac’s throat under the order of God, who held him back at the last moment (Genesis). And infanticide is also common in all cultures, not only because of congenital ailments, but also as a means of controlling population growth. A rough estimate suggests that probably around 15 % of all children in human history have been killed;50 in England this practice was preserved even into the 19th century. Infanticide is also common in animals, for instance, when a lion kills another lion and its cubs, but not the lionesses, in order for that lion to have cubs with her and not have to care for the others.

Violence in human history has often been the only means for survival: sparing another from violence only makes one a victim of violence. In a fight for resources, violence is moreover the fastest way of getting rich. But it is also genetically predetermined. The human race is an evolutionary branch with an inherited inclination towards domination and hierarchy, especially in males. The closest primates to us genetically are hunters who eat meat and display intraspecies aggression. Only predators kill individuals from their own species, and the most ferocious among them are those at the top of the evolutionary chain—chimpanzees and people. Most people, under certain circumstances, are capable of murder (though most would deny it) and, apart from that, most would even experience pleasure from this act in the right conditions.50, 90 Human babies are helpless for a relatively long time compared to other mammals’ babies; they therefore only have a chance at survival with two parents available. Thus, families generate. The rearing of children requires relative tranquility which, with humans’ aggressive nature, may only be guaranteed by a powerful state that can ensure peace, thereby protecting families and offspring. For this reason, all civilizations until only several centuries before now have been exclusively authoritarian. Between 600 BCE and 600 CE, the major religions, i.e., Judaism and its branches, Christianity, Islam, and Buddhism, were born. For the first time, the anti-authoritarian idea that people are equal (at least before God) sneaks in.


ISBN (Hardcover)
Publication date
2019 (November)
psychiatry mental disorders history social DNA evolution schizophrenia swahili ethnology Bulgaria
Berlin, Bern, Bruxelles, New York, Oxford, Warszawa, Wien, 2019. 184 pp., 5 fig. col., 12 fig. b/w, 6 tables.

Biographical notes

Georgi Onchev (Author)

Georgi Onchev is Professor in Psychiatry and Head of the Department of Psychiatry and Medical Psychology in the Medical University of Sofia. His main research experience and interests include transcultural psychiatry, personality disorders, schizophrenia, coercion in psychiatry, long-term follow up of chronic psychosis, innovative methods for rehabilitative care, and modern cognitive distortions.


Title: Culture and Psychopathology
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186 pages