Mediation between the shamanistic model and the psychiatric model in a shamanistic climate: a viewpoint of medical anthropology.

It is suggested that any clinician working on the Miyako islands, Okinawa, Japan, be a mediator or a negotiator between two worlds, namely the shamanistic and the modern psychiatric ones. On these islands, to subscribe to either is possible only by ignoring conflicting clinical realities. The main point is to summarize the complementary practices of these two medical systems on these islands. Psychiatric illness attributed to kamidaari is introduced. The initiatory illness for seeing a shaman is called kamidaari or kamburi. From the viewpoint of medical anthropology, aspects of the treatment of such patients in a shamanistic 'climate' (which is called fudo in Japanese), will be reported. In the shamanistic fudo, it must be recognized that, at a critical moment, shamanistic epistemology and psychiatric epistemology penetrate each other, and they exist together in a clinical 'mesh'. Two epistemologies must join in a coalition to access, and build continuity into, psychiatric and shamanistic medical care. It is demonstrated that these two worlds almost merge in dialogue but do not fuse, and that clinical relations occur on the boundary between these two epistemologies. 'Climatic' specific therapeutic stances are introduced and are clinically illustrated.

[Anti-cyclic manifestation of asthma bronchiale and schizophrenic psychosis]. / Antizyklische Manifestation von Asthma bronchiale und schizophrener Psychose.

The interaction between the central nervous system and the immune system has been focus of recent research. Whereas cyclic AMP has been described as a link between atopic and affective disorders, a possible link between atopic disorders and schizophrenia has not yet been investigated. A 33-year-old patient showed episodes of allergic-asthmatic and paranoid-catatonic symptoms which appeared in an anticyclic pattern. Biological, clinical and therapeutic aspects are discussed in respect to the interaction between immunological and psychiatric disorders. Cyclic-AMP as a second-messenger is not specific for a certain cell species and might represent a possible link for integrated communication between the nervous and the immune system.

Representation of the internal world in catatonic schizophrenia.

Catatonia, which until 1874 was called atonic melancholia, has remained a relative mystery despite many advances in the understanding of schizophrenia. Its typical symptoms are certainly distinctive: a motionless stupor, bizarre posturing, waxen flexibility, religious delusions, stereotyped movements, negativism, loss of will, confusion, and recurrent frenzy (Kahlbaum 1874). The processes which motivate this particular derailment of self and body have been sought in various organic etiologies, with little success. Arieti (1974) proposes several reasons for the paucity of case studies of the treatment of catatonic schizophrenia. First, catatonic schizophrenia has been declining in occurrence. Second, the symptoms themselves, such as mutism and excitement, make verbal therapy extremely difficult. Finally, catatonics often have no memory of their psychotic experiences. Psychotherapists have therefore had to rely on highly personal intuitions of their patients' crisis-in-being. Despite therapists' attention to nonverbal behavior, mutism and stupor are particularly effective hindrances to communication in psychotherapy. Psychotherapy is often not begun until the patient's symptoms ameliorate through chemotherapy and milieu support. The centrality of the verbal medium of communication in psychotherapy suggests that other approaches, using nonverbal media, may be indicated in the study of catatonia. This paper describes a treatment of a catatonic schizophrenic man which utilized movement and drama therapy. These methods were successful in evoking representations of the patient's inner life.

The Amytal interview in the diagnosis of late onset psychosis with cultural features presenting as catatonic stupor.

A case history of a man with atypical psychosis who exhibited catatonic stupor is reported. Amytal interview procedures used and the differential diagnosis for catatonia are discussed. Response to Loxitane was excellent, though this was clouded by the patient's belief in root medicine, a source of cultural incongruity between him and his therapist. Distinguishing between psychosis and cultural belief systems is shown to be essential in therapy.