human behavior

The cultural literacy demands of medicine

Posted in Australian Culture & Politics, Health & Medicine by humanb on September 24, 2009

I had a fascinating chat with a middle-aged woman with schizoaffective disorder today. We sat in a meeting room of the mental health ward of the hospital to which I am attached. The very abled senior psychiatrist led the interview as three of us students observed and asked a few questions towards the end.

Here is the patient – let’s call her Rita – in her own words. When asked about how she feels about taking the antipsychotic mediciations prescribed to her:

Rita: You can’t give me medicines! I am a doctor. That is illegal. I know. I am a high court judge.

Doctor: What is your evidence that you are a high court judge?

Rita: [Pause.] People tell me. I am a high court judge.

Doctor: Do you have any evidence? Do you have a degree? A piece of paper?

Rita: [Pause.] No. I have an honorary degree.

Rita also said on more than one occasion that she owns property in Pymble and in Paris, that her husband had bought her, but she could not provide the addresses.

I attempted to assess Rita’s understanding of what is true about her personal life, and so I asked her about her family – knowing she had several brothers and sisters.

humanb: Do you have any brothers and sisters Ma’am?

Rita: No. My parents are John F. Kennedy and Marilyn Monroe.

humanb: You don’t have any brothers or sisters?

Rita: Yes, JFK Jr. is my brother.

Rita made more references… to Kerry Packer and others.

Oh, and she spoke most of her husband. In fact, every other sentence she spoke was a declaration of her marriage:

Rita: My husband is Michael Hutchence. My husband is Michael Hutchence.

Doctor: But he’s dead Rita.

Rita: He’s in heaven. Michael Hutchence talks to me in heaven.

Student #2: Ma’am, is he talking to you now?

Rita: No. You are.

I hadn’t a clue who Michael Hutchence was. I am not sure the young, Asian, international student knew who Kerry Packer or Marilyn Monroe were.  Maybe she did. Maybe I was the only culturally illiterate one.

Schizophrenia is characterized by:

  1. delusions (disorders of belief): fixed, false beliefs that are not in keeping with one’s cultural background despite evidence to the contrary – including persecutory delusions (“they’re out to get me”), grandiosity (“I am the Messiah”), and misidentification (“my husband has been supplanted by an almost identical imposter”, e.g.)
  2. hallucinations (disorders of perception): the perception of things that do not exist – be they auditory, visual, olfactory or somatic
  3. disordered thought and speech: thought and speech that are illogical, with constant deviations in topic (tangential), loose associations, irrelevant detail (circumstantial) or made-up words (neologisms), which lacks connectivity, and which is difficult to follow

Schizoaffective disorder is schizophrenia with a significant affective component – that is, a mood disorder, such as major depression.

I find the definition of “delusion” fascinating. What is a fixed, false belief?

Is the worship of an omnipotent God (who came down from heaven to be born a Jewish boy in order to be crucified so his father/God/him could forgive every human that would ever live of all all their crimes) a fixed, false belief ?

Is the conviction that your deceased love one speaks to you and tells you to move on with your life a fixed, false belief?

No and no – primarily because the cultures in which we live declare these beliefs acceptable. I suppose also that there is no actual evidence to the contrary in either case.

Clearly, to be the best doctor to Rita, one must be acquainted with the culture in which she lives. So I just Googled Michael Hutchence.

(January 22, 1960 – November 22, 1997)

Thank you Rita, for teaching me about the human mind… and Australian culture.

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One Response

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  1. Condor said, on September 25, 2009 at 3:33 am

    Very nice. I am so glad you are back.

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