Between Trauma and the Sacred ― The Cultural Shaping of Remitting-relapsing Psychosis in Post-conflict Timor-leste

This volume discusses how recurrent brief-psychotic episodes represent an alternative, culturally shaped dissociative response to trauma and as such that trauma-imbued lulik symbols become sufficient to evoke the trauma-related patterns of distress described. The authors develop a contextually grounded and systemically informed dual model of psychotic and psychotic-like symptoms, which may represent an understandable reflection of traumatic structural dissociation, or, a form of culturally patterned dissociative-conversion process, predicated on popularised local understanding of madness. Narrative is proposed as the bridge between anthropological and traumatic models of dissociative-psychotic phenomena, and culture itself is argued to be a key organising principle bringing greater coherence to fragmented states of mind. Links between brief and more chronic psychotic states are also explored, in dialogue with the question of better outcomes for psychosis in “the developing world". ?ealth Study, conducted in the context of recently won independence and in the wake of the atrocities endured in the protracted fight for sovereignty. Further unanticipated was the frequent association of recurrence with the time of the new moon (fulan lotuk) and other times-places of sacred (lulik) cultural significance, while the perceived violation of culturally sacrosanct lulik obligations often appeared to foreshadow the onset of such patterns of distress. Significant episodes of trauma and loss appeared a hidden feature of affected individuals histories, which have become symbolically entwined with local cultural understandings of ritual obligation, sacredness, and taboo.

Dr. James Rodger is a Consultant Child and Adolescent Psychiatrist in the United Kingdom National Health Service and an Honorary Associate Research Fellow at the University of Exeter. He holds an additional degree in Medical Anthropology and has undertaken postgraduate training in Systemic Practice. His principle clinical and research interest is the developmental, social and cultural aspects of psychotic phenomena and related implications for intervention. He undertook the key fieldwork forming the basis of this work in 2004, in the context of an 18-month mental health research program in Timor-Leste. In addition Dr Rodger has provided expert evidence relating to transcultural trauma-related psychiatric presentations for both asylum and criminal cases. Previous publications relate to the wider epidemiological research findings and implications from Timor-Leste, to critical-relational challenges to psychiatric practice, and to the anthropology of altered mental states.

Zachar

y Steel is a clinical psychologist who holds the St John of God Professorial Chair of Trauma and Mental Health, School of Psychiatry, University of New South Wales and Richmond Hospital, New South Wales, Australia. Dr Steel has developed a program of mental health research across culturally diverse communities and settings with a particular focus on traumatic stress, forced displacement, conflict and culturally specific symptoms of mental disorder and distress. Within the Asia-Pacific region he is involved in collaborative mental health research programs in Vietnam, Aceh-Indonesia, and Timor-Leste as well as with asylum seeker and refugee communities in Australia and amongst Aboriginal communities in Far West New South Wales. His research with asylum seeker populations in Australia has helped to develop an evidence base on the adverse mental health consequences of harsh asylum policies including the use of immigration detention and temporary protection visas.