Of Spirits and Madness
An American Psychiatrist in Africa
Notwithstanding four years of medical school and an eight-year residency, a psychiatrist really learns his trade from his patients. After five years of practicing in San Francisco, including stints in the emergency room and the city jail, Paul Linde thought he had seen it all. When his pediatrician wife decided she wanted to practice medicine in Africa for a while, he went along for the ride, not expecting that the experience would transform his life. Of Spirits and Madness is Linde's account of his year spent practicing psychiatry at Zimbabwe's Harare Central Hospital. With compassion, good humor, and growing insight he describes his patients and their demons and difficulties. We meet Winston Chivero, who injures himself by sticking needles and nails into his leg in order to protect his community from a bewitchment; Sister Pagomo, a Shona nurse suffering from kufungisisa, or "thinking too much"; Esther Mawena, who tries to kill herself after her husband gives her AIDS; Samuel Rugare, a 28-year-old laborer driven mad by too much mbanje, or cannabis; and many others.
Overwhelmed at first by the press of suffering humanity waiting patiently in his clinic to see him, Linde gradually comes to understand how mental illness cuts across cultures. He also sees the devastation it can cause in a country where psychosis is severely stigmatized as a contagious spiritual illness caused by witchcraft. Most of all he is left with many important lessons from his patients who endure poverty and illness with incredible patience and spiritual dignity.
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What Reviewers Are Saying
An American doctor who served as a government psychiatrist for the Zimbabwe Ministry of Health draws on his clinical experiences to create a beguiling account of culture shock in a hospital setting. Linde, an emergency psychiatrist at San Francisco General Hospital, was no stranger to the interconnectedness of mind, body, and spirit in April 1994, when his search for personal fulfillment led him to Harare General's psychiatric unit. Eager to understand the role played by spirits in the lives of his beleaguered patients, he immersed himself in the belief system of the Shona people. Linde knew that families often brought members to him as a last resort after failed treatment by a traditional Shona healer, who treated for bewitchment by ancestor spirits, or an evangelical Christian healer, who used exorcism rituals to counter demonic possession. While sensitive to the cultural beliefs of the Shona, which included the notion that mental illness was contagious, Linde nevertheless followed a Western approach to treatment of his patients. Besides AIDS-related dementia, psychoses, schizophrenia, and depression, he was called on to treat "kufungisisa," or "thinking too much," a condition many Shona believed could be caused by supernatural factors. In one especially bizarre case, he concluded that a young man who asserted that he was bewitched, was actually inserting needles and nails into his own leg to protect his community from the punishment he feared it would suffer for his crime of killing an owl. Linde's clinical successes were limited, given his scarce resources and the extreme poverty he faced, and he returned to the US after a year. These accounts, written several years later, disguise the identities of his patients or are composites. An exception is the eleventh and final one, featuring a composed young man whose mindset the author especially admires but is unable to emulate. Revealing glimpses, sometimes amusing, sometimes appalling, of a world where spirits are accepted as a part of everyday life. (Kirkus Reviews)