Between Trauma and the Sacred

The relatively frequent occurrence of rapid onset and very brief, but often florid, psychotic states, with periodic recurrence, alongside relatively low rates of PTSD and chronic psychosis, were unexpected findings from the 2004 East Timor Mental Health Study, conducted in the context of the country's 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 or places of sacred (lulik) or associated cultural significance. The perceived violation of culturally sacrosanct lulik obligations often also appeared to foreshadow the initial onset of such patterns of distress. Significant episodes of trauma and loss appeared a hidden feature of affected individuals histories, which we argue have become symbolically entwined with local cultural understandings of ritual obligation, sacredness, and taboo.
This volume develops a dynamic but contextualized multi-level formulation of psychosis and psychotic-symptoms, able to incorporate a range of factors from the biological, through the sociocultural, to the political. The work is truly interdisciplinary drawing on both the quantitative and qualitative findings of our own study but further supported through local ethnography and broader anthropological enquiry into the outcomes of psychosis in non-Western settings; psychoanalysis and psychoanalytic anthropology; evidence and theory exploring links between trauma, dissociation and psychosis; and novel culturally-adaptable psychosocial focused interventions for psychosis. We situate both evidence and theorising in wider epistemological and political context, including in relation to the movement for Global Mental Health. Culturally patterned presentations of brief remitting-relapsing psychosis are ultimately conceived as the trade-off between competing fragmentary and synthetic forces: the former in part secondary to the lasting and deleterious effects of overwhelming loss, trauma and adversity; the latter emboldened by cultural meaning and social response in the context of broad ecological pressures demanding survival and resilience.
About the Author:

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.