Schizophrenia
Resources
Basic Information
What is Schizophrenia?Historical & Contemporary Understandings of SchizophreniaSchizophrenia Symptoms and DiagnosisSchizophrenia TreatmentSchizophrenia References
More InformationLatest NewsQuestions and AnswersLinksBook Reviews
Related Topics

Anxiety Disorders
Depression: Major Depression & Unipolar Varieties
Personality Disorders
Addictions: Alcohol and Substance Abuse

by Nancy Scheper-Hughes
University of California Press, 2001
Review by Gina Zavota on Mar 18th 2002

Saints, Scholars, and Schizophrenics: Mental Illness in Rural Ireland

When Nancy Scheper-Hughes’s Saints, Scholars, and Schizophrenics: Mental Illness in Rural Ireland first appeared in 1977, it attracted immediate attention on both sides of the Atlantic.  But despite being widely celebrated in North American anthropological circles, it shocked and outraged many of those who were its subjects: the residents of the tiny village of An Clochán on western Ireland’s Dingle Peninsula.  They took offense at what they perceived as a breach of trust, an illicit airing of secrets about their sexuality, mental and emotional health, and family life which they had confided in strictest confidence.  Now, more than 25 years after the conclusion of her fieldwork, Scheper-Hughes is still attempting to resolve the conflict between her professional duties as a psychological anthropologist and her personal responsibility toward her friends in An Clochán.  In her new prologue and epilogue, written especially for this 20th anniversary edition, she confronts this conflict in an eloquent discussion which touches on issues of philosophical importance to the field of anthropology while highlighting the development of her own relationship to her work and the subjects of that work in the intervening years.  The quality and substance of these added sections make this justifiably classic work even more valuable to scholars and interested laypersons alike.

The subject of Scheper-Hughes’s book alone would be enough to raise eyebrows in some circles: it is an attempt at “a broad cultural diagnosis of those pathogenic stresses that surround the coming of age in rural Ireland” (60) and that, in her opinion, contribute to an extremely high incidence of schizophrenia in the country’s western counties.  This tendency is especially pronounced among the area’s young and middle-aged “bachelor farmers,” the men who have been subtly coerced by their families into remaining in the village of their birth and taking over their fathers’ farms in an age where farming has lost its once high status as a profession and has become economically unprofitable in all but a very few cases.  The breakdown of the traditional extended family structure, along with the emigration of many of the eligible young women from rural Irish villages, has resulted in these men living lives of social isolation, loneliness, and mostly unwanted celibacy.  More than even this unfulfilling lifestyle, however, the brutal socialization process, in which the perceived “runt” of a family is demoralized, scapegoated, and made to feel overwhelming guilt if he refuses to remain at home to tend to his aging parents and inherit the family farm, is singled out by Scheper-Hughes as leading to the emergence of schizoaffective symptoms.

In her analysis, Scheper-Hughes draws on several different methodologies, ultimately developing a new and fruitful paradigm for fieldwork in psychological anthropology.  She attempts to strike a balance between a thoroughly medical view of schizophrenia, in which it is regarded as a personal, inner disorder – whether organic or psychical in nature – and an interactionist perspective that situates it in the relationship of the individual to her community and surroundings.  In addition, she emphasizes the significance of cultural and historical analysis to the interpretation of mental illness.  In her introduction, “Mental Illness and Irish Culture,” she situates her work within the “culture and personality” school, whose most celebrated adherent, Margaret Mead, revolutionized anthropology with her focus on the role of an individual’s culture in the development of her character.  By trading statistical analysis and cross-cultural hypotheses for intensive, immanent study of a single community, Mead ignited a profound and still unsettled methodological debate within cultural anthropology.  However, despite her debt to this school, Scheper-Hughes balances her subjective observations of life in An Clochán with analysis of the responses of several dozen youth to the Thematic Apperception Test (TAT) – a sample which included both “normal” village youth and young patients at the district mental hospital and a local psychiatric clinic.  The two approaches combine to give an extremely revealing view not only of the etiology of schizophrenia in rural western Ireland, but of the often pathogenic social and cultural dimensions of life in An Clochán and, presumably, other villages like it.

Cloaking the true name of the village under the moniker “Ballybran,” and referring to the villagers, or “parishioners,” with pseudonyms, Scheper-Hughes attempts to afford them a modicum of privacy while describing their intimate relations in great detail.  The complete failure of this strategy – not only were the villagers able to identify each other instantly upon reading the book, but the identity of the village itself was also eventually discovered by persistent researchers and curiosity-seekers – illustrates what is at once the greatest failing and one of the most intriguing aspects of this masterful and eloquent study.  Despite her extremely keen understanding of the social dynamics of the community in which she was immersed, Scheper-Hughes was ultimately unable to negotiate the Irish need for privacy, to reconcile it with her commitment to the demands of anthropological fieldwork and analysis.  For that need could not be met by the marginal anonymity afforded by pseudonyms; the very fact that their innermost fears and desires were committed to print at all, however, anonymously, is what so shocked and angered the villagers.  Thus a standard of privacy that would perhaps suffice for a resident of a large North American city was considered a betrayal of trust in tiny An Clochán.

The intimacy of the study was necessitated by Scheper-Hughes’s concentration on family relations, which she sees as profoundly implicated in the emergence of schizophrenia among the community’s most vulnerable members.  Before her analysis of family structure and socialization, however, she first gives an “ethnohistory” of An Clochán, a reconstruction of its mythic past from stories told about its founding by seafaring Celts and subsequent conversion to Catholicism by Saint Brendan.  She goes on to consider the changing demographic and economic patterns within An Clochán, most predominantly the emigration of many of its young women and firstborn sons and the devaluing of the traditional family farming lifestyle in the light of insurmountable competition from large international collectives.  These two developments have resulted in a widespread demoralization or anomie within the segment of the population that has been “left behind” in the village, especially its bachelor farmers, who are most directly affected by both.  Finally, Scheper-Hughes turns to conventional epidemiological data to elaborate on the distribution of mental illness in rural western Ireland.  Through consideration of variables such as gender, marital status, and birth order among hospitalized patients, she bolsters her argument that it is precisely those “discarded” late-born sons and potential farm heirs who are at greatest risk of developing schizophrenia and other forms of serious mental illness.  Weaving a discussion of the attitudes of the villagers toward various forms of unconventional behavior into the analysis, she simultaneously illustrates their predilection toward labeling this group “abnormal” and institutionalizing its members when they rebel against their prescribed societal role.

In the final three chapters of the book, Scheper-Hughes focuses on family relations, in particular those between mothers and children.  Here she presents the material that aroused the most ire among the parishioners of An Clochán, particularly in Chapter 4, “Brothers, Sisters, and Other Lovers,” where she describes what she characterizes as a climate of fear and mistrust between the sexes, an antipathy toward marriage, and a seeming rejection of adult conjugal relationships in favor of brother-sister and mother-son relations with repressed incestuous undertones.  After this analysis, she shift her focus to the socialization process which she believes produces schizophrenic potential farm heirs and anomic bachelor farmers – a process which she characterizes as being “weighted in favor of the mental health of daughters and earlier-born sons, and against the chances of healthy ego integration of later-born sons” (267).  She details a pattern which includes minimal contact as an infant, corporal punishment, and most tellingly, the chronic discouragement and humiliation of those sons considered to be, by their very nature, unsuitable for anything other than remaining at home to tend their aging parents in and inherit the family farm.  This labeling process, by means of which the most psychologically vulnerable member of the family is forced into the role of underachieving “black sheep,” encompasses not only the immediate family, but also schoolteachers, peers, and the community in general, and is for Scheper-Hughes profoundly psychogenic.

It is clear throughout Saints, Scholars, and Schizophrenics that Scheper-Hughes reflected profoundly on the social and sexual dynamics of the people among whom she lived, and with whom she developed a bond of friendship.  Despite her almost complete immersion into village life, however, it appears that this reflection did not extend to a consideration of the effects of her work on her neighbors and friends.  At the end of her original introduction, she states that “I trust [the villagers] realize that although I stress some of the more dismal aspects of their life . . . they will accept the large measure of my concern for their physical, emotional, and spiritual well-being” (75).  Seen from the perspective of current anthropological paradigms, such confidence seems impossibly naïve, perhaps a consequence of wishful thinking.  Despite the great care she takes to divorce her analysis from the influence of cross-cultural norms, in the end she draws her conclusions about how the villagers will react to her work on her own terms, not those of An Clochán.  This may very well be an almost unavoidable consequence of the anthropologist’s position, and indeed of human subjectivity in general, but its universality renders it no less problematic.  Rather, it calls into question the ethical status of anthropological fieldwork, forcing sensitive and perceptive researchers such as Scheper-Hughes to reflect profoundly on their human as well as scientific failings.  Thus, if the book exposes the dark secrets of the residents of An Clochán, it also affords the reader an intimate glimpse of the author’s biases, uncertainties, and weaknesses.

This unusual personal dimension gives Saints, Scholars, and Schizophrenics an appeal beyond that of ordinary accounts of anthropological fieldwork, an appeal that is intensified by the apologietic and self-reflective material which has been added for this new edition.  Given that Scheper-Hughes herself now acknowledges the problematic nature of her original analysis and attempts to make amends, it is difficult to take her to task for it, especially since the work is otherwise so thoughtfully executed.  In her new epilogue, “Crediting An Clochán” – a title undoubtedly inspired by one villager’s complaint that “ya just didn’t give us credit” (311) – she details the high status of women in the village, the nonexistence of crime, and the warmhearted way in which she was integrated into the community upon her arrival 1974.  Realizing that it is impossible “to diagnose just what ails a community and then prescribe a few magic, silver-bullet solutions” (20-1), she speculates in the prologue “Writing Ireland” about her shortcomings as a researcher and friend, many of which can be attributed to her understandably being unable, as a young researcher doing her first significant piece of fieldwork, to recognize and move beyond the flaws inherent in the anthropological paradigms of the time.  In confessing her sins, she, like the residents of An Clochán in their weekly sessions with the village curate, holds herself to an impossibly high standard. 

Despite having first appeared 25 years ago, Saints, Scholars, and Schizophrenics still feels remarkably current, due not only to its methods, but also to the often philosophical issues it raises, many of which are still very relevant today.  The debate over the extent to which mental or even physical illnesses are constructed by societal factors, for example, has taken on a new intensity with the emergence of poorly-understood conditions such as Attention Deficit Disorder and Chronic Fatigue Syndrome, and with forensic psychologists regularly being accused of fabricating various “syndromes” in order to help criminals escape conviction.  The relativity of terms such as “deviant” or “sinful” is also becoming increasing apparent as globalization brings cultures with diverse norms into ever more frequent contact, and conflict, with one another.  Finally, the forced institutionalization of young people who refuse to take on a particular societal role finds analogues in, among other places, current debates over a family’s right to choose to remove a patient from life support when her wishes are not explicitly known.

Saints, Scholars, and Schizophrenics exists at the nexus of anthropology, psychology, and philosophy.  This alone makes it highly recommended for professionals in any of these fields who appreciate the importance of both an interdisciplinary perspective and a personal investment in scholarly work.  In addition, Scheper-Hughes writes with a lucidity that clarifies without oversimplifying, rendering the work accessible to interested laypersons as well.  Her starkly eloquent prose perfectly reflects the intertwining of scientific rigor and personal insight so evident throughout the book.  Even – or perhaps especially – those who were engaged by the first edition will find this new one rewarding, for the insight, self-reflection, and philosophical inquiry contained in the new prologue and epilogue constitute a truly substantive addition.  Most importantly, perhaps, this book should be read because of its evolving history, its status as a work in progress, representing not merely an account of research carried out during several months in the mid-1970’s, but the ongoing engagement of a scholar with her profession, her world, and herself.

 

© 2002 Gina Zavota

Gina Zavota, Department of Philosophy, SUNY at Stony Brook