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This is not a fete in here...

Local team studies perceptions of 'madness'

By Robert Clarke

Mrs Wright has a son who "gone mad." At least, so would say some of her neighbours. His doctors prefer the term schizophrenic.

Jeremiah turned 25 in February. He used to play football, but since he's been afflicted by mental illness, he no longer can. He's too weak, and plagued by headaches when not on his medication. He sometimes holds down a job (most recently, he was hired by CEPEP to prop up the barrier that prevents missiles kicked up by grass-cutters from hitting cars or passers-by) but he has often walked out of the workplace for no apparent reason. He is occasionally violent. Once, he hit his father and tried to squeeze the life out of him. More than once, he has brandished a cutlass and threatened to chop his closest relatives.

Mrs Wright loves her son. She is a devout Orisha and holds prayers for him from time to time. She bathes him when he comes home and constantly declares her love. This is the kind of woman who marches onto the block, with fear in her heart and power in her voice, and orders the pushers to stop selling marijuana to her son. This is the type of woman who pushers heed.

On a recent Thursday, Mrs Wright attended a focus group at the Arima Health Facility with four other parents of young adults with mental illnesses. The five caregivers were interviewed by psychologists David Robertson and Maia Hibben, both part of a psychiatric study called INTREPID that wants to unravel how people across four cultures perceive mental illness, and how their perceptions inform the treatments they seek.

The study will last three years and is taking place simultaneously in London, England; Ibadan, Nigeria; Chennai, India, and here in Trinidad. The medical professionals conducting it are interviewing faith healers and herbalists, psychiatrists and obeah men, and relatives of the mentally ill. They will then track 25 cases for two years, paying particular attention to the mix of treatments and outcomes.

Psychiatrist Dr Gerard Hutchinson is the principal of the study in Trinidad, in charge of keeping it all on track while continuing to teach psychiatry at the Mount Hope Medical School. The study is only months old – too early to draw many conclusions – but Hutchinson already knows that caregivers like Mrs Wright are using everything at their disposal to care for loved ones whose behaviour has been deemed deviant. He calls it: "Our capacity to carry all the available beliefs in one receptacle." This means Mrs Wright will go to clinic to get her son's anti-psychotic medication, but she will also "call a prayers" and consult her religious leader.

Mental illness is just that, an illness with biological causes that science is still trying to fully understand. The gaps in the understanding of those causes help explain the remarkable tenacity of belief that the disease has spiritual components. Where total comprehension seems impossible, humans turn to a higher power.

Mrs Wright says people "confused her head a little bit," distracting her from the spiritual aspect of her son's condition, but she overcame the misdirection. "I am a spiritual person," she says. "I deal with the priest and the babalawo and everything. My son will get angry with me and say, 'You see you and this praying thing!' But I know part of it (his treatment) is prayers and love. I knew that from the beginning."

Dr Hutchinson says these sorts of non-medical beliefs may not be so bad. "There's a lot of literature now endorsing the role of faith and prayer and all those things," he says, "if it is consistent with your belief system." Some spiritual treatments are helpful at best, and harmless at worst, but the INTREPID (India, Nigeria, Trinidad, Research into the Epidemiology of Mental Illness) researchers have already come across a local healer who claims to cast out the demons that he says cause madness by inducing vomiting. It is not a treatment many psychiatrists would endorse.

But even Mrs Wright knows the effect of taking her son off his medication. "I was still in denial," she says. "Last week, I said, 'Girl, doh let him take the tablets, and leh we see how he going.' Eh heh! He come home with one headache and start to act up."

The health minister said last month that 60 per cent of the in-patient population at the St Ann's Psychiatric Hospital have been "dumped" there by family members who are unwilling to care for them. The INTREPID focus group, however, is a group of five parents sitting in a circle talking about the trials and frustrations of caring for adult children at home.

Mrs Lendore's 19-year-old son has a history of substance abuse. He, too, has schizophrenia — the most feared diagnosis in all of mental health, characterised at its worst by delusions and paranoia, but also manageable to a certain extent. She has seen him mocked ("All you eh see Dennis gone mad!") and is quite distressed by his inability to focus on his studies. He recently dropped out of the Civilian Conservation Corps job-training programme after attending classes for six months. He said the tests were too difficult. "Right now, he lonely," says Lendore. "All his brothers and sisters have they own place, and he alone does be home, lie down whole day in he bedroom, and I does

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