Ngā whakawhitinga: standing at the crossroads : Māori ways of understanding extra-ordinary experiences and schizophrenia.

Abstract

Indigenous peoples and ethnic minorities are being diagnosed with schizophrenia at significantly higher rates than majority groups all around the world. Aetiological literature reveals a wide range of causal explanations including biogenetic, social and cultural factors. A major limitation of this body of research is the assumption of schizophrenia as a universal syndrome. When viewed through an indigenous lens, experiences labelled schizophrenic by Western psychiatry have been found to vary from culture to culture in terms of content, meaning and outcome. The current project aimed to investigate Māori ways of understanding experiences commonly labelled ‘schizophrenic’. The philosophical frameworks that guided the research were Kaupapa Māori Theory and Personal Construct Theory. A qualitative approach was used and semi-structured interviews were conducted with 57 participants including tangata whaiora (service users), tohunga (traditional healers), kaumatua/kuia (elders), Pākehā clinicians, Māori clinicians, cultural support workers and students. Four categories were derived from qualitative thematic analysis. These being: making sense of the experiences, pathways of healing, making sense of the statistics and what can we do about the statistics. Overall, Māori constructions related to other indigenous constructions of mental illness and wellbeing cited in the international literature but were in stark contrast to current psychiatric constructions. The current project indicated Māori participants held multiple explanatory models for extra-ordinary experiences with the predominant explanations being spiritual. Other explanations included psychosocial constructions (trauma and drug abuse), historical trauma (colonisation) and biomedical constructions (chemical brain imbalance). Based on these findings, recommendations for the development of culturally appropriate assessment and treatment processes are presented. Over the last couple of centuries a single paradigm, the medical model, has come to dominate the explanation and treatment of illness in Western society. Via legal and political means, indigenous models of illness and wellness have been wiped out or forced to the margins of many societies. This thesis aims to challenge the dominant medical model that has privileged psychiatric knowledges while suppressing others by repositioning indigenous construction at the centre of the research via a Kaupapa Māori framework. Chapter One aims to deconstruct current medical constructions by presenting psychiatry as a culture in itself as opposed to a discipline dedicated to scientific truths. This chapter posits that the culture of psychiatry has lead many clinicians to suffer from “cultural blindness” when working with indigenous and ethnic minority groups. Chapter One uses the tools of science to question the scientific validity and reliability of the construct “schizophrenia”. I conclude that this construct is “unscientific” in itself. I will also look at three themes highlighted by other researchers regarding the treatment of mental illness throughout Western history: treatments are used as a form of social control; treatments can be dehumanising; and the dominance and power of the medical model to define who and what is considered ill. Chapter One also acknowledges the significant role of the consumer movement in developing more humane treatments.

Interactions between culture and psychiatry via colonisation are outlined in Chapter Two. I also critique research that is conducted cross culturally in terms of whether researchers attempt to establish the reliability of universal diagnoses or recognise local and unique constructions. Chapter Two challenges the commonly cited finding of higher rates of schizophrenia for ethnic minorities and indigenous peoples by questioning the validity of foreign cultural constructs to explain indigenous forms of illness. This chapter recognises indigenous and cultural constructions of what psychiatry labels ‘schizophrenic’. To illustrate, three ‘culture bound syndromes’ will be discussed. The development of indigenous psychological paradigms is also presented to position the current research within this wider international movement.

Chapter Three summarises Māori constructions of illness and wellness. This chapter predominantly draws from early anthropological literature and subsequent psychological studies to represent the resilience of Māori constructions of experiences commonly labelled schizophrenic. In accordance with the experiences of other indigenous populations, this chapter also recognises the impact of colonisation on Māori beliefs and practices relevant to maintaining wellness. To illustrate the effect of colonisation, disparities in statistics between Māori and non-Māori for admissions and readmissions to inpatients units for psychotic disorders will be discussed. Explanations for these disparities will also be outlined. Within Chapter Three, the resistance and revival of Māori constructions is also recognised as a function of the development of bicultural and Kaupapa Māori Services.

Chapter Four, summarises the theoretical orientation of the research. This research is qualitative and assumes a post-modern critical paradigm. Two theoretical frameworks were used within this research (Kaupapa Māori Theory and Personal Construct Theory) to represent the two worlds in which the research was conducted (Indigenous and Western).

Chapter Five outlines the methodology by recounting a somewhat layered journey. Within the first section, ‘Who am I’, I have positioned myself by sharing my journey towards conducting this project. The second section, ‘Where did I want to go’, outlines the research aims and process of consultation. The final section summarises ‘What I did’ in terms of qualitative interviews and the process undertaken for interpretation and presentation of the data.

Chapter Six presents the results of the research according to the four categories developed from qualitative analysis. These were: ‘Making sense of extra-ordinary experiences’, ‘Pathways of healing’, ‘Making sense of the statistics’ and ‘What can we do about the statistics’. Within this chapter I have attempted to present quotes with as little interpretation as possible (over and above sorting of themes) to allow the reader to make their own interpretations before reading the discussion.

Chapter Seven summarises the major findings from each category and relates the results to the national and international literature. Clinical and theoretical implications are discussed with recommendations for future research. The limitations and strengths of the research are highlighted and conclusions drawn from the research journey. The plan for dissemination is also presented.