My theme is travel. Travel, travelling, making a journey is often a metaphor for the journey of life. The great narratives, Homer’s Odyssey & Virgil’s Aeneid are both about journeys. In the Odyssey, Ulysses returns to Ithaca after the Trojan War & it takes 30 years to do so. His trials and his successes are symbolic of life’s trials and tribulations. In the Aeneid, the starting point is also the end of the Trojan War but this time it is the founding of the Roman Empire that results from Aeneas’ travels. Why is travelling and narratives about travel compelling? We are after all nomadic, migratory animals. Since our departure from the East African plains 150,000years ago, we have populated the earth and even now continue to travel. The fact of settlement in large cities, what we now call megalopolis, is a superficial cover for the irresistible desire to travel. Otherwise, there would be no Europeans in America or Australia, or indeed no Africans as modern Homo Sapiens all over the world. And the travel narrative harks back to this primordial nomadic urge and the interest in travel narratives satisfies this desire either to travel oneself or vicariously to do so.
I travelled among unknown men,
In lands beyond the sea;
Nor England! Did I know till then
What love I bore to thee
In travelling and meeting foreign peoples we can come to know who we are and also come to know and appreciate our own cultures. The expatriate English in Zimbabwe are more English than your average Englishman in Devon as are expatriate Indians or Nigerians across the world. Distance seems to accentuate the need to crystallise culture, to freeze it in time. My thesis is that there is much in common between the reports of travellers about the strange customs, appearance and behaviour of foreigners and the strange land of psychiatry. It is not accidental that psychiatrists were once referred to as alienists, a term that emphasises the perceived alien quality of psychiatric patients.
Let me start from Herodotus in his reference to Egyptians. By the time that he travelled in Memphis & Thebes, the Pyramids were already 2-3,000 years old. He said
About Egypt I shall have a great deal more to relate because of the number of remarkable things which the country contains, and because monuments which beggar description are to be found there than anywhere else in the world. The Egyptians seem to have reversed the ordinary practices of mankind. For instance, women attend market and are employed in trade, while men stay at home and do the weaving, Men in Egypt carry loads on their heads, women on their shoulders; [and Lord Almighty] women pass water standing up, men sitting down. To ease themselves they go indoors, but eat outside in the streets, on the theory that what is unseemly but necessary should be done in private, and what is not unseemly should be done openly
You can see that Herodotus, in describing another culture can only do so in comparison to what he is familiar with. In other words, descriptions always have a viewpoint and it is the departure from the usual, the familiar, and the supposed norm that attracts attention. As Edward Said would have said, in defining the Other we define ourselves. This is of course the case with psychopathology. It is the fact that thinking and perceptual disorders such delusions and hallucinations stand apart from what is usual, i.e.,are alien, that initiates our attention and interest and for the lay public, signals deviance and lays the groundwork for stigma and discrimination.
In travel writing, there is also, the fantastic, the impossible: This is yet still Herodotus describing what it is like south of Libya:
and here live the Garamantes, a very numerous tribe of people, who spread soil over the salt to sow their seed in..and it is among them that the cattle are found which walk backwards as they graze….The Garamantes hunt the Ethiopian hole-men, or troglodytes, in four-horse chariots, for these troglodytes are exceedingly swift of foot – more so than any people of whom we have information. They eat snakes and lizards and other reptiles and speak a language like no other, but squeak like bats. Ten days from the Garamantes is yet another hill and spring – this time the home of Atarantes, the only people in the world, so far as our knowledge goes, to do without names. Atarantes is the collective name – but individually they have none
Herodotus’ account of the Garamantes and Atarantes exemplifies the problem that social or cultural distance poses to clinical work. For Herodotus, social and cultural distance made anything south of Libya mysterious, fantastic or monstrous. The same is true of clinical practice. We meet this problem in many guises. See Falconer’s On horseback through Nigeria which opens
No one who is not quite callous to his fortune returns to Nigeria without feeling in full force of Touchstone’s argument. Those happy sunny days at home press upon one’s heart; in vain one thinks of busy cities and sweet companionship, of green fields and leafy lanes – those dank mangrove swamps are all too real! And beyond is a land of darkness, of sickness, of discomfort, of trial: the land where life at best is but existence, where one lives in the past and in the future, least of all in the present!’ And ‘Forcados should always be visited by night, for by day it is a dismal place. A few houses built on a spit of mud and mangrove-roots accommodate the Resident, the doctor, the Customs officer, and the Company’s agent. The native population consists of a dozen or so amphibious creatures, who inhabit a few waterlogged huts half-hidden amongst the mangroves and eke out a precarious existence upon the produce of their fishing nets
The emphasis is on the words ‘amphibious creatures’, that is less than human primarily because of their social distance from Falconer. What I am arguing is that the same sensitivity that ensures that we do not see any other human being in these terms, whether alien to our culture or not, also ensures that we treat patients irrespective of any abnormality of mind, as persons deserving respect, attention and proper concern.