Whenever a piece of glass breaks, Gede Sudiasih opens the notebook that lies on his living room table and makes an entry. He writes down what the glass was and the exact time, the day and the year that it broke. He then checks and rechecks his entry. Only after he is assured the information is accurate can he close the notebook and return to his daily routine. Decades of incidents have been recorded in this notebook.
Gede is an anxious, haggard-looking man who lives in a small village on the Indonesian island of Bali. Like many other Balians with mental illness, he is treated no differently than his fellow villagers and shows up for work as a government employee every day. But his compulsions are very real. Recording broken glass, in fact, is far from his only obsession. He keeps track of the name of every person who passes by his house; and he is driven to revisit dead chickens he sees along the road, until he has inspected their most minute details. If he can't get the names or information he needs, Gede is overtaken with feelings of anxiousness so strong that it makes him want to die.
To rid himself of this curse, Gede has gone to traditional healers known as balians. One balian diagnosed Gede as a victim of black magic; the prescribed cure, which involved receiving a magical gold amulet and performing a purification ritual, left him feeling no better.
A Western psychologist would make another diagnosis: obsessive-compulsive disorder (OCD). People with OCD are compelled to perform repetitive tasks in a repetitive way, coupled with uncontrollable thoughts or impulses. But the way the illness presents itself in Gede is quite different from the way OCD presents itself in an American. And that difference may give researchers like myself an opportunity to understand the illness better.
So much is still unknown about how biology drives behavior in people afflicted with mental illness. One way for researchers to get a handle on this question is to study the way certain illnesses express themselves in people living in other cultures. Mood disorders such as depression are in many ways shaped by culture—not only in what triggers the depression itself but also in how the mood is expressed. Even diagnoses have to contain some knowledge of the culture of the patient; someone who is battling unseen tormentors would appear psychotic in Western eyes but perfectly normal (if unlucky) in a region where spirits are believed to be real and powerful.
So-called normal behavior is defined differently from country to country. For a true understanding of a person's mental state, psychologists might have to piece together a complete cultural case study, much as an anthropologist would. For example, psychiatrist and anthropologist Devon Hinton, Ph.D., has studied how panic attacks are set off—and how they are expressed—among Cambodian refugees in America who suffered trauma at the hands of the Khmer Rouge. Hinton posits that the physical symptoms of panic are described as very different bodily experiences, such as the feeling of wind flowing through the body, and that these sensations better describe the panic attacks than the more psychological language used by post-traumatic stress disorder sufferers in the West.
What's more, by combining psychology and anthropology, a scientist can search for the universal biological cause that can create a multitude of behaviors. An illness such as depression or OCD can be thought of as a lens that magnifies certain aspects of a culture, and understanding the way the same illness differs across cultures can help researchers understand the way that lens is shaped. In 1997, I examined Balinese people who appeared to suffer from obsessive-compulsive disorder. In the people I studied, the outward signs of the illness—and the patients' own view of their behavior—was markedly different from what psychologists generally encounter in the West.
An estimated 3-million Americans suffer from obsessive-compulsive disorder. In most instances, the rituals of OCD victims are seen as a way to ward off some dreaded danger: repeated hand washing, for example, to prevent catching a disease, or hoarding seemingly useless items because they might one day come in handy.
Now, to be sure, many of us experience little compulsions from time to time, ranging from the desire to remember the name of a song to jumping over a crack that might "break your mother's back." But when obsessions stand in the way of doing everyday activities, psychologists begin to wonder if OCD may be driving those impulses.
Not everyone with OCD has the same obsessions. And the differences are especially marked when OCD is compared across cultures. In the U.S. and Europe, cleanliness pops up again and again. What's more, the worrying isn't simply about health: One of the more common obsessions is the ungrounded fear that one will commit some terrible sexual act.
Interestingly, though, the obsessions in predominantly Islamic countries focus on a different aspect of life. Research conducted in Saudi Arabia and Egypt shows that religion and the correct observance of religious ritual—not contamination—are very common compulsions. Assuming that OCD has the same biological effect on both Egyptians and Americans, what is it that creates such a different set of symptoms? And could studying the way obsessive-compulsive disorder drives behavior in people as different as Eskimos and Ethiopians help unlock the secret of exactly how the brains of people with OCD differ from healthy people?
