religious construction of a first episode of psychosis in urban brazil

Religious Construction of a First Episode ofPsychosis in Urban Brazil

CRISTINA REDKOCentre for Addiction and Mental Health

Abstract Religion plays an important role in the lives of people withpsychosis. Based on fieldwork with 21 families living in poor neighborhoodsof So Paulo, Brazil, this article examines how youth suffering a first episodeof psychosis resort to religion for help (including, Catholicism, Pente-costalism, Candombl, and Umbanda) and how this frames their experienceof psychosis and that of their family members. For young people, thepersonal articulation of religious idioms and signifiers served to communi-cate, elaborate and transform their experience of psychosis. Familymembers resorted to religion as a source of healing, complementary topsychiatric treatment, as well as for personal relief and comfort. For youth,involvement with religion worked in both progressive and regressive ways,to improve and, at times, to diminish functioning and well-being.

Key words Brazil psychosis religious healing religious help-seeking

A first episode of psychosis is a devastating experience that involvesthe construction, or better still, the creation of a world that makes sensefor the person who is experiencing psychosis, but does not make sense forothers. Phenomenological psychiatrists such as Binswanger (1963) havedescribed psychosis as a particular mode of being-in-the-world in termsof inconsistency, disordered experience or the inability to let things be.Blankenburg (1991) defined psychotic experience in terms of the loss ofthe sense of the self-evident that nurtures ones feeling of inhabiting a

Vol 40(4): 507530[13634615(200312)40:4;507530;038906]Copyright 2003 McGill University

transculturalpsychiatry

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December2003

familiar world. People suffering from psychosis lose access to commonsense and to the rules of the game that regulate everyday life. These lossesaffect their relationships with others because people with psychosis areunable to master the rules that run through and orient interpersonalrelationships.

In general, it is quite common to hear people talk about their experi-ence of psychosis by using religious referents: Im Jesus Christ, It is likemanifesting the devil, I became biblical, pure of heart and soul, It seemedlike the Apocalypse . . . nothing was real, nothing was true, Just like thevoice of God calling me. Because these religious referents emerge withgreat frequency, it becomes evident that religion influences the manifest-ation and the experience of psychosis. Beyond this, religion is alsoconsidered a potential source of help and healing. In these ways, religionplays an important role in the lives of people with psychosis. However, Iargue that resorting to religious referents does not necessarily have ahealing function. Religious referents occasionally reinforce only fear andconfusion, depending on the attitude adopted towards them.

In this article I describe how young people suffering a first episode ofpsychosis in urban Brazil resorted to religion and how this framed theirexperience of psychosis and the reactions of their families and commu-nities. All of the families who participated in this study sought religioussources of help in addition to psychiatric care. After psychiatric services,religious sources of help were by far the most prevalent in their help-seeking trajectories. As has been documented in the literature (Loyola,1984), seeking religious help is related to the importance attributed tospiritual healing in Brazilian culture, as many Brazilians believe thathealing must involve both bodily and spiritual aspects of the person.

Religious Idioms, Signifiers and the Work of Culture

Religious idioms and signifiers are diverse and pervasive in Brazilianculture. Religious idioms are the specific discourses disseminated bypopular Catholicism, Pentecostalism, Candombl, and all other religions.Religious signifiers (or referents) may intersect several religions, but havemore specific attributes than idioms, such as the notions of God, devil,Bible, macumba (black magic), and so forth. For instance, spirit possessionprovides a particular religious idiom that enables the possessed individualto articulate a certain dimension of his or her experience and to give it newmeanings. According to Crapanzano (1977), this articulation of thepersons experience takes place because cultural idioms represent a matrixof meanings and provide a basis for action both at the personal and thecultural levels. It is also important to pay attention to the different ways

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that cultural idioms and signifiers are borrowed, used, and transformed byparticular persons.

Through the notion of work of culture, Obeyesekere (1985, 1990)1

examined how certain religious idioms and signifiers contribute to elabor-ate the inner experience of the person suffering psychosis. A particularreligious signifier may be interpreted or used differently by people withpsychosis and their families, in different contexts or at different periods oftheir lives. Obeyesekere explored the ways in which collective symbols areappropriated by singular persons and used to express, transform, andcommunicate personal experiences of distress and suffering. His notion ofpersonal symbols expresses the idea that some symbols operate simul-taneously at the personal and cultural levels; they allow the expression ofthe unconscious thoughts of the individual and provide a basis for self-reflection (private dimension), as well as for communication with others(public dimension). Because these personal symbols are public and privateat the same time, they provide the person with options, choices, and theleeway for manipulation. In addition, they can operate either in a progres-sive way, towards restoration and elaboration, or in a regressive way,remaining trapped within repetition, personal conflicts, or problems(Obeyesekere, 1981, 1990).

Resorting to cultural signifiers, and more specifically religious signifiers,can contribute to articulating personal and interpersonal reactions topsychotic symptoms and in framing this experience lead to the furtherevolution of the disorder. This perspective is demonstrated in the seminalwork of Ortigues, Martino, and Collomb (1967) conducted in a clinic inDakar. They showed the particular ways that a patient, Aminata, was ableto solve interpersonal conflicts, and to re-organize her initial psychoticstate of bouffe dlirante while manipulating a series of religious signifiersthat involved her affiliation with the Islamic cult of rab, as well as herbeliefs in child spirits and magical practices. In a similar vein, Corin,Thara, and Padmavati (n.d.) have shown how people with psychosisand their families in South India mobilize different representations including religious referents while elaborating what is specific in theirexperience of psychosis.

Method

This research is based on 12 months of ethnographic fieldwork in the cityof So Paulo, Brazil. The first phase of fieldwork consisted of the recruit-ment of and participant observation with 21 young people (10 males, 11females) in the psychiatric emergency service of a large public universityhospital that primarily provides care to a low-income population. Thesecond phase of fieldwork unfolded as I interviewed these youths and their

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families and followed them in their everyday lives for a period of at least6 months after the initial recruitment and informed consent. I normallycontacted them once every two weeks. Initially, each young person and,separately, a family member (usually the mother) responded to theTurning Point Interview (TPI), a qualitative semi-structured questionnairefor the retrospective evaluation of the development of signs and diffi-culties, interpretations, and reactions in early schizophrenia (Corin,Lesage, King, & Van Haaster, 1996). The elements of the perceived lifehistory collected through the TPI were complemented during the secondphase of fieldwork with more interviews and informal conversations. I alsospent time with the youths during their daily lives trying to understandtheir life strategies, and their interactions with their family, socialnetworks, and neighbors. I paid special attention to their direct or indirectcontact with religious settings in order to understand how the youthsperceived their significance. The lengthy period of follow-up allowed meto interview other people in the social networks of the participants. Besidesthe young person and the mother, in many cases I was able to conducttape-recorded interviews with brothers and sisters, the father, neighbors,boyfriends, girlfriends, cousins, and psychiatrists

I selected participants who were experiencing a first episode of psychosisbecause during this period one can see more clearly the role played bycultural and social dimensions, because the process of experiencingpsychosis is not totally settled. Therefore, those people who had alreadyexperienced previous episodes of psychosis were not included. I alsoselected only individuals 1727 years of age, because youths share lifeexperiences common to their life stage. Throughout this article, caseexamples of youths are provided under fictitious names to protect theanonymity of the research participants.

Mapping Out the Religious Terrain

Recent increases in poverty, violence, and daily hardships have causedmeaningful changes in the quintessential Catholic religious landscape ofBrazil. For poor people, such changes have greatly affected their lifestyleand their culture in general, and many have converted to other religions.Especially in the impoverished urban areas, religious migration has oftenbecome the norm, not the exception (Burdick, 1993). Although three-quarters of the population still consider themselves Catholics, othercompeting religions have significantly increased their number of followersin the past few decades, especially the various forms of Pentecostalism,2

Kardecismo, and the Afro-Brazilian religions of Umbanda or Candombl(Pierucci & Prandi, 1996).

Catholicism in Brazil can be classified in traditional or internalized


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(Camargo, 1973). Most Brazilian Catholics are traditional, they go tochurch only sporadically, and for special occasions like baptisms,marriages, and funeral rites. These people usually call themselves non-practicing Catholics and only keep religion as an indicator of their socialidentity. This group also includes some people who attend mass regularly,but who do not become involved in any Catholic movement that proposesthe revitalization of Catholic life. Popular religion also integrates a largerrange of practices that constitute traditional Catholicism, like the devotionto saints, promessas (promises), miracles and pilgrimages to sanctuaries.

The Catholic charismatic renewal is exemplary of the internalizedCatholicism, because people experience Catholicism in a more internal-ized way that involves a personal movement of reorientation and a realcommitment to religion. A distinct characteristic of charismatic renewalin Brazil is the devotion made to the Virgin Mary, which is also found intraditional Catholicism, but does not exist in Pentecostalism. However, themessage transmitted by the Catholic charismatic renewal is very similar toPentecostalism in the sense that some of the followers also speak intongues(glossolalia) during meetings, practice touch-healing, believe inthe gift of the Holy Spirit as a spontaneous experience rather than as aritual sacrament delivered by some authority of the Church, and empha-size that people have the chance to change their lives by accepting the HolySpirit (Lehmann, 1996; Machado, 1996; Prandi, 1997).

Development of Brazilian Pentecostalism can be divided into threewaves: the first decades of the twentieth century, the 1950s and early 1960s,and the late 1970s and 1980s. Most Pentecostal churches in Brazil havedeveloped autonomously and have gone through divisions into smallersects a common form of proliferation. The Assembly of God (first wave),God is Love (second wave), and Universal Kingdom of God Church (thirdwave) are the most representative Pentecostal churches sought out by thepeople who participated in this study. In brief, while the emphasis of theAssembly of God is on baptism in the Holy Spirit as certified by speakingin tongues (glossolalia), God is Love is characterized by divine healing,while the Universal Kingdom of God Church stresses exorcism fromdemon possession. The Universal Kingdom of God Church also makesextensive use of television in order to divulge the exorcisms from demonpossession and the theology of rapid prosperity, which is interpreted as theoutcome of real work of God in ones life (Corten, 1995; Freston, 1994;Prandi, 1997).

Although Brazilian Pentecostalism emphasizes popular notions ofmagic and miracles, the rational dimension of life of the Pentecostalworld-view is also very appealing. Pentecostalism attracts the urban poormore than any other religion in Brazil. Pentecostalism is also becoming acultural strategy for coping with urban poverty. It succeeds in part because


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Pentecostalism fosters a sense of closeness to God, enhances self-esteem,develops leadership skills, promotes literacy, provides support networks,and encourages a sober and ascetic style of life (Mariz, 1994).

Parallel to the various Catholic movements and Pentecostal churches,the Brazilian religious terrain also includes more local forms of religionbased on spirit possession, mainly Kardecismo, Candombl, andUmbanda. Kardecismo has a significant influence among intellectuals andurban middle classes. They value the intellectual and spiritual progress ofthe individual and advocate social mobility through formal education. Itssystem of practices involves three interrelated principles that contribute tothe spiritual evolution of the person: development of spirit mediumship,the study of books about Spiritualism, and works of charity (Aubre &Laplantine, 1990).

Candombl is a religion of spirit possession with an African origin,which was restricted to black people until the 1960s. Afterwards, its rapidspread in So Paulo and Rio de Janeiro opened Candombl to people ofall colors and social classes (Gonalves da Silva, 1995; Prandi, 1997).Umbanda is a religion of spirit possession derived from the confluence ofKardecismo, Candombl, and traditional Catholicism. Most people arefirst attracted to Umbanda to obtain a spiritual consultation in order tosolve their everyday problems like illness, unemployment, family conflicts,or love affairs (Brown, 1994; Montero, 1985).

Religious Help-Seeking

In Brazil, religion is lived as a family matter. The initial religious affiliationof each person is usually framed by the familys previous religious back-ground, most frequently by that of the mother. Most people expect themother to be in charge of the religious life of the entire family. However,this initial affiliation tells very little about the meaning of religion inpeoples lives. I observed that peoples original religious affiliation isinsufficient to understand how religion affects everyday life for two mainreasons: (1) people often have different levels of religious participationover time, and (2) people make use of a variety of religious signifiers inde-pendent of active religious participation or affiliation. This was mostevident in those families with traditional Catholicism as the dominantreligious background. Catholic families are not as engaged in religious lifeas other denominations, they are also more receptive to simultaneousparticipation in other religious milieus. In the case of Pentecostalism,families often participate more in the everyday religious life of their owncongregations. This does not imply, however, that they restrict themselvesto their own church, or that they would not try other religious pathwaysin situations of deep crisis.


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Although most families who participated in this study initially soughtreligious help from their original religious background, they also exploreda wide range of religions, most frequently Pentecostalism and Umbanda.3

Both religions emphasize practices of spiritual healing, but Pentecostalismexpects religious conversion to be a major step towards healing, whereasUmbanda is commonly practised as a therapy independent of religiousconversion. The religious help-seeking trajectories were also influenced bythe fluidity of boundaries between the different religious domains, whichare further cross-cut by a common ground of shared beliefs, most signifi-cantly, spiritual healing, belief in sorcery and witchcraft, and moraldefinitions of good and evil.

During my fieldwork, families emphasized how their religious beliefsand practices reinforced morality, provided social links, and helped themto tolerate human suffering. Spiritual healing represented the key motivefor them to seek religion as a source of help and treatment. Practices ofspiritual healing are widely accepted because many Brazilians experiencepossession and the presence of spiritual beings as a natural occurrencein their lives. Every individual is conceived as a person with at least sometenuous link to some spirit. Consequently, the existence of spirits and thepossibility of spiritual healing is not even questioned, although thesespirits assume different identities in each religion: the Spirit Guides inKardecismo or Umbanda, the Holy Spirit in Pentecostalism, and the Saintsin Catholicism. Another element mediating the different religions is thatsome healing rituals have the analogous purpose of expelling or taking outthe supernatural source of evil from the persons body. Rituals of exorcismand purification often operate as a gateway to religious conversion(Campos, 1997). Practices related to spiritual healing are varied and extendbeyond rituals of exorcism of the devil or other evil spirits, for instance,prayer groups, pilgrimages, blessings, offerings to spiritual entities, and soforth.

It is important to remember that religious help-seeking ran parallel topsychiatric help-seeking. Of the 21 families who participated in this study,only one did not seek religious sources of help. Most psychiatrists acceptedthe religious beliefs and practices of these families because most youthaccepted being medicated while attending religious rituals.

Families Perspectives

Families felt confused, lost, and helpless during the outbreak of psychosis;they tried whatever was within reach to solve the problem. Even before thefamily had the chance to consider existing sources of religious help, believ-ers often would come to visit. Neighbors, friends, and the extended familywould come to suggest names of spiritual healers, or they attracted the


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family to their church or spiritual center. The most common form ofreligious help was home visits by faithful from different Pentecostalchurches who came regularly to pray, and to bless the person and the wholefamily. This phenomenon intensified during the first weeks of thepsychotic crisis, although I observed it happening over the whole courseof the study. These visits were well received because they motivatedfamilies to find alternative forms of religious help. Some familiesmentioned that sometimes they felt overwhelmed with the diversity ofreligious resources being offered to them, which was then experiencedmore as an added burden to the problem. In most cases, religious peopletried to help families tolerate the chaotic situation in which they wereengulfed. Messages of hope and faith were extremely significant, some-times even more important than expecting that the person would be curedthrough religious healing. Caring for the spiritual well-being of the sickperson was often more meaningful than finding the best religious therapy.Religious resources commonly complemented psychiatric care, rather thanbeing the main option.

One might suppose that families struggled to take the young person toinnumerable religious places due to some lack of efficacy of the previousoption, but this was not always the case. However, families claimed a kindof added efficacy: the more religious places to which one goes, the moreGods power one attains to solve the problem:

I took my son to the Church of Grace because the God who is in my churchis inside all the others. I have faith that God operated in his life, and thatGod helped in his treatment, and still is helping. We did prayers. In severalchurches we prayed for him. When the person has a problem we do collec-tive praying for 6 days, 7 days always at the same time, to talk with Godabout it. Thanks God, God has been operating. [Mateus mother]

It was God [who healed my daughter]. In part it was the physicians help,but in another part it was God through prayers and searching for [God]. Wedid two collective fasting and prayers. I would search for people in churches,and when they got acquainted with her they would always pray and fast forher. I took her to four churches . . . Trombetas, Assembly of God, CelestialArc, and God is Love . . . they are all good, all of them have the correctdoctrine to be followed. Just like in the words of . . . the more prayers, morepower, like they say. If I go into somebodys church then to somebody elseschurch, then the church sisters will help more, they are going to see her situ-ation, and mine, that I am fighting with her, they will pray more for her andlook more for [God], consequently God will liberate her [spiritually] evenfaster, thats why I did it. [Sarahs mother]

The basic reasoning remained the same whether it was expressed in termsof added efficacy or added burden. Most families strongly believed that


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religious resources were essential to complement the treatment providedby psychiatric care:

There is the spiritual part and the material part. The spiritual part belongsto the church while the material part belongs to the medical specialities.[Leonardos mother]

There is a part that was done by physicians; there is another part that wasdone by God plus the power of prayers and [spiritual] healing. [Sarahsmother]

The narratives of the various families reflect the widespread belief that thepersons body is composed of a spiritual and a material part, and that bothhave to be healed. In other words, Gods power in combination withspiritual healing transcends the work of physicians because physiciansattain their power through Gods will. Physicians remain importantbecause they take care of the material part of the sick person, whereas Godlooks after the spiritual part. Several parents were unable to determinewhether their child suffered from a spiritual or material problem. For thisreason, they took the youth to several religious places, frequently Pente-costal churches, in addition to the psychiatric emergency room. Becausethey perceived the efficacy of spiritual healing as ultimately certain, mostfamilies preferred to try another religious place whenever the help beingprovided did not solve the problem, and this happened frequently. Forthese families, spiritual healing always remained an open possibility. Mostfamilies aimed to take care of both the spiritual and the material dimen-sions of the person.

Another reason, which impelled families to seek religion, is that severalpsychotic symptoms are easily confused with signs of spiritual possession,or some other kind of spiritual disturbance. Religious explanations weregenerally well accepted by families because they resonated with their ownobservation that the youth expressed signs of nervousness, fear, insomnia,fainting or nervous attack, visions and hearing voices, which are popularlyassociated with signs of spirit or devil possession. These signs of disturb-ance or the strange behaviors might also be the consequence of some kindof malice, black magic committed by some other human or spiritualbeing to harm the youth. This can be exemplified by the case of a youththat will be called Jos. His mother was convinced that Joss problem hada supernatural causation: some evil spirit was disturbing her son, or thathe was the prey of some black magic perpetrated by her ex-lover. Thisbelief motivated Joss mother to force her son to be exorcised in a Pente-costal church. In this case, as in many others, the ritual of exorcism,through the work of culture, did not succeed in helping the youth toelaborate or to transform his experience of psychosis. Joss participation


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in the exorcism ritual only reassured him that his problem was not relatedto evil spirits, or analogous religious referents. He rejected any relationbetween the voices he was hearing and signs of devil possession:

After hearing voices, my mother took me to church to see if I would getbetter and to check if it was something, some evil spirit. She took me and Ifelt well there, I didnt see anything [of importance], I saw people fall downbut I didnt fall down. When the pastor said whoever hears voices, evilthings, things from the devil, things from Lucifer, you burn now! I remainednormal, I felt I was there normal, the pastor came to bless me, I believe Ihave nothing to do with the supernatural. [Jos]

The case above illustrates how families often resorted to religion becauseit yields causal explanations for the problem; however, this belief was notnecessarily shared by the youth. For families, religious explanationsprovided some benefit by removing the blame from the psychotic personand shifting it to spiritual entities or acts of sorcery perpetrated by otherpeople. This process allowed parents to keep a positive image of theirchildren as individuals who have not failed, or sinned, and who could notbe held responsible for their sudden strange, unexpected, or unexplainableactions. Besides the urge to exculpate their offspring, this reliance onreligious explanations helped parents to re-situate the problem within theshared social space of religion, and to become more actively involved whiletrying to find alternative ways to solve the problem.

Active religious involvement through prayers, consultations withspiritual healers, household rituals of protection, or church attendanceprovided a bounding frame for families to deal with the problem, but onthe negative side, this back-and-forth movement between differentreligious places generated ambiguity and contradiction. It was unaccept-able for some families to see themselves transgressing some of theirprevious religious beliefs and faith. For other families, the contradictionoccurred because different religions gave different definitions andsolutions to the problem, and yet a large space for fluidity and commonshared beliefs co-existed. In some circumstances, the family membercreated a cleavage between their previous (or present) religious identity,beliefs, or the involving religious context. For example, some mothersconverted to a different religion hoping that this would help their childrenimprove. More frequently, however, families apprehended religiousmeanings and signifiers through a process of bricolage of the differentreligious world-views and practices.


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Young Peoples Perspectives

Most youths only attended religious places when taken by their parents,although some also had the initiative to attend religious rituals by them-selves. Those who wanted to attend felt in many instances that theirpsychotic symptoms disappeared inside the religious setting. Leonardosaid that:

When my mother doesnt go to church, I go by myself or my father takesme to church. Ah, there I feel well, I feel well. . . . The voices, inside thechurch, I do not hear the voices! Not inside there, not inside! [Leonardo]

This feeling of wellness is not constant; some individuals felt threatenedwhile participating in the religious ritual, causing some youths to abandonthe faith altogether, and to question whether religion is what made themfeel worse:

I can only be very thankful to the pastor and all the other church brothers.The only issue is that I was not feeling well inside the church: sometimes thepastor would be there giving his sermon, while I only wanted to run awayfrom the church. . . . The pastor would be talking up in front but I was notpaying any attention. I was not really feeling well inside the church.[Leonardo]

Most youths attended church or other religious rituals more regularlyduring the outbreak of psychosis, however, their degree of religiousinvolvement varied through time, as suggested by Leonardos narrativeabove. Like their parents, the youths were particularly attracted to Pente-costalism, and in second place, to Umbanda. On some occasions, theirreligious involvement became very intense, and religion appeared to betheir leitmotif of being-in-the-world.4 They would go to church everyday,pray all the time, or always carry the Bible with them. On other occasions,they avoided any kind of contact with religion. It was far more commonto arrive at the familys home, only then to discover that the youthpreferred to postpone our visit to a religious setting for another day.

In most cases, the youths became involved with Pentecostalism becausethey were trying to escape from the evil world in which they lived. Thisevil world represented the strange experiences they were having whilepsychotic in addition to the ubiquitous adverse conditions of poverty andurban violence, and particularly, of drug addiction. Through their partici-pation in the Pentecostal community, they tried to protect themselvesagainst the modes of life in which the people of the world live. Pentecostalfollowers distinguish themselves from the inclusive society by calling everynon-Pentecostal, people of the world, those who are liable to commit eviland sinful actions. Pentecostals reject the world in such a way that a social


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withdrawal within their religious community protects them from themalignant forces that dominate the external world (everyone outside thereligious community). Within this religious community a privatemorality is created because you may keep an eye on the other followers,but they watch your acts as well (Machado, 1996). For instance, followerseasily recognize each other by the way they dress and the discrete way theyalways behave in public places (not religious places). They are also moreconfident of interacting with each other because they are reassured thatthese people are not affected by evil forces like every one else would be.

Religious participation remained unstable for most youths. In the caseof Pentecostalism, this could be partly explained because the world spacecreated inside the religion community comprises two main facets: on theone side, the faithful feel protected among the other believers, yet separ-ated from the evil that affects all the people of the world; on the otherside, people from the same religious community are allowed to keep an eyeon each other. However, this vigilant behavior might have exacerbated theinitial feelings of persecution that probably led the youths to look forprotection inside the religious community in the first place.

The strictness and ascetic behavior required to frame ones life afterconverting to Pentecostalism kept the youths in the mediating position ofnew-converted (without any converting baptism), or led them to quitsuch a straight path. This strategy of maintaining a position betwixt-and-between a previous lay life and a future religious conversion is a commonbehavior among young people, and therefore, not necessarily linked withthe experience of psychosis. Nevertheless, the strictness and a certainrigidity of rules imposed by these ascetic behaviors may be too hard oroverwhelming to follow for those youths with psychosis because they havelost access to the common sense rules of the game that regulate everydaylife. Thus, conversion to Pentecostalism pursued as a path towards healingremained controversial and contradictory.

Those few youths who alleged conversion to Pentecostalism revealedother ambiguities regarding their religious involvement. Their partici-pation in rituals of baptism (conversion) was a sudden decision they madeon their own while watching the ritual, hence without any previousapproval from the other church members. However, the church membersdid not prohibit their impulsive action allowing the youth to join theritual. Yet the significance of this mock conversion was not sustained, andthey also ended up abandoning the faith. This exemplifies how the youthsin some circumstances articulated the religious idioms idiosyncraticallybecause what they did was not completely accepted by the other believers.

Each time I had the opportunity to accompany youths to religious placesI was struck by how they maintained a certain position of distance anddetachment in relation to the general commotion of the religious ritual.


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They were often restless and paid little attention to what was happening.My impression was that these youths were participating in the religiousceremony without really being there. Apparently, they needed to createsome kind of inner distance towards the religious ritual. They also seemedto experience the ritual in a more positive and soothing way when theywere allowed to maintain a free circulation and tenuous links with thereligious ritual.

When comparing Umbanda practices to Pentecostalism, the youthsusually demonstrated more aversion towards Umbanda rituals: Ah I didntlike it, I got very anguished, I only got worse. Or they responded that theyfelt just the same, and experienced only a momentary relief. Two otherelements contributed to enhance their rejection of Umbanda: the contextof the help-seeking initiative, and of the healing ritual itself. ConsultingUmbanda was normally veiled from the other family members. Forinstance, the father took the youth without telling him or her where theywere really going or without the mothers knowledge or will. Those youths,who consulted Umbanda on their own initiative, did so secretly. They alsopreferred to keep secret most of what happened to them there. Right fromthe beginning most often the youths and their families regarded Umbandawith suspicion and mistrust. This character of secrecy is related to theambiguous place occupied by Umbanda in the religious arena of SoPaulo, particularly for those people with a Protestant religious back-ground. This initial shared attitude of suspicion, mistrust, and secrecyhelped to create an atmosphere of incredulity even before the start of theUmbanda therapy. Because most young people only stressed their uneasi-ness and discomfort while undergoing the therapy, Umbanda probablyreinforced fearful rather than soothing experiences.

What the youths resisted most was the directness and closeness of thephysical one-to-one interaction between the Umbanda healer (or thePentecostal pastor) and the sick person that inevitably occurs duringrituals of religious healing. For instance, the pastors gesture of laying-on-hands over the sick persons head to expel the evil spirit away from thesick persons body. This gesture conveys a very powerful meaning as itrepresents the direct contact with the evil (or devil) that has to be exor-cized from the persons body in order for the patient to enter into directcontact with the Holy Spirit. One can only speculate about how the youthsexperienced this ritual of a direct contact between the Holy Spirit and theevil forces. They may have confused the meanings attributed to thebeneficial power of the Holy Spirit with the malignant power of the evil(or devil). These therapeutic rituals also invaded bodily frontiers of theyouth, which were already blurred.

Another common way that youths resorted to religion was through thecreation of private rituals. They usually repeated or transformed portions


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of some well-known religious ritual, alone and idiosyncratically. Forexample, Alices automated behavior of reading the Bible continuouslyand of throwing away all Catholic saint images that she found in her way;Marias intransigent fasting and sole attempts of exorcism while kneelingdown over her bed and crying out loud burn the devil, burn the devil;Leonardos simulated work of macumba (black magic) while burningphotos and other personal objects in a campfire lit in the backyard; orDoras unremitting preaching and Bible reading around the town onbehalf of the salvation of all souls. Often the idiosyncratic, persistent, exag-gerated, or displaced character of these religious performances was whatfirst alerted family members to the existence of a problem.

In sum, the youth participated in a marginal way in most religioushealing rituals, or alternatively, they elaborated their experience ofpsychosis by making a profuse use of religious signifiers, for instance, whenthey created their own private rituals. In other words, the youths resistedbecoming normal followers by remaining at the margins. In this sense, themodes of behavior expected in religious rituals were played out by theyouths in a very flexible way. Since they resisted becoming normal follow-ers, why did religious referents continue to be so important to them?

Anchoring the Experience of Psychosis

It was unusual for youths to explain their resort to religion by looking fora causal explanation to their problems; even if they seemed perplexedregarding the meaning of what they were experiencing. When I explicitlyasked them about their ways of explaining their problems, their mostimmediate answer was I dont really know or I am not sure. They wereconstantly perplexed, confused, and full of uncertainties. In Joss case,although he rejected a supernatural cause of his problems when he noticedthat he was not being possessed by the devil like some of the other peoplein the church (who fell down during exorcism), on many other occasionsJos used religious signifiers (something spiritual, something supernatural,God) to give shape to try to understand the meanings of the unnatural,ambiguous, and exceptional quality of what he was experiencing:

I was running in the roadway and there was a guy following me. It seemedlike an animal thing. It seemed something spiritual, which knows, some-thing sent by God. I dont know why. I am, I have a lot of faith in God, butI dont know what it was. Maybe it is somebody who is coming to give somemessage. I dont know, I dont really know how to explain, it is somethingsupernatural, it seemed supernatural.

Expressions of bewilderment and vague allusions to the supernaturalrealm prevailed among the youths when they tried to describe their


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experience of psychosis or the drifting quality of their perceived environ-ment. It was much more an attempt to put into words and to qualify theirshifting and uncanny experience, rather than to provide an explanation assuch. I also observed qualitative variations attributed to the voices orvisions which constantly disturbed them and sometimes made them feeleven more unstable and uncertain regarding their own feelings andperceptions. For instance, sometimes the youths attributed positive andsoothing qualities to the voices they were overhearing, albeit most of thetime the negative, threatening, and uncanny aspects of these voices domi-nated their narratives. Voices that threatened to kill them or to destroy thewhole world were intermeshed with messages from God.

Being completely immersed in a world of uncertainties, strangeness, andchaos induced the youths to look for religious referents as some kind ofanchoring point, they were looking for some stability in the deterioratedworld they were experiencing:

In my mind I was feeling well . . . the unusual things I saw is because Ibelieved it was the end of the world that was normal for me. I had to searchfor the salvation of souls and preach to the people, that is what I thought.[Sarah]

I thought that the world had ended. That just bad people remained on earth.I would see everyone different, I would see everyone in the shape of devil.[. . .] Nothing was real, it was something from my head, and nothing wastrue. It was something from my head because it was not possible for peopleto remain in the way I saw them, of hearing voices . . . [Mateus]

In the excerpts above, Sarah evoked a more active reaction than Mateusparalysing mode of being-in-the-world because she also started to searchfor salvation and preached to all people as a way of fighting against theimagined end of the world. One could hypothesize that both of them werealso trying to protect their precarious sense of self in projecting thedeterioration of their experience to the outside world, as well as attachingreligious referents to describe and name their unusual experiences. Mostyoung people made frequent allusions to their missing a personal sense ofboundaries in relation to themselves, to other people, or to the outsideworld. Their sense of self seemed to be constantly dissolving and changinglimits or boundaries. In this context, any attempt to find or establish somekind of anchoring point becomes inevitable. Perceptions like everyone inthe shape of the devil; the end of the world further indicates how theworld around them appeared dominated by a fixed feeling of evil and ofending sometimes-even death. The youths repeatedly alluded to existen-tial questions concerning life and death, or they were particularlyconcerned with answering questions such as Who am I? and Do I exist?


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In sum, the young people manipulated the fluid semantics of religioussignifiers from one or more religions to play with psychosis, or even to putit out of play (Blankenburg, 1991). In this context, the diversity and ambi-guity of religious referents allowed youths to cope with psychosis.Nonetheless, the opposite movement was likely to happen as well. Theambiguity and diversity of religious signifiers momentarily accentuatedthe absence of anchoring points in which one could sustain ones sense ofbeing-in-the-world. When religious signifiers and anchoring points werecontinuously being re-signified, the psychotic person not only experienceda lack of stability, but a deterioration of his or her position within thesurrounding world.

Capturing Religious Signifiers

It is easier to understand how the youths resorted to religion in search ofanchoring points that would help them to overcome their existential angstby describing how they captured and interpreted religious signifiers.Instead of exploring the diversity of religious signifiers available, I havechosen to emphasize only how the Bible and God were appropriated ascore religious signifiers. For most young people, the Bible acquired aparticular and more exclusive significance during the outbreak ofpsychosis: I am reading the Bible now to see if I find the answer . . . thereare beautiful things in the Bible, I go back to read the Bible . . . becausethe Bible helps you a lot, one needs to read the Bible all the time, the Bibleexplains to you how things are, I lost the fear by reading the Bible. Likemost other people, the youths started reading the Bible seeking some kindof religious consolation and reassurance. In some cases, however, theyouths spent whole days reading the Bible, while others integratedthe Bible in their private rituals, and some would only go to sleep with theBible under their pillow.

Because the Bible is representative of the eternal truth, it hypotheticallycontains all the answers that people need. The Bible is also considered acore symbol that reveals the origins of human existence. When the youngpeople clung to the Bible, they were also questioning the meaning of life,of their own existence, and the very certainty of reality, destabilizing every-thing that was taken for granted in their common world. While they wereimmersed in uncertainty, the act of reading the Bible potentially providedthem with some certainty and truth. When everything around themseemed replete with religious meaning, the youths associated the act ofreading the Bible with their talks with God. The faithful equate the wordswritten in the Bible with personal talks with God. This occasionallygenerates confusion between the words of God (written in the Bible) andones reality: people talk about God and with God simultaneously (Cesar,


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1996). This confusion sometimes gained insurmountable proportions forsome youths, like Alice, because the Bible emerged absorbed into thedelirious quality of their lived world.

Alice recalled an episode in which she remained praying in the kitchenthe whole night and talking with the Bible (and God). She reacted withestrangement and was feeling very pressured because she was seeingshadows. She was not sure whether these shadows were somethingbeyond the lit candle over the neighbors window. Alice established acontiguous relationship between herself, the Bible and the lit candle. Whenshe read or talked to the Bible, the flame of the candle seemed to respond:the more she talked, the more the flame started to blaze; she interpretedthis as a work of black magic. Her reactions towards the lighted candlebecame exaggerated: she felt the urge to talk even more to the Bible,kneeling down in a praying position, and fainting on the floor as if she hadabandoned herself to the Holy Spirit. She only wanted to counteract thework of black magic that she associated with the lighted candle. She alsoasked the Bible systematically why all this was happening to her. Shementioned that on several other occasions she was unable to sleep becauseshe would only think and talk to the Bible. Although she was using theBible to cope with the enveloping strangeness, this also triggered a negativeexperience, especially when her reactions became exaggerated and out ofcontrol. Nevertheless, she always attributed a positive value to the Biblebecause she read it in search of some protection and orientation whilefacing such unstable reality, and during her incessant quest for significanceof such disturbing experiences: I would feel more safe because I was ableto read the Bible, I would feel more safe, and I had the urge to read it tolearn more . . . the religious teachings, I felt like reading it to understandbetter what was happening. The Bible reading retained a double meaningand ambiguous position in Alices world.

Several other youths suddenly found themselves imprisoned with Biblereading or some other religious referent, such as interminable praying,repetitive exorcisms, out-of-context rites against black magic, and fastinguntil starvation. Their feelings towards the world were dominated by anunbearable dread towards the evil world, or they divided the world in avery rigid way between good versus evil. These situations represent aparadox because while the youths were primarily trying to find positiveways to cope with psychosis, they ended up incorporating the religiousreferents in rigid or negative ways.

In certain circumstances, the youths captured religious signifiers inorder to construct a more positive image of themselves. For instance, someyouths started to perceive themselves as very special persons. This self-perception resonated with religious beliefs claiming that the faithful havebeen elected by God. Nevertheless, the idea of becoming a special person


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or in some way of having acquired special powers, is quite commonamong psychotic people. In psychiatric terms, it is only qualified as afeeling of omnipotence. However, for these youths, their feelings of special-ness helped them to tolerate the uncertainty and incomprehensibility ofwhat they were experiencing. Only people with special powers would beable to overcome so much anguish and terror. Such feelings sometimestook an extreme form giving the impression of them becoming in someway identified with God:

Oh . . . God helped me in such a way that I even had powers. I would looklike this to the light, the devil would turn off the light, and I would turn thelight back on with my eyes. I was fighting against the devil face to face [. . .]I made the sky and earth . . . die the sky and earth with my faith. With myfaith, I was able to move the skies and earth fighting against the devil.[Sarah]

When I started to go to church it seems that . . . The Spiritism started tochase me, with voices and doing macumba to me . . . They are spirits . . . Iam the Holy Spirit, and they are the spirits of evil [voices]. They domacumbaria, sorcery, and this kind of stuff. [. . .] And so people say that Idribble . . . that I listen to the voices . . . and then I dribble the spirit . . . thatI was going to die, that they [voices] wanted to kill my family. [Leonardo]

In the earlier narrative, Sarah associated her experience of psychosis withthe dreadful presence of the devil. She only felt capable of reacting againstthis terrifying experience after acquiring godly powers, which enabled herto try every strategy possible to deceive the devil. Leonardo attempted todribble the spirits of evil by identifying himself with the Holy Spirit.5 Thisgave Leonardo some sense of power which helped him to deal with theunbearable persecution in which he found himself caught. I suggest thatthis new sense of empowerment is what allowed him to dribble, irritate,and fight back the voices that had been disturbing him. One may hypoth-esize that dribbling these voices placed him in an active stance (by provok-ing the adversary) and gave him some sense of self-control (by controllingthe ball) towards his own existence. This is specially the case on thoseoccasions when the voices were there playing the soccer game against him.It could also be possible that a youths insurmountable fear and anguishare metamorphosed into some kind of power that dribbles psychoticsymptoms. In any case, Leonardo preferred to keep secret about how hemanaged to dribble these evil spirits.

Having special powers is not always experienced in such a positiveway. Because these special powers are often experienced as limitless,sometimes the youths believed that they were also able to harm otherpeople. For instance, Sarah was very reluctant to tell her mother about herpersonal fight against the devil because she imagined that the power of


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this revelation could kill her mother. Other youths were also anguished,frightened, and perplexed when they imagined that they could even killpeople just through thinking because of their powerful telepathicthoughts. Sarah commented that she dealt with this threatening situationbecause she finally lost her special powers when she abandoned herself toGod, thus allowing God to carry on with the fight against the devil.

The figure of God on whom youths relied was always that of an omnipo-tent God. Youths derived some sense of stability from believing that theyhad been elected by God, or even that they had become God, but this kindof perception occasionally remained entrapped within psychosis. Thus, avery thin and flimsy line seemed to separate ones experience of God fromoneself. One may question whether this close association between aspectsof the psychotic experience and ones experience of God weighted up inthe religious experience towards the negative or towards the positive, as theonly way out for youths to cope with psychosis. Therefore, the youths werenot always able to cope with psychosis in what psychiatry conceives as apositive way. Even so, the identification with God was a common attitudethat helped several youths create some kind of protection against the evilworld in which they felt themselves engulfed. From the psychiatricperspective, this attitude only reveals the prominence of psychoticsymptoms.

Conclusion: Transforming the Experience of Psychosis

I have examined how resorting to religion became important to youthsbecause this allowed them to articulate their personal and interpersonalreactions to psychotic symptoms through the manipulation of religiousreferents. What usually differed between individuals was the degree ofinvolvement that youths had with specific religious idioms and signifiers,and the particular ways they captured these signifiers and tried to makesense of their experience. The youths appropriated some religious signi-fiers more than others because they converged with their reality moreeasily. Therefore, religions have the potential to provide a set of repre-sentations and meanings, which contribute to inserting a personal andalienating experience within a stable frame of reference. In the case ofpsychotic people, religion equips them with a range of notions andsymbols that they can appropriate for their own quest for significance.

These young people manipulated the religious signifiers at threedifferent levels. First, religious signifiers were useful to label or describewhat they were experiencing. For example, when the youths mentionedthat what they were experiencing resembled something spiritual, super-natural. Second, the religious signifiers indicated continuous attempts orstrategies of coping with psychosis or in finding a way out of psychosis.


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At this level, religious signifiers eventually worked as anchoring points,which people with psychosis adhered to in their novel mode of being-in-the-world. For instance, some youths read the Bible all the time becausethey were seeking some kind of reassurance. Third, they reflected the questfor comprehensibility necessary to perpetuate and reassure ones ownexistence and sense of self. This was exemplified by the cases of Sarah andMateus who were fighting against the end of the world. It was commonto observe a convergence of religious idioms with ones own experienceand quest. In sum, the personal articulation of religious idioms and signi-fiers brings together three main functions in relation to ones experienceof psychosis. They help to communicate, to elaborate, and to transformthe experience of psychosis.

Family members resorted to religion from a slightly different pers-pective. They were primarily seeking alternatives, but most often,complementary forms of healing the patient. Religion was also a sourceof personal relief and comfort for family members, in addition to furnish-ing causal explanations that exculpated the psychosis of the child. Whenthe despair, confusion, and anguish of family members became insur-mountable, this often precipitated a back-and-forth help-seekingmovement between a diversity of religious therapies and religious signi-fiers. The fluid semantics and ambiguity of religious idioms and signifiersprovided alternative ways of solving, explaining, or coping with the youthsproblems, however, family members eventually felt burdened by thevariety of possible solutions they could have followed.

A crucial question that remains to be answered is to what extent thesereligious idioms and signifiers helped the youths to cope or find a way out,or whether they only tended to exacerbate the symptoms of psychosis. Theoutbreak of a first psychotic episode is such an unstable (and usually rapid)experience that it was rather difficult to distinguish the positive effects ofreligion from its negative or neutral effects. For both the youths and theirfamilies, certain religious idioms and signifiers had more potential to helpthe person muddle through his or her existential angst than others. Thiswas also dependent on the particular ways that each person re-interpretedand made sense of the variety of religious idioms and signifiers available.

For many youths, the fundamental aspect of resorting to religion wastheir attempt to seek a way out of psychosis in order to preserve and safe-guard their own existence. It also represented the youths quest for thesignificance of the unexplainable mode of being-in-the-world in whichthey felt engulfed. Because the youths seemed more preoccupied in findingways to understand what was happening to them, they very seldom attrib-uted a healing function to religion. Family members usually expected thatreligion would always bring positive effects, particularly through itshealing function.


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Through the notion of work of culture Obeyesekere (1985) suggestedthat some cultures offer a greater potential than others for a personal elab-oration of psychiatric disorders, including psychosis. Considering thework of culture in relation to the inner experience of psychotic patients,Obeyesekere noticed that religious and cultural signifiers may operate bothin a progressive way, towards restoration and elaboration of ones modeof being-in-the world, or in a regressive way, leaving the person trappedwithin repetition, personal conflicts or problems. In my study, youths andfamily members often gave more weight to the regressive elaboration ofthe experience in relation to these signifiers, rather than the progressive.I am not suggesting that youths resort to religion was merely regressive,but that they have paid far more attention to this aspect of their religiousinvolvement during the outbreak of psychosis. I believe that many youthwere so absorbed in their own delirious experience that together with theirfamily members, they were often impelled to emphasize the regressiveaspects. The progressive elaboration of the experience was also present,but less evident. However, one has to take into account the fact that I metyouths and their families during the outbreak of psychosis and just after,so that time had not yet allowed for the elaboration of more stablestrategies to cope with psychosis.

In addition, to talk in terms of the regressive or progressive elabora-tion of experience is also a value judgment. This became evident when Itried to discriminate in which situations youths were able to cope withtheir psychosis through the use of religious signifiers, and when they werenot able to do so. I recall Leonardos initial involvement with Neo-Pentecostalism when he would go to church every day. He was feeling asense of protection inside the church, because he would not hear thevoices during the rituals. This illustrates a way in which religious idiomsand signifiers helped Leonardo cope positively with psychosis. However,Leonardo also created a series of idiosyncratic macumba (black magic)rituals during both psychotic episodes that he went through. In thisinstance, macumba protected Leonardo from his fears, but that on anotheroccasion macumba also contributed to exacerbating his suicidal ideation.To the eyes of outsiders, the persistence and idiosyncratic nature of theserituals often indicated a worsening and accentuation of psychoticsymptoms. Why did Leonardo insist on the rituals? Perhaps this was theonly way he was able to cope with the strangeness and dreadful experiencesthrough which he was going.

In conclusion, religion occupies an important and irreplaceable space inthe experience of psychotic people and their significant others in Brazil. Itprovides support through the religious web to overcome and accept suchoverwhelming and anguishing experiences even when religion is taken outof context and is mainly absorbed in the delirious quality of the psychotic


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experience. However, the support provided by religion can be veryambivalent, sometimes acting in a more progressive, and in other times regressive way. Nevertheless, what other cultural signifiers could carry outthe same function in the sense of elaborating ones experience in relationto oneself and the world? One may wonder what people with psychosiswould do if religion did not exist as some kind of anchoring point, evenwhen it works only temporarily.

Acknowledgements

I would like to express my gratitude to Nora Jacobson for her insightful sugges-tions regarding the organization of this paper.

Notes

1. Obeyesekere (1990: xix) has defined work of culture as the process wherebysymbolic forms existing on the cultural level get created and recreatedthrough the minds of people.

2. Rolim (1992) defines autonomous Pentecostalism in opposition to classicPentecostalism. The former, he explains, is developed around strong leader-ship, yet is dissident from the classic that originates from the Pentecostalchurches of North American missionaries, and is very uncommon in Brazil.Healing, exorcism, and prosperity are the most significant characteristics thatdefine autonomous Pentecostalism in Brazil.

3. The cultural psychiatry literature describes how the experience of psychosisis often a burden to the family (e.g. Jenkins & Schumacher 1999). I am alsosuggesting that religious help-seeking can eventually enhance this burden thatfamilies are already experiencing with the problem.

4. This is a common expression employed by Pastors of Pentecostal churchesduring rituals of exorcism.

5. Dribble is a slang term in Brazil used in soccer games which means that thesoccer player is able to fool his adversary by provoking him through bodymovements to keep control of the ball, to run with it or to pass it over toanother player.

References

Aubre, M., & Laplantine, F. (1990). La table, le livre et les esprits: Naissance,volution et actualit du mouvement social spirite entre France et Brsil. Paris:ditions Jean-Claude Latts.

Binswanger, L. (1963). Being-in-the-world: Selected papers of Ludwig Binswanger[translated from the German and introduction by Jacob Needleman]. NewYork: Basic Books.

Blankenburg, W. (1991). La perte de lvidence naturelle. Une contribution la


528

psychopathologie des schizophrnies pauci-symptomatiques. Paris: PressesUniversitaires de France.

Brown, D. (1994). Umbanda: Religion and politics in urban Brazil. New York:Columbia University Press.

Burdick, J. (1993). Looking for God in Brazil: The progressive Catholic Church inurban Brazils religious arena. Berkeley: University of California Press.

Camargo, C. P. (1973). Catlicos, protestantes, espritas. Petrpolis: Vozes.Campos, L. S. (1997). Teatro, templo e mercado: Organizao e marketing de um

empreendimento neopentecostal. Petrpolis: Editora Vozes.Cesar, W. (1996). Linguagem, espao e tempo no cotidiano Pentecostal. Religio e

Sociedade, 17(12), 110123.Corin, E., Lesage, A., King, S., & Van Haaster, I. (1996). The Turning Point

Interview: Manual. Unpublished manuscript.Corin, E., Thara, R., & Padmavati, R. (n.d.). Living through a staggering world: The

play of signifiers in early psychosis in South India. Unpublished manuscript.Corten, A. (1995). Le pentectisme au Brsil Emotion du pauvre et romantisme

thologique. Paris: ditions Karthala.Crapanzano, V. (1977). Introduction. In V. Crapanzano & V. Garrison (Eds.), Case

studies in spirit possession (pp. 140). New York: Wiley.Freston, P. (1994). Breve histria do pentecostalismo brasileiro. In A. Antoniazzi

(Ed.), Nem anjos, nem demnios: interpretaes sociolgicas do pentecostalismo(pp. 67162). Rio de Janeiro: Vozes.

Gonalves da Silva, V. (1995). Orixs da metrpole. Petrpolis: Vozes.Jenkins, J., & Schumacher, J. (1999). Family burden of schizophrenia and depres-

sive illness: Specifying the effects of ethnicity, gender and social ecology.British Journal of Psychiatry, 174, 3138.

Lehmann, D. (1996). Struggle for the spirit: Religious transformation and popularculture in Brazil and Latin America. Cambridge: Polity Press.

Loyola, M. A. (1984). Mdicos e curandeiros: Conflito social sade. So Paulo:DIFEL.

Machado, M. D. C. (1996). Carismticos e pentecostais: Adeso religiosa na esferafamiliar. Campinas: Editora Autores Associados/ANPOCS.

Mariz, C. L. (1994). Coping with poverty: Pentecostals and Christian BaseCommunities in Brazil. Philadelphia: Temple University Press.

Montero, P. (1985). Da doena desordem a magia na umbanda. Rio de Janeiro:Graal.

Obeyesekere, G. (1981). Medusas hair: An essay on personal symbols and religiousexperience. Chicago: University of Chicago Press.

Obeyesekere, G. (1985). Depression, Buddhism, and the work of culture in SriLanka. In A. Kleinman & B. Good (Eds.), Culture and depression(pp. 134152). Berkeley: University of California Press.

Obeyesekere, G. (1990). The work of culture: Symbolic transformation in psycho-analysis and anthropology. Chicago: University of Chicago Press.

Ortigues, M. C., Martino, P., & Collomb, H. (1967). Lutilisation des donnesculturelles dans un cas de bouffe delirante. Psychopatologie Africaine, 3(1),121148.


529

Pierucci, A. F., & Prandi, R. (1996). A realidade social das religies no Brasil. SoPaulo: Hucitec.

Prandi, R. (1997). Um sopro do esprito. So Paulo: EduspRedko, C. (2001). Fighting against the evil. Religious and cultural construction of

the first psychotic experience of youth living in So Paulo, Brazil. Doctoralthesis, McGill University.

Rolim, F. C. (1992). Pentcotisme et vision du monde. Social Compass, 39(3),401422.

CRISTINA REDKO, PhD (McGill University) is an anthropologist particularly inter-ested in child and youth mental health. She wrote this article during her post-doctoral fellowship at the Centre for Addiction and Mental Health, Toronto,Ontario, Canada. Address: Wright State University, School of Medicine, Center forInterventions, Treatment and Addictions Research, Reducing Barriers, 3640Colonel Glenn Hwy., Dayton, Ohio 45435-0001, USA. [E-mail: [email protected]]


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religious construction of a first episode of psychosis in urban brazil

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