1 Seeman, M.V.: Raves, psychosis, and spirit healing. Transcultural Psychiatry. 47:491-501 (2010) doi:10.1177/1363461510378469 http://www.ncbi.nlm.nih.gov/pubmed/20688801 tps.sagepub.com Abstract This paper reflects the intersection of three cultures: the rave (all night dance party and use of the drug, Ecstasy) culture; the ward culture of an inpatient psychiatric program for First Episode Psychosis; the spirit healing culture of the Philippines. All three intersected in Toronto, Canada in the mid 1990s, as illustrated by the clinical case of a 19-year-old university student who was hospitalized with symptoms of drug-induced psychosis. Her initial treatment was not successful and presented dilemmas for the treating staff. Transfer to a second psychiatric facility that permitted attendance at a traditional Filipino healing ceremony resulted in a cure, with no recurrence ten years later. According to James Dow s 1986 formulation, the components of the key spiritual healing session paralleled the very elements the young woman had sought by participating in raves, an activity that was problematic because it led to family displeasure. Whereas attendance at a rave triggered illness, the healing session, sanctioned by her family and taking place in their midst, resulted in healing. Introduction Like-minded groups, whether connected by age, ethnic origin or common belief, form welldefined cultures with unique codes of manners, dress, language, and perspective. When the ethos of one group clashes with that of another, it poses problems for those with membership in both. This article will describe three separate traditions the rave culture, the psychiatric ward culture, and the immigrant Filipino healing culture, and how these three collided in the life of a young woman (RT) who was involved in all three in Toronto, Canada, in the mid 1990s. I was not this young woman s ward psychiatrist, but a consultant asked to see her at the hospital to which she was first admitted and in which she stayed for
2 four months. The young woman s consent was obtained on the condition that identifying characteristics be changed, which they were. Raves In the 1990s a new phenomenon had emerged in Toronto and it was thanks to RT that I learned about it. Because she was not doing well on the hospital ward, I received a consult request to see her and it was during my interviews that I asked her about and that she described to me the all-night dance parties, called raves, that she had attended during high school and her first two months of college. The rave culture, I was told by RT, stood for peace, love, and acceptance of diversity (Critcher, 2000). RT was a 19 year first generation immigrant from the Philippines who came from a family of devout Catholics. The family had fled the Philippines 7 years earlier, after her father was assassinated in a military coup. RT was very conscious of her immigrant status, of not being as Canadian as her friends seemed to be, but, at raves, she felt she was participating in a universal movement of social togetherness. She belonged when she went to raves; she felt equal to everyone else, on the same footing. At the same time, there was the excitement of rebellion because her family did not approve. She often lied to her mother about where she was going and this was unusual because, since her father s death, she and her mother had been particularly close. But she somehow justified lying, a sin in her eyes, because she strongly believed that the atmosphere of the raves she attended provided her with a form of spiritual healing (Hutson, 2000). Takahashi and Olaveson (2003) have identified seven central themes of the rave experience that corresponded with what she described to me: feelings of connectedness; the primacy of the body; an altered state of consciousness; a personal transformation; a spiritual interpretation of the experience; a neo-tribal affiliation; and an elaboration, in wishful fantasy, of utopian social models of living that could incorporate and extend this experience into everyday life. I have since read that rhythm, sensory deprivation and stimulation, fasting, meditation, psychotropic drugs, and communal rituals (ubiquitous to many religious practices) contribute to the connectedness and transcendence that many young people experience at
3 raves (Olaveson, 2001). But I have also read that three separate elements of raves have the potential to unsettle vulnerable people: the psychedelic effects of the many drugs that are freely available, the fact that the drugs and the music and the belief system of interconnectedness tend to dissolve interpersonal distances, and the added fact that parents and authority figures generally disapprove of the activity (Weir, 2000). In Toronto, at the time I met RT, raves were large-scale events at which participants danced to very loud, pulsing, electronic music tracks remixed by disc jockeys (DJs). Raves, open to all, were held in large spaces, often warehouses, and utilized a variety of visual props such as fluorescent mandala patterns, images of Hindu deities and aliens from outer space, projected on walls and screens with unexpected effects. Most raves were held in the dark. Accompanying the music were glowsticks (or light sticks ) and LED (light-emitting diode) lights of different hues, blinking strobe lights, and hand-held flashlights producing hallucinatory patterns of lines, circles, dots, and figure eights (Rill, 2006). The DJs were worshipped by the young people who attended. On the DJ s altar were candles and incense, and scattered dry ice, creating an atmosphere of fog within the darkness. RT told me that drugs were officially not permitted but were always available. She told me that she loved going because dance melded into sprituality at raves, with the DJ serving as high priest, officiating at the head of his dancing devotees. She had had previous experience with spiritual healers and DJs, she told me, used incantory techniques similar to those used by spiritual healers: mesmerizing intonation, syncopation, alliteration, internal rhyme, slurring of words, rolling of Rs, stuttering consonants, twisting and stretching vowels, dramatic accents, and onomatopeia (Reynolds, 1999). The song tracks often referred to sacred themes. By the time I met her and we discussed what it was that drew her to raves, the dominant musical genre at these events had become a repetitive hypnotic form of electronic dance music called trance, which seemed to augment the altered states of consciousness achieved by the dancers. A popular form of dance in Toronto during this period was the liquid in which dancers held both hands in front of the face, fingertips touching, and rippled their fingers, hands, and arms to produce a long, fluid snaky rope (Olaveson, 2004). This created a communal wave flowing through the dancing space, which could, at times, extend to many thousands of participants.
4 Toronto s rave scene was one of the largest in the world in the late 1990s (Weber, 1999). To emphasize inclusivity, dancers did not dress up for raves but, rather, dressed down, usually in layers of clothing that could be removed. It was cold on first entering the dance hall, often a warehouse, but the temperature climbed as the night progressed and the layers could be peeled off. Participants often dressed as children, angels, or clowns carrying stuffed animals, backpacks, coloured beads, and, often, pacifiers strung on necklaces. Sucking on pacifiers could alleviate nausea, jaw stiffness, and bruxism (tooth gnashing), all side-effects of Ecstasy (MDMA: 3,4-Methylenedioxymethamphetamine, sometimes called the hug drug ). Those were early side-effects that were then followed by a euphoric rush which lasted for a few hours and then a state of introspection and metaphysical preoccupation during which, RT claimed, you could gain insight into personal failings, and then share those insights with friends at after-rave parties. She felt connectedness and intimacy with other ravers, even when she did not know them, and often found herself hugging and massaging strangers. These phenomena have been described as puppy piles or cuddle puddles heaps of bodies huddled in non-sexual bodily contact on a mattress (Olaveson, 2004). Ecstasy was considered a safe drug when taken unadulterated. Each pill, RT told me, sold for about $20.00.What she did not know was that, as the size and frequency of raves escalated, the demand for Ecstasy soared and ingredients other than MDMA, such as amphetamines, ketamine ( Special K ), phencyclidine (PCP, angel dust), LSD, and ephedrine, were added to pills sold as Ecstasy. The drugs got progressively speedier and produced paranoid reactions rather than the warm feelings associated in young people s minds with Ecstasy. At the time RT was admitted to hospital, between 4% to 20% of Ecstasy tablets obtained at raves in Toronto contained other ingredients; the composition varied with the exact time period and location (Kalasinsky et al., 2004; Parrot, 2004) and posed an increased risk of psychotic reactions to Ecstasy users. In fact, acute psychosis, paranoid delusions, flash-back phenomena, anxiety/panic states and depressive mood disorders have all been reported following the use of Ecstasy, even after only one-time use (Van Kampen et al., 2001).
5 The Culture on a Psychiatric Ward RT presented at the Emergency Department of a downtown Toronto Hospital in November 1995. She was 19, brought to hospital by friends after attending an all-night rave. She was agitated, not making any sense, and appeared to be preoccupied with internal stimuli. She was admitted to an inpatient ward for First Episode Psychosis where, as a result of a drug screen, she was diagnosed as suffering from a drug-induced psychosis. She was considered a danger to herself and was placed on involuntary status. Her mother was contacted and supplied the history. The family (mother and 5 children) had arrived in Canada when RT was 12. Although they were all traumatized by the father s murder and the abrupt change of life style after immigration, RT had nevertheless become a good student, and mother s helper. She made friends and appeared to acculturate well. First year university, however, was proving difficult because of increased academic demands, the beginning of a relationship with a first ever boyfriend, and increased expectations at home because mother s mother, who was aged and infirm, had recently arrived from the Philippines and openly voiced her disapproval of many of her grandchildren s choices. Mother knew that RT occasionally went to all night dances but she was certain that her daughter did not experiment with drugs. When she learned at the hospital that her daughter s drug screen was positive, she was taken aback; she seemed more upset by this than by her daughter s psychotic state. The prevailing culture of the First Episode Program in Toronto to which RT was admitted was family-positive, similar in many ways to the First Episode Program recently described by Larsen (2007). The patients on the Toronto ward were young and generally rebellious. As a consequence, structure and discipline were emphasized. There was a focus on safety, avoidance of street drugs, adherence to a treatment regimen that included antipsychotic medication, psycho-education, and family involvement. During our first interview, RT told me she had nothing in common with the other people on the ward and could not identify with having a psychosis. She denied hallucinations but exhibited delusional thinking about the ward she was on: she thought the nurses were conspiring against her; she questioned whether she was in a hospital or in a prison; and she refused to talk to her ward physicians, although she talked to me because you are an outsider.
6 On the ward she received specialized treatment that included expert psychopharmacological management (risperidone up to 8 mg./day; when that did not work, olanzapine up to 40 mg./day; when that did not work, augmentation first with carbamezapine and then with lithium) and the first-rate care of an experienced mental health team. Despite this, she did not improve but, instead, grew steadily worse. She tried several times to elope from the ward, initiated fights with staff and with co-patients, and began to talk somewhat incoherently to me during our second interview about her guilt feelings about her father and about having used drugs; and she hinted at suicide. She appeared to blame herself for her father s death. The higher the doses of drugs prescribed and the more combinations of drugs (concomitant antidepressants were tried), the more symptomatic she became. Despite, or perhaps because of, these combined and intensive treatments, the patient s condition worsened. At my suggestion, a family meeting was called, the result of which was a request for a consultation with a traditional healer from the Philippines. The Culture of Filipino Spirit Healing The healer lit several candles in the patient s room and asked her what she saw in the melting wax and in the smoke. RT reported that she saw the profile of her boyfriend s mother. The healer interpreted this to mean that the girl s symptoms were caused by the jealous disapproval of her boyfriend s mother who must have cast an evil spell on the girl, precipitating her illness. He believed the woman s motive was to separate the two young people and, indeed, the boyfriend, who had been very attentive and caring when RT first came to hospital, was visiting her less and less often as time passed. According to the healer, the desired effect of the witchcraft was being achieved. In many regions of the Philippines, illnesses are thought to be caused by the sometimes accidental, sometimes deliberate intervention of human beings with magical powers. (Lee Mendoza, 2009) Inciting the anger or jealousy of such a person by enjoying too much good fortune or by violating a social norm or taboo frequently led to retribution through use of the evil eye. Burning candles, besides uncovering the evildoer, could also serve the purpose of honouring a patron saint or important ancestor, or of clearing the air of
7 malevolent spirits. Secret incantations and prayers, rituals, herbs, and powerful amulets could shield the vulnerable from enemies. Most traditional healers in the Philippines worked within the Christian tradition and used traditional prayers to guide their healing, which was attributed to the intercession of the Holy Spirit. The healer s ability to heal was heightened on certain days, coinciding with the feast of the Santo Niño de Cebu (the oldest Roman Catholic sacred relic in the Philippines, a depiction of the infant Jesus dating from 1521) and the feast of the Black Nazarene (a life-sized dark wood sculpture of Jesus brought to Manila in 1606 and treated as holy). Similar mechanisms of diagnosing and interpreting the cause of illness have been described in other parts of the world where indigenous groups have come under Spanish influence (Harwood, 1977). Accompanied by her mother, RT began to visit the traditional healer weekly. She received special permission to do so even though her status was still involuntary and she was not permitted to leave the ward otherwise. The nursing staff was skeptical about the healing but united in their support of family empowerment. Since the family believed in the healer, the nurses did their best to make therapeutic use of the idea of evil demons. They tried to engage RT in therapeutic discussions about how demons could represent not only other people such as the boyfriend s mother, but also personal failings such as envy, pride, avarice, and hatred (Favazza, 1982). RT was not responsive to this form of therapy and the staff became progressively impatient with the frequent visits of RT s large family (mother, brothers, sisters, aunts, grandmother, cousins), their sheer number difficult to accommodate on a busy ward. The nurses were especially concerned, for safety reasons, about the candles that the patient, encouraged by her family, lit in her room. Months were passing and RT was not improving. Culture Clash The patient s extended maternal family were due to fly in from the Philippines to attend a family celebration and the healer advised that, during this family reunion, an incantation service be performed which, through unified prayer, would have the necessary force to cure the patient. The family asked the staff to allow the patient to attend the upcoming occasion over a Saturday night. I supported the idea because RT seemed very keen on it. The ward
8 team met to discuss the request but felt, unanimously, that the patient was too ill to go. They explained that the event would be crowded and RT would be overly stimulated. They were afraid that RT, whose behaviour was at best unpredictable, would be left to her own devices in the large crowd; she would have access to alcohol and she would get no sleep all night. As a consequence of the refusal, RT threatened suicide. The family, nevertheless, assured the staff that she would be safe at the reunion. The family members guaranteed that they would protect her. Another ward meeting, at which I was present, was held to discuss the request. Several members of the family were also present and expressed their unanimous view that RT should be allowed to come to the reunion, that it would make her feel better. But the staff believed that the patient was potentially suicidal and it was their ethical responsibility to keep her on the ward. Part of the unspoken issue was that they were very uneasy about the nature of the praying ritual that was to take place at the ceremony. To their ears it sounded like an exorcism, something that could further disrupt their patient s fragile equilibrium. It would be irresponsible, they believed, to allow her to go. I suggested a compromise. I could arrange to have the patient transferred to another hospital. She would remain on involuntary status but the new clinical staff could reappraise the situation and make their own decision about the wisdom of letting RT attend the reunion. The staff at the First Episode Program agreed to this, as did RT and her family. Culture Clash Resolution I did not know what would happen at the new hospital. A change of setting could aggravate the patient s condition. Instead, the patient s behaviour stabilized and, after a few days, her status was changed to voluntary status. Her medication dose was reduced (to olanzapine 10 mg. and paroxetine 20 mg.) The weekend arrived and the patient s behaviour was considered stable; she was allowed out over Saturday night to attend the family ceremony. I heard about the ceremony from RT s mother, with whom I stayed in touch. The extended family and the traditional healer initially prayed together for the patient s recovery. On
9 prominent display were symbols of the cross, a crown of thorns, a rosary, incense, and nailed hands. No animals were sacrificed, although this sometimes occurs in Philippine tradition. One of the family members had obtained a hair of the presumed evil-doer (the boyfriend s mother) and it was covered in liquid to neutralize its evil power (Money, 2001). Apotropaics (amulets that have the power to ward off evil) were handed out to the attendees. There is a Filipino regional belief that illness signifies a soul that is lost and that must be regained in order for health to be restored. Throughout the night, various deities were called upon to enter into the body of the healer, whose task it was to track down the lost spirit. Once found, the lost soul was symbolically placed in a variety of foods that were offered to RT so that she could regain balance and wholeness. RT s mother told me that her daughter returned to hospital the next day much calmer than she had been and that her recovery continued. She was discharged home two weeks later, essentially psychosis-free. I lost touch with the mother, but ten years later I accidentally met them both, RT and her mother, in a social setting. RT told me she had returned to university a year after her hospitalization, that she had remained drug-free (no Ecstasy and no olanzapine) all these years, and had had no further recurrence of psychotic illness. Conclusion The healing ceremony that started this patient on the road to cure seems to have had much in common with the raves that precipitated her illness. This is important in the world of symbolic healing where two likes can cancel or neutralize each other. Symbolic healing requires an appropriate milieu, a modification of consciousness, the invocation of powerful imagery and reliance on shared meaning and belief. In Dow s model of symbolic healing (Dow, 1986), the first component is that the healing be grounded in a culturally meaningful context that is based on a set of shared assumptions and beliefs. In this case, the meaningful context was Christianity and Filipino tradition. Dow s second component is the therapeutic relationship and, in this case, that had been pre-established between the patient and the healer. Dow s third component is the particularization (within the shared set of assumptions) of the patient s specific issues. This too had been done earlier when the healer
10 identified the cause of the problem as the disapproving jealousy of the boyfriend s mother. The gathering was an ideal place to discuss the family s shared disapproval, in the light of their Christian values, of the patient s attendance at raves, experimentation with drugs, relationship with a boyfriend, relative neglect of the duty she owed her grandmother, and the increased distance that this had led to between herself and her immediate family prior to the onset of her psychosis. The healer was able to reformulate the patient s experiences and place her personal narrative (her father s death, her emigration from the Philippines, her family s disapproval of her recent activities, her need to belong) in a context that was congruent with the tenets of Catholicism and Filipino-Canadian traditions. A skilled healer, with the help of the family, was able to manipulate the symbolic subtexts in such a way as to make the performative act of healing a meaningful experience for the patient (Kirmayer, 2004). An important element was the patient s familiarity with and trust in the procedure and her expectation of a cure. The presence of so many participants, all of them emotionally close to the patient and all of them sharing in the belief and the expectancy of success must also have reinforced the power of the healer s symbolic acts (Wirth, 1995). As an immigrant who had lost her father, belonging to a group was particularly important to this patient, which may explain her initial involvement with raves and her inability to improve in a setting, the first psychiatric ward, in which she felt she did not belong. The second hospital and the traditional practitioner managed to co-operate in a way that finally did allow the patient to feel that she was understood and could be helped. It can be argued that drug-induced psychoses are by nature self-limited and that the concurrence of ceremony and cure was fortuitous. The chronology, however, does suggest that the family ritual of spirit healing played a crucial role. In summary, this presentation describes the intersection of three distinct cultures, that of the rave, the psychiatric ward, and traditional healing. Standard treatment of psychotic symptoms that started after attendance at a rave and ingestion of Ecstasy remained ineffective for four months until a change of setting and a ceremony of traditional spiritual healing, delivered in the context of the patient s extended family, was added to the therapeutic mix.
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