Out of Place: Madness in the Highlands of Papua New Guinea (review)

This unique exploration of madness in Papua New Guinea stands out for several reasons. While its central insight is not surprising—that in the mid-1980s the Kakoli people of the Upper Kaugel Valley lacked a concept of "mental illness" and, on the rare occasions when they used psychiatric services, saw them chiefly as a means of restraining destructive or violent madpeople—the data collected by Michael Goddard is both fascinating and sensitively presented. Though framed by the author as an anthropological critique of the premises and practice of transcultural psychiatry, I would suggest that this book's strongest feature is its careful rendering of the unknowns of ethnographic fieldwork—those situations and circumstances in which the gap between ways of being in the world is so profound as to thwart efforts at interpretation. Having had a quarter century to reevaluate these materials (the book is based on his PhD thesis), the author remains uncertain of what, if anything, precipitated the madness of his informants. This radical uncertainty is an epistemologically positive posture in an increasingly "applied" scholarly context in which cultural explanations for disorder are both ready-to-hand and too often essentially vacant.

In his introduction, Goddard notes that the people among whom he lived in 1985-1986 found his research topic puzzling. For the Kakoli, there was nothing to learn about the mad. Not only were their problems nonmental in nature, they appeared to lack any knowable cause that could be generalized across cases. The madpeople known to the Kakoli were so different from one another that they did not comprise a social or natural "type." Though all were described as kekelepa— an Umbu Ungu term Goddard translates roughly as "leaving a group or place" (70)—so were the intoxicated, the estranged, and the disobedient. To refurbish a phrase from Michel Foucault on homosexuality, kekelepa people were not a species. To the extent that they permit explanation, kekelepa episodes are for Goddard "part of the dialectics of Kakoli sociality" (6), collectively constructed "exercise[s] in moral iconography" (3) rather than forms of individual pathology or cultural disorder.

Chapter 1 outlines the history of psychiatry in Papua New Guinea, from early twentieth century concerns about mentally deranged "natives" going "amok," to the post-World War II shift toward institutional confinement, tranquilizing drugs, and electroshock therapy, to the "community-based care" framework of the ethnographic present. The history is much enriched by personal interviews with Dr B G Burton-Bradley, head of Papua New Guinea's mental health services under Australian rule, and Dr Wilfred Moi, the assistant secretary for mental health at the time of Goddard's fieldwork. Chapter 2 explores the basic contradiction belying this narrative of progress: despite changes in professional ideology and official policy, Goddard argues, psychiatric service provision has remained mostly unchanged since the 1960s. At the level of practice, psychiatry in Papua New Guinea is an apparatus of constraint and control, and patients usually have considerably more contact with law enforcement officers than with mental health professionals. In this context, "culturally sensitive" psychiatry does little more than provide an ideological justification for what is essentially incarceration—it is a "paper concept" (60) with no relevance for patients and their families or for health workers, whose foremost concern is controlling patients' extreme behaviors. Goddard illustrates this point with seven case studies from the 1970s and 1980s of patients from the Kaugel Valley who received psychiatric treatment at hospitals in Mt Hagen, Mendi, and Goroka. In all cases, patients were hospitalized after acts of violence or property damage (or, in the case of one female patient, mood swings and aggression combined with promiscuity), and cultural factors were completely absent from both diagnostic and therapeutic efforts.

Chapter 3 describes the "ambivalent" use of psychiatric services by the Kakoli despite their non-subscription to, and lack of...