Noe Valley Voice October 2001

What Paul Linde Learned from His African Patients

By Maire Farrington

Eight years ago, psychiatrist Paul Linde and his wife Laurie Schultz, a pediatrician, left their Noe Valley domicile and set off for an adventure overseas. After half a year of winding their way through Southeast Asia, the couple settled in Zimbabwe, where Laurie quickly found a pediatric position. Since job pickings were slim for an American psychiatrist, Linde hunkered down for a month and wrote "two really bad novels -- but it was good practice," he jokes. "I got really antsy and I said this isn't going to satisfy me, so I started to look for a job as a psychiatrist."

As fate would have it, a nationwide doctors' strike created immediate demands for skilled physicians, and Linde soon found himself toiling amidst the chaos of the woefully understaffed psychiatric unit at Harare Central Hospital.

It never occurred to Linde that his professional undertakings would prove just as dramatic as any novel he could cook up. It wasn't until after his return to the states a year later that he decided to put literary form to his extraordinary experiences practicing psychiatry among Zimbabwe's Shona people. In his just released book, Of Spirits and Madness: An American Psychiatrist in Africa, Linde describes how working with the native residents of this rural agrarian culture challenged him to view the world of psychiatry and mental illness with new eyes.

Eleven chapters feature different cases, which "were memorable either from the standpoint that they were exotic psychiatrically or that they really affected me deeply," says Linde. Though his first intention was to write good, literary-quality stories, the author also set out to "give people an understanding of the Shona culture and teach people about what a psychiatrist does."

Linde's bent is toward creative nonfiction mixed with clinical presentation, and his narrative is punctuated with descriptive passages depicting a vivid sense of place. The result is a volume that reads like equal-parts memoir, travelogue, and edge-of-your-seat page-turner as Linde struggles to acclimate to a whole new set of cultural and professional demands. Often, his role resembles that of a detective as, armed with only sparse information, he tries to puzzle out the causes for his patients' bizarre behaviors.

Linde's diagnostic work was complicated by the fact that many of his patients in Zimbabwe held a faith in ancestor spirits. "Most people, in any culture, who have a nervous breakdown want to believe that it's not a nervous breakdown, so they'll try to attribute it to something else," Linde says. "But in this case, they'd say, 'My ancestor spirits are putting a hex on me or bewitching me.'"

From a western perspective, "this sounds crazy and like a delusion in and of itself," Linde explains.

The psychiatric nurses who worked closely with Linde helped him "sort things out," he says. "The nurses said, 'Well, you know our people believe that as part of our culture, [bewitchment] is possible.' Pretty quickly I thought, I'm going to have to understand this better and take it seriously. It forced me to understand more about traditional healing in the Shona culture."

Before seeking psychiatric help, most Shona patients visit a traditional healer, or n'anga, Linde says. "The traditional healers would be able to say, 'Oh of course, your great aunt is bewitching you.' And it would be easy for them to find it.'"

Typically, the n'anga would then perform a ritual to get rid of the bewitchment. Only those cases that defied the n'anga's ministrations would be referred on for psychiatric consultation.

"That's why I saw so few, I think, of what a bewitchment really is," Linde says. "Because the people would first go to a traditional healer."

Though the vast majority of patients that Linde treated could be diagnosed as having a psychiatric illness, "about two percent" had syndromes that were less clear-cut. One such case involved a man who adamantly insisted that a witch had embedded numerous nails and needles in his shin. Though Linde came to believe this was a case of self-mutilation, there were still some unanswered questions. "I had no doubt he was jamming needles in his leg," Linde says. "But the thing I couldn't sort out was, Was there a witch that was somehow making him do stuff, like a voodoo? I doubt it, I highly doubt it, but I can't exclude it."

Linde's own religious and spiritual background provided little context for explaining the more unusual phenomena he witnessed. Describing himself as a "retired Catholic, with Christian beliefs," Linde moved from his native Minnesota to San Francisco in 1988. But he says, "in spite of the fact that I live here, I'm not really that mystical/spiritually inclined." Before traveling to Africa, Linde had an intellectual curiosity about alternative spiritual paths such as meditation and Buddhism, "but it's more of an interest in and not really practicing those things," he says.

Ultimately, says Linde, it was his travels in Indonesia, just before settling in Zimbabwe, that "primed the pump" for considering that the realm of spirits may indeed exert some influence on human behavior. Several times, Linde happened upon native peoples engaged in bizarre cultural rituals, sometimes involving self-flagellation and cutting. Some appeared to have lapsed into states of muscle rigidity and glassy-eyed stares, such as might be seen with catatonic patients.

During these rituals, "people would be in an altered state of mind, in a trance state," the author says. "They would come out of it in half an hour or an hour, which is different from psychiatric illness, where if you get hit with something where you're that out of touch with reality, you ain't coming back in an hour. The earliest you're coming back is a few days, usually."

Asked if during his year in Zimbabwe he came to believe in the concept of bewitchment, Linde reflects for a moment before answering. "Yes, I did. I think it's a possibility in that culture. It is exceedingly rare, but it's possible. But I've seen the way that psychiatric patients behave, and 99.9 percent of the time it's like, 'Whoa, this is a really bad case of mania, or schizophrenia. But once in a while, very rarely, you'll see somebody who's in an altered state of mind that doesn't look like schizophrenia or manic-depressive illness.... I can't exclude the possibility that people can be possessed, because I know that throughout the world, including the United States, people get into true altered states of mind -- trance states -- usually for some sort of healing purpose or some sort of ritual. So I can't rule out that spirits can do that to us. I think it's very unusual, and very unlikely, but yes."

Writing from his home on Elizabeth Street, Linde is already researching his next book, "about working in wild and crazy psychiatric environments."

He is currently employed half-time in the psychiatric emergency unit at San Francisco General Hospital, and has practiced psychiatry in jails, hospital wards, and intensive-care units. But his starring role is as father to two small sons, Jacob, 2, and Sam, 10 months old.

Says Linde, "My goal in the long run is I would love to be able to walk my kids to grade school, write and work, and then go pick them up and play with them after school. To me that would be perfect."

You can meet Linde at Cover to Cover Books on Saturday, Oct. 6, at 6 p.m., where African music, socializing, and refreshments will round out the evening of reading and book signing. You can also catch him at Black Oak Books in Berkeley on Sunday, Oct. 7, at 7:30 p.m.