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In this state, socially unaccepted feelings can be articulated,
e.g. when a young woman is possessed by a gruesome demon,
who can speak out of her mouth and voice aggressions against
family pressure and traumatisation which she is not otherwise
allowed to express due to her social status. Castillo suggested
that dissociative states are the manifestation of trance- like states
of consciousness in live threatening situations. This explanatory
model of dissociative states is akin to hypotheses trying to explain
multiple personality disorder, which – nevertheless – are quit
rare in India as compared to the United States of America [6,7].
In India, it has been described that multiple personality disorder
is characterised by the manifestation of a glamorous, idealised
self with western characteristics and traits, typically speaking in
English and not in Hindi [1]. Varma and colleagues [61] reported
phenomenological differences between multiple personality
disorder and possession and suggested that a person suffering
from spirit possession is usually aware of this possession, while
persons suffering from a multiple personality disorder do not
know about other personalities manifestating at different times.
Moreover, demons or spirits of ancestors who possess a person
are supernatural beings, while multiple personality disorder is
characterised by the manifestation of different personalities that
represent other humans. Varma and co- worker therefore suggest
that culturally infl uenced expectations, for example related to
the existence or non existence of spirits, infl uence symptom
presentation [61].
Moreover, cultural differences in the ability to fall into trance
(i.e. to enter a certain dissociative state) may contribute to the
manifestation of spirit possession. Lewis- Williams and Dowson
(1989) suggested that a majority of bush men in Namibia and
South Africa can fall into trance when participating in community
rituals [40]. The authors also suggested that trance experiences
are depicted in the rock paintings and mythology of the bush
men. Among bush men, to fall into trance is a normal ability
of a healthy human being; the trance state is consciously and
commonly induced and does not affl ict a person in a socially
isolated and psychologically stressful situation. In history, there
have been attempts to compare trance states and other forms
of experience related to religious rituals of non- Western people
with “primitive” states of mind. Such ideas are also present in
Freud´s “Totem und Tabu”. However, such models tend to mistake
populations under the rule of colonialism at the beginning of
20th century for phylogenetic ancestors of contemporary human
beings. Such hypotheses negate the history of colonialised people
and their specifi c cultural and cognitive achievements and developments,
one of the reasons why modern social anthropology
has criticised and abandon such theories [23].
9. The embodied self in different cultures
Jung suggested in 1907 that the so called “ego complex”
is a psychic structure representing the self, which exists due
to continuous sensory input from one’s own body [30]. Also
Metzinger [42] hypothesised that the phenomenal model of
the self differs from all other mental representations because
of a continuous, internally generated input, including sensory
and sensible information as well as neuronal representation
of the body and other neuronal structures. Metzinger went on
A. Heinz et al. / European Psychiatry 27 (2012) / supplement n°2 / S32-S43 S39
to suggest that this internally generated input explains why a
part of the human self model is based on (internally generated)
information. However, culture affects the specifi c ways in which
such information is integrated into a conscious representation of
one’s own body. For example, the anthropologist Sobo described
traditional Jamaican concepts of the human body, which also
infl uence explanatory models of physical and psychological
disorders [56]. According to such a traditional explanatory
model, the blood can be too “hot” or too “cold”, too “thin” or
too “thick”, too “sweet” or too “bitter”. In case a doctor trained in
modern Western medicine informs a Jamaican patient from such
a traditional background that he suffers from diabetes mellitus,
i.e. too much “sugar in the blood”, and that he therefore has to
maintain a diet, the traditionally oriented patient will follow the
advise, however, the diet will include bitter tees to balance the
“sweetness” of the blood [22]. In different explanatory models,
even the same terms may thus carry different meanings. Social
rules and regulations infl uence the construction of the concept
of one’s own body. For example, in Jamaica, blood represents
the substance that “binds” relatives together and expresses
obligations to kinship, i.e. to share not only one’s blood but also
material resources among the relatives. This concept may be
based in the matrilinear culture of West African people such as
the Ashanti, who had been abducted to Jamaica in large numbers.
In case an egoistic individual does not share food and resources,
it is assumed that this inadequate behaviour blocks the fl ow of
mutual exchange, just as excessive food consumption can block
the fl ow of nutriments in the belly [56].
Wilhelm Reich suggested that the socially enforced control
of one’s desires can directly affect the body [48]. Reich further
hypothesised that sexual desires are suppressed due to the
infl uence of parents and teachers, who act as agents of social
power. Reich used the picture of a stream of water that is
dispersed when hitting a rock and suggested that a drive can
also dissociate when it is inhibited in its direction towards the
object of desire due to social rules and regulations. The “ego” can
now use the energy of this dissociated drive and pose it directly
against the direction of the original drive; the confl icting drives
will then inhibit each other. Reich further suggested that the
energy of these drives is blocked and that the ego can transform
this blockade into a “Körperpanzer”, which manifests itself in
increased muscular tension and autonomic arousal [48]. Within
the ego, automatic habits replace fl exible affective reactions and
condensate into habitual traits, which represent the character of
a person. Physical illness can result from the increased muscular
tension and hyperarousal of the autonomic nervous system.
While Reich’s psycho- vegetative and psycho- motor models
today appear to be somewhat out- of- date, his work represents
a landmark concept of psychosocial interactions which suggested
that the perception of one’s body is not simply affected
by cultural factors but that – more specifi cally – interindividual
and social confl icts can be represented in the experience and
functions of a human body.
Cultural infl uences on the respective self concept and the
concept of a human body can further be elucidated when we
compare ideas among the matrilinear Ashanti, living in Southern
Ghana, with traditional concepts of the embodied self in Jamaica.
Among the Ashanti, marriage means that the husband leaves his
home and lives with the family of the wife, and in this family
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