Interview with Joseph Polimeni, MD on shamanism and schizophrenia

Joseph Polimeni, MD, is a Canadian psychiatrist and the author of the 2012 book Shamans Among Us: Schizophrenia, Shamanism and the Evolutionary Origins of Religion. The central premise of the book is that schizophrenia patients are the modern manifestation of tribal shamans, people who were vital to the success of early human cultures. “Shamans Among Us is the most detailed and comprehensive evolutionary theory yet assembled to explain a specific psychiatric diagnosis.”

I learned about Dr Polimeni’s work when I read Dick Russell’s memoir My Mysterious Son: A Life-Changing Passage Between Schizophrenia and Shamanism. I highly recommend both books.

The idea that people with schizophrenia are the modern manifestation of shamans is gaining a certain currency, to whit Phil Borges 2015 documentary, Crazywise. Borges spent many year documenting and filming tribal cultures and began to question why it is that ancient and tribal cultures reserve an honored place for the same kinds of persons who in Western cultures are labelled schizophrenic or bipolar, promptly medicated, and then largely degraded and ignored.

Dr. Polimeni’s belief that “the inborn cognitive factors or personality style that would have predisposed certain people to become shamans is the same psychological mindset that underlies schizophrenia ” seems entirely reasonable to me. As because it also seems reasonable to me that any mother would know her child’s inborn cognitive factors and personality style that might align themselves with shamanistic traits, I sent him a copy of my book. In it I flag several traits I noticed about my son that might work well with this theory.

RF: Dr. Polimeni, as it happens you didn’t read my book. I thought a psychiatrist with your research interests would be curious enough to do so. When I contacted you after I didn’t hear back from you, I let you in on a not very well kept secret, that male readers in general don’t want to read memoirs written by women. We were both somewhat amused, but I’m guessing you still haven’t read my book? Is that correct?

JP: I did read a few chapters of your book, however, I am no longer in a phase where I am exploring anecdotes, which I do acknowledge can be very valuable in the initial stages of scientific exploration. Most of my colleagues are probably not aware that I am no longer actively researching this topic, and have moved on to other research questions (I am currently trying to learn about the mechanics of artificial intelligence and its possible application to psychiatry). I do believe that there is still a lot of work to be done with the shaman-schizophrenia question but perhaps newcomers should be adding to the mix. I do enjoy talking about shamanism and schizophrenia, since it’s always exciting to share a counterintuitive idea; however, as a scientist – trying to be dispassionate – I realize there’s a fine line between sharing ideas and proselytizing. My ego, of course, wants to be right about the shaman idea, so I am always cognizant of not being overly invested in my ideas. The history of science has repeatedly shown that the scientific community will eventually discover useful scientific paradigms. If the shamanism-schizophrenia theory is on the right track, it will eventually be discovered by the mainstream scientific community.

RF: As you can see I’m not one to hold grudges and despite your non-response I even went so far as to send a note to the producers of Joe Rogan’s podcast (close to 3 million subscribers!) suggesting that you’d be an excellent interviewee based on a recent interview he had with author and journalist Michael Pollan on the topic of psychedelics.

So, before getting down to some basic questions that I have about your theory, bear in mind that I come at it from the opposite ends of where your interests lie: I’m interested in the innate characteristics behind predicting who becomes a shaman/diagnosed schizophrenic and finding ways to help someone use their innate characteristics productively in today’s world. Your interests, correct me if I’m wrong, are in answering the question as to why schizophrenia has persisted for thousands of years, when those afflicted do not reproduce to the extent of the normal human population.

JP: I didn’t really start with a research question. In fact, for ten years, I had been a full time clinical psychiatrist with absolutely no research aspirations before I wrote the introductory paper on the shaman-schizophrenia theory with my colleague Dr. Jeff Reiss. Initially, it was simply natural curiosity that got me reading about evolution and anthropology. I don’t recall exactly when, but at some point I must have seen parallels between shamans and schizophrenia patients, which led to the 2002 introductory paper. John Price, who was one of the important pioneers in evolutionary psychiatry, wrote to me a few months later, and told me that he really liked the paper. It was important feedback since it gave me the confidence to spend time systematically studying evolutionary theory and its possible application to psychiatric conditions.

I later learned of the “schizophrenia paradox”, which as you correctly point out is the idea that a long-standing, highly heritable condition with low reproductive potential doesn’t make sense in biology. There must be a reasonable explanation, so perhaps one of our basic suppositions about schizophrenia may be wrong. It was my opinion that the shaman theory of schizophrenia was a possible solution.

RF: You write that “a proper evaluation of the hypothesis is complicated and must take into account the latest discoveries from psychiatry, medical history, evolutionary science, anthropology, psychology, religious studies and genetics.” and, “One way to investigate a puzzling medical condition us to trace its evolutionary history” and,: “Psychiatrists have a long- standing tendency to overestimate environmental influences upon psychiatric conditions, to the relative exclusion of innate determinants.”

Well, perhaps I’m not seeing the bigger picture here, but, wouldn’t a more direct starting point be to “ask Mom”? I appreciate that there is no academic discipline in this area and research grants may be limited.

A “Mom” knows the innate characteristics and interests of her child.

JP: The question of how important is anecdotal evidence or personal experience relative to conventional scientific knowledge is a complicated matter – and here is where our emphasis may differ. I have previously said that a patient and physician hold a partnership of contrasting information. The patient brings in their personal experience where they are the expert, and the physician – with his or her experience of having treated perhaps several hundred patients with a similar problem – holds very valuable information inaccessible to the patient. It is a judgment call about whose information is more valuable in any given situation. For example, if I break my leg and start to have a myriad of weird sensations in my foot, these sensations may not be medically important. The physician will typically know exactly what to do in the situation, which is to fix the fracture and ensure neurological and vascular integrity. Once the leg is casted, focusing on every personally unique but clinically expected sensation is not productive. I do, however, acknowledge that psychological treatment usually necessitates a greater contribution from the patient compared to orthopedic procedures!

RF: You provide a brief description of the role of shamans in hunting and gathering societies. They

heal the sick.
institute magical curses
carry out divination rituals
lead religious ceremonies

I would suggest that one way you could find people today with these innate shaman-like interests is just by knowing who plays the card game Magic: The Gathering, a game in which spells are cast on your opponents with the object to drive their life points down to zero. According to one expert you can also choose “healing” spells for your deck, but what you want to look for are cards that both gain life and serve another purpose. There is also a Divination card on which is written “Half your studies will be learning the laws of magic. The other half will be bending them.”—Naru Meha, master wizard

And, from my observation point at the back of the church, the closer to the altar you are as a participant, (priest, rabbi, acolyte, choir member), chances are the more DSM diagnoses in the family members (if not yourself). Although these days, there is a diagnosis for everyone with the expansion of the DSM to 265 diagnosable mental disorders.

Astrology, numerology, and homeopathy are also excellent determiners of one’s “innate” and possibly, shamanic characteristics.

My point is that psychiatry, medical history, evolutionary science, anthropology, psychology, religious studies and genetics are beside the point. You won’t solve the riddle there, but there are plenty of intriguing questions.

JP: I believe that any useful scientific theory has to withstand the test of all of the convergent evidence. In other words, we can have greater faith in a theory that seems to fit into every aspect of nature. Take, for example, Isaac Newton‘s laws of motion which were eventually supplanted by Einstein’s theory. It was eventually discovered that Isaac Newton’s calculations broke down at those very high velocities approaching the speed of light. Einstein provided a theory that was consistent with a greater portion of nature. That is why I emphasized that the shaman-schizophrenia theory needs to be neatly integrated and consistent with every other related scientific field.

RF: You write: “How could such a disruptive and seemingly futile behavior not be a disease?” and, a little further along in the book you write: “Even though I am inclined to believe that schizophrenia is, technically, not a disease, this belief hardly affects my own day-to-day psychiatric practice.”

(I totally get it when you describe the behaviour as disruptive and seemingly futile. At the same time, what would be the point of “real” diseases such as ALD (underpinning the story of Lorenzo’s oil) which are also disruptive and seemingly futile?

What do you tell your patients, then? Why do you continue to prescribe drugs?

JP: This is an excellent question, and fortunately, psychiatrists are not confined to a singular treatment philosophy. First, the possible phylogenetic origins of schizophrenia is not a topic that usually comes up in psychiatric treatment. I have occasionally shared my theory with a patient when it seems to be especially apropos, however, patients must understand the difference between a novel theory and conventional standards of practice – standards that have been established over many decades with the input of a lot of clever clinicians. I do believe that the shaman theory should be integrated into the conventional knowledge of schizophrenia but how this should modify treatment is arguably an entirely different question.

I do acknowledge that sometimes medication treatments do not directly help a patient’s inner mental state but can help patients better adhere to social norms. If the patient is independently wealthy (and not too interested in social relationships), they may perhaps have the luxury of flouting social norms. However, adhering to arbitrary social norms usually makes life easier – just look at how much time, money and effort is given to straighten the teeth of our teenagers, simply to diminish that small amount of stigma associated with slightly crooked teeth. Accordingly, part of the impetus for psychiatric medication use is probably to help patients better adapt to their community by diminishing socially unusual behaviours, which hopefully provides greater dividends in the long run through friendship and socialization. These are extremely complicated matters where hopefully a good psychiatrist can help clarify such critical decisions facing the patient. I have read a number of vignettes in your book where psychiatric advice may have sometimes been suspect, however it must also be recognized that psychiatric treatment is incredibly difficult to get just right.

RF: Can you offer my readers any tips for how to succeed in a world that no longer seems to require these unique “gifts”? Or, along the same lines, can you offer family members some ideas on how to identify, raise and nurture such individuals? No matter what actually causes schizophrenia to manifest, the post-diagnosis environment can make all the difference in how someone takes control of their innate tendencies. I’ll give you an example based on a shamanic trait that you identified in your book, and that’s “not wanting to compete” or “extreme altruism” (or something to that effect). It’s really a negative symptom characteristic of schizophrenia, it’s just that the literature doesn’t frame it quite that way. What do you do with someone whose innate tendency goes against the survival instinct that is needed to go out and earn a living in today’s world?

JP: With regards to how to cope with possible inborn tendencies, every clinical case has to be uniquely analysed on its own merits. For some patients, hallucinations are a very distressing experience, and their psychosis remits with a very low dose of antipsychotic medication. For this type of clinical case, the patient’s choice to be on a medication seems straightforward. Another patient may only occasionally hear harmless voices while being extremely sensitive to medication side effects. In this case, medication treatment may not be warranted. Although I may encourage patients with schizophrenia to pursue hobbies and occupations most compatible to their affinities, I would be reluctant to encourage the practice of shamanism since I personally don’t believe in God or any other form of spirituality.

Your question about how to integrate persons with a schizophrenia personality (for lack of a better description) into the current global social structure may perhaps be the most important sociological question facing persons with “mental illness”. As societies become more technologically complex, we are finding that slight personality or intelligence differences (as well as luck) become amplified – resulting in some persons becoming wealthy enough to have their own private jet and others being homeless. The 17th century British workhouses were debatably the first administrative attempt to utilize some modest amount of labor from marginalized persons – those persons who couldn’t economically compete due to physical or behavioral limitations. It appears that post-industrial economic systems create minimal occupational expectations that can be reasonably achieved by about 80-90% of people. The system doesn’t want to lower its expectation of minimal individual productivity simply to add another 5-10% persons to the workforce – since your GDP would probably be no farther ahead. I believe these are the underlying unconscious forces that occupationally marginalize 10-20% of our population. Ideally every large-scale employer across the globe should be forced to absorb this historically marginalized group (there would be no competitive disadvantage if every global company chipped in equally). I believe societies need to be more methodical (i.e. scientific) about how we connect with each other – both socially and occupationally.

RF: I appreciated seeing this sentence in your book:,

“In the back of my mind I have always wondered whether schizophrenia’s elusiveness is simply due to one counterintuitive, misplaced fact.”

I’ll toss something out here that is not my research, but that of another mother who based her in-depth research on the work of Tomatis, and Ramachandran. Her research leads her to conclude that the clue to the origins and cure of schizophrenia and other mental disorders is found in the EAR not in the brain. I agree with her that science, by focusing on the BRAIN, continues to chase yet another red herring when it comes to schizophrenia. But interestingly, your book provides a clue that works well with her findings: “that in certain Aboriginal dialects, psychosis is indicated by the word “deaf” — the implication being that the “ears are blocked by the noxious spirit in their heads.” Care to comment?

JP: For me, the reference to “deafness” is a simple metaphor, but doesn’t provide any in-depth explanation of complex phenomena. I disagree that studying the brain is a red herring since all the machinations of the brain ultimately produce our thoughts and behaviors. In fact, I believe that any hint of devaluing the hard sciences deserves respectful pushback. Any progress in solving personal or societal problems will ultimately require delving into the intricacies of the brain. Other modes of inquiry will also be helpful such as population studies, sociology, and political science. Even fictional narratives (i.e. comedians, novels) can sometimes lend insight into the human mind. However, the greatest potential for progress probably lies in those sparsely charted fields of neurophysiology, genetics, and other hard to reach places. I suspect that some resistance to the hard sciences can be partially explained by self-serving behaviors on both sides. Non-scientists are sometimes guilty of weighing into questions where they simply haven’t done the hard work to offer a constructive opinion. On the other hand, many experts, if not most, overstate the certainty of their opinions. In addition, I believe that many experts – unconsciously – hide the triviality of their experiments through excessive complexity and unnecessary jargon in their work.

RF: Dr Polimeni, thank you for good luck with your latest research endeavor on machine learning. I look forward to reading the book!