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Global features on the landscape of the Mongolian plain. Photo by ADRIAN ARBIB/STILL PICTURES.
Feelings can become homeless too.
Trevor Turner finds some forgotten meanings in nostalgia.

The phrase ‘it’s a global village, you know’ is more than a depressing cliché – it’s the call-sign of our times. Once there was just the odd radio ham, talking to some other chattering soul from the Yukon, the Yemen or Yokohama. Now people climb on planes at the drop of a credit card, send e-mail without missing a click, call from the desert on their mobile phones.

All of which has an exciting gloss, particularly as Hollywood paints it. But there is also loss, a distinct loss – loss of the notion of ‘home’.


The boundary between personal and social well-being is impossible to draw because the two are so closely related. Yet ‘globalization’ has promoted individualism and a uniform economic orthodoxy. The result has not been a measurable increase in the sum of human happiness – rather, a relentless growth in clinical depression and its associated therapies. Friendship has turned to envy, ambition to greed. But what if social well-being can enhance personal well-being? The process of ‘globalization’ offers us no clues. We know that diversity and a degree of harmony between individuals and our environment – both social and ecological – is essential not just for human well-being, but for survival.

In one of the more obscure films by Sam Peckinpah (Junior Bonner) someone suggests that ‘the mobile home is the home of the future’. But this is said with sadness. In the US, mobility is now an established practice, with three-car families routine and Interstate highways used for neighbourhood shopping. Americans seem to travel all the time, remorselessly cruising up and down their highways, looking for adventure, but more often in the elusive pursuit of loneliness. Those archetypal novels, Jack Kerouac’s On the Road, or Robert Pirsig’s Zen and the Art of Motorcycle Maintenance, underscored the alienation of this instinct. Searching for oneself by hitch-hiking to Afghanistan (very popular in the 1960s and 1970s) has come to be seen as therapeutic, good for the soul, naturally healthy.

Serial travelling, in cyberspace or elsewhere, is part of the process of globalization. In the cynical comedy Grosse Pointe Blank one of the characters remarks that such concepts are largely a public-relations exercise, a means of diverting political concern and public initiative away from the machinations of corporate giants. Cynicism about politics bespeaks public awareness that things are being manipulated. From this perspective globalization is a depressing experience, creating anxieties that act as vectors for a bewildering range of psychiatric disorders. The most recent edition of the American classification of disorders (DSM-4) consists of 330, compared with 100 in the first edition just 40 years ago. It includes wonderful new diagnostic terms – ‘partner-relational problem’, ‘borderline intellectual functioning’, ‘oppositional defiant disorder’.

The process is remarkably new. People in their twenties have come to accept it as natural, a version of progress, the way things are. I can recall wandering the backstreets of Malacca in 1990, wanting to find out how the local folks spent their evenings. My fantasy was that they would be, perhaps, strolling by the docks or playing Mah Jong, or going to the temple, or doing something I had never seen done before in the evening. Here it was, a picture-postcard old town, a relic of Portuguese and British colonialism, a traditional part, surely, of modern Malaysia. But it wasn’t like that. House after house had an empty verandah, but you could see the television on inside. These people weren’t partaking in some culturally rich interaction. They were watching Dallas.

Yet back in Yugoslavia – as it was called in 1973 – I found a small town in Montenegro where it was different. Staying overnight, we ran into a whole-town event, when people and families, arm-in-arm, strolled and paraded up and down the main street dressed up in suits and shawls, talking about everything and to everyone, or so it seemed. Sights, sounds, smells, society – everything was local.

Something has been lost in the last 20 years. You may be able to stick your plastic into a money machine anywhere you like, but what’s the point? Why leave home? Anyway, holidays are renowned for family break-up, excessive alcohol consumption and all sorts of despair. But, if you don’t go on holiday, somehow you are made to feel deprived – that if you haven’t been everywhere and eaten ‘international’ meals in air-conditioned hotels that smell of nothing, you have been nowhere.

If there ever were any value in travel it was because you found out about what someone else called home. The aim was to use the alienation of being in foreign parts to de-alienate yourself from the things about your own home that were not doing you good. If you spent long enough away you might start to feel homesick. The missing of certain tastes and experiences helped you to understand the positive things about being at home. The difference helped to show up who you were, to see inside yourself.

In fact, eighteenth- and nineteenth-century doctors interested in psychiatry – themselves called ‘alienists’ – defined this feeling, of pain and longing from being far away from home, as a distinct form of psychological illness. They used the term ‘nostalgia’, from the Greek term nostos (return home) and algos (pain). The term was first used in 1688, but became established as an understandable condition, often diagnosed amongst depressed mercenary soldiers far from home. Treatises were written on the symptoms and diagnosis, the causes and treatments. It was agreed that – in the end and of course – the only effective management was the nostos, the journey back home.

Among those early physicians there was no problem with this formulation. They conceived of nostalgia as a natural, psychosomatic response to being in an alien environment, and developed theories thereby as to the wider nature and causes of mental illness. They felt that psychic distress in its common presentations, such as melancholia or neurasthenia, was generated by the soul’s discomfort at being in the wrong place. What went on day by day around you, in terms of people, smells, what you saw and what you absorbed, kept your mind in balance.

Today, the relentless drive towards psychological suburbia – best typified by the sprawl of Los Angeles or San Diego – may have frightening consequences. Such sterile environments, while safe, comfortable and much longed for by the occupants of inner cities or slums, may not provide a sense of home. Home is about difference. The rising demand for individuality, personal choice and designer labels reflects our growing awareness that we don’t know who we are.

The notion of nostalgia created a therapeutic approach. This included a sense of priority in altering the world around the patient. Detailed instructions as to one’s diet would be accompanied by advice as to physical activities, the correct topics of conversation, suitable books, where one should reside. The asylum itself was designed as a therapeutic community, sited on high ground with pleasant views, running water and clean air. The melancholic patient had to be removed from the stresses of the family house or the hurly-burly of business. Some patients even got sent to high mountains or on long sea voyages, ostensibly for the change of air and the general ambience, but probably just as much to get them out of their exasperated physicians’ hair.

You can go trekking in Nepal or drive a truck across the deserts of North Africa, but these are only temporary expedients. Up to a third of industrial populations, living in their amorphous conurbations, will have some kind of psychological disorder in their lifetime. The numbers rise remorselessly, partly because of better diagnosis, partly because the elimination of physical illness has allowed people to pay more attention to the way they feel. Which may explain why we have transformed the term nostalgia into a longing for the past – at least the past had distinctive homes and styles of living.

Among the psychiatric syndromes collected in the usual textbooks is a group termed ‘culture-bound’. For example, Dhat is a delusional belief seen in depressed Indian men, convinced that sperm is leaking from their body while they urinate. Amongst Chinese males there is a state called Koro, characterized by a fear that the penis will retract into the abdomen. The wearing of weights to keep it hanging out has made for interesting illustrations in textbooks. These were seen as distinctive, acceptable and self-limiting forms of expressing distress. Under the impact of the global eye they are embarrassing, archaic and no longer able to provide the largely harmless release mechanisms they used to.

Culture-bound syndromes in the West include strange behaviours like anorexia nervosa or taking overdoses. Commonly seen as cries for attention, they usually arise in just the kind of circumstances that led the old physicians to coin the term ‘nostalgia’. Sufferers usually come from disrupted homes and families and are contrasting their own state with some primitive, natural conception of what their home world should be like. The anorexic is nostalgic for herself as a child – small, thin and cared for. The overdoser longs for the hubbub – the family – of the hospital. These people are what you might call post-modern casualties. The whirling global village frightens them at the same time as it dazzles with instant convenience.

In the words of the prophet Daniel: ‘Many shall run to and fro, and knowledge shall be increased.’ But what about their sanity?

Dr Trevor Turner is a consultant psychiatrist based at the Homerton Hospital in the East End of London.

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