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Culture, Experience, Care: (Re-)Centring the Patient, 2014
Multi-culturalism and -ethnicity are key features of African societies and an understanding of traditional belief systems and cultural perceptions about health, illness and healing is therefore pivotal on the African continent. This is all the more true when it comes to mental health. Despite neuro-psychiatric disorders ranking third (after HIV/AIDS and other infectious diseases) in contributing to the overall disease burden in South Africa, mental health is still acutely stigmatized and is generally seen as a peripheral and isolated issue. This is partly due to the various cross-cultural causal explanations and perceptions that exist amongst Africans with regard to their mental health. In many of the indigenous languages, no equivalent words for concepts like ‘counselling,’ ‘therapy’ or ‘depression’ exist and traditional beliefs in supernatural causes of, and remedies for mental conditions are rife. It is furthermore not uncommon for people to accept biomedical explanations and treatment for their condition, even while espousing more traditional and cultural (ethno-etiological) perceptions about their mental health, and utilizing the traditional treatment options and rituals provided by traditional healers. This paper will consider some of these mental health ethnoetiologies in Southern Africa and will show how cultural, religious and spiritual beliefs about mental health can colour perceptions and influence communication. An argument will be made for a culture-sensitive understanding of mental illness in Southern Africa, the fundamental principles that underpin African beliefs with regard to health and illness will be considered, and a collaborative therapeutic approach that is culture-sensitive, pluralistic and patient-centred will be advocated. The primary example that will be explored in this chapter is kufungisasa, a cultural construction of the mental illness generally known as depression in Western biomedicine.
Abstract Mental health disorder threatens the quality of our well-being and is a severe threat to our quality of life. The aim of this qualitative review is to explore the causes and perceptions of mental health disorder in Cameroon where the disease is neither culturally acknowledged nor considered as an illness. The causes and cultural perceptions of mental disorder include but are not limited to: drug misuse, generational curses, God`s punishment and witchcraft or spiritual possession. Few Cameroonians accept a scientific explanation as a possible cause of mental health disorder. Combining a political economy of health framework, social suffering approach as well as an interpretive perspective in medical anthropology, this review suggests that the failure to recognize mental health illnesses instead tend to exacerbate the situation of mental health patients in a context where access to healthcare is unavailable for most of the population. Apart from the fact that the two urban-based hospitals that provide psychiatric services are acutely ill-equipped and understaffed the available human resources are trained in general medicine, not psychiatric medicine. Furthermore, the stigma associated with mental health disorder can be attributed to the fact that mental illness is believed to be caused by intergenerational curse or witchcraft. This perception, grounded in the communitarian worldview of most African societies according to which an individual represents a family, has led to the neglect of mental health patients. Underneath the suffering and absence of care, mental health patients are faced with stigma, shame, and exclusion. The fundamental human rights of mental health patients including their citizenship rights of voting, working, marriage, and access to state protections are violated with impunity. Stigma trails former mental health patients: they face problems of integration into the public sector. This study recommends that a positive mental health culture needs to be adopted. An effective treatment of mental health disorder should include the rehabilitation of the patients into society. An integrated preventive and curative approach will mitigate the cost of treatment for mental disorders and will enhance population health. Keywords: Mental health disorder, medical pluralism, stigma, human rights, patient rehabilitation, Cameroon, suicide, HIV/AIDS, economic crisis.
In the past few decades, there has been a growing interest in understanding the cultural dimensions of psychology (Bruner, 1984;. This work, along with the experiences of psychologists working with communities under war-time duress and in the immediate post-war context, has forced us to re-think our understanding of trauma and psychotherapeutic intervention; that is, we are beginning to recongnize the role of culture in what constitutes a traumatic experience, how people explain and understand the sources of their trauma, how these experiences are elaborated and manifested in pychological disturbances, and even the solutions people look for to deal with situations of extreme duress (di Giroloamo, 1993;. In particular, we are beginning to recognize the limitations of conventional views of psychotraumatiology developed in the west when attempting to develop psychotherapeutic interventions in crosscultural contexts. In the African context, for example, Dawes and Honwana (1998) suggest that we need to think more holistically to the traumatized individual-in context, for it is only in this way that psychologists can understand the meaning which the individual brings and gives to a stressful experience. Moreover, it is only from this perspective that we can understand the resources available to an individual for dealing with a traumatic event. From this broader cultural context, it may become apparent, as Honwana (1997) reveals, that there are many more healing resources avaliable not only to the individual, but also to the psychologist. Indeed, psychologists may soon discover that, as healers, the "medicine" of western psychotherapy may have little currency in certain contexts, particularly if they assume that they are the only healers available to individuals and communities in crisis.
Culturally congruent mental health research in Africa: Field notes from Ethiopia and Senegal
African Journal of Psychiatry, 2014
In this article we discuss culturally congruent methods for conducting mental health research in Africa, with a focus on field work in Ethiopia and Senegal. Our goal is to emphasize the centrality of culture to carrying out mental health research and to present community-participatory and qualitative approaches as frameworks for mental health research in Africa. We use field research examples from Ethiopia and Senegal to highlight key cultural considerations, including: obtaining community buy-in, connecting with local stakeholders, determining appropriate research questions, collaboration in developing questionnaires, working with interpreters, facilitating useful disclosure of findings and interpreting meaning from research data. Finally, we make the case for the richness of qualitative field research as a way to examine complex psychological and psychiatric topics.
The Global South - Global Mental Health & Psychiatry Newsletter - June 2018
In this essay, I discuss the evolving notion of the Global South. These considerations point to the need to understand and embrace the emerging characteristics of the Global south that I define as syncretism, conviviality, and porosity. Syncretism is the practice of different religious traditions such as Catholicism and Afro-Brazilian candomblé side by side to create new syntheses of belief and practice. I am applying this more generally to the capacity in the Global south to embrace plurality and difference to create more a more harmonious and inclusive syncretic culture. Conviviality is a similar term invoked by Ivan Illich, emphasizing interdependence. Porosity is an idea I adopted from the work of Walter Benjamin in my work in Brazil and Haiti to soften borders and boundaries in the daily work of culture. What these three notions have in common is a more fluid, less categorical approach to culture, medicine and politics.
2013
How may the mental health of socially deprived HIV/AIDS affected communities be supported in an era of 'global mental health'? To date, 'community' efforts have been informed by a largely biomedical and epidemiological body of evidence, distracting attention from lived realities, local contexts and their abilities to frame understandings of mental distress and treatment. This thesis seeks to contribute a productive critique of the Global Mental Health field, by expanding on some of the missing dimensions in their conceptualisations of health and healing. Through a focus on social psychological processes of community, knowledge and social change, it formulates a series of suggestions for how the Movement for Global Mental Health (MGMH) and other policy actors can build on their existing efforts, through establish health enabling contexts where communities actively participate in addressing mental distress, and tackling the contexts that constitute distress in locally relevant ways. The thesis reports on a case study of KwaNagase (Manguzi), an HIV-affected rural community in KwaZulu-Natal, South Africa. It takes interest in the intersection of three respective groups, exploring how they understand, cope with, and work together in efforts to support mental well-being: 1) poor HIV/AIDS affected women experiencing mental distress; 2) community level supports (local NGOs and traditional healers); and 3) public health services (primary health sector). Data was collected over a three month period using multiple methods. In-depth individual interviews (n = 43) were triangulated by a motivated ethnography (Duveen and Lloyd, 1999) that explored local cultural, structural and symbolic contexts of community that frame understandings of mental health and delivery of care. Grounded thematic analyses identified that women's understandings of mental distress were shaped by experiences of poverty, violence and HIV, which in turn, limited their ability to meet normative expectations linked to gender roles of 'mother' and 'wife'. Indigenous psychosocial coping strategies employed by women to tackle the aforementioned drivers of distress were underpinned by the presence or absence of social psychological resources that optimise health and well-being: agency, partnerships, critical thinking and solidarity. Primary mental health care actors' (NGOs and formal health service actors) understandings of women's distress were informed by an awareness of the structural and symbolic issues facing women in everyday life, aligning with the women's own understandings. Their best practices highlighted efforts to establish receptive social spacesa critical dimension of health enabling contexts but were limited by symbolic and structural barriers such as stigma among providers, and general under-resourcing of the sector. To overcome the limits facing community mental health services in Manguzi and similar contexts, the thesis concludes by highlighting a series of suggested actions to bolster identified community mental health competencies, and provides a tool kit of recommended strategies to support existing public sector efforts to promote mentally healthy communities.
2017
Psychology like other progressive scientific disciplines endures constant transformation, with one scientific revolution replacing or superseding another. The nascent field of community psychology represents a paradigm shift, and indeed a mental health revolution in psychology. The paper seeks to illuminate the themes, values, and methods of community psychology. Effort will be made to underscore how the discipline does not attempt to hide behind a “scientific” value free cloak but rather highlight the critical role values play in shaping and informing praxis in psychology and community psychology in particular. The paper also seeks to emphasise that the discipline is relevant in African cultural contexts given the synchronicity between its core values and African cultural values. Finally, an endeavour will be made to examine community psychology in the Zimbabwean context.
Culture, medicine and psychiatry, 2020
This paper examines how cultural, historical and contemporary perspectives of mental health continue to inform ways of understanding and responding to mental distress even under the biomedical gaze of the Movement for Global Mental Health (MGMH). Based on experiences in Malawi, the authors explore three prominent interventions (practical support, counselling and support groups) employed by village health workers within a mental health task-shifting initiative and reveal how the ancient philosophy of Umunthu with its values of interconnectedness, inclusion and inter-relationships informs and shapes the direction of these interventions. Practical support is marshalled through traditional village structures, counselling provides advice and an encouragement to hope, and support groups provide a place for emotional exchange and a forum for the enactment of values, reflection and reinforcement of Umunthu. What are pronounced as biomedical psychosocial interventions are in fact the deliver...
Community Perceptions of Indigenous Healers and Mental Disorders in Zimbabwe
Open Journal of Psychiatry
The World Health Organisation has made recommendations for partnerships between indigenous healing (IH) and biomedical therapy (BT) in the delivery of health services as a way of creating cultural sensitivity in mental health care (Bank, 2001). Yet, literature on prevalence, distribution, burden, and unmet needs for treatment of the mental disorders often exclude the role played by indigenous healing practitioners (IHPs). This study aimed to analyze mental health care from the perspective of communities on mental health care by IHPs to reveal their possible role in the surveillance studies of mental disorders in a settlement northeast of Harare in Zimbabwe through an exploratory qualitative methodology. Thirty in-depth interviews and three focus group discussions with key-informants were conducted to gather community perceptions of the nature of mental disorders treated by IHPs in Zimbabwe. Gathered data were coded using Constant Comparison Method with multiple members of the research team, enhancing validity and reliability. The results of the study reveal that while some patients presented with some mental disorders that were consistent with the BT diagnoses such as schizophrenia (Chirwere chepfungwa), depression (Kufungisisa), anxiety (Buka), post-traumatic stress disorder (Kurotomoka) somatisation (shungu), etc., other patients reported the disorders that were not recognised from a biomedical point of view such as the supernatural, cultural or social problems in IH. The findings were similar to the results of the first 17 world mental health surveys which show that the mental disorders are commonly occurring in all participating countries. This implied that the IHPs were treating common mental disorders reported in the low-income countries. More importantly, the IHPs treated a unique category which affected the majority of Zimbabwean patients. This study highlights the importance of the IHPs as complementary to