Cultural response to mental illness in Senegal: Reflections through patient companions--Part I. Methods and descriptive data

Falling, Dying Sheep, and the Divine: Notes on Thick Therapeutics in Peri-Urban Senegal

Peri-urban Senegal lies outside the influence of both the nation's historic public mental health model and contemporary global mental health. This paper examines how cultural logics in this underserved region spill over from social domains to widen the therapeutic sphere of psychoses and epilepsy. Observations and 60 carer and/or patient interviews concerning 36 patients afflicted by one or both conditions illustrate how the "crisis of the uncanny", a spectacular eruption of psychoses and seizures into the everyday, triggers trajectories across these domains. To resolve the crisis, patients and carers mobilize debts and obligations of extended kin and community, as well as a gift economy among strangers. The therapeutic and non-therapeutic are further linked through the semantics of falling, which associates this local term for the crisis with divine ecstasy and the slide from human to non-human forms of life. We introduce the concept of thick therapeutics to capture how the logics of sheep- other animal-human relationality, secular-divine politics of giving, and payment/sacrifice for healing imbue a therapeutic assemblage continually constructed through actions of patients, carers and healers. We ask what implications therapeutic thickening might have for mental health futures, such as monetized payment under global mental health.

Barriers to Family Caregivers' Coping With Patients With Severe Mental Illness in Iran

The broad spectrum of problems caused by caring for a patient with mental illness imposes a high burden on family caregivers. This can affect how they cope with their mentally ill family members. Identifying caregivers' experiences of barriers to coping is necessary to develop a program to help them overcome these challenges. This qualitative content analysis study explored barriers impeding family caregivers' ability to cope with their relatives diagnosed with severe mental illness (defined here as schizophrenia, schizoaffective disorders, and bipolar affective disorders). Sixteen family caregivers were recruited using purposive sampling and interviewed using a semi-structured in-depth interview method. Data were analyzed by a conventional content analytic approach. Findings consisted of four major categories: the patient's isolation from everyday life, incomplete recovery, lack of support by the mental health care system, and stigmatization. Findings highlight the necessity of providing support for caregivers by the mental health care delivery service system.

Explanatory model of psychosis: impact on perception of self-stigma by patients in three sub-saharan African cities

BACKGROUND

Most cultures in sub-Saharan Africa subscribe to the belief that the root cause of psychosis is supernatural. Individuals in the community who hold a religiomagical explanatory model of causation have been shown to exhibit more stigmatizing attitudes towards people with psychosis. Self-stigma among individuals with psychosis is less frequently studied.

METHOD

We used a mixed-method approach, consisting of key informant's interviews to elicit information on explanatory models of causation of psychosis and questionnaire assessment of internalized stigma with an adapted version of the Scale for Internalized Stigma of Mental Illness. Twenty-four, 31, and 30 subjects with recent experience of utilizing the service of traditional or faith healers for severe mental disorders in Ibadan (Nigeria), Kumasi (Ghana), and Nairobi (Kenya), respectively, were interviewed.

RESULTS

About 44 % (42.1 %) of the Nigerian respondents had a high (severe) level of self-stigma with the respective proportions among Ghanaian and Kenyan respondents being 20.7 and 37.5 %. Compared with 4 out of a total of 12 respondents (33.3 %) who reported low self-stigma reported supernatural attribution, 14 out of 20 respondents (70 %) with the highest level of self-stigma reported supernatural attribution across the three sites. When low scorers ascribed supernatural causation, it was often with a religious focus.

CONCLUSION

There is a greater tendency for persons with high levels of self-stigma than those with low levels to ascribe supernatural attribution to their experience of a severe mental health condition.

Exploring the relationship between stigma and help-seeking for mental illness in African-descended faith communities in the UK

Background

Stigma related to mental illness affects all ethnic groups, contributing to the production and maintenance of mental illness and restricting access to care and support. However, stigma is especially prevalent in minority communities, thus potentially increasing ethnically based disparities. Little is known of the links between stigma and help‐seeking for mental illness in African‐descended populations in the UK.

Objective and study design

Building on the evidence that faith‐based organizations (FBOs) can aid the development of effective public health strategies, this qualitative study used semi‐structured interviews with faith groups to explore the complex ways in which stigma influences help‐seeking for mental illness in African‐descended communities. A thematic approach to data analysis was applied to the entire data set.

Setting and participants

Twenty‐six men and women who had varying levels of involvement with Christian FBOs in south London were interviewed (e.g. six faith leaders, thirteen ‘active members’ and seven ‘regular attendees’).

Results

Key factors influencing help‐seeking behaviour were as follows: beliefs about the causes of mental illness; ‘silencing’ of mental illness resulting from heightened levels of ideological stigma; and stigma (re)production and maintenance at community level. Individuals with a diagnosis of mental illness were likely to experience a triple jeopardy in terms of stigma.

Discussion and conclusion

‘One‐size‐fits‐all’ approaches cannot effectively meet the needs of diverse populations. To ensure that services are more congruent with their needs, health and care organizations should enable service users, families and community members to become active creators of interventions to remove barriers to help‐seeking for mental illness.

The stigma of mental illness in Southern Ghana: attitudes of the urban population and patients' views

PURPOSE

Stigma is a frequent accompaniment of mental illness leading to a number of detrimental consequences. Most research into the stigma connected to mental illness was conducted in the developed world. So far, few data exist on countries in sub-Saharan Africa and no data have been published on population attitudes towards mental illness in Ghana. Even less is known about the stigma actually perceived by the mentally ill persons themselves.

METHOD

A convenience sample of 403 participants (210 men, mean age 32.4±12.3 years) from urban regions in Accra, Cape Coast and Pantang filled in the Community Attitudes towards the Mentally Ill (CAMI) questionnaire. In addition, 105 patients (75 men, mean age 35.9±11.0 years) of Ghana's three psychiatric hospitals (Accra Psychiatry Hospital, Ankaful Hospital, Pantang Hospital) answered the Perceived Stigma and Discrimination Scale.

RESULTS

High levels of stigma prevailed in the population as shown by high proportions of assent to items expressing authoritarian and socially restrictive views, coexisting with agreement with more benevolent attitudes. A higher level of education was associated with more positive attitudes on all subscales (Authoritarianism, Social Restrictiveness, Benevolence and Acceptance of Community Based Mental Health Services). The patients reported a high degree of experienced stigma with secrecy concerning the illness as a widespread coping strategy. Perceived stigma was not associated with sex or age.

DISCUSSION

The extent of stigmatising attitudes within the urban population of Southern Ghana is in line with the scant research in other countries in sub-Saharan Africa and mirrored by the experienced stigma reported by the patients. These results have to be seen in the context of the extreme scarcity of resources within the Ghanaian psychiatric system. Anti-stigma efforts should include interventions for mentally ill persons themselves and not exclusively focus on public attitudes.

Stakeholder's perceptions of help-seeking behaviour among people with mental health problems in Uganda

Introduction

Mental health facilities in Uganda remain underutilized, despite efforts to decentralize the services. One of the possible explanations for this is the help-seeking behaviours of people with mental health problems. Unfortunately little is known about the factors that influence the help-seeking behaviours. Delays in seeking proper treatment are known to compromise the outcome of the care.

Aim

To examine the help-seeking behaviours of individuals with mental health problems, and the factors that may influence such behaviours in Uganda.

Method

Sixty-two interviews and six focus groups were conducted with stakeholders drawn from national and district levels. Thematic analysis of the data was conducted using a framework analysis approach.

Results

The findings revealed that in some Ugandan communities, help is mostly sought from traditional healers initially, whereas western form of care is usually considered as a last resort. The factors found to influence help-seeking behaviour within the community include: beliefs about the causes of mental illness, the nature of service delivery, accessibility and cost, stigma.

Conclusion

Increasing the uptake of mental health services requires dedicating more human and financial resources to conventional mental health services. Better understanding of socio-cultural factors that may influence accessibility, engagement and collaboration with traditional healers and conventional practitioners is also urgently required.

Beliefs and community responses to mental illness in Ghana: the experiences of family carers

BACKGROUND

There is often a lack of agreement on how to understand mental illness in low-income countries and support those experiencing it. This article explores the debate on beliefs and the implications for how society responds.

MATERIAL

Semi-structured interviews were undertaken with 80 family carers across four sites in Ghana to explore the themes of beliefs, attitudes, carer burden and support.

DISCUSSION AND CONCLUSIONS

There appears to be greater reliance on culturally specific explanations of mental illness in rural areas, combined with more acceptance and support, particularly in one rural area with strong traditional belief systems. This suggests the need to develop integrated mental health services, which reflect these differing beliefs.

Therapeutic landscapes of the Jola, The Gambia, West Africa

This paper contributes to the 'new' medical geography through its analysis of the therapeutic landscapes of the Jola of The Gambia. The paper advances the debate surrounding the conceptualization of medicine and health through a review of literature on African medicinal systems; it examines in detail the health care system of the Jola of The Gambia, documenting indigenous human and ethnoveterinary medical beliefs and practices and focusing in particular on the role of herbal medicine; and it discusses the interactions and links between indigenous medicine and biomedicine, thus demonstrating the importance of placing an understanding of health care systems in different places within an awareness of global power relations. The paper therefore links cultural perspectives with a political economy analysis, to highlight the importance of place and specificity of cultural context when investigating health care beliefs and practices. The intention of the paper is to present a theoretically informed empirical case study which reinforces the practical value of a 'new' medical geography.

Perception of the social support role of the extended family network by some Nigerians with schizophrenia and affective disorders

Enquiries into patients' perception of psychosocial support from families should help objectively to identify the strengths and needs of families with sick members, in order to enhance management. The aim of this study was to identify the categories of relatives in the extended family whom a sample of Nigerian psychiatric patients perceived as having provided material, social and emotional support, and the factors associated with these perceptions. 123 schizophrenics and 31 patients with major affective disorders attending out-patient clinics were interviewed. Using operational definitions of family member (i.e. tendency to confide in and expect support from a relative), it appears that the size of extended family network that was mostly relied upon for support was five, including parents, full siblings, uncles/aunts, first cousins and in-laws. There were no significant differences in summary scores of family size and social support between the two illness groups. Age and duration of illness were significantly negatively correlated with perception of supports. The size of family network with whom patients interacted was predicted by tendency to confide in members, and emotional support. The findings indicate that the presumed support of the extended family should not negate the need to strengthen the resources of the nuclear family, in order to provide a focus for attraction and deployment of materials needed for the effective care of patients.

The involvement of families in Indian psychiatry

Ethnographic observations and interviews with psychiatrists at two general hospital psychiatric units in northern India reveal the extent of family involvement in the localized adaptation of biomedical psychiatry that occurs in these settings. By assuming many of the roles filled by auxiliary personnel in the USA, families maintain considerable control over many aspects of the psychiatric process: defining disorder, outpatient consultation, record keeping, admissions, inpatient care, discharge, and continuing care. The implications of these observations are considered in relation to theoretical concerns about biomedical hegemony, advantages and disadvantages of family involvement from an applied perspective, and the methodological adequacy of cross-cultural psychiatric epidemiology with respect to studies of "expressed emotion."