Locating the Social Origins of Mental Illness: The Explanatory Models of Mental Illness Among Clergy from Different Ethnic and Faith Backgrounds

Conceptualising mental illness among University students of African, Caribbean and similar ethnic heritage in the United Kingdom

OBJECTIVE

Students of African, Caribbean and similar ethnicity (ACE) encounter unique mental health challenges within the Western higher education system, such as feeling constrained in social spaces and perceiving greater stigma about mental health. Students of ACE are also resilient to mental health problems, such as depression, when enduring social inequality. This study aimed to conceptualise mental illness and help-seeking behaviours among university students in the United Kingdom (UK) in the context of their identity as ACE.

DESIGN

Six university students of ACE in the UK were interviewed about the meaning of mental illness, the influence of ACE culture on mental health and help-seeking by ACE students. Thematic analysis was applied from a socio-constructionist theoretical lens to interpret the interview transcripts.

RESULTS

Five main themes emerged, namely 'Perceived meanings and attitudes toward mental health problems', 'Beliefs about the non-existence of mental health problem and its spiritual attributions', 'Family dynamics and the 'silencing' of mental health problems', 'Help-seeking for mental health among people of ACE' and 'Stigma and discriminatory responses to mental health issues'. Participants expressed that mental health is an imported concept that people from ACE communities tend to shy away from. A reluctance to discuss mental health problems arose over fear of rejection from families and fear of not being understood by a mental health professional from a different cultural background.

CONCLUSION

University students of ACE and their families struggle to adopt the Western conceptualisation of mental health. Consequently, there is poor awareness of mental health issues and stigma of mental illness among university students of ACE which pose a barrier to help-seeking for mental health. The limited sample size constrains the ability to draw sound conclusions. Nonetheless, a culturally sensitive conceptualisation of mental health is needed to address poor help-seeking for mental health among people of ACE.

"It's easy to dismiss it as simply a spiritual problem." Experiences of mental distress within evangelical Christian communities: A qualitative survey

Evidence suggests that faith communities can support psychological wellbeing but can also potentially diminish wellbeing through stigma, imposed spiritualization, and marginalization. In particular, for evangelical Christianity, whose theological praxis typically accentuates literalist spiritual onto-etiologies, including the belief that mental distress can be treated solely through spiritual intervention (prayer, fasting, and deliverance), there may be negative implications for Christians with mental distress. The current qualitative survey examined the responses of 293 self-identified evangelical Christians, concerning their experiences of mental distress in relation to their church community. An inductive thematic analysis revealed five themes: 1) Tensions between Faith and Suffering; 2) Cautions about a Reductive Spiritualization; 3) Feeling Othered and Disconnected; 4) Faith as Alleviating Distress; and 5) Inviting an Integrationist Position. Findings reveal stigma and the totalizing spiritualization of mental distress can be experienced as both dismissive and invalidating and can problematize secular help-seeking. This lends support to previous research which has suggested that evangelical Christian communities tend to link mental distress to spiritual deficiencies, which can hold potentially negative consequences for their wellbeing. Nevertheless, a degree of complexity and nuance emerged whereby spiritual explanations and interventions were also experienced as sometimes helpful in alleviating suffering. Overall, findings suggest evangelical communities are increasingly adopting integrationist understandings of mental distress, whereby spiritual narratives are assimilated alongside the biopsychosocial. We argue that church communities and psychotherapeutic practitioners should support movement from a position of dichotomizing psychological suffering (e.g., spiritual vs. biopsychosocial) towards a spiritually syntonic frame, which contextualizes distress in terms of the whole person. Considerations for psychotherapeutic practice and further research are made.

Contending with Spiritual Reductionism: Demons, Shame, and Dividualising Experiences Among Evangelical Christians with Mental Distress

The belief that mental distress is caused by demons, sin, or generational curses is commonplace among many evangelical Christian communities. These beliefs may have positive or negative effects for individuals and groups. Phenomenological descriptions of these experiences and the subjective meanings associated with them, however, remain somewhat neglected in the literature. The current study employed semi-structured interviews with eight evangelical Christians in order to idiographically explore their experiences of mental distress in relation to their faith and wider communities. Through an interpretative phenomenological analysis, two superordinate themes were constructed: negative spiritualisation and negotiating the dialectic between faith and the lived experience of mental distress. Participants variously experienced a climate of negative spiritualisation, whereby their mental distress was demonised and dismissed, and they were further discouraged from seeking help in secular institutions and environments. Participants often considered such dismissals of their mental distress as unhelpful and stigmatising and experienced heightened feelings of shame and suffering as a result. Such discouragement also contributed to the process of othering and relational disconnection. Alongside a rejection of church teachings, which exclusively spiritualised psychological distress, participants negotiated a nuanced personal synthesis of faith, theology, and distress, which assumed a localised and idiographic significance. This synthesis included advocating for the uptake of aetiological accounts, which contextualised mental distress in terms of the whole person and resisted de-politicised, dichotomised, and individualistic narratives. Results are discussed in relation to a broad range of literature in the field, while further research suggestions are provided.

Turkish Muslim Healers: A Qualitative Investigation of Hocas and Their Methods

A vast majority of Turkish individuals are Muslim, and several Turkish individuals refer to traditional healers to get help for medical and psychological problems. The purpose of the present study was to investigate Turkish traditional healing methods and to delineate the kinds of presenting problems that the clients bring to healers, methods used by the healers, the healing process, and the effect of healing on the clients. For this purpose, 11 participants were interviewed. The data were analyzed using the consensual qualitative research method. Nine domains emerged from the interviews: symptoms, diagnosis, etiology, treatment, response to treatment, characteristics of healers, clients' beliefs and desire to be healed, all healing coming from Allah (God), and characteristics of jinns. The findings were discussed in light of Kleinman's (Patients and healers in the context of culture: an exploration of the borderland between anthropology, medicine, and psychiatry, University of California Press, Berkeley, 1980) illness explanatory model and characteristics of Turkish culture.

[The influence of religiosity on depressive disorders and suicidal behavior]

This review of the literature is focused on the positive influence of religiosity on recovery after depression and on the protective role of religiosity against suicidal activity. Despite the inconsistent results on the role of religiosity in treatment of mental diseases, to date there is a sufficiently large body of literature showing the beneficial effect of religiosity and describing specific therapeutic approaches and suicide prevention programs.

Beliefs About Etiology and Treatment of Mental Illness Among Korean Presbyterian Pastors

This descriptive study explored pastors' beliefs about etiology and treatment of mental illness. Surveys were completed by mail by 202 Korean and Euro-American Presbyterian clergy. Nearly one-third of Korean pastors viewed bad parenting and demon possession as very important causes of mental illness, in contrast to the more than two-thirds of Euro-American pastors who viewed genetics and chemical imbalances as the most important causes. Compared with their Euro-American counterparts, Korean pastors soundly endorsed spiritual treatment of mental illness. The findings of this study suggest the value of understanding the views of pastors working with populations that underutilize formal mental health services.

'The threads in his mind have torn': conceptualization and treatment of mental disorders by neo-prophetic Christian healers in Accra, Ghana

BACKGROUND

In many low- and middle-income countries, faith healing is used alongside biomedical treatment for many health problems including mental disorders. Further, Christianity in Africa has seen much transformation in recent decades with the growth of charismatic or neo-prophetic churches whose doctrines include healing, miracles and prophecies. As such, many charismatic pastors have been engaged in faith healing for many years. Such faith healers form a significant portion of the mental health workforce in these countries, partly due to the limited number of biomedically trained professionals. In this study, we sought to examine the beliefs of charismatic/neo-Pentecostal faith healers about mental disorders, as well as to examine the treatments that they employed to treat such disorders.

METHODS

We interviewed neo-prophetic pastors who undertook faith healing, and examined their work relating to mental disorders. Ten pastors from eight churches in the Greater Accra Region of Ghana were interviewed using semi-structured interviews.

RESULTS

The data suggest that the pastors' conceptualization of mental illness was generally limited to psychotic disorders. Their beliefs about causation were predominantly supernatural in nature although they acknowledged that drug misuse and road traffic accidents were also potential causes. The pastors' expectations of healing also showed different perceptions of illness chronicity. Their diagnostic and treatment methods revolved around using prayer, prayer aids such as oils and holy water, as well as spiritual counselling for patients and their caregivers. However, they were not opposed to referring patients to hospitals when deemed necessary.

CONCLUSION

We discuss the above results with emphasis on their implications for collaboration between biomedical and alternative healing systems in Ghana. In particular, we advocate a mutual understanding of illness perspectives between biomedical practitioners and faith healers as an important component for integrating different health systems in Ghana.

Explanatory model of illness of the patients with schizophrenia and the role of educational intervention

This randomized controlled trial was conducted at Department of Psychiatry, Lady Reading Hospital, Peshawar from February to August 2015 to explore beliefs and concepts of patients with schizophrenia about their illness and to find out the effectiveness of structured educational intervention in changing the explanatory models of illness of the patients and in their symptoms reduction. One hundred and three patients were recruited in the trial who were randomly assigned to two groups i.e., Experimental (n=53) and Control i.e., Treatment As Usual, TAU (n=50). Intervention was applied to experimental group only, once a month for three months. Short Explanatory Model Interview (SEMI), Brief Psychiatric Rating Scale (BPRS), Positive And Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF) and Compliance Rating Scale were applied on all patients at baseline and at 3months follow up. Scores on PANSS (Total), BPRS and GAF showed improvement in the experimental group as compared to TAU group, at follow up, with the p values of 0.000, 0.002 and 0.000, respectively. On follow up, 44 (95.6%) patients of experimental group achieved complete compliance as compared to 17 (47.2%) patients of TAU group [p=0.000]. On baseline analysis of SEMI, in the experimental group, only 3.8% (n=2) knew about name of the illness, which increased to 54.3% (n=25) on follow up, while in TAU group it improved to 5.6% (n=2) as compared to 0% at baseline (p=0.000). The result suggest that Structured educational intervention can be effective in modifying the beliefs of the patients regarding their illness.

A Mental Health Survey of Different Ethnic and Occupational Groups in Xinjiang, China

Poor mental health has become a serious social and public health-care burden. This cross-sectional study used multistage stratified cluster random sampling to gather mental health information from 11,891 adults (18-60 years) employed in various occupations categorized according to the Chinese Standard Occupational Classification. Mental health was measured by the General Health Questionnaire, and participants exceeding the cut-off score were defined as having poor mental health. The overall prevalence of poor mental health was 23.8%. The prevalence of poor mental health was significantly higher in the Han ethnic group than Kazak ethnic group and in health-care workers, teachers, and civil servants compared to manual workers. Females (odds ratios (OR) = 1.139, 95% confidence intervals (CI): 1.012-3.198) and knowledge workers (1.697, 1.097-2.962) were risk factors for poor mental health, while Kazak ethnicity (0.465, 0.466-0.937), other minority status (non-Han) (0.806, 0.205-0.987), and working ≥15 years in the same occupation (0.832, 0.532-0.932) were protective (p < 0.05). We concluded that the general level of mental health in Xinjiang, China, is higher in the Kazak ethnic group than the Han ethnic group. The prevalence of poor mental health is higher among knowledge workers than in manual workers due to high incidences of poor mental health in civil servants, health-care workers, and teachers.

A Pilot Study of a Novel Method of Measuring Stigma about Depression Developed for Latinos in the Faith-Based Setting

In order to understand the effects of interventions designed to reduce stigma about mental illness, we need valid measures. However, the validity of commonly used measures is compromised by social desirability bias. The purpose of this pilot study was to test an anonymous method of measuring stigma in the community setting. The method of data collection, Preguntas con Cartas (Questions with Cards) used numbered playing cards to conduct anonymous group polling about stigmatizing beliefs during a mental health literacy intervention. An analysis of the difference between Preguntas con Cartas stigma votes and corresponding face-to-face individual survey results for the same seven stigma questions indicated that there was a statistically significant differences in the distributions between the two methods of data collection (χ(2) = 8.27, p = 0.016). This exploratory study has shown the potential effectiveness of Preguntas con Cartas as a novel method of measuring stigma in the community-based setting.