Explanatory models, illness, and treatment experiences of patients with psychosis using the services of traditional and faith healers in three African countries: Similarities and discontinuities

Abstract

As part of formative studies to design a program of collaborative care for persons with psychosis, we explored personal experience and lay attributions of illness as well as treatment among persons who had recently received care at traditional and faith healers’ (TFHs) facilities in three cultural groups in Sub-Saharan Africa. A purposive sample of 85 individuals in Ibadan (Nigeria), Kumasi (Ghana), and Nairobi (Kenya) were interviewed. Data was inductively explored for themes and analysis was informed by the Framework Method. Across the three sites, illness experiences featured suffering and disability in different life domains. Predominant causal attribution was supernatural, even when biological causation was also acknowledged. Prayer and rituals, steeped in traditional spiritual beliefs, were prominent both in traditional faith healing settings as well as those of Christianity and Islam. Concurrent or consecutive use of TFHs and conventional medical services was common. TFHs provided services that appear to meet the therapeutic goals of their patients even when harmful treatment practices were employed. Cultural and linguistic differences did not obscure the commonality of a core set of beliefs and practices across these three groups. This similarity of core worldviews across diverse cultural settings means that a collaborative approach designed in one cultural group would, with adaptations to reflect differences in context, be applicable in another cultural group. Studies of patients’ experience of illness and care are useful in designing and implementing collaborations between biomedical and TFH services as a way of scaling up services and improving the outcome of psychosis.

The role of culture on the phenomenology of hallucinations and delusions, explanatory models, and help‐seeking attitudes: A narrative review

“…Bewitchment was the predominant explanatory model employed in African cultures. African clients attributed hallucinations to jealousy‐induced witchcraft from external agents, which was consistent across African studies (Ayinde et al, 2021; Campbell et al, 2017; Napo et al, 2012). Voice content in African patients was typified by hearing the voice of God, inducing positive AH appraisal.…”

Inequality and barriers in psychosis prevention: A systematic review on clinical high-risk for psychosis studies from developing countries

“…A systematic review on the issue found that a large proportion of patients with psychosis use religious healers as their first point of contact for accessing care (41). Psychotic symptoms are therefore frequently interpreted by the leigh belief as supernatural or religious manifestations-as shown by previous works in Brazil (42), Kenya, Nigeria, Ghana (43), and many other countries, for instance (42,44,45). This also occurs in individuals with an Islamic background, who may attribute psychotic symptoms to jinn (invisible spirits) (46).…”

Contingent universality: The epistemic politics of global mental health

“…Although they recognize ‘cultural and linguistic differences’, they highlight that these ‘did not obscure the commonality of a core set of beliefs and practices across these three groups’ (p. 521). Such commonalities were especially pronounced in how psychosis impacts people's lives; for example, their difficulties getting married, setbacks in educational attainment, in occupation and life achievements (Ayinde et al, 2023).…”

“…The cultural lens may have also become somewhat decentred in GMH through the prominence of the social as a comparative plain for the shared and divergent features of mental health across contexts. Ayinde and colleagues (2023), in this issue, for example, compare explanatory models of psychosis and care experiences care across Nigeria, Ghana and Kenya. Although they recognize ‘cultural and linguistic differences’, they highlight that these ‘did not obscure the commonality of a core set of beliefs and practices across these three groups’ (p. 521).…”