“I want the one that will heal me completely so it won’t come back again”: The limits of antipsychotic medication in rural Ghana

Abstract

Campaigns to scale up mental health services in low-income countries emphasise the need to improve access to psychotropic medication as part of effective treatment yet there is little acknowledgement of the limitations of psychotropic drugs as perceived by those who use them. This paper considers responses to treatment with antipsychotics by people with mental illness and their families in rural Ghana, drawing on an anthropological study of family experiences and help seeking for mental illness. Despite a perception among health workers that there was little popular awareness of biomedical treatment for mental disorders, psychiatric services had been used by almost all informants. However, in many cases antipsychotic treatment had been discontinued, even where it had been recognised to have beneficial effects such as controlling aggression or inducing sleep. Unpleasant side effects such as feelings of weakness and prolonged drowsiness conflicted with notions of health as strength and were seen to reduce the ability to work. The reduction of perceptual experiences such as visions was less valued than a return to social functioning. The failure of antipsychotics to achieve a permanent cure also cast doubt on their efficacy and strengthened suspicions of a spiritual illness which would resist medical treatment. These findings suggest that efforts to improve the treatment of mental disorders in low-income countries should take into account the limitations of antipsychotic drugs for those who use them and consider how local resources and concepts of recovery can be used to maximise treatment and support families.

Implications of healing power and positioning for collaboration between formal mental health services and traditional/alternative medicine: the case of Ghana

“…At the core of these notions of power lies an expectation that the outcome of treatment will be a complete cure of the disorder [12,35]. This cure is manifested when the treatment restores patients to their previous state of productivity, and they are able to reintegrate into the social strata of the community.…”

“…Despite these acknowledgements, the dualistic bifurcation between western medicine on the one hand and traditional/faith healing on the other does not reflect the plurality of healing systems in operation in many contexts – there are many different kinds of healers, using differing systems of justification for their work, and engaging in complex and at times unpredictable ways [35]. Consequently, part of what has not been fully explored in the study of the potential for collaboration between western medicine and other approaches to healing is the question of the diverse investments that different non-biomedical healing approaches may have in their own power to heal, and the relationship between that power and the perceived power of biomedical approaches.…”

Contextualising women's mental distress and coping strategies in the time of AIDS: A rural South African case study

“…Mental illness is conceptualised in terms of decontextualized diagnostic categories that pay less attention to the wider contexts of peoples' distress, and give little attention to patients' own accounts of their illness. Given the poor resonance between psychiatric services and the experiences and life worlds of many African communities (Read, 2012), there is growing attention to the need for phenomenological studies that explore how patients themselves conceptualise and deal with distress, as a way of facilitating improved interfaces between services and users. This literature is heavily influenced by the development of patient explanatory models of distress (See Kleinman, 1980).…”

“Now he walks and walks, as if he didn’t have a home where he could eat”: Food, Healing, and Hunger in Quechua Narratives of Madness

“…Side-effects, alternative priorities, and question marks over its lasting effectiveness are all factors that may contribute to decisions to discontinue anti-psychotic medication in lowincome countries (Read 2012), so Francisco's refusal of his adulterated meals is unsurprising.…”