Madness or sadness? Local concepts of mental illness in four conflict-affected African communities

Abstract

BackgroundConcepts of ‘what constitutes mental illness’, the presumed aetiology and preferred treatment options, vary considerably from one cultural context to another. Knowledge and understanding of these local conceptualisations is essential to inform public mental health programming and policy.MethodsParticipants from four locations in Burundi, South Sudan and the Democratic Republic of the Congo, were invited to describe ‘problems they knew of that related to thinking, feeling and behaviour?’ Data were collected over 31 focus groups discussions (251 participants) and key informant interviews with traditional healers and health workers.ResultsWhile remarkable similarities occurred across all settings, there were also striking differences. In all areas, participants were able to describe localized syndromes characterized by severe behavioural and cognitive disturbances with considerable resemblance to psychotic disorders. Additionally, respondents throughout all settings described local syndromes that included sadness and social withdrawal as core features. These syndromes had some similarities with nonpsychotic mental disorders, such as major depression or anxiety disorders, but also differed significantly. Aetiological concepts varied a great deal within each setting, and attributed causes varied from supernatural to psychosocial and natural. Local syndromes resembling psychotic disorders were seen as an abnormality in need of treatment, although people did not really know where to go. Local syndromes resembling nonpsychotic mental disorders were not regarded as a ‘medical’ disorder, and were therefore also not seen as a condition for which help should be sought within the biomedical health-care system. Rather, such conditions were expected to improve through social and emotional support from relatives, traditional healers and community members.ConclusionsLocal conceptualizations have significant implications for the planning of mental-health interventions in resource-poor settings recovering from conflict. Treatment options for people suffering from severe mental disorders should be made available to people, preferably within general health care facilities. For people suffering from local syndromes characterized by loss or sadness, the primary aim for public mental health interventions would be to empower existing social support systems already in place at local levels, and to strengthen social cohesion and self-help within communities.

Inter- and intra-group differences in psychological concerns among international students

“…For example, client factors such as perceptions of psychological difficulties, shame and stigma associated with mental illness, mistrust of counseling services, English proficiency, stronger reliance on other sources of help, and culturally congruent coping methods have been identified as hindrances for international students in obtaining counseling (Mori, 2000). Among African communities, for instance, research has shown that Africans may not consider less severe distress as "medical" or worthy of intervention but rather wait for psychological distress to become severe prior to seeking treatment (Ventevogel, Jordans, Reis, & de Jong, 2013). Moreover, unavailability of therapists who are culturally similar and competent, and nonexistence of counseling services in students' home countries may deter students from seeking counseling (Mori, 2000).…”

Integration of mental health into primary healthcare in low-income countries: Avoiding medicalization

“…Some argue that sociocultural differences in symptomatology and culture are not suffi ciently taken into consideration by global mental health initiatives such as the mhGAP programme (Bass et al, 2007;White & Sashidharan, 2014), despite the fact that there are important variations in how mental distress presents and is experienced (Fernando, 2012;Kohrt et al, 2014;Patel, 1995;Ventevogel et al, 2013).…”

“…depression, anxiety disorder, or harmful use of substances or alcohol), would not conceptualize their problem as a medical disease, but rather frame their problem in non-medical terms. This would occur, utilizing culturally relevant labels and causal explanations for their distress as being inextricably linked to life experiences or misfortune (Aggarwal, 2014;Patel 1995;Ventevogel et al, 2013).…”

Towards a contextually appropriate framework to guide counseling of torture survivors in Sub-Saharan Africa

“…It can be difficult to determine whether non-specific but chronic somatic complaints (including generalized pain, weakness and fatigue, and a weakened immune response) arise from physical damage caused by prolonged torture and incarceration in poor conditions, or have their origins in emotional distress (de C Williams & Baird, 2016). Such determinations are further complicated in sub-Saharan Africa where emotional distress is often communicated through idioms rooted in the body (Ventevogel, Jordans, Reis & de Jong, 2013).…”