Ngā Whakāwhitinga (standing at the crossroads): How Māori understand what Western psychiatry calls “schizophrenia”

Abstract

This project explored how Māori understand experiences commonly labelled "schizophrenic" or "psychotic". Semi-structured interviews were conducted with 57 Māori participants who had either personal experiences labelled as "psychosis" or "schizophrenia", or who work with people with such experiences; including tangata whaiora (users of mental health services), tohunga (traditional healers), kaumatua/kuia (elders), Māori clinicians, cultural support workers and students. Kaupapa Māori Theory and Personal Construct Theory guided the research within a qualitative methodology. The research found that participants held multiple explanatory models for experiences commonly labelled "psychotic" or "schizophrenic". The predominant explanations were spiritual and cultural. It seems that cultural beliefs and practices related to mental health within Māori communities remain resilient, despite over a century of contact with mainstream education and health services. Other explanations included psychosocial constructions (interpersonal trauma and drug abuse), historical trauma (colonisation) and biomedical constructions (chemical brain imbalance). Participants (both tangata whaiora and health professionals) reported they were apprehensive about sharing their spiritual/cultural constructions within mainstream mental health settings due to fear of being ignored or pathologised. This study highlights the importance of asking users of mental health services about the meaning they place on their experiences and recognising that individuals can hold multiple explanatory models. Māori may hold both Māori and Pākehā (European) ways of understanding their experiences and meaningful recognition should be afforded to both throughout assessment and treatment planning in mental health services. Clinicians need to be aware that important personal and cultural meanings of experiences labelled psychotic may be withheld due to fear of judgement or stigmatisation.

The Transformative Potential of Kaupapa Māori Research and Indigenous Methodologies: Positioning Māori Patient Experiences of Mental Health Services

“…This approach has been used to legitimize and advance the political and social agendas of the colonizer, portraying Indigenous peoples through context-devoid and deficit-focused comparisons (Smith, 2012;Walter, 2016). There is now an established body of Indigenous health research that demonstrates the role of Indigenous Methodologies in ensuring cultural safety within the research process (for both research community and researcher), and which contributes to positive research and health outcomes for Indigenous communities (Boulton, 2005;Chilisa, 2012;Cochran et al, 2008;Cram et al, 2003;Dudgeon et al, 2010;Dyall, 2003;Eade, 2007Eade, , 2014Edwards et al, 2009;Elder, 2008Elder, , 2013Harris, 2014;Hotu, 2018;Hughes, 2007;Johnson, 2009;Jones et al, 2013;Jones et al, 2006;Kerr et al, 2010;Lambert, 2015;Makowharemahihi et al, 2014;McLellan et al, 2014aMcLellan et al, , 2014bNgata, 2014;Penney et al, 2006;Pere, 2006;Staps et al, 2019;Stevenson, 2018;Taitimu et al, 2018;Tricklebank, 2017;Wakaiti, 2007;Warbrick et al, 2016;Watkins, 2007;Wharewera-Mika, 2012).…”

“…Various reasons were given for selecting a KMR methodology to study Māori experiences of mental health. Strengths in this approach included: the flexibility to use different data collection and analysis methods; the ability to ensure safety of Māori researchers and participants; the focus on producing results of value to Māori communities; and the positioning from Māori worldviews (Awatere-Walker, 2015;Boulton, 2005;Dyall, 2003;Eade, 2007Eade, , 2014Elder, 2008Elder, , 2013Harris, 2014;Hughes, 2007;Johnson, 2009;Lambert, 2015;Ngata, 2014;Pere, 2006;Staps et al, 2019;Sweetman, 2017;Taitimu et al, 2018;Tricklebank, 2017;Wakaiti, 2007;Walsh-Mooney, 2009;Watkins, 2007;Wharewera-Mika, 2012;Wilson & Baker, 2012). Kaupapa Māori Research methodologies were described as particularly relevant in mental health settings because they provide a protected space for Māori participants to share sensitive information, and a non-deficit framing approach positioning Māori participants as experts to critique the influence and impact of mental health systems on their overall wellbeing (Dyall, 2003;Eade, 2007Eade, , 2014Harris, 2014;Ngata, 2014;Pihama, 2010;Reid et al, 2019;Smith, 2012;Tricklebank, 2017;Walsh-Mooney, 2009;Watkins, 2007;Wharewera-Mika, 2012).…”

“…To date KMR employing qualitative methods has provided valuable insights into how health services can be adapted to achieve health equity for Māori (Palmer et al, 2019). Recommendations have included the need to change the ways that clinical staff interact with and relate to Māori patients and their whānau, and other health service-specific adaptations (Awatere-Walker, 2015; Boulton, 2005;Drawson et al, 2017;Dyall, 2003;Eade, 2007Eade, , 2014Elder, 2008Elder, , 2013Harris, 2014;Hughes, 2007;Johnson, 2009;Lambert, 2015;Ngata, 2014;Palmer et al, 2019;Pere, 2006;Pihama et al, 2002;Staps et al, 2019;Sweetman, 2017;Taitimu et al, 2018;Tricklebank, 2017;Wakaiti, 2007;Walsh-Mooney, 2009;Watkins, 2007;Wharewera-Mika, 2012;Wilson & Baker, 2012). Some have also recognized that health services need to become more holistic in their view of wellbeing, and in their approaches to service delivery when working with Māori (Boulton, 2005;Dyall, 2003;Eade, 2007;Elder, 2013;Harris, 2014;Johnson, 2009;Ngata, 2014;Palmer et al, 2019;Staps et al, 2019;Sweetman, 2017;Taitimu et al, 2018;Tricklebank, 2017;Walsh-Mooney, 2009;…”

“…An inductive thematic analysis was chosen for this study because of the theoretical flexibility of the method, its capacity to build the repertoire of junior members of the research team who were learning to undertake qualitative analysis, and its strengths when managing large data sets (Braun & Clarke, 2006). Thematic analysis was also the most frequently employed method of analysis among the sample of KM qualitative research projects reviewed during the development of this study due to the ease of alignment with a KMR theoretical position (Braun & Clarke, 2006;Eade, 2014;Elder, 2008Elder, , 2013Harris, 2014;Johnson, 2009;Pere, 2006;Staps et al, 2019;Taitimu et al, 2018;Tricklebank, 2017;Wakaiti, 2007;Walsh-Mooney, 2009;Watkins, 2007;Wharewera-Mika, 2012). The data management software NVivo12 was used to assist with data display and analysis, and to facilitate review of emerging codes, categories and themes by all members of the Māori research team.…”

The Potential Role of Applied Behavior Analysis in the Cultural Environment of Māori Mental Health

“…An Uneasy Fit for Current Practices Within MHS Adoption of Western medicine in Aotearoa led to the replacement of tohunga with professionals trained in the Western medical model, and Māori knowledge and practices associated with healing were marginalized (Durie, 1995). Taitimu, Read, and McIntosh (2018) demonstrated how conflicts arise due to differing perceptions of mental health between indigenous communities and practitioners of Western medicine. Fifty-seven Māori were asked about their perceptions of schizophrenia.…”