Traditional treatment for mental illness in Africa: a review

Conceptualizations of subjective recovery from recent onset psychosis and its associated factors: A systematic review

AIM

There is no standard definition of "subjective recovery" from psychosis, its nature is currently contested and debated among service-users and professionals. Individual studies have explored conceptualizations of subjective recovery from recent onset psychosis, but there have been no previously published systematic reviews on the topic. The aim of this review was to examine and synthesize quantitative and qualitative studies examining the concept of subjective recovery from recent onset psychosis and identify common factors associated with this recovery process.

METHODS

Relevant electronic databases (Medline, CINAHL, PsychInfo and ProQuest Dissertations and Theses) were searched and hand searches were also carried out. Publications in each database from the inceptions of the databases to April 12, 2017 were included. Data from selected articles were extracted using a piloted extraction form and thematic integrative analysis was performed.

RESULTS

Ten studies with different study designs were included in this review. Subjective recovery was conceptualized into 3 main themes: "recovery as outcome", "recovery as process" and "endeavours during recovery". Factors contributing to subjective recovery were categorized into 4 main themes; "treatment related", "illness related", "individual related" and "social environment" related. Non-linear and subjective nature of the process of recovery were reinforced by the review findings.

CONCLUSIONS

Studies in subjective recovery from recent onset psychosis are limited to developed countries. Acquiring hope and self-confidence, overcoming symptoms and stigma through mobilizing all resources available were accentuated in conceptualizing subjective recovery and related factors. Recovery-oriented health care services should acknowledge individual differences and involve service users in their care decisions.

The politics and practice of Thomas Adeoye Lambo: towards a post-colonial history of transcultural psychiatry

This article traces the career of Thomas Adeoye Lambo, the first European-trained psychiatrist of indigenous Nigerian (Yoruba) background and one of the key contributors to the international development of transcultural psychiatry from the 1950s to the 1980s. The focus on Lambo provides some political, cultural and geographical balance to the broader history of transcultural psychiatry by emphasizing the contributions to transcultural psychiatric knowledge that have emerged from a particular non-western context. At the same time, an examination of Lambo's legacy allows historians to see the limitations of transcultural psychiatry's influence over time. Ultimately, this article concludes that the history of transcultural psychiatry might have more to tell us about the politics of the 'transcultural' than the practice of 'psychiatry' in post-colonial contexts.

A narrative analysis of the link between modern medicine and traditional medicine in Africa: a case of mental health in Uganda

BACKGROUND

Traditional Medicine Practices (TMP) which are premised on indigenous knowledge and experiences within a local context of the culture and environment, are common place in low income countries. In Africa and in Uganda specifically, nearly 80% of the Ugandan population relies on TMP for the care of their mental health but they also use Modern Medicine. There are areas of departure between Traditional and Modern Medical practices in Africa that have been cited. What has attracted less research attention, are the areas of convergence.

OBJECTIVE

This paper aims to critically examine the link between Modern Medicine and Traditional Healing Practices in Africa, citing Uganda as case example.

METHOD

A Narrative literature review with critical element assessment was undertaken to identify documented points of departure, areas of common practice, and ways in which the two models can co-exist and work together through a carefully thought out integration.

RESULTS

Points of departure between Modern Medicine and Traditional Medicine Practices are philosophical underpinnings of both practices, training of practitioners, and methods and ethics of work. Common areas of practice include human rights perspective, descriptions of mental illnesses, clinical diagnostic practice, particularly severer forms, intellectual property rights, and cross prescriptions. Exhibiting cultural humility and responsibility on the side of the Modern Medicine Practitioners is one of the ways to work together with TMPs.

CONCLUSION

Points of departure are more documented and explicit and overshadow areas of common practice while the links between the two are mainly implicit but sadly unrecognized. Mental disorders are disorders of the brain and in neuroscience; the brain is culturally and socially constructed. Sociocultural issues therefore cannot be divorced from disorders of the brain and their management. For better patient outcome and patient-centered approach of care, it is necessary to acknowledge and enhance the links in teaching, clinical and policy level and carry out research on how the links could be improved.

Indigenous Categories of Distress and Dysfunction in South African Xhosa Children and Adolescents as Described by Indigenous Healers

There is a paucity of information on indigenous idioms and categories of distress in children and adolescents in South Af rica. Indigenous healers were asked to provide descriptions of indigenous idioms and categories of distress in children and adolescents in a predominantly Xhosa speaking community. The healers identified five indigenous categories of distress, namely ukuphaphazela, isimnyama esikolweni ukuthwasa, ukuphambana, amafufunyana. These are compared with available descriptions in the literature and differences in presentation and understanding are discussed. The study confirmed that indig enous categories of distress not only affect adults, but also children and adolescents, and that 'brain fag' also occurs in South Africa. The results of this study indicate that indigenous categories of distress such as amafufunyana, ukuthwasa and ukuphambana require an emic approach and may be best un derstood at the individual level. Etic approaches, such as inclusion in psychiatric epidemiological studies are not suit able for these categories because symptoms are not prioritized. Categories such as isimnyama esikolweni and ukuphaphazela, which are associated with more discrete symptoms, could fea sibly be included in epidemiological investigations.

Women's orientation toward help-seeking for mental disorders

Based on a sample survey of 1000 women in Accra Ghana, this study addresses a number of individual, social and cultural factors that have been found in previous research on diverse populations to be important determinants of treatment-seeking behavior. Bivariate analysis is used to identify those factors that are significantly related to orientation toward help-seeking for mental disorders (use of biomedical vs traditional services), and multivariate analysis is utilized to determine the importance of each, and the effect of causal beliefs independent of sociodemographic factors. The results show that perceived cause of mental disorders, area of residence, age, ethnicity, membership in voluntary associations and prior contact with medical facilities or personnel are the most important determinants of the orientation toward help-seeking for mental disorders. The implications for an effective mental health care delivery system in Ghana are discussed. Also, suggestions for further research are made.

Psychiatric epidemiology in cross-cultural perspective: a review

Advances in psychiatric research have reestablished the importance of psychiatric community epidemiological studies. Psychiatric epidemiological surveys that used the same standardized diagnostic interview and classification system in different parts of the world were reviewed. The lifetime prevalence for any psychiatric morbidity ranged from 21 to 65%. The prevalence of psychiatric disorders was higher than that in the first- and second-generation community surveys. The relevance of these findings to clinical practice, public health, and the directions for future epidemiological research are discussed.

Culture and schizophrenia: the DOSMD challenge

The World Health Organization's International Pilot Study on Schizophrenia (IPSS) and subsequent Determinants of Outcomes of Severe Mental Disorder (DOSMD) studies have reported that the course of schizophrenia is more favourable in 'developing' than 'developed' societies. The 1992 DOSMD study attributes this difference to culture. We review studies concerning the course of schizophrenia and conclude that the evidence for a more favourable course in developing societies is not conclusive. Indeed, a favourable course has also been reported in various industrialised societies. We also raise questions about the findings reported in the recent DOSMD study, including the conclusion that the putatively more favourable course is a product of culture. Finally, we argue that longitudinal, direct observation of patients in their natural environments must be carried out before variations in the course of schizophrenia can be adequately understood.

Psychiatric stigma in non-Western societies

Factors bearing on social stigma in persons with a psychiatric illness are the subject of this review of the literature. The review concentrates on material pertaining to non-Western societies. This is a topic that has not received much systematic attention. The cultural meanings associated with psychiatric illness are examined. Emphasis is given to societies ordinarily studied by anthropologists and social historians of non-Western medicine. Stigma is variable in the more elementary societies. It is present in India and especially China, and studies suggest the social stigma is less prevalent in Islamic societies. It is important to distinguish between how psychiatric illness is handled in community settings as versus in the system and tradition of medicine.

On the significance of an anthropological approach to schizophrenia

Psychotic disturbances like those termed schizophrenia are universal in human groups. Anthropological and social historical studies underscore the varied appearance and significance of such disturbances. In contemporary psychiatry, neurobiological emphases and the exigencies of positivistic research have tended to standardize the picture of schizophrenia. This is reflected in the rationale, methodology and results of the International Pilot Study of Schizophrenia (IPSS), which have tended to support the validity of diagnostic criteria that have evolved in modern Western European societies. Thus, contemporary psychiatric theory appears to stipulate a homogeneous picture of a phenomenon that abounds with social, cultural and psychological complexity as well as human poignancy. There are reasons for challenging this picture of schizophrenia and the biases and limitations in it. Reductionistic and standardized accounts may further immediate, short-range, and practical needs, but they be-cloud academic questions having wide-ranging significance in psychiatry, the social sciences, and the humanities.