Psychiatry in the East African colonies: a background to confinement

Reimagining global mental health in Africa

In 2001, the WHO launched The World Health Report most specifically addressing low-income and middle-income countries (LAMICs). It highlighted the importance of mental health (MH), identifying the severe public health impacts of mental ill health and made 10 recommendations. In 2022, the WHO launched another world MH report and reaffirmed the 10 recommendations, while concluding that 'business as usual for MH will simply not do' without higher infusions of money. This paper suggests the reason for so little change over the last 20 years is due to the importation and imposition of Western MH models and frameworks of training, service development and research on the assumption they are relevant and acceptable to Africans in LAMICs. This ignores the fact that most mental and physical primary care occurs within local non-Western traditions of healthcare that are dismissed and assumed irrelevant by Western frameworks. These trusted local institutions of healthcare that operate in homes and spiritual spaces are in tune with the lives and culture of local people. We propose that Western foundations of MH knowledge are not universal nor are their assumptions of society globally applicable. Real change in the MH of LAMICs requires reimagining. Local idioms of distress and healing, and explanatory models of suffering within particular populations, are needed to guide the development of training curricula, research and services. An integration of Western frameworks into these more successful approaches are more likely to contribute to the betterment of MH for peoples in LAMICs.

A pioneer of psy: The first Ugandan psychiatric nurse and her (different) tale of psychiatry in Uganda

In Africa, the emergence of a "modern" mental health regime centered on psychiatry is often portrayed as a unidirectional intervention by "the West." Analyses ranging from medical histories of colonial psychiatry to more recent studies of Global Mental Health focus mostly on the role of external actors and the ways their actions impact(ed) on local populations. Uncritical studies simply reduce the complexity of African therapeutic landscapes to a "treatment gap" and see the introduction of "science-based" mental health approaches as necessary "civilizing" missions. Critical studies emphasize the harms of psychiatric interventions and celebrate local healing practices instead. Both approaches are problematic: they ignore the many interconnections between highly dynamic treatment regimes that cannot be neatly designated as African or western, portray local populations as largely passive, and neglect the multiple ways in which psychiatry has been embraced, adapted, and disrupted by Africans themselves. This article challenges simplistic depictions of "western" psychiatry in Africa by providing a portrait of Rwashana Selina, the first Ugandan psychiatric nurse who-after being sent to the UK in the 1950s for training-became a central figure in Ugandan psychiatry. Based on interview material, I recount her life story and discuss her formative role in the development of psychiatric care in the colonial and postcolonial era. Rwashana's tale of Ugandan psychiatry emphasizes co-operation, mutual acknowledgments and pluralistic leadership and thus breaks with typical images of and dichotomies between white doctors and supposedly inferior African medical staff.

A social history of serious mental illness

Despite medical, technological, and humanitarian advances, the criminalization of those with serious mental illness continues. This is not an isolated phenomenon. The benefits of treatment reform and innovation are difficult to maintain or sometimes outright harmful. Across time and geography, the care of those with serious mental illness tends towards maltreatment, be it criminalization or other forms of harm. We present a social history of serious mental illness, along with the idea that the treatment of serious mental illness is a Sisyphean task-perpetually pushing a boulder up a hill, only for it to roll down and start again. The history is provided as a basis for deeper reflection of treatment, and treatment reform, of those with serious mental illnesses.

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.

Neurasthenia at Mengo Hospital, Uganda: A case study in psychiatry and a diagnosis, 1906-50

This article uses a case-study approach to examine the complex and contradictory nature of diagnoses like neurasthenia in colonial Africa. Drawing on the case notes of European and African patients diagnosed with neurasthenia at the Church Missionary Society's Mengo Hospital, Uganda, it argues that in practice, and outside the colonial asylum in particular, ideas about race and mental illness were more nuanced than histories of psychiatry and empire might imply. At Mengo, the tales of pain and suffering recorded by the doctors remind us that there is more to the history of neurasthenia than colonial anxieties and socio-political control. This was a diagnosis that was negotiated in hospital examination rooms as much as in medical journals. Significantly, it was also a diagnosis that was not always reserved exclusively for white colonisers-at Mengo Hospital from the early 1900s neurasthenia was diagnosed in African patients too. It became part of a wider discussion about detribalisation, in which a person's social environment was as important as race.

History of psychopathology, psychiatric treatments and the psychiatric profession

PURPOSE OF REVIEW

This review addresses articles published on the subject of the history of psychiatry during 2006 and 2007.

RECENT FINDINGS

Original findings in the fields of psychopathology, treatments, the psychiatric profession, its institutions and psychiatrists are described.

SUMMARY

Research into psychopathology continues to shed light on how modern society can learn from the past in terms of issues such as whether people are ill, whether they are responsible for their actions, and what constitutes an effective and ethical treatment.