Elements of cultural scripts of trauma sequelae among trauma victims in East Africa

Background

As a new, unifying approach to mapping the cultural expressions of trauma sequelae, cultural scripts of trauma sequelae are empirically investigated here for the first time in a primarily qualitative study. Elements of Cultural Scripts of Trauma (CST) include the typical symptoms and appraisals of changes of those who have experienced traumatic events. These elements refer to the value orientations in the given culture.

Aims

To identify post-traumatic cultural scripts' elements and their groupings, as expressed by trauma survivors from the East African population, and to explore the cultural values that serve as a reference to such scripts' elements.

Methods

Semi-structured, in-depth interviews were conducted in nine focus groups of trauma survivors and trauma experts. Grounded theory was the basis for the content analysis, and MAXQDA was used for coding and grouping. Semi-quantitative analyses of the frequency of groupings followed.

Results

The study extracted 270 elements of the cultural scripts of trauma. Three stages of cultural scripts' elements were identified including unspeakable, heart wounds and painful scars and growth. The reported elements are only those in the three last stages and they are grouped into six categories, such as cognitive appraisals, worldview, interpersonal relationships, body-related, positive changes and changes in family interest and management, while the elements of the first stages are not codable as the survivors do not yet get the words of their expressions. The cultural values that served as a reference consisted of holding the sadness, Christianity, community reputation, solidarity, social connectedness, social cynicism, and reproductiveness, among others.

Discussion

This comprehensive study with participants from several countries in East Africa collected a large number of elements of cultural scripts of trauma for this regional area. Notably, these elements were based mostly on man-made traumas, such as the genocide against the Tutsis in Rwanda. Further steps in the CST investigation are subject to future studies, such as a more systematic investigation of the relationship with cultural values and the temporal relationships within the scripts.

Precarious engagements and the politics of knowledge production: Listening to calls for reorienting hegemonic social psychology

In this paper, we invite psychologists to reflect on and recognize how knowledge is produced in the field of social psychology. Engaging with the work of decolonial, liberation and critical psychology scholars, we provide a six-point lens on precarity that facilitates a deeper understanding of knowledge production in hegemonic social psychology and academia at large. We conceptualize knowledge (re)production in psychology as five interdependent 'cogs' within the neoliberal machinery of academia, which cannot be viewed in isolation; (1) its epistemological foundations rooted in coloniality, (2) the methods and standards it uses to understand human thoughts, feelings and behaviours, (3) the documentation of its knowledge, (4) the dissemination of its knowledge and (5) the universalization of psychological theories. With this paper we also claim our space in academia as early career researchers of colour who inhabit the margins of hegemonic social psychology. We join scholars around the world in calling for a much-needed disciplinary shift that centres solutions to the many forms of violence that are inflicted upon marginalized members of the global majority. To conclude, we offer four political-personal intentions for the reorientation for the discipline of hegemonic social psychology with the aim to disrupt the politics of knowledge production and eradicate precarity.

Deconstructing institutional racism and the social construction of whiteness: A strategy for professional competence training in culture and migration mental health

The position presented in this article draws on the professional insights of the authors, reflecting on issues of global political importance in culture and migration mental health. As institutional theory perspectives continue to develop, solutions to complex social problems such as racism require embodied knowledge if the lines of authority and basic occupational routines are to be meaningfully renegotiated. Embodied knowledge is socially situated and self-reflexive and reflects cumulative and marginalized experiences that contribute to a better understanding of institutional racism and the social construction of whiteness. The authors foreground the development of critical consciousness and emotional literacy in order to be more professionally competent in institutional contexts of mental health training, education and practice. To this end, elements of due process, transparency, inclusiveness, community engagement and accountability are at the center of a political and intellectual movement towards epistemological justice to promote antiracism and social justice in culture and migration mental health. The authors define decolonial intersectionality as a clear philosophical vision outlining how best to respond to those at risk of experiencing racism and the associated mental health burdens.

The role of causal knowledge in stigma considerations in African genomics research: Views of South African Xhosa people

INTRODUCTION

Advances in genomics research have raised several ethical concerns. One concern is the potential impact of genomics research on stigma experienced by people affected by a disease. Studies have found that the type of illness as well as disease causal beliefs impact on the relation between genetic attribution and stigma. This study explored the potential impact of genetic attribution of disease on stigma among Xhosa people with Rheumatic Heart Disease (RHD).

METHODS

Study participants were 46 Xhosa people with RHD living in the Western Cape Province of South Africa. Using video vignettes in 7 focus group discussions we explored whether and how genetic attribution may impact on disease-stigma. Vignettes introduced participants to non-genetic and genetic causal explanations and were followed-up with a series of open-ended questions eliciting their perceptions of non-genetic disease causes as well as genetic causation and its impact on internalised stigma.

RESULTS

This study found that Xhosa people with RHD have a general understanding of genetics and genetic attribution for disease. Additionally, and not withstanding their genetic knowledge, these participants hold multiple disease causal beliefs including genetic, infectious disease, psychosocial, behavioural and cultural explanations. While there was evidence of internalised stigma experiences among participants, these appeared not to be related to a genetic attribution to the disease.

DISCUSSION

The findings of this study provide clues as to why it is unlikely that a genetic conceptualisation of disease impacts internalised stigma experiences of Xhosa people. The causal explanations provided by participants reflect their cultural understandings and their context, namely, living in low-income and poverty-stricken environments. Divergence in these findings from much of the evidence from high-income countries emphasises that context matters when considering the impact of genetic attribution on stigma and caution against generalising findings from one part of the globe to another.

Botho as an essential ingredient of African psychology: an insider perspective

The African notion of botho appears to have attracted a lot of attention and research efforts in various fields of study. It is presented as a positive concept that is associated with the good side of human beings. In this article, we have adopted an Afrocentric position to analyse the philosophical construct of ‘botho’ as lived and practised in communities that we grew up in. We acknowledge our historical and cultural locatedness in these communities and recognise that this positionality has influenced the way we have engaged with our subject matter. We have interrogated the concept of botho and have identified what we consider as its four key elements. These are African spirituality, botho as personhood, botho and interconnectedness, and botho and communalism. Through a critical discussion of these key elements, we have tried to demonstrate that botho is essentially a valid human experience that forms the bedrock of African psychology. We conclude by suggesting that botho and other themes that constitute the field of African psychology need to be acknowledged, embraced, and mobilised as foundational building blocks in the production of knowledge that is centred on and in Africa.

The feasibility of prolonged exposure therapy for PTSD in low- and middle-income countries: a review

There is a need in the global south to evaluate and implement empirically supported psychological interventions to ameliorate symptoms of posttraumatic stress disorder (PTSD). Empirically supported treatments (ESTs) have increasingly been developed and implemented, yet the majority people in the global south do not have access to these treatments for mental disorders such as PTSD. Prolonged exposure therapy has accrued substantial empirical evidence to show it as an effective treatment for PTSD. Research on the effectiveness and acceptability of prolonged exposure in a low- and middle-income countries (LMICs) are sparse. This brief report presents a review of prolonged exposure (PE) therapy and its feasibility as a trauma therapy for PTSD in LMICs. First, we present a brief overview of PE as a first-line treatment for PTSD. Second, using South Africa as a case example, we present a brief overview of traumatic stress in South Africa and how mental healthcare has developed since the abolishment of apartheid in 1994. Lastly, we discuss the challenges pertaining to the dissemination and implementation of PE in LMICs and propose future perspectives regarding the implementation of ESTs such as PE in LMICs.

On addressing ‘Whiteness’ during clinical psychology training

In discussing ‘Whiteness’, a context is provided as to current issues facing British clinical psychology, with an overview of the history of clinical psychology in the United Kingdom, and a particular focus on how issues of immigration, diversity, and racism have been addressed. Following this, the constantly changing training context of clinical psychologists within Britain is explored, with lacunae evident around confronting institutional racism and Black trainee experiences. The history of addressing this issue within the University of East London’s clinical psychology training programme is outlined, as well as the recent introduction of workshops to focus on ‘Whiteness’ and ‘decolonising’ the profession, in response to consistent trainee concerns. This is integrated with respect to focusing on the sorts of psychologists that might be needed to advance and transform the profession positively in the current global political climate.

Black South African caregivers’ understanding and responses to their children with autism spectrum disorder symptoms: a qualitative study

The purpose of this study was to investigate Black South African caregivers’ understanding and approaches to securing a cure for their children with autistic spectrum disorder symptoms. Qualitative data were collected focusing on exploring caregivers’ narratives. A purposive sampling technique was used to draw study participants who were of Black South African background and had a child with a diagnosis of an autistic spectrum disorder. Thematic analysis was used to analyse the data collected and to give analytical meaning to the narratives. The results yielded four dominant themes regarding the level of caregivers’ understanding of autistic spectrum disorder and the options they followed in searching for the cure of their children’s illness. The study drew attention to the feelings of frustration experienced by caregivers in their discovery that the use of both indigenous and Western approaches to autistic spectrum disorder symptoms yielded little benefits. Given these findings, a number of recommendations were made to improve policy and practice in the mental health treatment of children with autistic spectrum disorder symptoms among Black South African clients.

The content of delusions in a sample of South African Xhosa people with schizophrenia

BACKGROUND

Although the relationship between cultural beliefs and schizophrenia has received some attention, relatively little work has emerged from African contexts. In this study we draw from a sample of South African Xhosa people with schizophrenia, exploring their cultural beliefs and explanations of illness. The purpose of the article is to examine the relationship between this cultural context and the content of delusions.

METHODS

A sample comprising 200 Xhosa people with schizophrenia participating in a South African schizophrenia genomics study were interviewed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Participant delusions were thematically analyzed for recurring themes.

RESULTS

The majority of participants (n = 125 72.5%) believed that others had bewitched them in order to bring about their mental illness, because they were in some way jealous of the participant. This explanation aligns well with the understanding of jealousy-induced witchcraft in Southern African communities and highlights the important role that culture plays in their content of delusions.

CONCLUSIONS

Improved knowledge of these explanatory frameworks highlights the potential value of culturally sensitive assessment tools and stigma interventions in patient recovery. Furthermore such qualitative analyses contribute towards discussion about aspects of delusional thought that may be more universally stable, and those that may be more culturally variable.

The Psychology and Content of Dreaming in Africa

As understood in mainstream Western psychology, people dream for themselves and are essentially self-contained in their overall mechanism of dreaming. This article argues that although this Eurocentric perspective on dreaming is largely universal and not to be ignored, it needs to be recognized alongside other dream perspectives. The article examines the concept of dreaming from an African perspective. Its aim is to demonstrate that dreaming from an African psychological perspective goes beyond the Eurocentric paradigm suggesting that in the African-centered paradigm, the individual can dream for others. In the African perspective, there, at times, occurs the phenomenon of triangulation in dreaming where dreams originate from another source to give messages to the individual for the benefit of others. The article presents three anecdotes and some resulting implications that highlight descriptive elements of African dream theory. A number of questions for further reflections and research emanating from the discussion are highlighted.