Malignant Anxiety

Sociocultural Antecedents of Magical Thinking in a Modernizing African Society

Despite the consensual adherence to a magico-mythical orientation in Africa, it was hypothesized that a deeper fear of bewitchment is likely to exist among persons with low as opposed to those who enjoy high levels of social functioning. A community survey involving 771 adult respondents in an urban and a rural area in Western Nigeria was under-taken. Socioeconomic background data and indices of the social functioning level of the respondents were collected. The index for level of social functioning was derived on the basis of recognized Yoruba normative patterns. Stepwise regression analysis was used to investigate the predictive factors of the fear of bewitchment. A deeper fear of bewitchment appears to exist in the urban but not in the rural subgroup. Some of the items which constitute the social functioning index also appear to predict the fear of bewitchment.

Traumatic pasts and the historical imagination: Symptoms of loss, postcolonial suffering, and counter-memories among African migrants

This work aims to rethink the relationship between anthropology and cultural psychiatry from a historical perspective, through reflections on the dynamics of forgetting and remembering in the context of migration. While migrants' symptoms often bear cultural hallmarks of suffering, they also reveal images of a traumatic history, which resurface in moments of danger, uncertainty, and crisis. I claim these symptoms are allegories of a dispossessed past, and can be interpreted as counter-memories, as "palimpsests" of an eclipsed script. Trauma symptoms keep returning to a collective past, and thus can be considered a particular form of historical consciousness. Psychiatric diagnoses may obscure these counter-memories. In particular, the diagnostic category of posttraumatic stress disorder that is commonly attached to traumatic experiences in current clinical practice recognizes the truth of individual traumatic events, but at the same time contributes to concealing the political, racial, and historical roots of suffering.

From peculiar psychiatric disorders through culture-bound syndromes to culture-related specific syndromes

This article reviews the historical evolution and progress of nosological concepts from exotic psychiatric disorders and culture-bound syndromes to culture-related specific syndromes. Approaches to classification and subgrouping these disorders are disccused and an argument offered for finding a place for culturally unique syndromes in the existing classification system. The characteristics of various syndromes are elaborated and suggestions are made for future research. Finally, emphasis is given to the need to be concerned with the impact of culture on every psychiatric disorder, not only culture-specific syndromes, to promote culturally competent care for every patient.

Psychoactive substance abuse among inmates of a Nigerian prison population

The objectives of the study were: (1) to assess the prevalence rate of psychoactive substance use and dependence among inmates of a Nigerian prison population within the past month; (2) to highlight how aware these prisoners were, of the various drugs of abuse; (3) to compare the findings with those of reports from abroad, and general Nigerian population samples. In mid-1995, 395 subjects (97.5% males, mean age 30.5 years) were interviewed, with a questionnaire that contained DSM-III-R criteria for dependence. About two-thirds were those on remand or awaiting trial, and the majority (70%) were accused of theft and armed robbery. Compared with Nigerian general population samples, the cohort had much higher prevalence rates of awareness and life-time use of psychoactive substances. Cannabis was the only drug regularly abused in the past month, by 26 (6.6%) subjects (all males); out of whom 11 (42.3%) satisfied DSM-III-R criteria for dependence. Use of intravenous drugs was not evident. This pattern differed markedly from the situation in industrialised countries. Cannabis abuse was significantly associated with those in prison for less than six months and on a charge of theft/armed robbery.

Witchcraft and psychotherapy

Belief in witchcraft, which serves a variety of social functions and personal defences, is bound to emerge in psychotherapy with individuals from a culture that holds such beliefs; endeavouring to understand it can open up new therapeutic possibilities. The nature of witchcraft, the profiles with which it intrudes into therapy, and the socio-psychological functions it fulfills are considered. Referring such patients to witchdoctors is morally unjustifiable, but the witch-doctor's folk-image provides a floating transference, around which the therapeutic relationship can be built. In dealing with witchcraft-ideation, understanding is based as much on cultural as on personal empathy, and to enhance its relevance, therapy may appropriate some of the functional dynamics of the witchcraft system into its own therapeutic manoeuvres.

The interrelationship of tropical disease and mental disorder: conceptual framework and literature review (Part I--Malaria)

Substantial interactions between tropical diseases and psychiatric illness have long been recognized, but the impact of biological factors in the field of cross-cultural psychiatry has been less well studied than psychosocial factors. In reviewing the literature at the intersection of tropical medicine and psychiatry in order to summarize the existing data base in this field, a generalized interactive model informed by the theoretical contributions of George Engel, the WHO Scientific Working Group on Social and Economic Research, Arthur Kleinman, P. M. Yap, Edward Sapir and others has been developed to serve as a conceptual framework for this analysis of the literature and to guide further research. The clinical literature of tropical medicine and psychiatry which recognizes the significance of concurrent tropical disease and mental disorders is reviewed along with the more specific literature on malaria and concomitant psychiatric illness. Many authors have focused on the role of organic mental disorders, especially in connection with cerebral malaria, but several have also addressed psychosocial parameters through which the interrelationship between malaria and a full range of mental disorders is also mediated. The effects of malaria may serve as biological, psychological or social stressors operating in a cultural context which precipitate or shape features of psychiatric symptomatology. Psychiatric illness may likewise precipitate an episode of malaria with typical symptoms in a patient with a previously subclinical infection. Implications of the literature and this generalized interactive model are considered as they apply to clinical practice, public health and the application of social science theory in medicine.

Koro: how culturally specific?

Koro has been described as an acute anxiety state related to the fear of penile shrinkage into the abdomen with resultant death. This partial depersonalization disorder is found primarily among the people of the Malay Archipelago and Southern Chinese, with extremely rare incidences documented in the West. The symptomology of Koro is commonly said to be linked to ancient Chinese medical beliefs on sexual functioning and is therefore referred to as a culturally bound syndrome. Our paper summarized the case of an American male with Koro-like symptoms. It compares the Western concept of penis loss to the Chinese or Malaysian concept, and then proposes a combined hypothesis for the development of Koro.

The practice of behaviour therapy in West Africa: the case of Ghana

The purpose of this report is to discuss the role of behavior therapy as an additional treatment model in the field of mental health in Ghana. The problems and achievements in its pioneer stage have been discussed. Ghanaian neurotics' concept of etiology of illness is profoundly rooted in cultural beliefs such as evil machination and cosmic forces. The profound role played by the traditional healers' definition of "mysterious illness" and treatment of neurotic symptoms has been modified since the introduction of behaviour therapy and this serves as a threat to the "healers". Analysing the findings so far one can recommend that behaviour therapy be included and emphasized in the future training of African psychiatrists and other mental health professionals in Africa in general and in Ghana in particular.

Indigenous Healing in South Africa: A Neglected Potential

The incidence of indigenous healing, recognition of the spiritual and emotional dimension in the lives of our population, lack of ‘professionally’ qualified mental health workers, inadequacy of imposing Western approaches on other cultures, proven effectiveness of nonprofessional workers in the mental health area, shortcomings in and disenchantment with Western models of healing and the holistic nature of indigenous healing compel cognisance. The similarity between certain Western approaches, such as that of Jung, and indigenous healing, development in brain research, humanistic and transpersonal psychology, arguments by the World Health Organization (WHO), and the call to integrate indigenous and Western approaches to healing, necessitates a closer look at the area. South African academics and professionals have urged for the recognition of indigenous healing in order to provide a comprehensive mental health service. It is felt that indigenous healing can teach us and offer unique opportunities in the applied and research aspects of psychology.

A survey of criminal homicide in Nigeria

Reports on 500 cases of murder were extracted from the case records of the Federal Supreme Court of Nigeria. Offenders were nearly always men and the victims were males in 64% of cases. The weapons were most often machetes or cutlasses. The killer and the victim were often related or were friends; only 8% were strangers. In 42% of cases, financial motives were involved.

Homicide in Western Nigeria

Homicide is a universal phenomenon which occurs both among developed and developing communities, but to a varying extent. Homicide in this context does not include the lawful killing of criminals convicted of capital offence, or killing in war or in conditions of political strife. Considerable work has been done on various aspects of criminal homicide in many countries—Verkko (1951) in Finland, Jacqueline H. and Murray A. Strauss (1953) in Ceylon, Wolfgang (1958) in the United States. The book African Homicide and Suicide edited by Paul Bohanan (1960) contains only a chapter on homicide among the Tivs of Central Nigeria, and this is based on a retrospective study of case files. Lambo (1962) reported twenty-nine cases which he had interviewed for the courts; these came from the whole of Nigeria, and therefore represent different peoples and cultures.