Frontal Lobe Function and the African

Impact of Mindfulness-Based Cognitive Therapy on Depressive Symptoms Reduction among Depressed Patients in Nigeria: A Randomized Controlled Trial

Depression is a common mental health disease with a high risk of relapse in people with a mental health condition. Mindfulness-based cognitive therapy (MBCT) showed higher efficacy in reducing depressive symptoms and prevent relapse for depressed patients. The study examined the effectiveness of MBCT versus the control group (CG) for the depression symptom reduction. A controlled trial was used to examine the effectiveness of MBCT or CG on depressive patients in Nigeria. Out of 357 screened subjects, 101 patients were randomized to receive either MBCT (n = 50) or CG (n = 51) and prospectively followed for 2 months. The intervention delivered according to the published manuals, and Beck Depression Inventory (BDI) was used to assess MDD severity among the patients. All assessments were conducted at three levels (baseline, 2 and 4 months). At the end of the 8 weeks of MBCT intervention, MBCT participants did not have significantly fewer depressive symptoms compared to those in the CG. However, the MBCT group had a significant depressive symptom reduction after 2 month follow up. The findings are in line with other studies, which show MBCT significantly decreased depression severity and improved treatment response rates after 2 months follow up, confirmed MBCT viability in the management of MDD.

Frequently asked questions about African psychology: another view

The South African Journal of Psychology, in pages 273–279, of 2017, published a very important and commendable editorial by Kopano Ratele aimed at re-igniting the debate on issues surrounding ‘decades-old confusion about the definition, scope, impetus for, and ultimate aims of an African psychology within South Africa (SA)’. His incisive contribution in response to these issues was submitted under the title: Frequently asked questions about African psychology. In attempting to join this debate, the aim is not to challenge but to complement the fine responses made by Ratele (2017b) to the questions he had raised. Specifically, the aim of this article is to keep this important debate about the state of African psychology alive by showing that there are still some unexplored questions about African psychology that need to be raised and responded to. It is the conviction of the present author that it is through such debates that a better understanding of the meaning and scope, and vision and mission of the nascent academic discipline of African psychology could be achieved.

Madness: Recursive Ethnography and the Critical Uses of Psychopathology

From the late 1990s, a wave of writing in anthropology took up the idiom of madness to orient a critical approach. However, anthropology's use of madness as critique reflects a longer conversation between psychiatry and anthropology. As madness is used to point to and connect other things—afflictions, therapeutics, medicine, politics, colonialism, religion, and, especially, trauma as a social condition—it is noteworthy not only for its breadth, but also because it is often applied to contexts in which it already has purchase as critique. Thus, madness in anthropology is a mirror onto the discipline's recursive engagements with psychiatry and the worlds to which both turn their attention.

Global Mental Health: concepts, conflicts and controversies

This paper introduces, describes and analyses the emerging concept of Global Mental Health (GMH). The birth of GMH can be traced to London, 2007, with the publication of a series of high-profile papers in The Lancet. Since then, GMH has developed into a movement with proponents, adherents, opponents, an ideology and core activities. The stated aims of the Movement for GMH are 'to improve services for people living with mental health problems and psychosocial disabilities worldwide, especially in low- and middle-income countries where effective services are often scarce'. GMH could be considered an attempt to right a historic wrong. During the colonial and post-colonial eras, the mental health of subject populations was accorded a very low priority. This was fuelled by scientific racism, which alleged that mental illness was uncommon in places such as Africa. As developing nations have made the epidemiological transition, the burden of mental illness has proportionately increased, with research suggesting a massive 'treatment gap' between those in need and those actually receiving formal mental health care. As such, much GMH research and action has been devoted to: (i) the identification and scale-up of cost-effective evidence-supported interventions that could be made more widely available; (ii) task-shifting of such intervention delivery to mental-health trained non-specialist Lay Health Workers. GMH has come under sustained critique. Critics suggest that GMH is colonial medicine come full circle, involving the top-down imposition of Western psychiatric models and solutions by Western-educated elites. These critiques suggest that GMH ignores the various indigenous modalities of healing present in non-Western cultures, which may be psychologically adaptive and curative. Relatedly, critics argue that GMH could be an unwitting Trojan horse for the mass medicalisation of people in developing countries, paving the way for exploitation by Big Pharma, while ignoring social determinants of health.

Biopolíticas da depressão nos imigrantes Africanos

Este artigo foca o tema controverso das biopolíticas da depressão em imigrantes, em particular nos originários da África sub-sahariana. Os sintomas depressivos, ligados à ansiedade, são identificados também pela nova e mais importante patologia mental dos imigrantes: a Síndroma de Ulisses, de stress múltiplo e crónico, já definido como "o mal do século vinte e um", e que atinge principalmente os africanos. Não só entre estes imigrantes mas também em África, segundo um estudo conduzido pela OMS, a depressão tornou-se uma das principais patologias mentais. O tratamento farmacológico do sofrimento, entendido como fenómeno orgânico, é considerado o único caminho possível, silenciando os processos históricos, políticos e socioeconómicos que lhe estão na base. A atenção é portanto focada na saúde mental do indivíduo, desviando-a de problemas sociais de difícil resolução, que necessitariam de respostas económicas e políticas.

Manifestations of affective disturbance in sub-Saharan Africa: key themes

BACKGROUND

Affective disorder, once seen as rare in sub-Saharan Africa, is now viewed as more common. There are however challenges in assessing rates of depression, exploring manifestations of depression, and understanding risk factors for depression, especially those related to gender.

AIM

To identify key themes and new directions for research on affective disorder in sub-Saharan Africa, with particular reference to gender issues.

METHODS

Interpretive review of selected literature, and theoretical analysis.

RESULTS

There are gender differences in manifestations and rates of depression in sub-Saharan Africa, and there are forms of presentation (largely somatic, based on interpersonal relationships, or spiritual in nature) which may obscure the detection of depression. Studies are consistent however that when depressive symptoms are sought and are present, these are reasonably easy to elicit.

LIMITATIONS

This was not a systematic review, and the substantial grey literature from sub-Saharan Africa was not reviewed. For many countries, there are no data available.

CONCLUSIONS

Affective disorder, when properly sought for through both qualitative and quantitative methods, has been found to be common in sub-Saharan Africa. There is a paucity of research on interventions with affective disorder in this region.

Psychiatry in the East African colonies: a background to confinement

This article is concerned with the discipline of psychiatry in colonial East Africa as it emerged out of the crime and disorder problem to become an intellectually significant 'East African School' of psychiatry. The process of lunacy certification, in particular, provides a snapshot of the medical and political tensions that existed among the medical establishment, the prison system and the colonial courts, all of whom sought to define collective African behaviour. This historical article utilises archaic terminology, such as 'lunatic' or 'lunacy', as these categories were in use at the time.

History of psychiatry in West Africa

This paper explores the social context of the development of mental asylums in colonial Nigeria. The characteristics of the medical leadership is described, as is the environmental condition of the asylums. The colonial period produced conceptualizations of the African mind and of the pattern and distribution of mental illness in Africans. These conceptualizations are critically examined.

Some origins of cross-cultural psychiatry

The interface between insanity, race and culture was a challenging subject for some of the most influential nineteenth-century alienists. Our paper reviews some of the theoretical and clinical investigations of comparative psychiatry of this period. The idea that insanity was supposedly rare among 'primitive' people, e.g., Africans, American Natives and some Eastern populations, was repeatedly defended by prominent alienists. Associated with this notion, many authors believed that insanity tends to become more prevalent as civilization evolves. According to them, civilization had an unfavourable effect on insanity rates because it demanded a much higher degree of organization and mental production. Moreover, a greater degree of mental excitation would explain why insanity occurs more frequently in Europe than in the East, Africa or South America. Eventually, at the end of the nineteenth century, the coalition of cross-cultural and neuropsychiatry produced a notion that the brain of the 'native' is more simple and crude than that of the civilized, and more vulnerable to the evil effects of civilized life. In conclusion, some ethnocentric bias and racial stereotypes still pervasive in contemporary psychiatry are identified and traced back to their historical origins.

Focus on psychiatry in East Africa

East Africa is made up of Kenya, Uganda and Tanzania, all previous colonies of the British Empire which attained their independence in the early 1960s. At the time of independence, the East African community held the three countries together. Political expedience broke up the community in 1977 but greater wisdom and economic reality have brought the three countries back together in December 2001, in the form of a common Legislative Assembly and Court of Appeal. A Customs Union is expected soon, ahead of full political integration.

Culture and classification: the cross-cultural application of the DSM-IV

Changes incorporated into the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) include a number of features designed to enhance its cross-cultural applicability. However, the overt move toward a culture-sensitive nosology is undermined by an implicit assumption of the universality of its primary syndromes. In this review we argue that the DSM-IV's underlying thesis of universality based on Western-delineated mental disorders is problematic and has limited cross-cultural applicability. Research on the cross-cultural manifestation of schizophrenia and depression shows that presentation of these disorders varies significantly across cultures. We conclude by discussing the research and clinical implications of these findings.

Frantz Fanon and political psychiatry

Man is a social being. Factors such as political conflict, social tension and economic stress affect his mental health. Such factors are at least as important as biological factors. Frantz Fanon paid particular attention to these social problems and his brand of political psychiatry is as relevant today as it was during his time. Alienation and oppression still exist. Unemployment is widespread and tyrannical rulers still oppress their people. Mental illness cannot be solved by drugs but by changes in the political and social order.

Social factors and depression in Nigerian women

A sample of 30 depressed patients was matched for age and social class with an equal number of non-psychiatrically disturbed subjects. The two groups were similar with regard to the vulnerability model of Brown and his colleagues. However, more depressed patients reported job dissatisfaction than controls. Depressed patients had experienced excess of life events prior to the onset of depression. They were also distinguished from the controls by categories of events involving losses and those related to work.

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.

A cross cultural study of symptomatology of depression--eastern versus western patients

The symptoms exhibited by 100 depressed patients from Western India were studied. A statistical comparison was made of these symptoms with the symptoms of British depressed patients, reported in two studies from Newcastle-upon-Tyne. The symptoms in this group are similar to what has been reported for the Indian population in general except for paranoid features, which were less common. Compared with depressed patients from North India, somatic symptoms were significantly more common, while late insomnia, reduction in work and activities, and retardation were significant less frequent. Compared to South Indian depressed patients, depressed mood and hypochondriasis were significantly greater, and suicidal tendency and diurnal variation significantly less. Amongst Indian depressed patients generally, somatic symptoms, hypochondriasis, anxiety and agitation are present in a significantly larger percentage of patients, but guilt feelings, obsessional and paranoid symptoms are significantly less frequent, compared with British depressed patients.

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.

Suicide rates in Lusaka, Zambia: preliminary observations

The records of all suicides and of all open verdicts in Lusaka (Zambia) over a 5-year period (1967-71) were studied. The following suicide rates (per 100 000 of the population per annum) were found: 7.4 for all races; 11.3 for men of all races; 3.0 for women of all races; 6.9 for all African residents; 11.2 for African males; 2.2 for African females; 12.8 for all Africans above the age of 14 years; 20.9 for all European residents; 20.7 for all European males; 21.0 for all European females. The male:female ratio among Africans was 5:1. There was a tendency for the suicide rate among Africans to rise with age. Differences in suicide rates between African and European residents were found not to be statistically significant. Though hanging was by far the most commonly used method of suicide by Africans, Europeans and 'doubtful suicides' among Africans preferred other methods to a statistically significant degree. It is suggested that the role of other methods in African suicides may well have been underestimated in the past. No definite seasonal variation in suicide rates was found. Domestic quarrels, mental illness and physical diseases would appear to be some of the important precipitating factors of suicide in Lusaka. It is also suggested that the question of whether or not suicide is rare in Africans cannot be answered until such time as when reliable figures are available in Africa.

Aspects of clinical psychiatry in Sub-Saharan Africa

Baan was referring to the underdeveloped world, or the ‘third world’ as it is often called. This review is concerned with psychiatry in a small part of it—Sub-Saharan Africa—that part of the African continent inhabited by black Africans. At the time of writing, the term is used more specifically to describe independent black Africa, excluding South Africa—hence a bloc of cultures and sub-cultures with ethnic, economic, religious and customary patterns very different from those of the continents of Europe and North America where the bulk of current data and theory about psychiatric disorders has been obtained and expanded. In view of such major differences in factors long thought to influence the occurrence and nature of psychiatric illnesses, the patterns of these disorders in Sub-Saharan Africa are important in clarifying theories about psychiatric disease despite the paucity of adequate research carried out to date.

Depressive illness and aggression in Belfast

An inverse relation has been suggested between the incidence of depressive illness and the opportunity to externalize aggressive behaviour. The riot situation in Belfast in 1969-70 provided an opportunity to study this hypothesis. The incidences of depressive illness in the city and a neighbouring peaceful rural county were compared over a number of years. Data regarding age, sex, area of the city, and type of depression were obtained. The city was divided into areas and four of these were studied in detail. Similar data were obtained for persons showing aggressive behaviour.There was a significant decrease in depressive illness in Belfast in both sexes and all age groups. This was more pronounced in males but the decrease was confined to those in social groups IV and V. The decrease was more significant in riot areas. The suicide rate fell by almost 50% and there was a noticeable increase in the rates of homicide and crimes of violence. In contrast the rural county showed a sharp increase in male depressives.

Preliminary psychiatric observations in Egypt

In the following paper a short clinical, descriptive account is given of the first 1,000 patients attending Ain Shams University Psychiatric Clinic from the beginning of 1966. Although the clinic is in the centre of Cairo, its catchment area extends all over Egypt. Patients are referred through three channels; either general practitioners send them for a psychiatric opinion or they come from other medical out-patient clinics at the University. The third group represents those who come independently and ask for psychiatric examination. Usually these are patients from the countryside who have tried lay therapy in their villages but without improvement. This group represents a deficit in the organization of referral, as many of them, having been examined at the psychiatric clinic may have to be referred to another medical out-patient clinic because of a non-psychiatric organic pathology.

The role of cultural factors in paranoid psychosis among the Yoruba tribe

It is certainly noteworthy that, during the last few decades, whatever the contributory forces, more and more emphasis is being placed on the contention that man is a social being and that his individuality as a person is meaningful only in terms of his relations with others. Mead (1947) has shown that man as a social being is subjected “throughout his entire individual existence to systematic cultural pressures” which reinforce or intensify, elaborate or suppress his psycho-biological potentialities in a way which not only refutes the false belief in the uniformity of human behaviour but reveals also its most extreme types.