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The Culture of Mental Illness and Psychiatric Practice in Africa

The Culture of Mental Illness and Psychiatric Practice in Africa

EMMANUEL AKYEAMPONG
ALLAN G. HILL
ARTHUR KLEINMAN
Copyright Date: 2015
Published by: Indiana University Press
Pages: 362
Stable URL: http://www.jstor.org/stable/j.ctt16gz69f
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    The Culture of Mental Illness and Psychiatric Practice in Africa
    Book Description:

    In many African countries, mental health issues, including the burden of serious mental illness and trauma, have not been adequately addressed. These essays shed light on the treatment of common and chronic mental disorders, including mental illness and treatment in the current climate of economic and political instability, access to health care, access to medicines, and the impact of HIV-AIDS and other chronic illness on mental health. While problems are rampant and carry real and devastating consequences, this volume promotes an understanding of the African mental health landscape in service of reform.

    eISBN: 978-0-253-01304-0
    Subjects: Psychology, Sociology
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Table of Contents

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  1. Front Matter (pp. i-vi)
  2. Table of Contents (pp. vii-viii)
  3. ACKNOWLEDGMENTS (pp. ix-xii)
  4. INTRODUCTION: Culture, Mental Illness, and Psychiatric Practice in Africa (pp. 1-23)
    EMMANUEL AKYEAMPONG, ALLAN G. HILL and ARTHUR KLEINMAN

    This volume originated in a working group at Harvard University on “Health, Healing and Ritual Practice,” which was part of an interdisciplinary and interschool research project of the Committee on African Studies called the “Africa Initiative.” The working group’s members were scholars with training in public health, demography, medical science, anthropology, linguistics, ethno-musicology, and history, and their deliberations on health and healing brought to light revealing interdisciplinary perspectives. John Mugane, the linguist, was interested in medical diagnosis in African languages. Kay Shelemay, the ethnomusicologist, had worked for many years on Ethiopian church music and its interface with healing. The demographer,...

  5. 1 A HISTORICAL OVERVIEW OF PSYCHIATRY IN AFRICA (pp. 24-49)
    EMMANUEL AKYEAMPONG

    Mental illness is a phenomenon in all societies. The predominance of preliterate societies in subSaharan Africa before the nineteenth century meant fewer written records on medical systems that could enable us to study mental illness in precolonial Africa and the efficacy of traditional African therapeutic systems. Diviners, priests, and healers (including herbalists) have a long tradition of healing in Africa, and their practice certainly predated the colonial encounter. Their skills were particularly indispensable in the case of mental illnesses, which many African societies even in the 1980s ascribed to supernatural causes such as witchcraft or offenses against the gods and...

  6. 2 COMMON MENTAL DISORDERS IN SUB-SAHARAN AFRICA: The Triad of Depression, Anxiety, and Somatization (pp. 50-72)
    VIKRAM PATEL and DAN J. STEIN

    Any understanding of depression and anxiety in sub-Saharan Africa—indeed, in all developing countries, and in all probability in developed countries too—must highlight the fact that depression and anxiety more commonly occur together than separately, at least in community and primary health care settings. For example, the World Health Organization’s multinational study on general health care found that the comorbidity of depression and anxiety exceeded 50 percent (Goldberg and Lecrubier 1995), confirming previous observations made in primary care. Even if there are valid differences between depression and anxiety in terms of phenomenology, risk factors, and treatment, from a clinical...

  7. 3 SCHIZOPHRENIA AND PSYCHOSIS IN WEST AFRICA (pp. 73-111)
    URSULA M. READ, VICTOR C. K. DOKU and AMA DE-GRAFT AIKINS

    In psychiatry, the term “schizophrenia” refers to a group of major mental disorders whose etiology is still unknown and that involves a complex set of disturbances of thinking, perception, affect, and social behavior (Barbato 1998). It is characterized by psychotic symptoms, known as “positive symptoms,” such as auditory hallucinations (hearing voices) and delusions, as well as by “negative symptoms” such as social withdrawal, blunted affect, and self-neglect. Schizophrenia has been viewed as the prototypical manifestation of madness. It can have a devastating effect on the person’s sense of self and ability to conform to social norms and to engage successfully...

  8. 4 MENTAL ILLNESS AND DESTITUTION IN GHANA: A Social-Psychological Perspective (pp. 112-143)
    AMA DE-GRAFT AIKINS

    The African literature on mental illness and destitution has limited itself to “vagrant psychotics.” A typical definition of a vagrant psychotic would be the one that guided Taha Baasher and colleagues in their work in Lesotho and Egypt in the 1980s: “A person who was without permanent accommodation, employment, money or regular sources of food and who lived a socially and geographically unsettled life. He should also manifest gross abnormality of behaviour in such a way that his general conduct, emotional reactions, or cognitive functions were such that a psychotic illness could clearly be established” (1983, 35).

    In that cross-country...

  9. 5 CHILDREN AND ADOLESCENT MENTAL HEALTH IN SOUTH AFRICA (pp. 144-162)
    ALAN FLISHER, ANDREW DAWES, ZUHAYR KAFAAR, CRICK LUND, KATHERINE SORSDAHL, BRONWYN MYERS, RITA THOM and SORAYA SEEDAT

    Prevalence studies of psychiatric disorders among children and adolescents in South Africa are characterized by small and unrepresentative samples and/or the use of diagnostic instruments that have not been validated in the local context. Nonetheless, estimates are necessary to inform the development of policies and plans for child and adolescent mental health services. In an effort to fill this information gap, Sharon Kleintjies and coauthors (2006) produced a set of prevalence estimates for children and adolescents in the Western Cape Province. The estimates were based on the results of relevant epidemiological studies, with greater weight being given to studies that...

  10. 6 SOME ASPECTS OF MENTAL ILLNESS IN FRENCH-SPEAKING WEST AFRICA (pp. 163-185)
    RENÉ COLLIGNON

    Since they first blossomed in Europe in the nineteenth century, two scientific disciplines that take the concept of “difference” as an object of reflection—psychiatry and ethnology—have both been haunted by the question of “otherness.” In his study of the history of madness (1961), Michel Foucault showed how the identity of the modern rational subject, as subject of the contract, has been constructed in the West by contrasting it to a backdrop of a series of figures of otherness: the primitive, the savage, the child, the woman, the madman. Since before the period of colonization the African had already...

  11. 7 WOMEN’S SELF-REPORTED MENTAL HEALTH IN ACCRA, GHANA (pp. 186-203)
    ALLAN G. HILL and VICTORIA DE MENIL

    In recent years, interest in international comparisons of health across populations has grown considerably. So has interest in the concept of global health and the concern with measuring a country’s progress towards set targets, especially the Millennium Development Goals. The key assumption in tracking international progress towards such targets is that information on health can be collected in similar ways and compared on similar scales across countries. This makes good sense when dealing with objective measures such as height, weight, and blood pressure, but it becomes more questionable when dealing with conditions that are subjective, socially shameful, difficult to assess...

  12. 8 ONE THING LEADS TO ANOTHER: Sex, AIDS, and Mental Health Reform in South Africa (pp. 204-222)
    PAMELA Y. COLLINS

    South Africa, like many other African countries, struggled with the reality of limited mental health resources as it entered the era of democracy. Under these circumstances, how did the mental health system address the specter of a growing AIDS epidemic? The development of public mental health policy and interventions is not always a linear process. Often, a chance collision of epidemiology (a devastating AIDS epidemic), politics (a society in transition to democracy), policies (changing health priorities), and people with overlapping interests catalyzes events and spurs systemic change. This chapter describes a series of HIV and mental health service research and...

  13. 9 HEALTH CARE PROFESSIONALS’ MENTAL HEALTH AND WELL-BEING IN THE ERA OF HIV/AIDS: Perspectives from Sub-Saharan Africa (pp. 223-248)
    GIUSEPPE RAVIOLA

    The phenomenon of the demoralization and burnout of health care professionals practicing in environments characterized by significant lack of resources and high numbers of patients with HIV/AIDS constitutes a major crisis for African medicine, its practitioners, and the patients they treat. This chapter presents a biosocial perspective on issues of medical professionalism and health care professionals’ distress and demoralization, both globally and in sub-Saharan Africa. That is, it seeks to examine such issues beyond the biological and clinical spheres, taking into consideration the social, political, and economic aspects of medicine as it is practiced in global and local contexts (Walton,...

  14. 10 THE ROLE OF TRADITIONAL HEALERS IN MENTAL HEALTH CARE IN AFRICA (pp. 249-261)
    ELIALILIA OKELLO and SEGGANE MUSISI

    Africa has experienced much strife in its recent history, especially south of the Sahara. Most of the continent’s countries are characterized by low incomes, high prevalence of communicable diseases, malnutrition, low life expectancy, and poorly staffed services (World Bank 1998). Mental health issues are often last on the list of priorities for policy makers. Health care in general is still poorly funded in most African countries, and mental health services are the least developed and most poorly funded of all health services. Indeed, the majority of African countries do not have a mental health policy, nor do they have mental...

  15. 11 IMPROVING ACCESS TO PSYCHIATRIC MEDICINES IN AFRICA (pp. 262-281)
    SHOBA RAJA, SARAH KIPPEN WOOD and MICHAEL R. REICH

    The World Health Organization (WHO) recommends a combined psychosocial and pharmacological approach to treating mental illness (2001). However, the limited availability of the essential medicines recommended by the WHO contributes significantly to the mental health treatment gap in most of Africa. The irregular supply of medicines seriously undermines intervention efforts, especially community-based mental health treatment initiatives. BasicNeeds is an international mental health organization that works with poor people with mental disorders in ten low-income countries in Asia and Africa. The organization does not generally provide direct treatment services, nor does it promote one form of treatment over another. BasicNeeds works...

  16. 12 CHILD SOLDIERS AND COMMUNITY RECONCILIATION IN POSTWAR SIERRA LEONE: African Psychiatry in the Twenty-First Century (pp. 282-310)
    WILLIAM P. MURPHY

    Reconciling former child soldiers with their communities has become a central problem in contemporary African psychiatry. It is a dramatic problem because the goal is to heal the traumas of children who were victims and/or perpetrators of violence during a civil war, and to enable them to live peacefully and productively in postconflict communities. It is also a problem of scale. Since 1975 Africa has become “the epicenter of the problem, providing the largest concentration of both [civil] conflicts and child soldiers,” with estimates suggesting that “120,000 children, 40 percent of all child soldiers, were soldiering in Africa at the...

  17. 13 USING MIXED METHODS TO PLAN AND EVALUATE MENTAL HEALTH PROGRAMS FOR WAR-AFFECTED CHILDREN IN SUB-SAHARAN AFRICA (pp. 311-332)
    THERESA BETANCOURT

    Few child and adolescent mental health interventions have been proved effective in addressing the needs of war-affected children in sub-Saharan Africa. Such interventions are difficult to develop because of the absence of appropriate and valid measures of mental health problems and related constructs, as well as the practical problems of working in settings with few trained mental health professionals. Ethical issues also complicate research on children’s mental health in resource-poor settings. Research addressing these ethical, logistical, and methodological challenges is sorely needed. There is little empirical work that identifies the key ingredients needed to develop interventions or assesses which interventions...

  18. CONTRIBUTORS (pp. 333-336)
  19. INDEX (pp. 337-349)