Madness or sadness? Local concepts of mental illness in four conflict-affected African communities
Open Access
- 18 February 2013
- journal article
- Published by Springer Science and Business Media LLC in Conflict and Health
- Vol. 7 (1), 3
- https://doi.org/10.1186/1752-1505-7-3
Abstract
Concepts of ‘what constitutes mental illness’, the presumed aetiology and preferred treatment options, vary considerably from one cultural context to another. Knowledge and understanding of these local conceptualisations is essential to inform public mental health programming and policy. Participants from four locations in Burundi, South Sudan and the Democratic Republic of the Congo, were invited to describe ‘problems they knew of that related to thinking, feeling and behaviour?’ Data were collected over 31 focus groups discussions (251 participants) and key informant interviews with traditional healers and health workers. While remarkable similarities occurred across all settings, there were also striking differences. In all areas, participants were able to describe localized syndromes characterized by severe behavioural and cognitive disturbances with considerable resemblance to psychotic disorders. Additionally, respondents throughout all settings described local syndromes that included sadness and social withdrawal as core features. These syndromes had some similarities with nonpsychotic mental disorders, such as major depression or anxiety disorders, but also differed significantly. Aetiological concepts varied a great deal within each setting, and attributed causes varied from supernatural to psychosocial and natural. Local syndromes resembling psychotic disorders were seen as an abnormality in need of treatment, although people did not really know where to go. Local syndromes resembling nonpsychotic mental disorders were not regarded as a ‘medical’ disorder, and were therefore also not seen as a condition for which help should be sought within the biomedical health-care system. Rather, such conditions were expected to improve through social and emotional support from relatives, traditional healers and community members. Local conceptualizations have significant implications for the planning of mental-health interventions in resource-poor settings recovering from conflict. Treatment options for people suffering from severe mental disorders should be made available to people, preferably within general health care facilities. For people suffering from local syndromes characterized by loss or sadness, the primary aim for public mental health interventions would be to empower existing social support systems already in place at local levels, and to strengthen social cohesion and self-help within communities.Keywords
This publication has 41 references indexed in Scilit:
- Improving Access to Mental Health Care and Psychosocial Support within a Fragile Context: A Case Study from AfghanistanPLoS Medicine, 2012
- Evidence-Based Guidelines for Mental, Neurological, and Substance Use Disorders in Low- and Middle-Income Countries: Summary of WHO RecommendationsPLoS Medicine, 2011
- Global Mental Health 5 Human resources for mental health care: current situation and strategies for actionThe Lancet, 2011
- The Effect on Mental Health of a Large Scale Psychosocial Intervention for Survivors of Mass Violence: A Quasi-Experimental Study in RwandaPLOS ONE, 2011
- Building capacity in mental health interventions in low resource countries: an apprenticeship model for training local providersInternational Journal of Mental Health Systems, 2011
- The influence of demographic characteristics, living conditions, and trauma exposure on the overall health of a conflict-affected population in Southern SudanBMC Public Health, 2010
- Development of a multi-layered psychosocial care system for children in areas of political violenceInternational Journal of Mental Health Systems, 2010
- A Qualitative Study of Mental Health Problems among Children Displaced by War in Northern UgandaTranscultural Psychiatry, 2009
- Closing the gap between psychiatric epidemiology and mental health in post-conflict situationsThe Lancet, 2002
- Conceptions of Psychosis in Four East African Societies1American Anthropologist, 1966