Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-09T08:48:39.677Z Has data issue: false hasContentIssue false
  • English
  • Français

The phenomenology and explanatory models of common mental disorder: a study in primary care in Harare, Zimbabwe

Published online by Cambridge University Press:  09 July 2009

V. Patel ,
F. Gwanzura ,
E. Simunyu ,
K. Lloyd  and
A. Mann
V. Patel*
Affiliation:
Department of Psychiatry, University of Zimbabwe Medical School, Harare, Zimbabwe; Section of Epidemiology and General Practice, Institute of Psychiatry, London
F. Gwanzura
Affiliation:
Department of Psychiatry, University of Zimbabwe Medical School, Harare, Zimbabwe; Section of Epidemiology and General Practice, Institute of Psychiatry, London
E. Simunyu
Affiliation:
Department of Psychiatry, University of Zimbabwe Medical School, Harare, Zimbabwe; Section of Epidemiology and General Practice, Institute of Psychiatry, London
K. Lloyd
Affiliation:
Department of Psychiatry, University of Zimbabwe Medical School, Harare, Zimbabwe; Section of Epidemiology and General Practice, Institute of Psychiatry, London
A. Mann
Affiliation:
Department of Psychiatry, University of Zimbabwe Medical School, Harare, Zimbabwe; Section of Epidemiology and General Practice, Institute of Psychiatry, London
*
1Address for correspondence: Dr Vikram Patel, Department of Psychiatry, Medical School, PO Box A178, Avondale, Harare, Zimbabwe.
Get access Rights & Permissions [Opens in a new window]

Synopsis

In order to describe the explanatory models and the etic and emic phenomena of common mental disorder in Harare, Zimbabwe, 110 subjects were selected by general nurses in three clinics and by four traditional healers from their current clients. The subjects were interviewed using the Explanatory Model Interview and the Revised Clinical Interview Schedule.

Mental disorder most commonly presented with somatic symptoms, but few patients denied that their mind or soul was the source of illness. Spiritual factors were frequently cited as causes of mental illness. Subjects who were selected by traditional healer, reported a greater duration of illness and were more likely to provide a spiritual explanation for their illness.

The majority of subjects were classified as ‘cases’ by the etic criteria of the CISR. Most patients, however, showed a mixture of psychiatric symptoms that did not fall clearly into a single diagnostic group. Patients from a subgroup with a spiritual model of illness were less likely to conform to etic criteria of ‘caseness’ and they may represent a unique category of psychological distress in Zimbabwe. A wide variety of emic phenomena were elicited that have been incorporated in an indigenous measure of non-psychotic mental disorder. Kufungisisa, or thinking too much, seemed to be the Shona term closest to the Euro-American concept of neurotic illness.

Type
Original Articles
Information
Psychological Medicine , Volume 25 , Issue 6 , November 1995 , pp. 1191 - 1199
Copyright
Copyright © Cambridge University Press 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Abas, M., Broadhead, J., Mbape, P. & Khumalo-Sakatukwa, G. (1994). Defeating depression in the developing world: a Zimbabwean model. British Journal of Psychiatry 164, 293–296.CrossRefGoogle ScholarPubMed
Bridges, K. & Goldberg, D. (1985). Somatic presentations of DSM-III psychiatric disorders in primary care. Journal of Psychosomatic Research 29, 563–569.CrossRefGoogle ScholarPubMed
Channabasavanna, S. M., Raguram, R., Weiss, M., Parvathavardhini, R. & Thriveni, M. (1993). Ethnography of psychiatric illness: a pilot study. NIMHANS Journal 11, 1–10.Google Scholar
Chavunduka, G. L. (1994). Traditional Medicine in Modern Zimbabwe. University of Zimbabwe Press: Harare.Google Scholar
Gelfand, M. (1967). Psychiatric disorders as recognized by the Shona. Central African Journal of Medicine 13, 39–46.Google ScholarPubMed
Kleinman, A. (1980). Patients and Healers in the Context of Culture. University of California Press: Berkeley, CA.CrossRefGoogle Scholar
Leff, J. (1978). Psychiatrist's versus patients' concepts of unpleasant emotions. British Journal of Psychiatry 133, 306–313.CrossRefGoogle ScholarPubMed
Leff, J. (1990). The ‘New Cross-Cultural Psychiatry’ a case of the baby and the bathwater. British Journal of Psychiatry 156, 305–307.CrossRefGoogle ScholarPubMed
Lewis, G., Pelosi, A., Araya, R. & Dunn, G. (1992). Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychological Medicine 22, 465–486.Google Scholar
Littlewood, R. (1990). From categories to contexts: a decade of the ‘New Cross-Cultural Psychiatry’. British Journal of Psychiatry 156, 308–327.CrossRefGoogle ScholarPubMed
Mutambirwa, J. (1989). Health problems in rural communities, Zimbabwe. Social Science and Medicine 29, 927–932.Google Scholar
Ndetei, D. M. & Muhangi, J. (1979). The prevalence and clinical presentation of psychiatric illness in a rural setting in Kenya. British Journal of Psychiatry 135, 269–272.Google Scholar
Orley, J. & Wing, J. K. (1979). Psychiatric disorder in two African villages. Archives of General Psychiatry 36, 513–520.Google Scholar
Patel, V. (1993). Traditional medicine has much to offer [letter]. British Medical Journal 307, 387.Google Scholar
Patel, V. (1995). Explanatory models of mental illness in sub-Saharan Africa: a review. Social Science and Medicine 40, 1291–1298.Google Scholar
Patel, V., Musara, T., Maramba, P. & Butau, T. (1995). Concepts of mental illness and medical pluralism in Harare. Psychological Medicine 25, 485–493.Google Scholar
Patel, V., Simunyu, E., Gwanzura, F., Mukandatsama, I. & Mann, A. (1994). The Shona Symptom Questionnaire: the development and evaluation of an indigenous measure of non-psychotic mental illness [abstract].Proceedings of the Annual Medical Research Day of the University of Zimbabwe. ICHE (Medical School):Harare.Google Scholar
Reeler, A. P., Williams, H. & Todd, C. H. (1993). Psychopathology in primary care patients: a four year study in rural and urban settings in Zimbabwe. Central African Journal of Medicine 39, 1–7.Google Scholar
Weiss, M., Doongaji, D., Siddartha, S., Wypij, D., Pathare, S., Bhatwadekar, M., Bhave, A., Sheth, A. & Fernandes, R. (1992). The Explanatory Model Interview Catalogue (EMIC): contribution to cross-cultural research methods from a study of leprosy and mental health. British Journal of Psychiatry 160, 819–830.Google Scholar
World Bank (1993). World Development Report. Oxford University Press: Washington.Google Scholar