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Concepts of mental illness and medical pluralism in Harare

Published online by Cambridge University Press:  09 July 2009

V. Patel ,
T. Musara ,
T. Butau ,
P. Maramba  and
S. Fuyane
V. Patel*
Affiliation:
Department of Psychiatry, University of Zimbabwe Medical School, Harare, Zimbabwe
T. Musara
Affiliation:
Department of Psychiatry, University of Zimbabwe Medical School, Harare, Zimbabwe
T. Butau
Affiliation:
Department of Psychiatry, University of Zimbabwe Medical School, Harare, Zimbabwe
P. Maramba
Affiliation:
Department of Psychiatry, University of Zimbabwe Medical School, Harare, Zimbabwe
S. Fuyane
Affiliation:
Department of Psychiatry, University of Zimbabwe Medical School, Harare, Zimbabwe
*
1 Address for correspondence: Dr Vikram Patel, Department of Psychiatry, University Medical School, PO Box A178, Avondale, Harare, Zimbabwe.
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Synopsis

The Focus Group Discussions (FGD) described in this paper are the first step of a study aiming to develop an ‘emic’ case-finding instrument. In keeping with the realities of primary care in Zimbabwe, nine FGD were held with 76 care providers including 30 village community workers, 22 traditional and faith healers (collectively referred to as traditional healers in this paper), 15 relatives of patients and 9 community psychiatric nurses. In addition to the general facets of concepts of mental illness, three ‘etic’ case vignettes were also presented.

A change in behaviour or ability to care for oneself emerged as the central definition of mental illness. Both the head and the heart were regarded as playing an important role in the mediation of emotions. The types of mental illness described were intimately related to beliefs about spiritual causation. Angered ancestral spirits, evil spirits and witchcraft were seen as potent causes of mental illness. Families not only bore the burden of caring for the patient and all financial expenses involved, but were also ostracized and isolated. Both biomedical and traditional healers could help mentally ill persons by resolving different issues relating to the same illness episode. All case vignettes were recognized by the care providers in their communities though many felt that the descriptions did not reflect ‘illnesses’ but social problems and that accordingly, the treatment for these was social, rather than medical.

The data enabled us to develop screening criteria for mental illness to be used by traditional healers and primary care nurses in the next stage of the study in which patients selected by these care providers on the grounds of suspicion of suffering from mental illness will be interviewed to elicit their explanatory models of illness and phenomenology.

Type
Original Articles
Information
Psychological Medicine , Volume 25 , Issue 3 , May 1995 , pp. 485 - 493
Copyright
Copyright © Cambridge University Press 1995

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