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Explanatory models and concepts of West African Malian patients with psychotic symptoms

Published online by Cambridge University Press:  15 April 2020

F. Napo*
Affiliation:
Department of Psychiatry and Psychotherapy, Charité – Berlin, Germany Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Germany
A. Heinz
Affiliation:
Department of Psychiatry and Psychotherapy, Charité – Berlin, Germany
A. Auckenthaler
Affiliation:
Department of Clinical Psychology and Psychotherapy, Freie Universität Berlin, Germany
*
*Corresponding Author. E-mail address:[email protected] (F. Napo)
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Abstract

Background

Subjective explanations of illness concepts and disease can differ from culture to culture. We examined explanatory models of West African patients with schizophrenia in a communitycentred department of psychiatry in Mali, West Africa.

Methods

Patients and experts volunteered to be interviewed in the Department of Psychiatry of the University Hospital, Pont G, in Bamako, the capital of Mali. We used semi-structured interviews to explore key psychotic symptoms and explanatory models of psychosis in five experts and fifteen patients with schizophrenia. All interviews were analysed using computer assisted content-analysis with the program Atlas.ti.

Results

African patients displayed key symptoms of schizophrenia such as commenting and imperative voices, inserted thoughts and other phenomena of alien control, which were often subjectively explained as obsession by witches or jinns. Explanatory models differed depending on occidental migration experience and age. The involvement of family members in the treatmentsetting facilitates inclusion and recovery. Experts emphasized the need to integrate traditional and ethno-pharmacological approaches and modern medicine to treat their patients in a culture sensitive manner.

Discussion

Our data suggests a strong influence of illness concepts on the experience of psychotic symptoms, treatment expectations and health-related behaviour.

Type
Research Article
Copyright
Copyright © 2012 Elsevier Masson SAS

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References

Antonovsky, A.Gesundheitsforschung versus Krankheitsforschung. In Franke, A. & Broda, M. (Editors), Psychosomatische Gesundheit. Versuch einer Abkehr von Pathogenese-Konzept Tübingen: DGVT-Verlag, 1993; 314.Google Scholar
Bleuler, E.Dementia praecox oder die Gruppe der Schizophrenien. Berlin: Springer; 1911.Google Scholar
Blumhagen, D.On the nature of explanatory models. In: Reidel, R. (Editors) Culture, Medecine and Psychiatry, Dordrecht,Holland, and Boston, U.S.A: R Publishing, 1981; 5. 337437.Google Scholar
Bhui, K., Bhugra, D.Explanatory models for mental distress:implications for clinical practice and research. Brit J Psychiatry 2002; 181: 67.CrossRefGoogle ScholarPubMed
Callan, A, Littlewood, R. Patient satisfaction: ethnic origin or explanatory model? International Journal of Social Psychiatry 1998:44.CrossRefGoogle Scholar
Carothers, J.C.Frontal lobe function and the African. J MentSci 1951; 97: 122148.Google ScholarPubMed
Cochrane, R., Bal, S.Mental hospital admission of 1971 and 1981. Soc Psychiatry 1989; 24: 211.Google ScholarPubMed
Cristeiner, S.Frauen im Spannungsfeld zwischen Gesundheit und Krankheit Bielefeld: Kleine Verlag, 1999; 330452.Google Scholar
David, M., Borde, T., Kentenich, H.Warum bin ich krank? Subjektive Krankheitsursachen-Vorstellungen türkischstämmiger und deutscher Patienten im Vergleich. In: Dankwart, M.v., Hertel, G., Büring, S. (Editors), Störungsspezifische Konzepte und Behandlung in der Psychosomatik Frankfurt: VAS-Verlag für Akademische Schriften, 2002; 7480.Google Scholar
Dolo, M.Problématique du système d’accompagnement des malades mentaux dans le service der psychiatrie de l‘hôpital du point. Thèse 2007; 1: 120.Google Scholar
Okello, E.S., Musisi, S.Depression as a clan illness (eByekika):an indigenous model of psychotic depression among the Baganda of Uganda. World J P 2006; 6073.Google Scholar
Haasen, C., Kleinemeier, E., Yagdiran, O.Kulturelle Aspekte bei der Diagnostik psychischer Störungen. In Assion, H.J. (Hrsg.), Migration und seelische Gesundheit. Kulturelle Aspekte bei der Diagnostik psychischer Störungen. Berlin: Springer Verlag, 2004; 45153.Google Scholar
Hardon, A., Hodgkin, C., Fresle, D.How to investigate the use of medicines by consumers. World Health Organization and University of Amsterdam 2004; 169.Google Scholar
Hardon, et al. Analysis of qualitative data.in. Applied health research manual: Antropology of health care. Amsterdam, Het Spinhuis. 2001.Google Scholar
Heinz, A.Colonial practices in the construction of the schizophrenic patient as primitive man. Critique of Anthropology 1998; 18: 421444.CrossRefGoogle Scholar
Heinz, A.Die Konzeptionen des „Selbst“ im kulturellen Vergleich. In: Wohlfahrt, E., Zaumseil, M. (Editors), Transkulturelle Psychiatrie-Interkulturelle Psychotherapi. e. Interdisziplinäre Theorie und Praxis Berlin: Springer Verlag, 2006; 387390.Google Scholar
Inem, V.A., Ayankogbe, O.O., Obazee, E.M., Ladipo, M.M.A., Udonwa, N.E., Odusote, K.Conceptual and contextual paradigm of the family as a unit of care. Nig Med Pract 2004; 45(1): 912.CrossRefGoogle Scholar
Kahraman, B.Die kultursensible Therapiebeziehung: Störungen und Lösungsansätze am Beispiel türkischer Klienten. Gießen:Psychosozialverlag 2000; 4546.Google Scholar
Kleinman, A., Eisenberg, L., Good, B.Culture, illness, and care: clinical lessons from anthropological and cross-cultural research. Ann Intern Med 1978; 88: 251288.CrossRefGoogle Scholar
Kleinman, A.Rethinking Psychiatry: from Cultural Category to Personal Experience. New York: Free Press, 1988: 256.Google Scholar
Kleinman, A.Patient and healers in the context of culture.An Exploration of the borderland between Anthropology, Medicine and Psychiatry. Berkeley, Los Angeles, London: University of California press: 1980.Google Scholar
Kora, K., Özek, M., Baral, I.Ein Beitrag zum Thema der wahnhaften Depressionen (mit Fallbeispielen aus der Türkei). In Koch, E., Özek, M., Pfeiffer, W.M., Schepker, R.Chancen und Risiken von Migration-Deutschtürkische Perspektiven Freiburg: Lambertus; 1998.Google Scholar
Koumare, B., Coudray, J.P., Miguel-Garcia, E.Der psychiatrische Dienst in Mali Überlegungen zur Unterbringung von chronischen psychiatrischen Patienten bei traditionellen Heilkundigen. Curare 1989; 12: 145152.Google Scholar
Lambo, A.The role of cultural factors in paranoid psychoses among the Yoruba tribe. The Journal of Mental Science 1955; 101: 239266.CrossRefGoogle Scholar
Leventhal, H., Nerenz, D.R., Steele, D.J.Illness representation and coping with health threats. In Baum, A., Taylor, S.E., Singer, J.E. (Editors), Handbook of Psychology and Health Volume IV:: Social Psychological Aspects of Health New Jersey: Erlbaum; 1984; 219252.Google Scholar
Linden, M.Krankheitskonzepte von Patienten. Psychiat Prax 1985; 12: 812.Google Scholar
Livingstone, F.B., Dobzhansky, T.On the non-existence of human races. Curr. Anthropol 1962; 3(3): 279281.CrossRefGoogle Scholar
Makanjjoula, J.D.A., Olaifa, E.A.Masked depression in Nigerians treated at the Neuro-Psychiatric Hospital Aro. Abeokuta. Acta Psychiatr scand 1987; 76: 480485.CrossRefGoogle Scholar
Mayring, P. Qualitative Inhaltsanalyse [28 Absätze]. Forum Qualitative Sozialforschung /Forum: Qualitative Social Research [On-sline Journal],1(2). Available from: http://qualitative-research.net/fqs/fqsd/2-00inhalt-d.htm, 2000, Juni.[11.05:2011].Google Scholar
Murphy, H.B.M.The advent of guilt feelings as a common depressive symptom: a historical comparison on two continents. Psychiatry 1987; 42: 229249.Google Scholar
Mayring, P.Qualitative Inhaltsanalyse. In Flick, U., Kardorff, E.v. & Steinke, I. (Editors), Qualitative Forschung: Ein Handbuch Reinbek: Rohwohlt; 2000; 468475.Google Scholar
Napo, F. Eine afrikanische Perspektive der Psychologi.e. Saarbrücken: Vdm Verlag, 2008.Google Scholar
Ohaeri, J.U., Oedjide, A.Somatization symptoms among Patients using primary health facilities in a rural community in Nigeria. Am J Psychiatry 1994; 151: 728731.Google Scholar
Patel, V.Explanatory models of mental illness in sub-Saharan Africa. Social Science Medicine 1995; 40: 12911298.CrossRefGoogle ScholarPubMed
Ritter, R., Chaudhry, H.R., Aigner, M., Zitterl, W., Stompe, T.Subjektive Krankheitsmodelle zwischen spezifischer Krankheitserfahrung und Kultur. Neuropsychiatr 2010; 24: 3341.Google Scholar
Sartorins, N., Jablensky, A., Korten, A., et al.Early manifestation and firstcontact incidence of schizophrenia in different cultures. A preliminary report on the initial evaluation phase of the WHO Collaboration study on determinates of the outcome of severe mental disorders. Psychol Med 1986; 16(4): 909928.CrossRefGoogle Scholar
Schneider, K. Klinische Psychopathologie Stuttgart New York: Thieme, 1992:471-80.Google Scholar
Stehphen, M., Adebimpe, M.D., et al.Ethnicity and Diagnosis in Patients with Affective Disorders. J Clin Psychiatry 2003; 64: 747757.Google Scholar
Weiss, M.G., Sarna, S.D., Gaur, R.K., Sharma, J.S., Desai, A., Doongaji, D.R.Traditional concepts of mental disorder among Indian psychiatric patients: Preliminary report of work in progress. Soc Sci Med 1986; 23: 379386.CrossRefGoogle ScholarPubMed
Weiss, M.Explanatory Model Interview Catalogue(Emic):framework for comparative study of illness. Transcultural Psychiatry 1997; 34: 235263.CrossRefGoogle Scholar
Williams, B., Healy, D.Perceptions of illness causation among new refeerrals to a communtity mental health team:explanatory model or explanatory map? Social Science and Medecine 2001; 53: 465476.CrossRefGoogle Scholar
Witzel, A.Das Problemzentrierte Interview In Jüttemann, G.H. (Editors), Qualitative Forschung in der Psychologie Weinheim: Beltz 1985; 227252.Google Scholar
Wohlfart, E., Kluge, U., Napo, F.Ethnopsychiatrische Differentialdiagnostik psychotischer Phänomene. Zeitschrift für Medizinische Soziologie 2009; (18): 140150.Google Scholar
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