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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.
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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

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