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There is growing concern within the global mental health arena that interventions currently being executed to scale up mental health services in Africa will be ineffective unless simultaneous steps are taken to address people’s help-seeking behaviour. Drawing upon two conceptual tools arising from science and technology studies (STS), those of a “classification system” and “the black box,” this paper looks critically at discursive constructions of help-seeking in Africa within mental health research over the last decade. Research in this area can be divided into two dominant traditions: the knowledge-belief-practice survey and indigenous-knowledge-system approaches. Although the content and value-codes between these approaches differ, structurally they are very similar. Both are mediated by the same kind of system of classification, which demarcates the world into homogenous entities and binary oppositions. This system of ordering is one of the most stubborn and powerful forms of classification buried in the “black box” of the modernist/colonial knowledge archive and is fraught with many questionable Eurocentric epistemological assumptions. I consider whether there might be other ways of understanding help-seeking for mental illness in Africa and discuss two studies that illustrate such alternative approaches. In conclusion, I discuss some of the challenges this alternative kind of research faces in gaining more influence within contemporary global mental health discourse and practice. [ABSTRACT FROM AUTHOR]

Guidelines on psychosocial interventions in postconflict areas commonly mention that interventions should be based on local needs and be built on culture-specific expertise. This paper is based on a dissociative cult, the Kiyang-yang (KYY), in Guinea Bissau. In a previous article, we used a refined definition of the concept of idiom of distress to analyze the dissociative behavior displayed in KYY as a symbolic language addressing politically dangerous truths. This paper uses the concept of “collective trauma processing” to analyze how the idiom offered the local population a pathway to mitigate the consequences of protracted and widespread political violence. The paper first argues that the field of psychotraumatology lacks a comprehensive ecological theory on trauma. Moreover, within clinical psychology and psychiatry, little attention is paid to local cultural healing mechanisms addressing traumatic stress. This paper is an effort to study such mechanisms in their own right. To compare trauma processing mechanisms across the globe, we propose to analyze trauma processing mechanisms with the help of a comprehensive model discerning five ontological dimensions that are considered to be involved in suffering and are addressed in healing approaches. Our paper describes similarities and differences between psychological healing traditions and collective trauma processing within the West African context of Guinea Bissau. We will illustrate how the KYY movement uses the idiom of dissociation as both a collective expression of distress and as a vehicle to process social suffering and traumatic stress as a circular phenomenon. [ABSTRACT FROM AUTHOR]

Idioms of distress have become a central construct of anthropologists who aspire to understand the languages that individuals of certain sociocultural groups use to express suffering, pain, or illness. Yet, such idioms are never removed from global flows of ideas within biomedicine that influence how cultural idioms are conceived, understood, and expressed. This article proposes a preliminary model of ethnopsychology described by urban Kenyans, which incorporates local (traditional) and global (biomedical) idioms of distress that are both distinct and overlapping in symptomology and experience. This ethnopsychology was generated from analyzing 100 life history narrative interviews among patients seeking care in a public hospital in Nairobi, Kenya, which explicitly probed into how people experienced and expressed the Kiswahili idioms huzuni (roughly translated as sadness or grief) and dhiki (stress or agony) and English terms stress and depression. Kufikiria sana, or "thinking too much", emerged organically as a powerful cultural idiom and as a symptom or sign of other forms of psychological distress. We propose a preliminary model of ethnopsychology that: 1) highlights social and political factors in driving people to express and experience idioms of distress; 2) reveals how the English terms "stress" and "depression" have been adopted into Kiswahili discourse and potentially have taken on new meaning; 3) suggests that the role of rumination in how people express distress, with increasing severity, is closely linked to the concept of "thinking too much", and; 4) emphasizes how somatization is central to how people think about psychological suffering. [ABSTRACT FROM AUTHOR]

Millions of refugees are on the move globally, mostly settling in low- and middle-income (LMIC) “host” countries, where they often receive insufficient assistance and encounter a multitude of barriers. Despite a risk for developing mental illness, limited research exists on their struggles and coping strategies in these settings, especially outside of camps. Against this backdrop, our qualitative study aimed to gain a deeper understanding of refugee experiences in Durban, South Africa. We conducted semistructured individual interviews with 18 adult refugees from Zimbabwe and the Democratic Republic of Congo at a community-based support center in Durban. Participants described their problems, effects on mental health, and coping abilities. Interviews were recorded and analyzed for themes. Major problems were reported with work, xenophobia/racism, mental health, physical safety, housing, healthcare, and quality of life. Participants discussed feelings of worry, fear, emotional pain, anger, powerlessness, hopelessness, worthlessness, and passive suicidal ideation. Coping mechanisms consisted of friendships, church, praying, work, physical activities, family, learning the local language, and avoidance of thoughts. Many interviewees expressed a strong desire to either return to their homeland or move elsewhere. Refugees in South Africa face considerable hardships including xenophobia, physical abuse, and work/legal obstructions. More research is needed in LMICs to identify the challenges, psychological effects, and coping in such populations so that appropriate and accessible mental health services can be created for those who require them. [ABSTRACT FROM AUTHOR]

A qualitative study, investigating the representations and explanatory models of 'madness' held by indigenous and religious healers, was undertaken in urban Uganda. Case vignettes of individuals with a diagnosis of a psychotic disorder were discussed by the healers in terms of phenomenology, causality, intervention and outcome. Indigenous healers primarily understood 'madness' as spiritual or physiological, whereas religious healers also held psychological models. Healers' understandings of 'madness' are inextricably linked with the historical and sociopolitical context and may be useful to individuals with psychotic experiences, however, it is likely that these models are dynamic and continually changing. [ABSTRACT FROM AUTHOR]

L'Oedipe Africain is a vital text from the early years of post-colonialism and transcultural psychiatry. Psychologist Marie-Cécile Ortigues and her philosopher husband, Edmond Ortigues produced this study after 4 years of clinical work (from 1962 to 1966) at the Fann Hospital in Dakar, Senegal. These were years of intense creativity at Fann, as Dr Henri Collomb set in motion a series of innovations that transformed a classical asylum into an open-door, culturally sensitive therapeutic center. L'Oedipe Africain confronts the transcultural project in the early post-colonial era with such candor and insight that it continues to speak to the profession today. The discussion of transference in situations of racial and cultural difference, and the theorizing of the cultural and universal dimensions to the psyche, emerge as enduring contributions of this text. The assumptions about history, tradition and modernity, and the gloss on female patients prove less durable. [ABSTRACT FROM AUTHOR]

The author recounts his introduction to ethnically-oriented psychiatric consultations for immigrant families, which has gained increasing recognition in France over the lastl5 years. Based on the theoretical work of George Devereux on the relation of culture to psychiatry, a group led by Tobie Nathan, a psychoanalytic psychologist, has developed large group multicultural consultations to make sense of the complex problems presented by patients from non-Western societies. Their work in clinical settings has evolved into the Centre George Devereux at the University of Paris Nord, where training in methods of consultation and mediation for immigrant communities take place. Their thinking has often challenged established psychiatric theories and practices based on Western society norms. [ABSTRACT FROM PUBLISHER]