Madness or sadness? Local concepts of mental illness in four conflict-affected African communities

Conflict and Health

Joop de Jong²  Ria Reis³  Mark Jordans¹  Peter Ventevogel⁴ 

[1] London School of Hygiene and Tropical Medicine, Center for Global Mental Health, London, UK;Rhodes University, Grahamstown, South Africa;Leiden University Medical Center, Leiden, the Netherlands;War Trauma Foundation, Diemen, the Netherlands

关键词: Idioms of distress;    Mental disorder;    Local concepts;    Rapid assessment;    South Sudan;    Democratic Republic of Congo;    Burundi;   

Others  :  806349
DOI  :  10.1186/1752-1505-7-3

 received in 2012-09-12, accepted in 2013-02-14,  发布年份 2013

【 摘 要 】

Background

Concepts of ‘what constitutes mental illness’, the presumed aetiology and preferred treatment options, vary considerably from one cultural context to another. Knowledge and understanding of these local conceptualisations is essential to inform public mental health programming and policy.

Methods

Participants from four locations in Burundi, South Sudan and the Democratic Republic of the Congo, were invited to describe ‘problems they knew of that related to thinking, feeling and behaviour?’ Data were collected over 31 focus groups discussions (251 participants) and key informant interviews with traditional healers and health workers.

Results

While remarkable similarities occurred across all settings, there were also striking differences. In all areas, participants were able to describe localized syndromes characterized by severe behavioural and cognitive disturbances with considerable resemblance to psychotic disorders. Additionally, respondents throughout all settings described local syndromes that included sadness and social withdrawal as core features. These syndromes had some similarities with nonpsychotic mental disorders, such as major depression or anxiety disorders, but also differed significantly. Aetiological concepts varied a great deal within each setting, and attributed causes varied from supernatural to psychosocial and natural. Local syndromes resembling psychotic disorders were seen as an abnormality in need of treatment, although people did not really know where to go. Local syndromes resembling nonpsychotic mental disorders were not regarded as a ‘medical’ disorder, and were therefore also not seen as a condition for which help should be sought within the biomedical health-care system. Rather, such conditions were expected to improve through social and emotional support from relatives, traditional healers and community members.

Conclusions

Local conceptualizations have significant implications for the planning of mental-health interventions in resource-poor settings recovering from conflict. Treatment options for people suffering from severe mental disorders should be made available to people, preferably within general health care facilities. For people suffering from local syndromes characterized by loss or sadness, the primary aim for public mental health interventions would be to empower existing social support systems already in place at local levels, and to strengthen social cohesion and self-help within communities.

【 授权许可】

   
2013 Ventevogel et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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