FOUNDATIONS FOR QUESTIONING AN AFRICAN PERSPECTIVE ON PSYCHOPATHOLOGY

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Overview

This chapter serves as the foundation of the study. Background information is provided, followed by the justification for the study. Thereafter, the research problem is introduced, leading towards the presentation of the research question. The researcher then discusses the delimitation of the scope of the study as well as the research goals. A brief view on the theoretical orientation of the study is offered, in addition to a section dedicated to clarifying key terms. The researcher then provides a synopsis of the research methodology and a brief structure of the research report.

Background

The prelude to this investigation commenced early in my clinical training during research into clinical interviewing and evaluation. The training institution is a South African based tertiary healthcare institution offering evaluative, diagnostic, and treatment interventions to patients who are directly affected with severe psychiatric disturbances. Progressively, it became apparent during my practical training, and via direct observation, that culture-related material did not feature as prominently as one would expect in a country that comprises of diverse cultures. In fact, Bhugra and Bhui (1997) made a similar observation. In this regard, Sinha (2000) is of the view that discounting culture corresponds with the repudiation of subjectivity and context. This implies a depreciation of the lived experiences of the patient. In acknowledging culture, one fosters the humanisation of patients (Kazarian & Evans, 1998). As previously mentioned, South Africa comprises many diverse cultures, but traditional African practices form a substantial part of the Black South African cultural milieu (Chick, 2000). As culture mediates psychological process (McCrae, 2001), an understanding of the way in which African culture influences psychopathological responses and experiences would potentially promote further appreciation of the experiences of a large faction of the clinical population in South Africa (see Thomas& Bracken, 2004). Further observation and interest in this regard prompted the initiation of this study. The topography of mental health care is currently in a process of transformation. It has become apparent that patients yearn for more than a diagnosis. They have a great need to appreciate their experiences from a cultural and social perspective (Thomas & Bracken, 2004). Culture influences views and experiences during the course of one’s life, which then has an influence on behaviour. Thus, persons of different cultures may express similar behavioural tendencies, but express them according to culturally- sanctioned norms (McCrae, 2001). The logical question here, then, is: do people experience psychological distress according to culturally-sanctioned norms? This certainly lays the foundation for investigation into the field of cultural psychopathology and therefore substantiates questioning an African perspective on psychopathology. In traditional African cosmology, the symbiosis between the seen and unseen is unquestionably acknowledged (Chandler, 1998). Of significance is culture’s capacity to modulate emotional regulation (Eshun & Gurung, 2009). Numerous theories focused on the composition of emotion do not illustrate the African experience effectively (Dzokoto & Okazaki, 2006). In an attempt to illustrate the African experience, there appears to be a need for thorough assessment into African views on psychopathology. However, the need for exploring African conceptualisations of psychopathology is not new. Edgerton (1966) expressed this view by requesting that research forage within the African domain so as to inform academia in this regard. Edgerton’s primary concern questioned Western nosologies as misrepresenting the cultural and social veracity of authentic African experience. The current study aims to address Edgerton’s request to explore the possibility of African conceptualisations on psychopathology.

Justification for the study

In particular, the current investigation emphasised the current status of African perspectives on psychopathology of which a similar investigation could not be located by the author. Conducting such an investigation corresponds with Wilkinson’s (2005) guidelines to conduct a study such as the present investigation. In terms of temporal trends regarding clinical processes, it appeared that more recent literature (Gorman et al., 2004; Luck et al., 2002; McLay, Rodenhauser, Anderson, Stanton, & Markert, 2002; Pfeiffer, Madray, Ardolino, & Willms, 1998; Williams & Heikes, 1993) indicated a greater appreciation of culture, diversity, subjective experience, specificity regarding the course of psychopathology, the humanisation of clinical interviews, and acknowledging the complexity of human participants. This was in marked contrast to archaic literature (see Prince, 1915) which focused on patients as subjects and mere recipients of treatment protocols. It is therefore logical to infer that clinicians are moving towards a more holistic (inclusive) approach to understanding patients, in preference to a primarily diagnostic (reductive) system. Haidet and Paterniti (2003) also agree with this view. As such, a more holistic approach to understanding patients remains fairly contemporary. It was therefore anticipated that a large volume of the literature used in this study would comprise mainly of fairly contemporary academic articles.

CONTENTS :

• Acknowledgements
• Declaration
• Abstract
• Keywords
• CHAPTER INTRODUCTION
  • 1.1 Overview
  • 1.2 Background
  • 1.3 Justification for the study
  • 1.4 Research problem
    • 1.4.1 Research question
    • 1.4.2 Delimitation of the scope of study
  • 1.5 Research goals
  • 1.6 Theoretical orientation of the study
  • 1.7 Clarification of terminology
    • 1.7.1 Defining African
    • 1.7.2 Clinical terminology
  • 1.8 Research methodology
  • 1.9 Structure of the thesis
  • 1.10 Conclusion
• CHAPTER 2 THEORETICAL POINT OF DEPARTURE
  • 2.1 Introduction
  • 2.2 Background to integrative theory
  • 2.3 Integrative theory
  • 2.4 An African epistemology
  • 2.5 Theoretical transformation
  • 2.6 Integrative therapies
  • 2.7 Psychopathology for the African
  • 2.8 Exploring race – a process of humanisation
  • 2.9 Conclusion
• CHAPTER 3 RESEARCH METHODOLOGY
  • 3.1 Introduction
  • 3.2 Research design
  • 3.3 The systematic literature review
    • 3.3.1 Descriptive reviewing in systematic literature reviews
    • 3.3.2 Aims and principles of the systematic literature review
  • 3.4 Criteria for eligibility of literature
    • 3.4.1 Inclusion criteria
    • 3.4.2 Exclusion criteria
  • 3.5 Doing the systematic literature review
  • 3.5.1 The stages of the systematic review
    • 3.5.1.1 The problem formulation stage
    • 3.5.1.1.1 Various functions in literature reviewing
      • 3.5.1.1.2 Moderating conceptual relevance
      • 3.5.1.2 The data collection stage
      • 3.5.1.2.1 Locating literature
      • 3.5.1.2.2 Abstracting and indexing services
      • 3.5.1.2.3 Determining the competence of literature searches
      • 3.5.1.2.4 Legitimacy issues
      • 3.5.1.2.5 Protecting legitimacy
      • 3.5.1.2.6 Judging the quality of research
      • 3.5.1.3 The data evaluation stage
      • 3.5.1.3.1 Appraisal assessment in scientific inquiry
      • 3.5.1.4 The analysis and interpretation stage
      • 3.5.1.5 The presentation stage
  • 3.6 Ensuring research quality
  • 3.7 Ethical considerations
  • 3.8 Dissemination of research results
  • 3.9 Conclusion
• CHAPTER 4 LITERATURE REVIEW: FOUNDATIONS FOR QUESTIONING AN AFRICAN PERSPECTIVE ON PSYCHOPATHOLOGY
  • 4.1 Introduction
  • 4.2 The cultural context
    • ng definitions of culture
  • 4.2.2 The locus of culture
  • 4.3.3 Culture as a multidirectional construct
  • 4.3.4 The framework of culture
  • 4.3.5 ‘Culture’ misunderstood
  • 4.3.6 Culture and psychopathology
  • 4.4 Ethnicity
  • 4.5 Race
  • 4.6 Who is African?
  • 4.7 African identity
    • 4.7.1 Developing an African identity
    • 4.7.2 Acculturation
    • 4.7.3 Influences on identity
  • 4.8 The influence of colonisation in Africa
  • 4.9 Cosmology
    • 4.9.1 African cosmology
    • 4.9.1.1 Igbo cosmology
    • 4.9.1.2 Tabwa cosmology
    • 4.9.2 The creation of the universe
    • 4.9.3 Worldview and psychopathology ila mom
    • 4.9.4 The African epistemology and psychopathology
    • 4.9.5 Witchcraft
    • 4.9.6 Symbolism
    • 4.9.7 Legend and mythology
    • 4.9.7.1 The Zulu creation story
    • 4.9.7.2 The Boshongo creation story
    • 4.9.7.3 The Abaluyia creation story
    • 4.9.7.5 The legend of the bed of reeds
    • 4.9.7.6 The hole in the ground myth
    • 4.9.7.7 The miraculous child of Sankatane
  • 4.10 The historical context of psychopathology
    • 4.10.1 Misunderstanding psychopathology
    • 4.10.2 Progressive philosophical conceptualisations on mental health
  • 4.11 Conclusion
• CHAPTER 5 LITERATURE REVIEW: EXPLORING AN AFRICAN PERSPECTIVE ON PSYCHOPATHOLOGY
  • 5.1 Introduction
  • 5.2 Psychopathology
  • 5.2.1 Psychopathology and being Black
    • 5.2.2 Psychopathology in Africa
    • 5.2.2.1 An African-specific perspective on psychopathology
    • 5.2.2.2 Prototypal names
    • 5.2.2.2.1 Alien-self disorder
    • 5.2.2.2.2 Anti-self disorder
    • 5.2.2.2.3 Individualism
    • 5.2.2.2.4 Mammyism
    • 5.2.2.2.5 Materialistic depression
    • 5.2.2.2.6 Self-destructive disorder
    • 5.2.2.2.7 Theological misorientation
    • 5.2.2.3 From then to now
  • 5.2.2.4 Contemporary trends in the manifestation of psychopathology
  • 5.2.2.5 Context-specific modes of expression
  • 5.3 Somatisation
  • 5.4 Psychopathology from a cultural perspective
  • 5.5 The theory of culture-bound syndromes
  • 5.6 Culture-bound syndromes in Africa
  • 5.6.1 Amafufunyane
  • 5.6.2 Amok
  • 5.6.3 Brain fag
  • 5.6.4 Roast breadfruit syndrome
  • 5.6.5 Koro and genital-shrinking
  • 5.6.6 Zar
  • 5.6.7 Boufée deliriante
  • 5.6.8 Falling out / blacking out
  • 5.6.9 Hex, rootwork, voodoo death
  • 5.6.10 Spell
• • 5.7 Traditional healing
  • 5.7.1 On becoming a traditional healer
  • 5.7.2 Types of healers
  • 5.7.3 The difference between traditional healers and witches
  • 5.7.4 Traditional healing processes
  • 5.7.4.1 Muthi
  • 5.7.4.2 Traditional healing and psychopathology
  • 5.7.5 Harmony and balance
  • 5.7.6 Traditional and modern collaboration
  • 5.8 Western perspectives on psychopathology
  • 5.9 Africa in relation to the West
  • 5.10 On universalism, relativism, and absolutism
  • 5.11 Ethnocentricity
  • 5.12 Comparative views
  • 5.13 Cultural diversity
  • 5.14 Multiculturalism
  • 5.15 Epistemology and science
  • 5.16 Psychiatry and clinical psychology
  • 5.17 Psychopathology in South Africa
  • 5.17.1 A reconciled South Africa
  • 5.17.2 South Africa: The present tense
  • 5.18 Excluded studies
  • 5.19 Conclusion
• CHAPTER 6 DISCUSSION
  • 6.1 Introduction
  • 6.2 Trends in the literature
  • 6.3 Presentation of findings
  • 6.3.1 Theme 1: Redefining psychopathology
  • 6.3.2 Theme 2: The supernatural in the psychoanalytic- oriented frame
  • 6.3.3 Theme 3: The locus of pathology
  • 6.3.4 Theme 4: Exploring somatisation
  • 6.3.5 Theme 5: Metaphysical vitalism
  • 6.3.6 Theme 6: Culturology
  • 6.3.7 Theme 7: Culture-bound syndromes
  • 6.3.8 Theme 8: The representational world
  • 6.3.9 Theme 9: Psychopathology embedded in interpersonal relationships
  • 6.3.10 Theme 10: Legends
  • 6.3.11 Theme 11: Transformation
  • 6.3.12 Theme 12: Ecumenical psychopathology
  • 6.3.13 Theme 13: The psychosocial and socio-political aetiological sphere
  • 6.3.14 Theme 14: The social functions of psychopathology in Africa
  • 6.3.14.1 Sub-theme 1: Stigma
  • 6.3.14.2 Sub-theme 2: Secondary gain
  • 6.3.14.3 Sub-theme 3: Social healing
  • 6.3.15 Theme 15: Configurationism
  • 6.3.16 Theme 16: Traditional healing
  • 6.3.17 Theme 17: Schism / immix
  • 6.3.18 Theme 18: Sectionalisation
  • 6.4 Conceptual conclusions
  • 6.5 A conceptual view on an African perspective on psychopathology
  • 6.6 Recommendations for clinicians and future researchers
  • 6.6.1 Updating the review
  • 6.6.2 Limitations of the current state of affairs with regards
  • to research on cultural psychopathology
  • 6.6.3 Research in somatisation
  • 6.6.4 Self-development and awareness
  • 6.6.5 Collaboration
  • 6.6.6 Culture-aligned reformulation and intervention
  • 6.7 Reflexivity
  • 6.7.1 On emic and etic
  • 6.7.2 On kinship and oneness
  • 6.7.3 On culture
  • 6.7.4 On critical theory
  • 6.7.5 Warnings
  • 6.7.6 Personal process
  • 6.8 Limitations of the research
  • 6.9 Directions for future research
  • 6.10 Conclusion
• CHAPTER 7 REPORT
  • 7.1 Introduction
  • 7.2 Literature review protocol
  • 7.3 Closing remarks
  • 7.4 Conclusion
  • References
  • Appendix A: Coding sheet – literature details
  • Appendix B: Coding sheet – themes

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