Over the years, understanding of the interrelationship of culture, medicine, and psychiatry has changed enormously just as the understanding of illness, as distinct from disease, has also changed. Today, it is better understood that cultural understandings of health and illness as well as beliefs about causes and cures are directly related to actual and perceived effectiveness and ultimate recovery. Medicine has become far more ‘Social’ and cross-cultural, which has given birth to a more encompassing, interdisciplinary and less culturally parochial perspective of mental health even in developing countries. These advances suggest that mental health, in an indigenous context is better thought of as a qualitative index of the integrity and strength of an individual’s relationships with his or her natural, spiritual and social world.
The medical model of mental illness comes out clear, even in cross-cultural and international psychiatry, where a strong orientation exists among psychiatrists to discover cross-cultural similarities and universalities in mental disorder. The underlying principle is to demonstrate that mental illness, like other disorders, occurs in all societies and can be detected universally if certain standardised guidelines and diagnostic criteria are followed. The World Health Organisation conducted certain pilot studies to demonstrate that mental illness has symptoms occurring together in certain ways in Western and non-Western, industrialised and non-industrialised societies.
Over 100 years ago, Emil Kraeplin envisaged a new discipline of studying mental illness that would focus on ethnic and cultural aspects of mental health and illness. This new discipline was eventually organised in 1950 as Transcultural psychiatry by Eric Wittkover of McGill University, Montreal. Wittkover’s collaborator, Henry Murphy, defined the principal objectives of the discipline: “To identify, verify and explain the links between mental disorder and the broad psychosocial characteristics which differentiate nations, peoples, and cultures.” Despite ample evidence demonstrating that major psychiatric disorders exist in all societies with similar presentations. There is also evidence that culture exerts modification in a way that determines form, course and final outcome of major disorders. It has been amply demonstrated that these socio-cultural factors shape the symptoms profile manifested by sufferers differently in developed and developing countries.
A special comparative study conducted in Agra, India and Ibadan showed important differences in manifestations of schizophrenia, which led investigators to conclude that the manifestation of mental illness tends to identify critical problems existing in a particular culture. These potent ethnic and cultural differences are reflective on the symptom profiles of mental illness even if the populations adhere to the same religion as revealed in the findings of comparative studies of patients in Pakistan and Saudi-Arabia. Major and more global studies had amply demonstrated that the course and outcome of mental illness have been more favourable in developing countries than in highly developed countries. However, the specific cultural factors could not be defined.
Factors such as the nuclear pattern of the family, dwindling kinship support for the mentally ill, covert rejection and isolation and confusing roles for the young in our emerging societies are potent cultural issues. Our African societies are no longer culturally virgin as we parade a hybrid of western and native cultural orientations with grave mental health consequences. Although we have seen how cultural factors modify mental illness, but certain situations of socio-cultural change in which the stress of acculturation or enculturation can exert profound psychological effect capable of causing mental illness either at individual or community level are home with us. The impact of rapid westernisation transforms small, tradition – directed communalist societies, consolidated over many centuries into modern mass societies which invariably lead to an anonymous impersonation of social relationships that generates the loss of guiding norms of behavior. This breeds conflict between the modern western notions and traditional non-western values which in turn creates cultural confusion and a widening gap between the models of an affluent western lifestyle and the often bleak socioeconomic reality causing feelings of relative deprivation, attrition of traditional guiding norms, cultural identity confusion which may lead to the development of psychosocial syndrome loaded with mental illness.
The recent inhuman acts of Xenophobia that took place in South Africa falls into this category and it should be carefully studied in this context. Africa is bedeviled with these forms of occurrences consequent on the loss of traditional culture and social marginalisation due to imposed westernisation. Africans should interrogate their cultural beliefs and practices to modify them in the context of emerging globalization of values rather than parochially holding on to them despite apparent signs of irrelevance and mediocrity. This paradigm can also adequately explain and fundamentally handle the Bokoharam debacle and other emerging militant groups in Africa.
Overall, the crucial role of the mental health paradigm of engaging these issues cannot be over-emphasised.
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