Mental illness and health-seeking of adults and children: A critical ethnography of Karamoja, north-eastern Uganda
Year: 2020
Type: dissertation
Abstract: In current global mental health debates, the themes of taking cultural issues seriously, and sensitivity to local contexts, predominate.Specifically, there is an emphasis on how embracing the knowledge of lay people's explanatory models (EMs) of mental illness can inform actions that target them.Nomadic pastoralists are among the world's poorest and most marginalised people.However, the question of how they understand mental illness is largely unexamined in the literature.This research examined lay EMs of mental illness and healthseeking in a context of humanitarian crisis in Karamoja, north-eastern Uganda.It also examined what informs lay EMs of mental illness and the decisions to seek (or not to seek) care.Data were collected using six complementary qualitative methods: participant observation, conversations, life history interviews, focus group discussions, key informant interviews and secondary data review.The Karimojong cultural concepts of mental illness described syndromes that closely resemble the diagnostic entities of psychiatry, but there were also significant differences.Psychosis was seen as a complex and multilayered serious mental illness, consisting of three distinct subtypes.The local syndrome, defined as having many thoughts, sadness, worries, and solitude, are core features resembling major depression, but was not seen as a persistent problem and thus was not treated.The local syndrome that resembled psychological trauma was perceived to symbolise widespread and collective suffering.In addition, the local syndromes of epilepsy and intellectual disability were identified but were considered to be childhood mental illnesses.With regard to causation, the Karimojong relied significantly on supernatural and psychosocial explanations of mental illness and less on biological explanations.Psychosis-like syndromes were seen as illnesses caused by the actions of different supernatural agents: God, ancestor spirits, the spirits of dead people/ghosts, curses, and bewitchment.The causes of depressive illness and psychological trauma were considered to be social and contextual factors.Experiences of epilepsy and intellectual disability were believed to be largely supernatural in nature, being similar to the explanations of psychosis.However, epilepsy and intellectual disability were regarded as having a biological aetiology, with mainly genetic and physical factors.In terms of the impact and course of mental illness, the sufferers and their families were said to confront numerous social and health difficulties.These difficulties mainly involved being confronted with negative societal attitudes exemplified in stigmatisation and discrimination, as well as dispossession or loss of resources.Moreover, these experiences commonly affected those with conditions thought to be incurable and associated with severe impairment in Stellenbosch University https://scholar.sun.ac.zaOpsomming In huidige globale debatte oor geestesgesondheid oorheers die temas om kulturele kwessies ernstig op te neem en sensitiwiteit vir plaaslike kontekste.Daar word spesifiek klem gelê op hoe die kennis van leekmense se verklarende modelle (VM) van geestesongesteldheid omhels kan word om die aksies wat hulle teiken in te lig.Nomadiese veeboere is van die armste en mees gemarginaliseerde mense ter wêreld.Die vraag hoe hulle geestesongesteldheid verstaan, is egter grootliks onondersoek in die literatuur.In hierdie navorsing is ondersoek gelê na VM's vir geestesongesteldheid en gesondheidsoeking in 'n konteks van humanitêre krisis in Karamoja, Noordoos-Uganda.Daar is ook ondersoek ingestel na wat die VM's oor geestesongesteldhede inlig en die besluite om sorg te kry (of nie).Data is versamel met behulp van ses aanvullende kwalitatiewe metodes: waarneming van deelnemers, gesprekke, lewensgeskiedenisonderhoude, fokusgroepbesprekings, sleutel-informantonderhoude en sekondêre datahersiening.Die Karimojong-kulturele konsepte van geestesongesteldhede het sindrome beskryf wat baie ooreenstem met die diagnostiese entiteite van psigiatrie, maar daar was ook beduidende verskille.Psigose is gesien as 'n ingewikkelde en meervoudige ernstige geestesongesteldheid, bestaande uit drie verskillende subtipes.Die plaaslike sindroom, wat gedefinieer word as baie gedagtes, hartseer, bekommernisse en eensaamheid, is kerneienskappe wat soos ernstige depressie blyk, maar is nie as 'n aanhoudende probleem gesien nie en word daarom nie behandel nie.Die plaaslike sindroom wat soortgelyk het aan sielkundige trauma word gesien as simbolisering van wydverspreide en kollektiewe lyding.Daarbenewens is die plaaslike sindrome van epilepsie en intellektuele gestremdheid geïdentifiseer, maar dit word as geestesiektes van die kinderjare beskou.Wat oorsaaklikheid betref, vertrou die Karimojong op bonatuurlike en psigososiale verklarings van geestesongesteldheid en minder op biologiese verklarings.Psigose-agtige sindrome word gesien as siektes wat veroorsaak word deur die optrede van verskillende bonatuurlike middels: God, voorvadergeeste, geeste van dooie mense / spoke, vloeke en betowering.Die oorsake van depressiewe siekte en sielkundige trauma word as sosiale en kontekstuele faktore beskou.Daar is geglo dat ervarings van epilepsie en intellektueel gestremdheid grotendeels bonatuurlik van aard was, soortgelyk aan die verklarings van psigose.Epilepsie en intellektuele gestremdheid word egter beskou as 'n biologiese etiologie, met hoofsaaklik genetiese en fisiese faktore.Wat die impak en verloop van geestesongesteldheid betref, word daar gesê dat die lyers en hul gesinne talle sosiale en gesondheidsprobleme ervaar.Hierdie probleme het hoofsaaklik te make gehad met negatiewe samelewingshouding wat in Stellenbosch University https://scholar.sun.ac.za 2009 Kirmayer & Pedersen, 2014;Swartz, 1998).A diversity of EMs of mental illness exist in SSA (Patel, 1995).Yet, to the best of my knowledge nothing is known about nomadic pastoralists, who are the focus of this study, in Karamoja, Uganda.This study was conducted in Karamoja, a region that is home to 1.37 million nomadic pastoralists.1 They occupy 27,200 km 2 of semi-arid land in north-eastern Uganda, bordering South Sudan to the north and Kenya to the east (Uganda Bureau of Statistics [UBOS], 2016; United Nations Population Fund [UNFPA], 2018).As a result, there are recurrent structural stressors: extreme poverty, famine, and on-going raids and inter-border wars (Green, 2008;Krätli, 2010).People suffer frequent epidemics of infectious diseases but lack access to quality healthcare.The co-morbidity of infectious diseases and mental illness is well known (Prince et al., 2014), and contributes to shaping people's EMs of health (Helman, 1994(Helman, , 2007;;Kleinman, 1980).But there is no research on mental health in Karamoja, and particularly on how the experience of structural violence (Rylko-Bauer & Famer, 2016) impacts on people's mental health.Therefore, in this thesis, I examine local conceptions of mental illness and health-seeking among nomadic pastoralists in Karamoja, north-eastern Uganda. Thesis layoutThis thesis comprises six chapters.Chapter 1 presents the general introduction to the study.Chapter 2 reviews the literature.In Chapter 3, the methodology is discussed.Chapter 4 presents the results, focusing on the description of the research participants and conceptualisations of mental illness.Chapter 5 discusses the results, and Chapter 6 presents the conclusion.
Author: James Wasike Mangeni Byanasaye
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: Universiteit Stellenbosch
OpenAlex ID: W3136469600