The Culture of Mental Illness and Psychiatric Practice in Africa , livre ebook

THE CULTURE OF MENTAL ILLNESS AND PSYCHIATRIC PRACTICE IN AFRICA
THE CULTURE OF MENTAL ILLNESS AND PSYCHIATRIC PRACTICE IN AFRICA

EDITED BY
EMMANUEL AKYEAMPONG, ALLAN G. HILL, AND ARTHUR KLEINMAN
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Library of Congress Cataloging-in-Publication Data
The culture of mental illness and psychiatric practice in Africa / edited by Emmanuel Akyeampong, Allan G. Hill, and Arthur Kleinman.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-253-01286-9 (cl : alk. paper) - ISBN 978-0-253-01293-7 (pb : alk. paper) - ISBN 978-0-253-01304-0 (eb)
I. Akyeampong, Emmanuel Kwaku, editor. II. Hill, Allan G., editor. III. Kleinman, Arthur, editor.
[ DNLM : 1. Mental Disorders-Africa. 2. Cultural Characteristics-Africa. 3. Health Care Reform-methods-Africa. 4. Socioeconomic Factors-Africa. WM 140]
RC 451. A 43
362.196890096-dc23
2014047048
1 2 3 4 5 20 19 18 17 16 15
To all those who suffer from mental illness in Africa and their caregivers (professionals and families)
CONTENTS

Acknowledgments

Introduction: Culture, Mental Illness, and Psychiatric Practice in Africa Emmanuel Akyeampong, Allan G. Hill, and Arthur Kleinman
1
A Historical Overview of Psychiatry in Africa

Emmanuel Akyeampong
2
Common Mental Disorders in Sub-Saharan Africa: The Triad of Depression, Anxiety, and Somatization

Vikram Patel and Dan J. Stein
3
Schizophrenia and Psychosis in West Africa Ursula M. Read, Victor C. K. Doku, and Ama de-Graft Aikins
4
Mental Illness and Destitution in Ghana: A Social-Psychological Perspective Ama de-Graft Aikins
5
Children and Adolescent Mental Health in South Africa Alan Flisher, Andrew Dawes, Zuhayr Kafaar, Crick Lund, Katherine Sorsdahl, Bronwyn Myers, Rita Thom, and Soraya Seedat
6
Some Aspects of Mental Illness in French-Speaking West Africa Ren Collignon
7
Women s Self-Reported Mental Health in Accra, Ghana

Allan G. Hill and Victoria de Menil
8
One Thing Leads to Another: Sex, AIDS, and Mental Health Reform in South Africa Pamela Y. Collins
9
Health Care Professionals Mental Health and Well-Being in the Era of HIV / AIDS : Perspectives from Sub-Saharan Africa Giuseppe Raviola
10
The Role of Traditional Healers in Mental Health Care in Africa Elialilia Okello and Seggane Musisi
11
Improving Access to Psychiatric Medicines in Africa Shoba Raja, Sarah Kippen Wood, and Michael R. Reich
12
Child Soldiers and Community Reconciliation in Postwar Sierra Leone: African Psychiatry in the Twenty-First Century William P. Murphy
13
Using Mixed Methods to Plan and Evaluate Mental Health Programs for War-Affected Children in Sub-Saharan Africa Theresa Betancourt

Contributors

Index
ACKNOWLEDGMENTS
T HE EDITORS ACKNOWLEDGE with gratitude sponsorship from the Committee on African Studies at Harvard University and the Michael Crichton Fund of the Harvard Medical School, which funded the December 2006 international workshop on African psychiatry. The following provided invaluable assistance in the preparation of the manuscript: Olufolakemi Alalade, Marty Alexander, Marilyn Goodrich, Bridget Hanna, Emily Harrison, Richard Landrigan, Maria Stalford, and Liang Moses Xu.
THE CULTURE OF MENTAL ILLNESS AND PSYCHIATRIC PRACTICE IN AFRICA
INTRODUCTION
Culture, Mental Illness, and Psychiatric Practice in Africa
EMMANUEL AKYEAMPONG, ALLAN G. HILL, AND ARTHUR KLEINMAN
T HIS VOLUME ORIGINATED in a working group at Harvard University on Health, Healing and Ritual Practice, which was part of an interdisciplinary and interschool research project of the Committee on African Studies called the Africa Initiative. The working group s members were scholars with training in public health, demography, medical science, anthropology, linguistics, ethnomusicology, and history, and their deliberations on health and healing brought to light revealing interdisciplinary perspectives. John Mugane, the linguist, was interested in medical diagnosis in African languages. Kay Shelemay, the ethnomusicologist, had worked for many years on Ethiopian church music and its interface with healing. The demographer, Allan Hill, was part of a multiyear research project on women s health in urban Africa. Wafaie Fawzi, the epidemiologist, worked on HIV / AIDS . Majid Ezzati, a public health expert on environmental health, had worked in East and West Africa, examining different kinds of domestic fuels used for cooking and their impact on health and the environment. Emmanuel Akyeampong, the historian, had worked on the history of addiction and on disease and urbanization in West Africa. Arthur Kleinman, a psychiatrist and medical anthropologist, has published extensively on mental illness and psychiatry in non-Western contexts, with a particular focus on China. Akyeampong and Kleinman jointly offered a course on Violence, Substances, and Mental Illness: African Perspectives, in the fall of 2006 (and again in 2011), and the working group hosted a workshop on psychiatry in Africa in December 2006. The interest that this generated encouraged the editors to compile a select number of papers in what, we hope, is a coherent volume.
This volume thus emerged out of conversations between a psychiatrist and nonpsychiatrists about the history, culture, and practice of psychiatry in Africa. The conversation highlighted the changing social terrain for the practice of psychiatry and psychology in Africa, and why both disciplines are attracting the interest of nonspecialists in African studies. This book is not intended to be a comprehensive volume on psychiatry in sub-Saharan Africa. Its significance lies in the ways in which psychiatry or mental health can provide a lens for our understanding of African worldviews, lifestyles, and social processes, while African ideologies and lived realities can provide an important critique of psychiatry. Africa has figured prominently in contemporary global health planning and policy, particularly regarding HIV / AIDS , tuberculosis, malaria, and other infectious diseases. It has figured less centrally in thinking about mental illness and the sequelae of social suffering. This has not always been the case.
To the extent that these have been the subjects of inquiry, the West regarded Africa and Africans in the nineteenth and twentieth centuries through lenses tinted by psychiatry and presumptions of African inferiority (Fabian 2000). Medical science-in particular, psychiatry-was an important medium for the construction of knowledge about the African other in the colonial period (Carothers 1953; McCulloch 1995). Studies have revealed similar processes in the case of colonial India (Arnold, 1993; Mills 2000). Works by historians have examined the social construction of medical knowledge, and how Western medical science in the colonial era framed the production of knowledge about the African (Hunt 1999; Lyons 1992; Vaughan 1991; Wylie 2001). Africans, however, have gazed back, their therapeutic practices resilient even in an era of colonialism, and their innovative eclecticism in the realm of medical pluralism a reflection of a confident rather than a diffident spirit (Abdalla 1997; Flint 2008; Luedke and West 2006; Taylor 1992). These nuances inform the growing interest by psychiatrists in African studies, as well as their interest in the history, practice, and culture of psychiatry and psychology. Africans seem to score quite favorably compared to European and North American populations on scales used worldwide to assess mental disorders (de Menil et al., 2012). The possibility that schizophrenic patients in the developing world may have better outcomes than those in the developed world-according to the International Pilot Study of Schizophrenia, which included Ibadan, Nigeria-has raised questions about the matrix of African social structures and relations and how they may provide a more supportive social environment (Odejide, Oyewunmi, and Ohaeri 1989, 710-11). This possibility potentially revises our understanding of schizophrenia as a progressively deteriorating condition that is frequently irreversible, thereby illustrating how Africa and African studies can influence psychiatry.
This introductory chapter provides a historical and social context for mental health in twentieth-century Africa and for changing psychiatric practices, with the objective of shedding light on social dynamics in colonial and independent Africa and the challenges these throw up in terms of mental health-or, more precisely, the approach to the care and treatment of the mentally ill. This discussion situates the subsequent chapters in this volume, as we review the history of psychiatry in Africa; common mental disorders in community and p