Concepts of madness in diverse settings: a qualitative study from the INTREPID project

Abstract

BackgroundIn order to facilitate case identification of incident (untreated and recent onset) cases of psychosis and controls in three sites in India, Nigeria and Trinidad, we sought to understand how psychoses (or madness) were conceptualized locally. The evidence we gathered also contributes to a long history of research on concepts of madness in diverse settings.MethodsWe conducted focus group discussions and individual interviews to collect information about how informants in each site make sense of and respond to madness. A coding framework was developed and analyses of transcripts from the FGDs and interviews were conducted.ResultsAnalyses suggest the following: a) disturbed behaviors are the primary sign of madness; b) madness is attributed to a wide range of causes; and, c) responses to madness are dictated by cultural and pragmatic factors. These findings are congruent with similar research that has been conducted over the past 50 years.ConclusionsThe INTREPID research suggests that concepts about madness share similar features across diverse settings: a) terms for madness are often derived from a common understanding that involves disruptions in mental processes and capacities; b) madness is recognized mostly by disruptive behaviours or marked declines in functioning; c) causal attributions are varied; and, d) help-seeking is a complex process.

Social inclusion and exclusion of people with mental illness in Timor-Leste: a qualitative investigation with multiple stakeholders

“…The stigmatising beliefs that Timorese people with mental illness are dangerous, lack capacity and have an incurable illness are consistent with stereotypes that have been reported in both HICs and LMICs [12,46]. Sometimes these beliefs were related to the sociocultural conceptualisation of mental illness as a sign of intractable ancestral punishment, as has been reported in other parts of Asia [30].…”

“…Stigma is a social and subjective process involving problems of knowledge, prejudicial attitudes, and discriminatory behaviour [7][8][9]. Across countries, stigmatising beliefs often cast people with mental illness as dangerous, unpredictable and unintelligent; beliefs which are enacted through discriminatory and exclusionary behaviours [10][11][12]. Globally, many people with mental illness are excluded from employment (economic exclusion), denied legal rights to vote, marry or own land (political exclusion), and ostracized (sociocultural exclusion) [13][14][15][16].…”

The experience of being a psychiatric nurse in South Africa: A qualitative systematic review

“…These considerations, which are applicable to many countries in the world, can affect the care for mental disease in some African countries, as there is a predominant vision of mental health and those who suffer from it based on magic/religious beliefs, rather than scientific knowledge (Jenkins et al, 2013;Njenga, 2007;Okasha, 2002). Furthermore, the presence of any stigma could influence the provision of healthcare, the distribution of resources and the development of policies and strategies directed towards mental health (Cohen et al, 2016;Makanjuola et al, 2016;Reta et al, 2016;WHO, 2013).…”

“…Indeed, most African countries have no mental health policies, programmes or action plans against the stigma of mental illness, or for improving human resources and providing specialised training, whatsoever (Okasha, 2002). Previous studies (Cohen et al, 2016;Okasha, 2002;Reuter et al, 2016) have highlighted specific barriers to mental health development programmes in Africa, such as both a lack of awareness of the extent of the problem as well as a reliable information system, insufficient resources, both economic and human, the lack of national mental health policies, a shortage of specialized staff, the presence of civil unrest and violence and, occasionally, supernatural attributions for mental disorders. Additionally, the shortage of mental health programmes and the necessity to make the pertinent fiscal, staffing, and structural changes to these services can result in inferior levels of care (WHO, 2008;.…”

Estimating the incidence of psychosis in diverse settings

“…We approached this task in two ways. First, we conducted focus groups in each site to collect information about local concepts of psychotic illness (Cohen et al, 2016). An understanding of such concepts has been demonstrated to facilitate communication with informants about community members who might be experiencing a psychotic illness (Shibre, Teferra, Morgan, & Alem, 2010).…”