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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.
Highlights
In order to facilitate case identification of incident cases of psychosis and controls in three sites in India, Nigeria and Trinidad, we sought to understand how psychoses were conceptualized locally
The pilot study phase of INTREPID was a populationbased programme of research designed to implement and evaluate methods for identifying, assessing, and following incident cases of psychosis and controls in catchment areas in India, Nigeria and Trinidad
Explanatory models In developing the concept of explanatory models as a framework for understanding how individuals make sense of illness, Kleinman [4] suggested a series of questions to elicit such models, including: What name does it have? What are the biggest problems the illness has caused? What caused the problem? What is the appropriate response, treatment? These questions focus on the key pieces of information necessary to elucidate local understandings of illness, i.e., the names or terms used, the signs and behaviours associated with, the causal attributions that help individuals understand, and the local responses when an individual becomes ill with a condition
Summary
In 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. In regard to mental disorders: a) typical signs range from external, behavioural manifestations to internal, emotional feelings and perceptions; b) causes are often located within a restricted number of domains (i.e., the supernatural or spiritual, the psycho-social, the biological or physical); and, c) responses can occur in one of three sectors of local health care systems (i.e., the popular [e.g., self-help or help from family and friends], the folk [e.g., spiritual and traditional healers], and the professional [e.g., mental health services]) [5] These formulations shaped how we sought to investigate and understand local concepts of madness in the INTREPID sites in India, Nigeria, and Trinidad. We do not mean to use it that way and would prefer to think of our usage as being in line with other work, e.g., a sweeping history of mental illness [6], a personal narrative of bipolar disorder [7], or an established classic about the establishment of national asylum systems [8]
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