Mental Health and Ethno-Etiologies in Southern Africa: Towards Collaborative Therapeutic Relationships

Abstract

Multi-culturalism and -ethnicity are key features of African societies and an understanding of traditional belief systems and cultural perceptions about health, illness and healing is therefore pivotal on the African continent. This is all the more true when it comes to mental health. Despite neuro-psychiatric disorders ranking third (after HIV/AIDS and other infectious diseases) in contributing to the overall disease burden in South Africa, mental health is still acutely stigmatized and is generally seen as a peripheral and isolated issue. This is partly due to the various cross-cultural causal explanations and perceptions that exist amongst Africans with regard to their mental health. In many of the indigenous languages, no equivalent words for concepts like ‘counselling,’ ‘therapy’ or ‘depression’ exist and traditional beliefs in supernatural causes of, and remedies for mental conditions are rife. It is furthermore not uncommon for people to accept biomedical explanations and treatment for their condition, even while espousing more traditional and cultural (ethno-etiological) perceptions about their mental health, and utilizing the traditional treatment options and rituals provided by traditional healers. This paper will consider some of these mental health ethnoetiologies in Southern Africa and will show how cultural, religious and spiritualbeliefs about mental health can colour perceptions and influence communication. An argument will be made for a culture-sensitive understanding of mental illness in Southern Africa, the fundamental principles that underpin African beliefs withregard to health and illness will be considered, and a collaborative therapeutic approach that is culture-sensitive, pluralistic and patient-centred will be advocated. The primary example that will be explored in this chapter is kufungisasa, a culturalconstruction of the mental illness generally known as depression in Western biomedicine.