Xhosa-Speaking Schizophrenic Patients' Experience of Their Condition: Psychosis and Amafufunyana

Abstract

This study investigates the experience of 10 Xhosa-speaking schizophrenic patients attending a community psychiatry clinic in Cape Town. Drawing on social constructivist theory, and its critique of psychiatric constructions of psychopathology and culture, the study explored psychiatric patients' construction of their experience of their condition. In face-to-face open-ended interviews, patients were asked to describe their experience of their condition and its treatment, and their understanding of aetiology. Analysis of the transcribed interviews employed qualitative methodologies. While patients frequently described their condition in terms of ‘amafufunyana’ or ‘nerves’, they reported that their preferred mode of treatment had shifted from consultation with traditional healers to use of psychiatric services. Discussion notes (1) the apparent anomaly between explanatory models and preferred mode of treatment; (2) the complex uses of the term amafufunyana, which include diagnostic, explanatory and aetiological functions; and (3) in the absence of ‘psychological’ language, the presence of ‘medical’ and ‘mystical’ language. It is argued that the separation of amafufunyana and psychosis is a false dichotomy, since patients employ both in a complex web of psychiatric, religious and social constructions. The importance of the consideration of patients' experience for the development of psychiatric services is stressed.