Doctoral Degrees (Psychology)

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Browsing Doctoral Degrees (Psychology) by Author "Byanasaye, James Wasike Mangeni"

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    Mental illness and health-seeking of adults and children: A critical ethnography of Karamoja, north-eastern Uganda
    (Stellenbosch : Stellenbosch University, 2020-12) Byanasaye, James Wasike Mangeni; Tomlinson, Mark; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
    ENGLISH ABSTRACT: In current global mental health debates, the themes of taking cultural issues seriously, and sensitivity to local contexts, predominate. Specifically, there is an emphasis on how embracing the knowledge of lay people’s explanatory models (EMs) of mental illness can inform actions that target them. Nomadic pastoralists are among the world’s poorest and most marginalised people. However, the question of how they understand mental illness is largely unexamined in the literature. This research examined lay EMs of mental illness and health-seeking in a context of humanitarian crisis in Karamoja, north-eastern Uganda. It also examined what informs lay EMs of mental illness and the decisions to seek (or not to seek) care. Data were collected using six complementary qualitative methods: participant observation, conversations, life history interviews, focus group discussions, key informant interviews and secondary data review. The Karimojong cultural concepts of mental illness described syndromes that closely resemble the diagnostic entities of psychiatry, but there were also significant differences. Psychosis was seen as a complex and multilayered serious mental illness, consisting of three distinct subtypes. The local syndrome, defined as having many thoughts, sadness, worries, and solitude, are core features resembling major depression, but was not seen as a persistent problem and thus was not treated. The local syndrome that resembled psychological trauma was perceived to symbolise widespread and collective suffering. In addition, the local syndromes of epilepsy and intellectual disability were identified but were considered to be childhood mental illnesses. With regard to causation, the Karimojong relied significantly on supernatural and psychosocial explanations of mental illness and less on biological explanations. Psychosis-like syndromes were seen as illnesses caused by the actions of different supernatural agents: God, ancestor spirits, the spirits of dead people/ghosts, curses, and bewitchment. The causes of depressive illness and psychological trauma were considered to be social and contextual factors. Experiences of epilepsy and intellectual disability were believed to be largely supernatural in nature, being similar to the explanations of psychosis. However, epilepsy and intellectual disability were regarded as having a biological aetiology, with mainly genetic and physical factors. In terms of the impact and course of mental illness, the sufferers and their families were said to confront numerous social and health difficulties. These difficulties mainly involved being confronted with negative societal attitudes exemplified in stigmatisation and discrimination, as well as dispossession or loss of resources. Moreover, these experiences commonly affected those with conditions thought to be incurable and associated with severe impairment in functioning, namely psychosis, epilepsy and intellectual disability. Treatment of the different syndromes depended on what was regarded as the cause. For psychosis-like syndromes, the Karimojong relied on indigenous therapy because it was considered culturally appropriate for illness of spirits. Bio-medical care was not sought because it was thought to be neither a cure nor a suitable treatment for “illness of spirits”. In the case of depressive illness, management was primarily psychosocial, involving receiving emotional and social support from relatives, friends, and significant others. The treatment of both epilepsy and intellectual disability was also predominantly traditional therapy, but in a few cases the families of affected children sought bio-medical care. This study is the first of its kind to make an important contribution to understanding mental health issues among nomadic pastoralists in Uganda. It particularly reveals how this marginalised population articulates issues regarding mental health and well-being. In this regard, this study is of critical public health significance. It is not only of mental health relevance but also assists in revealing the broader socio-economic and political issues that impact well-being in Karamoja. Consequently, it provides important insights that can inform the design of culturally sensitive and contextually appropriate mental health interventions for the Karimojong and similar populations in Uganda.