“How I Floated on Gentle Webs of Being”: Psychiatrists Stories About the Mental Health Treatment Gap in Africa
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A strong movement has emerged recently which is highlighting the high levels of untreated mental illness in Africa and making proposals for reducing this ‘gap’ in mental health care. This movement has been criticised for insufficiently attending to the epistemologies embedded in its recommendations, and inadequately considering the views of practitioners ‘on the ground’. Employing a narrative-based approach, I accessed the stories about the mental health ‘treatment gap’ of 28 psychiatrists all working clinically in public mental health care settings in South Africa, Uganda, Nigeria or Ethiopia. Rather than focusing on the content of these stories, I was more interested in their underpinning meaning-codes and epistemological politics. Dominant thinking about the ‘treatment gap’ was heavily informed by a biomedical paradigm, and associated epistemological order of European Colonial Modernity. There were, however, cracks in this master narrative, which crystalised in the stories that were told by three particular psychiatrists. Their narratives operated within an alternative paradigm, one which appears to be informed by the tradition of phenomenology, and in particular the ideas associated with French philosopher Merleau-Ponty. This more marginalised thinking may offer important insights into reducing the mental health ‘treatment gap’ in Africa in ways very different from those created by current seats of power.
KeywordsMental health treatment gap Africa Psychiatrists Narrative
This study was funded by the following doctoral research fellowships: Patrick and Margaret Flanagan Award (Rhodes University, South Africa); South African National Research Foundation (Grant no. 74724); Oppenheimer Memorial Trust Award (Reference: 19512/01).
Compliance with Ethical Standards
Conflict of Interest
Sara Cooper has received research grants from the Patrick and Margaret Flanagan Trust (Rhodes University, South Africa); the South African National Research Foundation and the Oppenheimer Memorial Trust (South Africa).
All research procedures performed were in accordance with the ethical standards of the London School of Hygiene and Tropical Medicine’s, UK and the University of Cape Town’s, South Africa research ethics committees, and with the 1964 Helsinki declaration and its later amendments.
Informed consent was obtained from all individual participants included in the study.
- Bracken, Pat, Philip Thomas, Sami Timimi, Eia Asen, Graham Behr, Carl Beuster, Seth Bhunnoo, Ivor Browne, Navjyoat Chhina, Duncan Double, Simon Downer, Chris Evans, Suman Fernando, Malcolm R Garland, William Hopkins, Rhodri Huws, Bob Johnson, Brian Martindale, Hugh Middleton, Daniel Moldavsky, Joanna Moncrieff, Simon Mullins, Julia Nelki, Matteo Pizzo, James Rodger, Marcellino Smyth, Derek Summerfield, Jeremy Wallace, and David Yeomans 2012 Psychiatry beyond the current paradigm. BJP 201: 430–434.CrossRefGoogle Scholar
- Carroll, Lewis 1872 Through the Looking-Glass. Raleigh, NC: Hayes Barton Press.Google Scholar
- Clark, Jocalyn 2014 Medicalization of global health: The medicalization of global mental health, Glob Health Action 7:24000.Google Scholar
- Comaroff, Jean 1993 The Diseased Heart of Africa: Medicine, Colonialism and the Black Body. In Knowledge, Power and Practice: The Anthropology of Medicine and Everyday Life. S. Lindenbaum and M. Lock, eds., pp. 305-329. Berkeley, CA: University of California Press.Google Scholar
- Ethiopian Ministry of Health .2012. National Mental Health Strategy. Ethiopia: Ministry of Health.Google Scholar
- Good, Byron 1994 Medicine, rationality and experience: An anthropological perspective. Cambridge: Cambridge University Press.Google Scholar
- Husserl, Edmund 1972 Experience and judgement. Evanston:Northwestern University Press.Google Scholar
- Issa, Baba 2005 Dearth of Psychiatrists in Nigeria. Nigerian Medical Practitioner 47(6):127-128.Google Scholar
- Jackson, Michael 1996 Things as they are: New directions in phenomenological anthropology. Bloomington: Indiana University Press.Google Scholar
- Kuhn, Thomas 1962 The structure of scientific revolutions. Chicago:University of Chicago Press.Google Scholar
- Kvale, Steinar 1996 InterViews: An introduction to qualitative research interviewing. California: Sage.Google Scholar
- Lamarque, Peter 1990 Narrative and invention: The limits of fictionality. In Narrative in Culture: The Uses of Storytelling in the Sciences, Philosophy and Literature. C Nash, ed., pp.131-53. London: Routledge.Google Scholar
- Latour, Bruno 1999 Pandora’s hope: Essays on the reality of Science Studies. Cambridge, MA:Harvard University Press.Google Scholar
- Law, John 1999 After ANT: Complexity, naming and typology. In Actor network theory and after. J Law and J Hassard, eds., pp. 1–14. Oxford: Blackwell Publishers.Google Scholar
- Matthews, Eric 2002 The philosophy of Merleau-Ponty. Chesham:Acumen.Google Scholar
- Merleau-Ponty, Maurice 2004 The world of perception. London:Routledge.Google Scholar
- Merleau-Ponty, Maurice 1962 The phenomenology of perception. London:Routledge.Google Scholar
- Mills, China and Fernando, Suman 2014 Globalising Mental Health or Pathologising the Global South? Disability and the Global South 1(2):188-202.Google Scholar
- Mol, Annemarie 2008 The logic of care: Health and the problem of patient choice. New York:Routledge.Google Scholar
- Montgomery, Katherine 2006 How doctors Think: Clinical judgment and the practice of medicine. Oxford: Oxford University Press.Google Scholar
- Parker, Ian 1992 Discourse dynamics: Critical analysis for social and individual psychology. London:Routledge.Google Scholar
- Riessman, Catherine K. 2008 Narrative methods for the Human Sciences. London:Sage.Google Scholar
- Riessman, Catherine K. 1993 Narrative Analysis. London:Sage.Google Scholar
- Timimi, Sami 2011 A Reply to ‘Grand Challenges in Mental Health. Science, Medicine, and Anthropology: http://somatosphere.net/?p=2033.
- Turnbull, David 2004 Narrative traditions of Space, Time and Trust in Court. In Expertise in Regulation and Law. G Edmond, ed., pp.116-183. Ashgate: Aldershot.Google Scholar
- Vaughan, Megan 1991 Curing their ills: Colonial power and African illness. Cambridge: Polity Press.Google Scholar
- Willig, Carla 2001. Introducing qualitative research: Adventures in theory and method. Berkshire: Open University Press.Google Scholar
- World Health Organization 2008 Mental Health Gap Action Programme: Scaling-up care for mental, neurological, and substance use disorders. Geneva:WHO.Google Scholar
- World Health Organization 2001 Mental Health: New Understanding, New hope. Geneva:WHO.Google Scholar