“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.
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