Local suffering and the global discourse of mental health and human rights: An ethnographic study of responses to mental illness in rural Ghana

Globalization and Health - Tập 5 Số 1 - 2009
Ursula M. Read1, Edward Adiibokah2, Solomon Nyame2
1Department of Anthropology, University College London, UK
2Kintampo Health Research Centre, Kintampo, Brong Ahafo, Ghana

Tóm tắt

Abstract Background The Global Movement for Mental Health has brought renewed attention to the neglect of people with mental illness within health policy worldwide. The maltreatment of the mentally ill in many low-income countries is widely reported within psychiatric hospitals, informal healing centres, and family homes. International agencies have called for the development of legislation and policy to address these abuses. However such initiatives exemplify a top-down approach to promoting human rights which historically has had limited impact at the level of those living with mental illness and their families. Methods This research forms part of a longitudinal anthropological study of people with severe mental illness in rural Ghana. Visits were made to over 40 households with a family member with mental illness, as well as churches, shrines, hospitals and clinics. Ethnographic methods included observation, conversation, semi-structured interviews and focus group discussions with people with mental illness, carers, healers, health workers and community members. Results Chaining and beating of the mentally ill was found to be commonplace in homes and treatment centres in the communities studied, as well as with-holding of food ('fasting'). However responses to mental illness were embedded within spiritual and moral perspectives and such treatment provoked little sanction at the local level. Families struggled to provide care for severely mentally ill relatives with very little support from formal health services. Psychiatric services were difficult to access, particularly in rural communities, and also seen to have limitations in their effectiveness. Traditional and faith healers remained highly popular despite the routine maltreatment of the mentally ill in their facilities. Conclusion Efforts to promote the human rights of those with mental illness must engage with the experiences of mental illness within communities affected in order to grasp how these may underpin the use of practices such as mechanical restraint. Interventions which operate at the local level with those living with mental illness within rural communities, as well as family members and healers, may have greater potential to effect change in the treatment of the mentally ill than legislation or investment in services alone.

Từ khóa


Tài liệu tham khảo

WHO: Global Burden of Disease 2004 Update. 2008, Geneva: World Health Organization

Gureje O, Lasebikan V: Use of mental health services in a developing country. Soc Psychiatry Psychiatr Epidemiol. 2006, 41: 44-49.

WHO: Mental Health Atlas. 2005, Geneva. World Health Organization,http://www.who.int/mental_health/evidence/mhatlas05/en/index.html

WHO: The World Health Report 2001: Mental Health: New Understanding, New Hope. 2001, Geneva. World Health Organization, http://www.who.int/whr/2001/en/

Lancet Global Mental Health Group: Scale up services for mental disorders: a call for action. The Lancet. 2007, 370: 1241-1252. 10.1016/S0140-6736(07)61242-2.

United Nations: Principles for the protection of persons with mental illness and the improvement of mental health care. 1991, Office of the High Commissioner for Human Rights, Resolution 46/119, http://www.un.org/documents/ga/res/46/a46r119.htm

Maingay S, Thornicroft G, Huxley P, Jenkins R, Szmukler G: Mental health and human rights: the MI Principles-turning rhetoric into action. International Review of Psychiatry. 2002, 14: 19-25. 10.1080/09540260120114023.

United Nations: Convention on the Rights of Persons with Disabilities and Optional Protocol. 2006, http://www.un.org/esa/socdev/enable/rights/convtexte.htm

WHO: Mental Health Legislation and Human Rights. Mental Health Policy and Service Guidance Package. 2003, Geneva: World Health Organization

Farmer P, Gastineau N: Rethinking health and human rights: time for a paradigm shift. J Law Med Ethics. 2002, 30: 655-666.

Read UM, Doku VCK, De-Graft Aikins A: Schizophrenia and psychosis in West Africa from the colonial era to the present. Culture, Mental Illness and Psychiatric Practice in Africa. Edited by: Akyeampong E, Hill A, Kleinman A. Cambridge: Indiana University Press

Forster EB: The Theory and Practice of Psychiatry in Ghana. Am J Psychother. 1962, 16: 7-51.

Commonwealth Human Rights Initiative Africa: Human Rights Violations in Prayer Camps and Access to Mental Health in Ghana. 2008, Accra: CHRI

WHO: Ghana Country Summary. Mental Health Improvement for Nations Development (MIND) Geneva. 2007, Department of Mental Health and Substance Abuse, http://www.who.int/mental_health/policy/country/countrysummary/en/index.html

Ministry of Health Ghana: Creating Wealth Through Health: The Health Sector Programme of Work. 2007,http://www.moh-ghana.org/moh/docs/programs_of_work/pows/5YPoW(2007-2011).pdf

Flisher AJ, Lund C, Funk M, Banda M, Bhana A, Doku V, Drew N, Kigozi FN, Knapp M, Omar M: Mental health policy development and implementation in four African countries. Journal of Health Psychology. 2007, 12: 505-516.

WHO: Mental Health Gap Global Action Programme: Scaling Up Care for Mental, Neurological and Substance Use Disorders. 2008, Geneva. World Health Organization, http://www.who.int/mental_health/mhgap/en/index.html

Craig TJ, Siegel C, Hopper K, Lin S, Sartorius N: Outcome in schizophrenia and related disorders compared between developing and developed countries: a recursive partitioning re-analysis of the WHO DOSMD data. Br J Psychiatry. 1997, 170: 229-233.

Edgerton RB, Cohen A: Culture and schizophrenia: the DOSMD challenge. Br J Psychiatry. 1994, 164: 222-231.

Hopper K: Interrogating the meaning of "culture" in the WHO international studies of schizophrenia. Schizophrenia, Culture and Subjectivity: the Edge of Experience. Edited by: Jenkins JH, Barrett RJ. 2004, 62-86. Cambridge: Cambridge University Press

Harrison G, Hopper K, Craig T, Laska E, Siegel C, Wanderling J, Dube K, Ganev K: Recovery from psychotic illness: a 15- and 25-year international follow-up study. Br J Psychiatry. 2001, 178: 506-517.

Patel V, Cohen A, Rangaswamy T, Gureje O: Is the outcome of schizophrenia really better in developing countries?. Revista Brasileira de Psiquiatria. 2006, 28: 149-152.

Littlewood R: The Butterfly and the Serpent: Essays in Psychiatry, Race and Religion. 1998, London; New York: Free Association Books

Bernard HR: Research Methods in Anthropology: Qualitative and Quantitative Approaches. 2006, Lanham: Altamira Press, 4

Miescher SF: Making Men in Ghana. 2005, Bloomington; Indianapolis: Indiana University Press

Wiredu K: Cultural Universals and Particulars: An African Perspective. 1996, Bloomington: Indiana University Press

Alem A: Human rights and psychiatric care in Africa with particular reference to the Ethiopian situation. Acta Psychiatr Scand. 2000, 101: 93-96.

Eaton J, Agomoh AO: Developing mental health services in Nigeria: the impact of a community-based mental health awareness programme. Soc Psychiatry Psychiatr Epidemiol. 2008, 43: 552-558.

Shibre T, Kebede D, Alem A, Negash A: Schizophrenia: illness impact on family members in a traditional society- rural Ethiopia. Soc Psychiatry Psychiatr Epidemiol. 2003, 38: 27-34.

Ukpong DI: Demographic factors and clinical correlates of burden and distress in relatives of service users experiencing schizophrenia: A study from south-western Nigeria. International Journal of Mental Health Nursing. 2006, 15: 54-49.

Martyns-Yellowe I: The burden of schizophrenia on the family: a study from Nigeria. Br J Psychiatry. 1992, 161: 779-782.

Ohaeri JU: Caregiver burden and psychotic patients' perception of social support in a Nigerian setting. Soc Psychiatry Psychiatr Epidemiol. 2001, 36: 86-93.

Quinn N: Beliefs and Community Responses to Mental Illness in Ghana: The Experiences of Family Carers. Int J Soc Psychiatry. 2007, 53: 175-188.

Sierra Leone: Insanity of War. Unreported World, Channel 4. 2009

Doku V, Ofori-Atta AL, Akpalu B, Read U, Osei A, Ae-Ngbise K, Awenva D, Lund C, Flisher AJ, Petersen I: A Situation Analysis of Mental Health Policy Development and Implementation in Ghana. 2008, Mental Health and Poverty Project, http://workhorse.pry.uct.ac.za:8080/MHAPP

Roberts H: A way forward for mental health care in Ghana?. The Lancet. 2001, 357: 1859-10.1016/S0140-6736(00)05020-0.

Selby H: Mental Illness, Prayer Camps And Society: A Factor of Human Rights Abuse. The Ghanaian Chronicle. Accra. 2008

Asiedu W, Kwei R: Patients chained at prayer camp. The Mirror. Accra. 2004

Vinorkor M-A: Move to Protect Mental Patients. The Daily Graphic. Accra. 2004

WHO: WHO Resource Book on Mental Health, Human Rights and Legislation. 2005, Geneva. World Health Organization

Government of Ghana: Mental Health Bill. Ghana. 2006

National Redemption Council Ghana: Mental Health Decree NRCD 30. Ghana. 1972

Government of Ghana: The Constitution of the Republic of Ghana. 1992,http://www.ghana.gov.gh/ghana/constitution_republic_ghana.jsp

Englund H: Prisoners of Freedom: Human Rights and the African Poor. 2006, Berkeley; Los Angeles; London: University of California Press

Englund H: The dead hand of human rights: contrasting Christianities in post-transition Malawi. The Journal of Modern African Studies. 2000, 38: 579-603. 10.1017/S0022278X00003487.

Gyekye K: An Essay on African Philosophical Thought: The Akan Conceptual Scheme. 1987, Cambridge: Cambridge University Press

Turner T, Graham LR, Fluehr-Lobban C, Cowan JK: Do anthropologists have an ethical obligation to promote human rights? An open exchange. Human Rights: An Anthropological Reader. Edited by: Goodale M. 2009, 198-205. Chichester: Wiley-Blackwell; Blackwell Readers in Anthropology

Abu-Lughod L: Writing Against Culture. Recapturing Anthropology: Working in the Present. Edited by: Fox RG. 1991, Santa Fe: School of American Research Press

de Jong JTVM, Van Ommeren M: Toward a Culture-informed Epidemiology: Combining Qualitative and Quantitative Research in Transcultural Contexts. Transcultural Psychiatry. 2002, 39: 422-433. 10.1177/136346150203900402.

Sefasi A, Crumlish N, Samalani P, Kinsella A, O'Callaghan E, Chilale H: A little knowledge: caregiver burden in schizophrenia in Malawi. Soc Psychiatry Psychiatr Epidemiol. 2008, 43: 160-164.

Murthy RS, Kumar KVK, Chisholm D, Thomas T, Sekar K, Chandrashekar CR: Community outreach for untreated schizophrenia in rural India: a follow-up study of symptoms, disability, family burden and costs. Psychol Med. 2005, 35: 341-351.

Patkai I: Relatives help abolish physical restraints in Northern Nigeria: The role of the family in inpatient psychiatric care. Global Forum for Community Mental Health. Accessed 6th May; 2009, http://www.gfcmh.com/?page_id=118

Thông tin
Thông tin xuất bản

Globalization and Health

Tập 5 Số 1

Thông tin tác giả