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.
Get full access to this article
View all access options for this article.
References
1.
African National Congress (ANC). (1994). National health plan for South Africa: Prepared by the ANC with the technical support of the WHO and UNICEF.Johannesburg: African National Congress
2.
American Psychiatric Association (APA). (1994). Diagnostic and statistical manual of mental disorders (4th Ed). Washington: American Psychiatric Association
3.
BarrettR.J. (1988). Clinical writing and the documentary construction of schizophrenia. Culture, Medicine and Psychiatry, 12, 265–299
4.
BodibeR.C. (1993). What is the truth? Being more than just a jesting Pilate in South African psychology. South African Journal of Psychology, 23, 53–58
5.
BromleyY.V. (1987). Anthropology, ethnology, and ethnic and racial prejudice. International Social Science Journal, 111, 31–43
6.
BührmannM.V. (1977). Western psychiatry and the Xhosa patient. South African Medical Journal, 51, 464–466
7.
BührmannM.V. (1984). Living in two worlds: communication between a white healer and her black counterparts.Cape Town: Human and Rousseau
8.
CheethamR.W.S.GriffithsJ.A. (1980). Changing patterns in psychiatry in Africa with special reference to Southern Africa. South African Medical Journal, 58, 166–168
9.
CheethamR.W.S.GriffithsJ.A. (1981). Errors in the diagnosis of schizophrenia in black and Indian patients. South African Medical Journal, 59, 71–75
10.
CheethamR.W.S.RzadkowolskiA. (1980). Cross-cultural psychiatry and the concept of mental illness. South African Medical Journal, 58, 320–325
11.
DanzigerK. (1986). The methodological imperative in psychology. Philosophy of the Social Sciences, 15, 1–13
12.
DavisD.L.GuarnacciaP.J. (1989). Health, culture and the nature of nerves. Medical Anthropology, 11, 1–95
13.
EdwardsS.D.GrobbelaarP.W.MakungaN.V.SibayaP.T.NeneL.M.KuneneS.T.MagwazaA.S. (1983). Traditional Zulu theories of illness in psychiatric patients. Journal of Social Psychology, 121, 213–221
14.
EstroffS.E. (1981). Making it crazy: an ethnography of psychiatric clients in an American community.Berkley: University of California Press
15.
EstroffS.E. (1991). Everybody's got a little mental illness: Accounts of illness and self among people with severe, persistent mental illnesses. Medical Anthropology Quarterly, 5, 331–369
16.
FarrandD. (1989). Idliso: a phenomenological and psychiatric comparison. Unpublished PhD thesis, University of the Wit-watersrandJohannesburg
17.
FawcettS.B. (1991). Some values guiding community research and action. Journal of Applied Behaviour Analysis, 24, 621–636
18.
FischerP.J. (1962). Cultural aspects of bantu psychiatry. South African Medical Journal, 38, 133–138
19.
FreedE.D.BishopE. (1980). Major psychiatric disability in open ward patients referred by medical and surgical units at Baragwanath hospital: a study of 1889 patients. The Leech, 50, 56–62
20.
FreemanM. (1992). Providing mental health care for all in South Africa: structure and strategy. Unpublished paper prepared for the Centre for Health Policy, University of WitwatersrandJohannesburg
21.
GelderM.GathD.MayouR. (1983). Oxford textbook of psychiatry.Oxford: Oxford University Press
22.
GergenK. (1985). The social constructionist movement in modern psychology. American Psychologist, 40, 266–275
23.
GijanaE.W.M.LouwJ. (1981). Psychiatric disorders in a developing community as reflected by archival material. South African Medical Journal, 59, 988–991
24.
GillisL.S.KochA.JoyiM. (1989). Improving compliance in Xhosa psychiatric patients. South African Medical Journal, 72, 205–208
25.
GobodoP. (1990). Notions about culture in understanding black psychopathology: are we trying to raise the dead?South African Journal of Psychology, 20, 93–98
26.
HalpernR. (1988). Action research for the late 1980s. Journal of Community Psychology, 16, 249–260
27.
HelmanC.G. (1985). Psyche, soma and society: the social construction of psychosomatic disorders. Culture, Medicine and Psychiatry, 9, 1–26
28.
HicksonJ.ChristieG.M. (1989). Research on cross-cultural counselling and psychotherapy: implications for the South African context. South African Journal of Psychology, 19, 163–171
29.
HirschS.R.HarrisJ. (Eds). (1994). Consent and the incompetent patient: ethics, law and medicine.London: R.R. Bowker
30.
KaplanH.I.SadockB.J.GrebbJ.A. (1994). Kaplan and Sadock's synopsis of psychiatry: behavioural sciences, clinical psychiatry. (7th Ed). Baltimore: Williams and Wilkins
31.
KleinmanA.M. (1980). Patients and healers in the context of culture.Berkeley: University of California Press
32.
KleinmanA.M. (1988). Rethinking psychiatry: from cultural category to personal experience.New York: The Free Press
33.
KleinmanA.KleinmanJ. (1992). Suffering and its professional transformation: toward an ethnography of interpersonal experience. Culture, Medicine and Psychiatry, 14, 275–301
34.
KottlerA. (1990). South Africa: psychology's dilemma of multiple discourses. Psychology in Society, 13, 27–36
35.
LaubscherB.J.F. (1937). Sex, custom and psychopathology: a study of South African pagan natives.London: Routledge and Sons
36.
LockM. (1987). DSM III as a culture-bound construct: commentary on culture-bound syndromes and international disease classifications. Culture, Medicine and Psychiatry, 11, 35–42
37.
LuizH.A. (1981). Profile of a psychiatric clinic in Soweto. Transactions of the College of Medicine of South Africa, 25, Supplementum, 187–190
38.
MdleleniT. (1986). Amafufunyane spirit possession and faith healing practices, a pilot study. Unpublished psychology honours research project, University of Cape Town
39.
MdleleniT. N. (1990). Cultural construction of psychiatric illness: a case of amafufunyane. Unpublished MA Thesis, University of Cape Town
40.
NgubaneH. (1977). Body and mind in Zulu medicine: an ethnography of health and disease in Nyuswa-Zulu thought and practice.London: Academic Press
41.
PotterJ.WetherellM. (1987). Discourse and social psychology: beyond attitudes and behaviour.London: Sage publications
42.
RappaportJ. (1977). Community psychology: values, research and action.New York: Holt, Rinehart and Winston
43.
RappaportJ. (1990). Research methods and the empowerment social agenda. In TolanP.KeysC.ChertokF.JasonL. (Eds), Researching community psychology (pp. 51–63). Washington DC: American Psychological Association
44.
ReynoldsJ.SwartzL. (1993). Professional constructions of a ‘lay’ illness: ‘nerves’ in a rural coloured community in South Africa. Social Science and Medicine, 36, 657–663
45.
RobertsonB.BergerS. (1994). Child psychopathology in South Africa. In DawesA.DonaldD. (Eds), Childhood and adversity: Psychological perspectives from South African research (pp. 154–176). Cape Town: David Philip
46.
RogersP. (1992). Explanatory models of illness amongst primary health care users in Mamre. Unpublished masters thesis, University of Cape Town
47.
RoperK. (1992). The cross-cultural application of analytical psychology: a consideration of the research of M. Vera Buhrman. South African Journal of Psychology, 22, 157–162
48.
RosenthalR.RosnowR. (1991). Considerations in the selection of subjects and stimuli. In RosenthalR.RosnowR., (Eds), Essentials of behavioural research methods (pp. 205–230). New York: McGraw-Hill
49.
RumbleS.SwartzL.ParryC.ZwarensteinM. (1996). Prevalence of psychiatric morbidity in the adult population of a rural South African village. Psychological Medicine, 26, 997–1007
50.
SchweitzerR.D. (1977). Categories of experience amongst the Xhosa: a psychological study. Unpublished master's thesis, Rhodes UniversityGrahamstown
51.
SeedatM.NellV. (1992). Authoritarianism and autonomy: Conflicting value systems in the introduction of psychological services in a South African primary health care system. South African Journal of Psychology, 22, 185–193
52.
SibisiH. (1975). The place of spirit possession in Zulu cosmology. In Whisson & West. (Eds), Religion and social change in South Africa (pp. 48–57). Cape Town: David Philip
53.
SiegelS. (1956). Nonparametric statistics for the behavioural sciences.Tokyo: McGraw-Hill Koyakusha
54.
South African Advertising Research Foundation (SAARF). (1993). All media and products survey.Johannesburg: SAARF
55.
SpiroM. (1991). Illness models of relatives of African psychiatric patients: implications for a family-based service. Unpublished MA thesis, University of Cape Town
56.
SwartzL. (1985). Issues for cross-cultural psychiatric research in South Africa. Culture, Medicine and Psychiatry, 9, 59–74
57.
SwartzL. (1986). Transcultural psychiatry in South Africa. Part I. Transcultural Psychiatric Review, 23, 273–303
58.
SwartzL. (1987). Transcultural psychiatry in South Africa. Part II. Transcultural Psychiatric Review, 24, 5–29
59.
SwartzL. (1989). Aspects of culture in South African psychiatry. Unpublished doctoral dissertation, University of Cape Town
60.
SwartzL. (1991). The politics of black patients' identity: ward-rounds on the ‘black side’ of a South African psychiatric hospital. Culture, Medicine and Psychiatry, 15, 217–244
61.
SwartzL. (1992). On the edge: ward rounds in a South African psychiatric emergency department. Social Science and Medicine, 35, 1115–1122
62.
SwartzL. (1996). Culture and mental health in the rainbow nation: transcultural psychiatry in a changing South Africa. Transcultural Psychiatric Research Review, 33, 119–136
63.
SwartzL.FosterD. (1984). Images of culture and mental illness: South African psychiatric approaches. Social Dynamics, 10, 17–25
64.
WatermeyerB. (1992). Biomedical reductionism, conflicting explanatory models, and the subjective experience of chronic mental illness. Unpublished psychology honours project, University of Cape Town
WilkinsonS. (1981). Personal constructs and private explanations. In AntakiC.. (Ed.). The psychology of ordinary explanations of behaviour.London: Academic Press
67.
YoungA. (1987). How medicine tamed life. Book Review. Culture, Medicine and Psychiatry, 11, 107–121
