Perceptions of psychological distress and treatment among the Ovambo in northern Namibia: A multiple method study.

摘要

The biomedical model of psychiatric care and psychological distress has dominated the Western world's approaches to psychological treatment (Wampold, 2001; 2007). Moreover, psychology has, historically, been exported wholesale beyond its Western base of development. Such exportation lends itself to the overshadowing of local psychologies in favor of dominant, universal psychology. Imposition of Western theory is further true in applied psychology insofar as how clinical practice and mental illness are defined. This study intended to understand the nature of psychological distress and treatment in a non-Western context -- the Ovambo people of Northern Namibia. Little is known about the perceptions of mental illness in this context. A two-phase qualitative design was used to explore Ovambo beliefs about and experiences of mental illness and its treatment. The first ethnographic phase (N = 22) was analyzed in two portions -- one thematic analysis for general Ovambo participants and a second for practitioners. Six themes, (a) Where Madness Comes From: Witches, Sickness, and Other Explanations, (b) Omananamwengu and Eemwengu, (c) The Role of Families and Communities for Omananamwengu and Distress, (d) Witchdoctors, Frauds, and Odudu, (e) Counseling, Medicine, and Religion as means for Healing, and (f) Seeking Care: Decisions Based on Belief and Need, for the general Ovambo were identified, and four themes were identified in the data from practitioners, (a) Mental Health Services in the North, (b) Traditional Beliefs and Healing, (c) Explaining Mental Illness through Modern and Traditional Lenses, and (d) Integration of Treatment Modalities. An ethnographically contextualized multiple case-study followed in which four cases were sampled to understand experiences of mental illness beliefs identified in the ethnographic phase. Four cross-case themes emerged: (a) Symptoms of Mental Illness, (b) Marginalization and Omananamwengu, (c) Family Roles in Treatment, and (d) Belief in Treatment. The results describe culturally-pertinent psychological symptoms and the perceptions of treatment within Ovambo culture. Understanding beliefs about mental illness in Ovambo culture may help shape integration of tradition and Westernized psychological practice in meaningful and helpful ways. These results also add to the growing international literature base in Counseling Psychology and highlight the need for attention to withinculture perspectives of mental health.