Healing at the margins: discourses of culture and illness in psychiatrists', psychologists' and indigenous healers' talk about collaboration
- Authors: Yen, Jeffery
- Date: 2000
- Subjects: Traditional medicine -- South Africa , Medical policy -- South Africa , Mental health -- South Africa , Healers -- South Africa
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:3090 , http://hdl.handle.net/10962/d1002600 , Traditional medicine -- South Africa , Medical policy -- South Africa , Mental health -- South Africa , Healers -- South Africa
- Description: This dissertation explores discourses about culture and illness in the talk of mental health professionals and indigenous healers. It represents an attempt to situate the issue of indigenous healing in South Africa within a particular strand of critical discourse analytic research. In the context of current deliberations on the value, or otherwise, of indigenous healing in a changing health and specifically mental health system, the talk of both mental health practitioners and indigenous healers as they conceptualise “disorder”, and discuss possibilities for collaboration, is chosen as a specific focus for this study. Disputes over what constitutes “disorder” both within mental health, and between mental health and indigenous healing are an important site in which the negotiation of power relations between mental health professionals and indigenous healers is played out. The results of this study suggest that despite the construction of cogent commendations for the inclusion of indigenous healing in mental health, it remains largely marginalised within talk about mental health practice. While this study reproduces to some extent the marginalisation of indigenous healing discourse, it also examines some of the discursive practices and methodological difficulties implicated in its marginalisation. However, in the context of “cultural pride strategies” associated with talk about an African Renaissance, indigenous healing may also function as a site of assertion of African power and resistance in its construction as an essentially African enterprise. At the same time, it may achieve disciplinary effects consonant with cultural pride strategies, in constructing afflictions in terms of neglect of, or disloyalty to cultural tradition. These results are discussed in terms of the methodological difficulties associated with interviewing and discourse analysis of translated texts, which contributes to difficulties with articulating indigenous healing discourse in a way that challenges the dominant psychiatric discourses implicated in its marginalisation within mental health. It concludes with recommendations for future research which addresses indigenous healing discourse in its own terms, and examines its operation as a disciplinary apparatus in South African society.
- Full Text:
- Authors: Yen, Jeffery
- Date: 2000
- Subjects: Traditional medicine -- South Africa , Medical policy -- South Africa , Mental health -- South Africa , Healers -- South Africa
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:3090 , http://hdl.handle.net/10962/d1002600 , Traditional medicine -- South Africa , Medical policy -- South Africa , Mental health -- South Africa , Healers -- South Africa
- Description: This dissertation explores discourses about culture and illness in the talk of mental health professionals and indigenous healers. It represents an attempt to situate the issue of indigenous healing in South Africa within a particular strand of critical discourse analytic research. In the context of current deliberations on the value, or otherwise, of indigenous healing in a changing health and specifically mental health system, the talk of both mental health practitioners and indigenous healers as they conceptualise “disorder”, and discuss possibilities for collaboration, is chosen as a specific focus for this study. Disputes over what constitutes “disorder” both within mental health, and between mental health and indigenous healing are an important site in which the negotiation of power relations between mental health professionals and indigenous healers is played out. The results of this study suggest that despite the construction of cogent commendations for the inclusion of indigenous healing in mental health, it remains largely marginalised within talk about mental health practice. While this study reproduces to some extent the marginalisation of indigenous healing discourse, it also examines some of the discursive practices and methodological difficulties implicated in its marginalisation. However, in the context of “cultural pride strategies” associated with talk about an African Renaissance, indigenous healing may also function as a site of assertion of African power and resistance in its construction as an essentially African enterprise. At the same time, it may achieve disciplinary effects consonant with cultural pride strategies, in constructing afflictions in terms of neglect of, or disloyalty to cultural tradition. These results are discussed in terms of the methodological difficulties associated with interviewing and discourse analysis of translated texts, which contributes to difficulties with articulating indigenous healing discourse in a way that challenges the dominant psychiatric discourses implicated in its marginalisation within mental health. It concludes with recommendations for future research which addresses indigenous healing discourse in its own terms, and examines its operation as a disciplinary apparatus in South African society.
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Therapists' constructs of healthy functioning as aspirational goal in transformative psychotherapy
- Authors: Steyn, Reinette
- Date: 2000
- Subjects: Psychotherapy , Mental health -- South Africa , Mental health
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:3064 , http://hdl.handle.net/10962/d1002573 , Psychotherapy , Mental health -- South Africa , Mental health
- Description: This dissertation reviews the ways in which psychotherapists working in relatively long-term 'transformational' therapies construct the outcome goals of their interventions. It is generally accepted that a therapist's beliefs about what constitutes mental health will influence the client, and will therefore facilitate a certain outcome accordingly. A problem in a long-term, 'non-directive' therapy is that the eventual outcome is not always visible in the interim development of the client or in the business of individual sessions. Without a clearly defined 'plan' or 'goal' there is a real danger of the intervention having opposite results to what would have been desirable, or no noticeably beneficial results, both of which can be an abuse of the client's investment and trust in the process. The absence of clearly constructed goals makes it difficult to assess efficacy of a therapeutic method used to attain an improved state of mental health that will be lasting, i.e. a positive 'transformation'; it also problematises comparisons across orientations. The identification of explicit goals is of special importance in a developing 'third-world' community like South Africa, where western ('European') concepts of mental health are being offered as an alternative to so-called 'indigenous healing' and where different cultural communities may have different expectations, needs or demands of their members 'in health'. Individual-based therapeutic orientations included in the research were psychoanalysis and psychoanalytic therapies, including object-relational therapies with various emphases and self psychology, as well as transformative types of hypnosis, Gestalt therapy, client-centred therapy and transactional analysis. Twenty of the semi-structured interviews with 52 therapists working in one or more of these areas were selected for construct analysis. Through analysis of the constructs of mental health as aspirational goal that emerged in therapists' talking about their experience of the process and the consequences of therapy observed in their patients, it appeared that there are generalisable constructs across various orientations in the transformative therapies. It is hoped that these constructs may serve as a foundation for further research in the problem areas indicated, but also that therapists working in the field may use this research not only as a basis for self-evaluation, but for adding to the constructs from their own experience, to the further enrichment of the whole field of work.
- Full Text:
- Authors: Steyn, Reinette
- Date: 2000
- Subjects: Psychotherapy , Mental health -- South Africa , Mental health
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:3064 , http://hdl.handle.net/10962/d1002573 , Psychotherapy , Mental health -- South Africa , Mental health
- Description: This dissertation reviews the ways in which psychotherapists working in relatively long-term 'transformational' therapies construct the outcome goals of their interventions. It is generally accepted that a therapist's beliefs about what constitutes mental health will influence the client, and will therefore facilitate a certain outcome accordingly. A problem in a long-term, 'non-directive' therapy is that the eventual outcome is not always visible in the interim development of the client or in the business of individual sessions. Without a clearly defined 'plan' or 'goal' there is a real danger of the intervention having opposite results to what would have been desirable, or no noticeably beneficial results, both of which can be an abuse of the client's investment and trust in the process. The absence of clearly constructed goals makes it difficult to assess efficacy of a therapeutic method used to attain an improved state of mental health that will be lasting, i.e. a positive 'transformation'; it also problematises comparisons across orientations. The identification of explicit goals is of special importance in a developing 'third-world' community like South Africa, where western ('European') concepts of mental health are being offered as an alternative to so-called 'indigenous healing' and where different cultural communities may have different expectations, needs or demands of their members 'in health'. Individual-based therapeutic orientations included in the research were psychoanalysis and psychoanalytic therapies, including object-relational therapies with various emphases and self psychology, as well as transformative types of hypnosis, Gestalt therapy, client-centred therapy and transactional analysis. Twenty of the semi-structured interviews with 52 therapists working in one or more of these areas were selected for construct analysis. Through analysis of the constructs of mental health as aspirational goal that emerged in therapists' talking about their experience of the process and the consequences of therapy observed in their patients, it appeared that there are generalisable constructs across various orientations in the transformative therapies. It is hoped that these constructs may serve as a foundation for further research in the problem areas indicated, but also that therapists working in the field may use this research not only as a basis for self-evaluation, but for adding to the constructs from their own experience, to the further enrichment of the whole field of work.
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The interface between Western mental health care and indigenous healing in South Africa: Xhosa psychiatric nurses' views on traditional healers
- Authors: Kahn, Marc Simon
- Date: 1996
- Subjects: Mental health services -- Research -- South Africa , Traditional medicine -- South Africa , Black people -- Mental health -- South Africa , Mental health -- South Africa
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:2999 , http://hdl.handle.net/10962/d1002508 , Mental health services -- Research -- South Africa , Traditional medicine -- South Africa , Black people -- Mental health -- South Africa , Mental health -- South Africa
- Description: Xhosa psychiatric nurses stand unique at the interface between Western mental health care and indigenous healing in South Africa. They stem from a cultural history that is embedded within traditional health care discourses and yet are trained and work within a Western psychiatric model. In embodying the intersection between these two paradigms, they are faced with the challenge of making sense of such an amalgamation. These nurses' views are thus valuable in reflecting this intersection and illustrating many of the central concerns that surround it. This study explicates the views of these nurses toward traditional healers and their potential role in mental health care in South Africa. In addition, it illuminates some of the cultural dynamics at work amongst these subjects as they struggle to make sense of their unique cultural position. Using a questionnaire-based methodology, the views of Xhosa psychiatric nurses in a psychiatric hospital in the Eastern Cape, toward traditional healers and their role in mental-health care, were examined. The findings reveal that the vast majority of these nurses believe in traditional cosmology, involve themselves in traditional ritual practices and regularly visit traditional healers as patients. In suggesting ways in which indigenous healing and Western mental health care can work together, 75% of the nurses were in favour of a general referral system between the hospital and traditional healers, most (77%) agreed that certain patients would be better off being treated by both the hospital and traditional healers than they would if they were only being treated by the hospital alone, and 85% of the subjects agreed that patients who are already seeing traditional healers should check if psychiatric medication might help them. These findings indicate that these nurses operate across two healing systems which are at this point not conceptually compatible. This results in deep cultural tension for the nurses. In being entangled in the dialectical tension created in this context, the nurses manage the incongruencies in three general ways: a) Most, in one form or another, incorporate beliefs from both systems into an integrative model, b) some assimilate their cultural belief system into the Western mental health paradigm, throwing off their beliefs in traditional healing, and c) others remain ambivalent in the dialectic between traditional and Western health care discourses. Although this may suggest that these nurses reside within a cultural milieu that is somewhat unhealthy, at another level, in managing and containing the incompatibility between the two systems, these nurses ensure a space for on-going and healthy critique of the underlying assumptions involved in this health care malaise.
- Full Text:
- Authors: Kahn, Marc Simon
- Date: 1996
- Subjects: Mental health services -- Research -- South Africa , Traditional medicine -- South Africa , Black people -- Mental health -- South Africa , Mental health -- South Africa
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:2999 , http://hdl.handle.net/10962/d1002508 , Mental health services -- Research -- South Africa , Traditional medicine -- South Africa , Black people -- Mental health -- South Africa , Mental health -- South Africa
- Description: Xhosa psychiatric nurses stand unique at the interface between Western mental health care and indigenous healing in South Africa. They stem from a cultural history that is embedded within traditional health care discourses and yet are trained and work within a Western psychiatric model. In embodying the intersection between these two paradigms, they are faced with the challenge of making sense of such an amalgamation. These nurses' views are thus valuable in reflecting this intersection and illustrating many of the central concerns that surround it. This study explicates the views of these nurses toward traditional healers and their potential role in mental health care in South Africa. In addition, it illuminates some of the cultural dynamics at work amongst these subjects as they struggle to make sense of their unique cultural position. Using a questionnaire-based methodology, the views of Xhosa psychiatric nurses in a psychiatric hospital in the Eastern Cape, toward traditional healers and their role in mental-health care, were examined. The findings reveal that the vast majority of these nurses believe in traditional cosmology, involve themselves in traditional ritual practices and regularly visit traditional healers as patients. In suggesting ways in which indigenous healing and Western mental health care can work together, 75% of the nurses were in favour of a general referral system between the hospital and traditional healers, most (77%) agreed that certain patients would be better off being treated by both the hospital and traditional healers than they would if they were only being treated by the hospital alone, and 85% of the subjects agreed that patients who are already seeing traditional healers should check if psychiatric medication might help them. These findings indicate that these nurses operate across two healing systems which are at this point not conceptually compatible. This results in deep cultural tension for the nurses. In being entangled in the dialectical tension created in this context, the nurses manage the incongruencies in three general ways: a) Most, in one form or another, incorporate beliefs from both systems into an integrative model, b) some assimilate their cultural belief system into the Western mental health paradigm, throwing off their beliefs in traditional healing, and c) others remain ambivalent in the dialectic between traditional and Western health care discourses. Although this may suggest that these nurses reside within a cultural milieu that is somewhat unhealthy, at another level, in managing and containing the incompatibility between the two systems, these nurses ensure a space for on-going and healthy critique of the underlying assumptions involved in this health care malaise.
- Full Text:
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