Background to the Study
Mental disorder has been one of the major concerns in the health care delivery system as more people come down with mental illness every day. According to Nordquist (2009), it is estimated that about one in every five adults has some kind of mental disorder. He further cited that we all have the potential of suffering from mental health problems no matter how old we are, whether rich or poor, male or female or any ethnic group we belong and this often creates fear.
Mental disorder according to Canadian Mental Health Association (2014) are still feared and misunderstood by many people but the fear will disappear as people learn more about them. However, according to Kendler (2008), a more comprehensive explanation of a psychiatric disorder must include an understanding of the production of the key symptoms and signs underlying that disorder. Parts of these explanations will have to be framed in psychological terms. Genes and molecules will surely prove to be critical causes of schizophrenia and thus will explain important things about the disorder. But alone, they cannot explain it completely (Kendler, 2008). These explanations however can be in so many ways.
Henrique (2012) however identified five broad explanatory models of mental disorder which includes: spiritual; moral character; biological and neurophysiologic; learning and developmental or psychological; and sociological models. He however explained that the first and the oldest explanatory system for mental illness is the spiritual. He further explained that there is usually a religious narrative that explains that there are good and bad forces in the world and that suffering is a function of either being possessed by the bad, or through the ideal that the afflicted have fallen out of favor with the good. According to Henrique (2012), mental disorder generally occurs because of sin or related concept of immoral behavior that leads to some form of badness or contamination and this often informs the reason why most of the clients prefer to visit traditional healers who use traditional medicine for their treatment.
Traditional medicine according to Adesina (2014) is a cultural gem of various communities around the world and encompasses all kinds of folk medicine, unconventional medicine, and indeed any kind of the therapeutic method that had been handed down by the tradition of the community or ethnic groups. Okeke, Okafor and Uzochukwu (2006) added that in Nigeria, traditional healers play an important role in the health care delivery and majority of the population depend on the traditional healers for most of their ailments.
In Nigeria, like most developing countries, mental health care (and health care in general) is still elusive to a significant proportion of the population. About 70% of the population live in rural areas while 30% live in urban areas. In contrast, 70% of the health facilities are in urban areas while 30% are in rural areas (Ajara, Makanjuola & Morakinyo, 2008). This seems to present a state of inequality of health distribution. Most of the populace still patronize traditional healers and spiritual healers; either because of poverty, poor accessibility to mental health facilities and hospital care, stigma or lack of belief in the efficacy of treatment received in these facilities regarding the cause of mental illness. Some of these reasons are also applicable to majority of those living in urban areas, irrespective of level of education. The peculiarity and importance of these alternative sources of mental health care has necessitated research into knowledge, attitude and practice of traditional mental health care treatment modalities and herbs in mental health practice classification and training of traditional healers and cost comparison of traditional mental health care versus care received from psychiatrists or other medical facilities (Ajara, Makanjuola & Morakinyo, 2008). WHO also noted that majority of the population, which is about 70-90%, depend on traditional medicine for their Primary Health Care needs. In many African and Asian countries, about 45% of the clients of the traditional healers are people suffering from mental disorders (Morny, 2012). Adesina, (2014) noted that traditional medicine has developed in various communities in Nigeria, in response to the health needs of people.
One way of examining the role of culture in psychiatric disorders is to elicit the explanatory models of traditional healers. An understanding and appreciation of the concepts of mental disorders held by traditional healers, as well as their treatment practices, would help play mental health services in developing world contexts and might shed light on the debate concerning the most appropriate way to collaborate with traditional healers. Although formally engaging traditional healers in treating mentally ill patients may hinder to some extent appropriate diagnosis and treatment for the mentally ill, a pragmatic approach would be to work within the current structures for positive change. It is a common observation for mental health care workers who have had the experience of working in African communities that many of their patients seek alternative therapies – either of the religious or traditional variety, in place (Museum,2009).
In the opinion of Young, Grant and Swartz, (2010) traditional medicine has proven to be quite effective in treating both chronic diseases and psychological problems especially those associated with stress, which frequently stem from social alienation, anxiety and loss of esteem as well as psychosomatic illnesses. Many practitioners of traditional medicine however have solid knowledge of herbs and of their effects in healing organically based disorders as well. They maintained that it is probably more useful to emphasize that most traditional healers utilize a holistic approach which deals with a wide variety of problems on three (3) levels: Physical, emotional and spiritual. Holistic treatment emphasizes disease prevention and positive changes in life style to ensure a balance among these three (3) aspects of life. Traditional healers usually know their patients personally and are well acquainted with their backgrounds, lifestyles and cultural beliefs. Another benefit of traditional medicine is that it is decentralized; it is easily and quickly available to individuals for whom travelling to urban centers for treatment is inconvenient, time consuming and costly.
In many traditional belief systems, mental health problems may be attributed to the influence of ancestors or to bewitchment. Traditional healers are viewed as having the expertise to address these causes. However, there is limited information on their explanatory models and consequent treatment practices. Health information is an essential component of many identified and established human rights according to Land and Pakenham-Walsh (2012). It is therefore pertinent to identify the explanatory models of mental disorders and treatment practices used by these traditional healers.
Statement of the Problem
In many traditional belief systems in Africa, including Nigeria, mental health problems may be attributed to the influence of ancestors or to bewitchment. Traditional healers are viewed as having the expertise to address these causes. There has also been a rapid expansion of allopathic health care in Nigeria over the last three decades, including an increase in the number of allopathic health care providers. At the same time, Nigerians use traditional medicine, the Government of Nigeria has shown appreciation for the importance of traditional medicine in the delivery of health care (WHO, 2013).
Through the interaction with the families of patient with mental disorder, the researcher discovered they believe that the cause of mental disorder is a punishment from the gods or when the person commits a taboo or abomination in the community. This informs their preference to be treated by the traditional healers rather than the modern treatment available in the psychiatric hospitals. They also believe that the treatment by the traditional healers is more affordable than the hospitals. This is supported by the assumption of Khoury, Kaiser, Keys, Brewster and Kohrts (2012) that attribution of illness to supernatural possession drives individuals to seek care from priests and other practitioners.
In Anambra State, these traditional healers are available but there is however, limited information on the explanatory models and consequent treatment practices among them. The researcher therefore intends to find out the explanatory models and treatment practices among the traditional healers in Anambra State and the factors that determine these explanatory models and treatment practices.
Purpose of the Study
The purpose of the study was to determine the explanatory models and treatment practices among the traditional healers in Anambra State.
Objectives of the study
The specific objectives are to:
- establish the conceptualization of mental disorder by traditional healers in Anambra State
- to identify what the traditional healers attribute as causes of mental disorders
- ascertain the different treatment practices for mental disorders employed by traditional healers in Anambra State.
The research questions to guide the study include:
- how do traditional healers in Anambra State conceptualize mental disorders?
- what do the traditional healers attribute as causes of mental disorder?
- what are the different treatments practices for mental disorders amongst traditional healers in Anambra State.
The following null hypotheses will guide the study and will be tested at (P< 0.05) level of significance.
- There will be no significant difference in the treatment practices for mental disorders by the traditional healers based on their years of practice.
- There will be no significant difference in the traditional healers’ explanatory model of mental disorders based on their gender.
- There will be no significant difference in the traditional healers’ explanatory model of mental disorders based on their educational status.
- There will be no significant difference in the treatment practices of the traditional healers based on their educational status.
Significance of the Study
This study is aimed at establishing the explanatory models and treatment practices of mental disorders among traditional healers in Anambra State. The findings from this study will establish the concept of mental disorders, the causes, the explanatory models and the treatment practices among traditional healers in Anambra State. The findings when communicated can be used to create public awareness and treatment interventions on mental disorders.
The findings when communicated will provide students and researchers with the knowledge about the explanatory models on mental disorders and treatment practices among traditional healers which will help make better communication during their field/community experiences especially during psychiatric experience. The findings will assist in future research and make further contributions to knowledge in this area.
The findings when published will create an understanding and appreciation of the concepts and explanatory models of mental illnesses held by traditional healers, as well as their treatment practices. This will help Policy Makers plan mental health services in developing world contexts and might shed light on the debate concerning the most appropriate way to collaborate with traditional healers.
The findings when made public will help to inform them about the explanatory models and treatment practices of healers in relation to mental health care so that they can make better informed decisions about their choice of mental health care provider.
Scope of the Study
The study will basically focus on the explanatory models and treatment practices among the traditional healers in Anambra State as well as their concept of mental health and causes, that informs their explanatory models and treatment practices.
Operational Definitions of Terms
Explanatory models of mental disorders: Explanatory model are the ways the traditional healers perceive or conceptualize (create in their mind) mental disorders. It is also the way they make clear, mental disorders and it is measured in this study as: spiritual; moral character; biological and neurophysiologic; learning and developmental or psychological; and sociological models.
Causes of mental disorders: These are the traditional healers’ perception of what initiates or gives rise to mental disorders. It is measured in this study as: biological, psychological, and Environmental/Sociological causes.
Treatment practices of mental disorders: are approaches used by the various categories of traditional rulers to treat mental disorders such as: chaining, flogging, music therapy, use of herbs, use of oracles measured in this study under psychotherapy, medication, traditional belief, physical and spiritism.
Traditional healers: These are native doctors well known in the communities in which they live and use herbal preparations from leaves, roots and bark of trees; and animals as remedies for treatment of illnesses. They may consult various spirits including oracles, prescribe appropriate rituals and make sacrifices to the gods. For the purpose of this study focus will be on herbalists, traditional psychiatrists and spiritualists, who are engaged in the treatment of mental disorders.
Mental Disorders: This is an illness or health problem which significantly affects an individual’s thinking, behaviour and interaction with others. In this study, it comprise of illness attributed to the influence of bad spirits or bewitchment and which traditional healers are viewed as having expertise to address their causes.
Treatment Practices: These are methods used or processes applied in order to bring about cure such as treatment practices used by traditional healers to cure mental disorders such as psychotherapy, medication, traditional belief, physical and spiritism.