African traditional healers’ understanding of depression as a mental illness : implications for social work practice

Abstract

The research reviews that the majority of Black South Africans will frequent a traditional African healer as a primary means of health care. This may be partly due to the fact that traditional African healer is accredited as offering more affordable means of health care. Traditional African healing has been esteemed in treating the physical, mental and spiritual health of the population. This paradigm is also respected for its holistic approach which stretches beyond sole biological assumptions in the pursuit of optimum health. Depression is also confirmed as being an illness which is rife in contemporary living. South Africans may also be at an increased risk with regards to this mood disorder, due to harsh psychosocial circumstances including poverty, unemployment and crime. The research offers that the social worker and mental health care professional alike are under increased pressure to obtain ‘cultural competence’ in understanding how traditional African discourse constructs common mental illnesses like depression. Therefore in light the above, the research attempted to explore an understanding of depression amongst a sample of traditional healers in Johannesburg. There is little research done on this subject. Therefore a qualitative research approach was adopted. Qualitative research may offer a more reflective space as a point of entry into a subject which has not been explored. The case study research design, specifically a collective case study was used and semi-structured interviews were conducted, using an interview schedule. The researcher interviewed 10 traditional healers. The interview aimed to explore how traditional healers understand depression. iii The research used a content analysis to draw common themes from the transcribed interviews with the participants who formed part of the sample, selected by means of purposive sampling. The themes derived from the interviews offer some reflections on the traditional healers’ understanding of depression. These themes included: relevancy of depression; distinctions between depression and sadness; intuitive assessments of depression; external circumstances and psychosocial circumstances; relevance of biomedical interventions; treatment by the African traditional healer; counselling; supernatural and spiritual influences; punishment; depression experienced as a collective vs. individualistic cultural experience; somatisation and specific emotional difficulties related to the vocation of traditional African medicine. The research concluded that the traditional healers’ conception of depression was in a state of flux and was very much dependent on the individual interpretations by the traditional healer. This appeared to be influenced by the level of the traditional healers’ acculturation into westernized culture and exposure to biomedical interventions. The relevancy of the concept of depression was viewed as being both redundant and ripe in relevance by the sample. Depression and sadness could not always be distinguished between. However, there was a conceptualization of depression as being a more intense and severe form of sadness. Intuitive assessments of depression were generally adopted as opposed to exploring specific diagnostic criteria. Cognitive distortions such as ‘thinking too much’ and external circumstances were recognized as significant contributors. Depression was mostly indirectly recognized as an illness. Allopathic medicine was both rejected and held in high regard. Counselling was viewed as being necessary. This was not always adopted by the traditional healers. The spiritual significance was graded on a subjective spectrum of making meaning of depressive experiences. However the ancestors were still revered in all assessments and interventions. Depression was viewed on a continuum between individualistic and collective cultures. There were no significant somatic reports. In a nutshell the research concludes that there is no unified perception of depression, but highlights some common cultural variables. The research specifically highlighted the psychosocial and spiritual qualifying factors which may differentiate and qualify this paradigm from other biological and allopathic interventions. iv The research paves the way for further research to be done in this area. Recommendations are made for social workers and mental health care professionals alike to become more fluent in traditional African healing discourse in the area of mental health and depression in order to understand their clients from the African culture.