Challenging the nexus: Integrating Western psychology and African cultural beliefs in South African mental health care

Thabani Maphanga

22 September 2025

The  growing  discourse  on  African  psychology,  enriched  by  the  contributions  of  thinkers  like  Ratele  (2014,  2017)  and  other  esteemed  scholars,  underscores  the  vital  need  for  a  psychological  framework  that  truly  resonates  with  the   African  context.   This   growing   discourse   critiques   traditional     Euro-American     psychological     frameworks     and  calls  for  a  psychology  that  authentically  represents  the  experiences  and  cultures  of  the  African  continent.

African psychology,  as  systematically studied  and  defined  by  scholars  such  as  Baloyi and  Ramose  (2016),  Cooper  (2013),  Mkhize  (2004),  Nwoye  (2015),  and  Oppong  (2022),  emphasises  a  holistic  view  of  human  life  and  culture,  integrating  both  pre-  and  post-colonial    African    contexts.    This    perspective,    diverging    from    mainstream    Western    psychology,    focuses    on    communal    interconnectedness    and    situates    individual    experiences within a broader environmental and social context (Adelowo, 2015).The  evolution  of  African  psychology  has  undergone  several  phases,  beginning  with  an  uncritical acceptance of Western approaches in the 1940s, as noted by Nwoye (2015). The subsequent  phases  saw  a  growing  appreciation  and  integration  of  African  and  Western  perspectives, culminating in the current phase which advocates for innovative strategies and theories that address contemporary challenges specific to Africa.

As  practitioners  and  educators  in  psychology,  we  recognise  our  discipline’s  historical  reliance   on   Western   theories   and   principles,   with   its   empirical   origins   rooted   in   the   contributions of several familiar figures, including but not limited to Wundt (1879), Freud (1905),  Pavlov  (1927),  Rogers  (1951),  and  Beck  (1976).  However,  the  global  mental  health  landscape  is  gradually  changing,  as  evidenced  by  the  increased  emphasis  on  the  Cultural  Formulation  Interview  (CFI)  (Aggarwal  &  Lewis-Fernández,  2015),  reflecting  a  growing recognition of diverse cultural perspectives on mental health. CFIs assist mental healthcare practitioners  by  providing  a  structured  method  to  understand  the  cultural  background  and  context  of  patients.  This  can  help  identify  culturally  relevant  stressors,  supports,  and  coping  mechanisms,  leading  to  more  effective  and  culturally  sensitive  treatment  plans (Lewis-Fernández et al., 2020). Despite these advancements, there remains a tendency to fit diverse belief systems into existing Western models of illness and recovery. This  tendency  particularly  resonates  in  African  contexts,  where  sociocultural  dynamics  often  contrast  with  biomedical  conceptualisations  of  health  and  illness  (Mapaling  & Naidu,  2023).  Mabaso  and  Kotze  (2020)  found  that  awareness  of  CFIs  in  South  Africa  is  low,  and  practitioners  who  are  aware  of  it  tend  not  to  implement  it  in  their  practice.  Lewis-Fernández  et  al.’s  (2020)  research  on  the  uptake  of  CFIs  in  training  and  practice  supports this by indicating limited integration despite acknowledging the need for cultural sensitivity, primarily due to the tension between standardisation and flexibility. Effective dissemination   and   practical   implementation   strategies   are   essential   for   encouraging   adoption  and  sustainability  in  varied  practice  settings.  While  CFIs  holds  significant potential;  awareness,  training,  further  research,  and  real-world  testing  are  needed  to  address the interview’s user-friendliness and practicality in day-to-day practice.

In  this  article,  we  aim  to  position  mental  illness  within  the  African  cultural  context,  acknowledging the existence of spiritual or supernatural dimensions that extend beyond the  biomedical  model.  Our  argument  advocates  for  an  integrative  approach  in  South Africa, especially considering the indigenous population’s reliance on traditional healers. We propose that psychology as a discipline should not entirely shift away from current methodologies, but rather embrace an inclusive model that incorporates African-centred perspectives. The critical question we explore is: Are there possibilities of merging African and Western perspectives to effectively address serious mental illness? By integrating these diverse  perspectives,  we  aspire  to  establish  a  holistic  and  culturally  relevant  framework  for  mental  healthcare  that  resonates  with  the  lived  experiences  and  worldviews  of  African communities.

Conceptualisation of Mental Illness in Western Culture(s)

The  Western  orientation  to  mental  illness  relies  on  biomedical  reasoning  (for  instance,  neurochemical imbalance) (Freitas-Silva & Ortega, 2016), and its diagnosis and treatment are  systematic,  relying  on  the  Diagnostic  and  Statistical  Manual  of  Mental  Disorders  (American Psychiatric Association, 2013) and the International Classification of Diseases (World  Health  Organization,  2019).  Unfortunately,  the  process  of  mainstream  diagnosis  and  treatment  in  hospitals,  clinics,  and  private  practices  have  been  Western-based  for  most  cultures  globally  (Briskman  et  al.,  2012)  and  this  is  not  surprising  as  theories  and  scholars  have  given  more  attention  to  Western  culture  when  it  comes  to  mental  illness  (Beck,  2011;  Brown,  1999;  De  Shazer  &  Molnar,  1984;  Rector  &  Beck,  2012,  Truax,  1966;  Walker, 2001). Consequently, other cultures and belief systems are often neglected and pathologised in the therapeutic setting. In  Western  therapeutic  settings,  there  is  a  focus  on  parameters  of  normal  conduct,  and  misconduct  behaviour,  dissimilarities  in  the  symptom  clusters  of  diagnosable  disorders  that   seem   not   to   be   in   line   with   universal   patterns   and   cultural   beliefs   regarding   treatment and phenomenological meaning (Hassan, 2021; Lefley, 1990; Lewis-Fernández et   al.,   2010).   We   found   most   common   psychiatric   illnesses   such   as   schizophrenia,   depression,   autism   spectrum   disorder   (ASD),   and   other   mental   disorders   being   commonly  diagnosed  and  treated  using  Western  instruments  or  psychological  tests.  For  example, some instruments used for schizophrenia are the Brief Psychiatric Rating Scale [BPRS] (Overall & Gorham, 1988) and the Positive and Negative Syndrome Scale [PANSS] (Kay  et  al.,  1987).  The  Beck  Depression  Inventory  [BDI]  (Beck  et  al.,  1961)  is  used  for  depression and the Autism Diagnostic Observation Schedule [ADOS] (Lordet al., 2000) for ASD. There are also many different pharmacological treatments. Psychiatric  hospitalisations  have  been  a  place  of  treatment  used  in  Western  cultures,  underpinning   the   biomedical   perspective.   When   mentally   ill   people   are   admitted   to   a   psychiatric   hospital   in   well-resourced   Western   countries,   they   receive   mental   healthcare   from   multidisciplinary   teams   [psychiatrists,   psychologists,   professional   nurses, occupational therapists, social workers and dieticians] (Mezzina, 2014; Pec, 2019; Rickwood  et  al.,  2019).  There  is  collaborative  healthcare  to  provide  the  mentally  ill  with  holistic  professional  care,  although  this  is  not  always  the  case.  During  discharge  to  the  community, people who are mentally ill receive follow-up care from the multidisciplinary teams  to  ensure  that  there  is  no  revolving  door  (Doupnik  et  al.,  2020;  Haselden  et  al.,  2019).  While  this  is  the  standard  treatment  plan,  this  is  not  always  followed  and  is  dependent  on  resource  availability  and  service  delivery  efficiency.  However,  mental illness   treatment   in   most   Western   cultures   is   restricted   to   the   above-mentioned   professionals who, by training, are still predominantly biomedical. Mental  healthcare  can  become  financially  costly  in  countries  where  public  healthcare services  are  limited,  overburdened,  or  not  easily  accessible.  In  developing  nations,  especially  in  African  countries,  public  healthcare  is  not  always  easily  accessible,  giving  medical aid a monopoly on the market. This further exacerbates the high levels of socio-economic  inequality.  Thus,  people  tend  to  seek  alternative  options  including  new  age  methods or traditional help, which is not only easily accessible, familiar, and affordable (Letsoalo  et  al.,  2021;  Ngobe  et  al.,  2021)  but  also  align  well  with  their  beliefs  of  disease  causality.

A  patient,  in  Africa,  suffering  from  mental  illness,  such  as  schizophrenia  or depression,  is  more  likely  to  receive  healthcare  from  traditional  healers  (Shange  &  Ross,  2022).  While  seeking  healthcare  from  traditional  healers  holds  significant  benefits, it  also  holds  its  limitations.  The  methods  of  traditional  healers  for  mental  health  are  largely unknown, as their approaches are often kept secret, so there is no set of ethical guidelines  or  parameters  of  standardisation  (Shange  &  Ross,  2022).  Importantly,  while  the patient’s mental illness can be rooted in spirituality, it can also be rooted and treated through  biomedical  interventions.  This  can  lead  to  over-spiritualisation,  stigmatisation,  and medical neglect. Mental illness and the patient in context are a complex intertwined tapestry.   The   patient’s   biology,   psychology,   social   context,   culture,   spirituality,   and   even environment intersect to influence mental illness. These aspects are not mutually exclusive;  thus,  an  integration  of  both  Western  and  African  approaches  is  essential,  ensuring  that  mental  healthcare  is  accessible  and  aligns  with  the  diverse  needs  and  beliefs of the population.

Clinical  observations  (Gazzilloet  al.,  2020),  impressions  (Bouchard  &  Rizzo,  2019),  and  standardised  psychometric  tests  (El-Den  et  al.,  2018;  Yıldırım  et  al.,  2018)are  regarded  as  essential  in  making  an  accurate  diagnosis  of  mental  illnesses.  Theories  guiding  these  methods  are  from  the  Western  culture  (Sampson  &  Group,  1986).  Little  to  no  formal  theories  guiding  the  approach  to  mental  illness  in  African  contexts  can  be  found  in  mainstream psychology, a situation which has historically led to the adoption of Western approaches in most African cultures.

This trend towards Western models was influenced by  their  formal  documentation  and  extensive  research  support  but  also  significantly by  the  legacy  of  colonialism  (Nwoye,  2015).  During  the  colonial  era,  colonial  powers  systematically  marginalised  and  even  banned  traditional  medicine  while  promoting  biomedicine  as  a  symbol  of  modernity  and  progress  (Abdullahi,  2011).  This  not  only devalued  traditional  African  practices  and  understandings  of  mental  health  but  also  legally  and  socially  suppressed  them,  resulting  in  a  predominance  of  Western  methods  in  the  field  of  mental  healthcare  (Abdullahi,  2011).  This  historical  context  is  crucial  in understanding  why  Western  approaches  have  become  standardised  in  many  African  societies, often at the expense of indigenous knowledge and practices.

The  argument  is  that  mental  illness  differs  based  on  individuals’  social  environmental factors  (culture,  traditions,  and  past  experiences)  (Gopalkrishnan,  2018).  Environmental  variables  correlate  with  mental  illnesses  in  the  form  of  prognosis  and  intercultural  differences (Abbo et al., 2008; Kotera et al., 2020; Lefley, 1990; Wittchen & Jacobi, 2005). In  Western  cultures,  individuals  diagnosed  with  mental  illness  are  more  commonly  treated  using  Western  methods,  which  include  psychosocial  education,  psychotherapy,  social  support,  and  pharmacology  (Koç  &  Kafa,  2019;  Van  Weeghel  et  al.,  2019).  Such  methods  have  ingredients  which  need  to  be  delivered  by  Western-trained  professionals  to  treat  mental  illness.  Up  to  the  present,  Western  cultural  paradigms  continue  to  exert  significant influence over the global discourse in mental health, shaping the perspectives of scholars, theorists, and practitioners (Limenih et al., 2024). This dominant influence often overlooks the unique contextual factors that are crucial in understanding mental illness  across  diverse  cultural  backgrounds  (Shange  &  Ross,  2022).  However,  there  is  an  increasing  recognition  of  the  need  to  advocate  for  a  mental  health  framework  that  is  more reflective of the various cultural nuances (Lewis-Fernández et al., 2020).Western  culture  has  practised  treatment  for  serious  mental  illness  for  centuries.  There  is  ample  evidence  that  a  combination  of  psychopharmacology  and  psychotherapeutic  techniques  has  been  effective  in  the  treatment  of  serious  mental  illness  [mental disorders]  (Kao  et  al.,  2020;  Ryle  &  Kerr,  2020;  Shalaby  &  Agyapong,  2020).  In  other  cases,    depending    on    the    patient’s    presentation,    psychopharmacology    can    be    used    alone    for    treatment,    while    others    require    both    psychopharmacology    and    psychotherapy  (Greenway  &  Rees  Edwards,  2020;  Javelot  et  al.,  2021;  Needs  et  al.,  2019).  Psychopharmacology  (medication)  alone  does  not  wholly  treat  serious  mental  illness,  it  rather  subsides  the  diagnosed  mental  illness  (Greenway  &  Rees  Edwards,  2020).  Therefore,  it  could  be  argued  that  the  combination  of  psychopharmacology  and  psychotherapy is more effective. Psychotherapeutic  treatments  draw  on  a  range  of  techniques  as  dictated  by  the  type  of  mental  illness  and  suitability  of  the  modality,  for  example,  psychoanalysis,  cognitive  behavioural  therapy  (CBT),  supportive  therapy,  psychodynamic  therapy,  interpersonal  therapy,  and  dialectical  behavioural  therapy  [DBT]  (Calderon  et  al.,  2019;  Conceição  et  al.,  2019;  Mohamadi  et  al.,  2019;  Novalis  et  al.,  2019;  Peri  Herzovich  &  Govrin,  2021;  Schweiger et al., 2019; Van Bronswijk et al., 2021). These techniques are provided by well-trained  and  registered  professionals  (for  example,  clinical  psychologists;  psychiatrists) who  are  certified  by  professional  boards  which  license  and  authorise  their  practice. In  some  cases,  therapy  is  provided  to  individuals,  families,  groups,  and  couples  (Carr,  2019;  Hogue  et  al.,  2022;  Tadros  et  al.,  2019).  For  psychotherapeutic  techniques  to  be  more  effective,  there  is  a  likely  possibility  that  patients  will  be  advised  to  use  both psychopharmacology  and  psychotherapeutic  treatment  (Heinonen  &  Nissen-Lie,  2020;  Wampold, 2019).  Incongruence  due  to  different  cultural  perspectives  in  the  context  of Western psychological mindsets on treatment is more likely to be possible among social groups universally (Awaad & Reicherter, 2016). Brief History of Mental Illness in African Culture(s)In  this  exploration  of  the  history  of  mental  health  in  African  cultures,  it  is  important  to  acknowledge  the  ongoing  debate  surrounding  the  terminology  used  to  describe  mental  health  issues.  Increasingly,  there  is  a  preference  for  terms  like  ‘mental  health  problems’  or ‘mental health conditions’ over ‘mental illness’, reflecting a shift in understanding and a preference for euphemistic language within the field (Price, 2022). The shifts observed in  Price’s  (2022)  study  are  particularly  relevant  to  our  discussion,  as  they  align  with  one  of  the  core  arguments  of  this  article:  the  experience  and  narrative  of  what  constitutes  ‘illness’ can vary significantly across different cultures.

In  many  African  belief  systems,  individuals  may  understand  what  Western  perspectives  categorise  as  ‘illness’  in  entirely  different  terms,  which  carry  varied  connotations  and implications   (Mji,   2020;   Omonzejele,   2008).   This   cultural   variance   in   understanding   mental  health  challenges  the  conventional  use  of  the  term  ‘mental  illness’.  Therefore,  while  we  use  the  term  ‘mental  illness’  in  this  article,  it  is  with  the  recognition  of  its  diverse  interpretations  and  meanings.  This  usage  is  intended  to  facilitate  a  focused  discussion within the specific context of this work, rather than to endorse a universally applicable definition. We acknowledge and respect the varying connotations of ‘mental illness’  and  the  importance  of  culturally  sensitive  approaches  in  understanding  mental  health across different African cultures.

Mental illness has always been part of all societies and, on this note, it is irrefutable that humankind has faced challenges in dealing with its presence and treatment. With such a conundrum at hand, there was a necessity to find ways to address it (Mothibe & Sibanda, 2019).  Healers,  diviners,  herbalists,  and  priests  have  always  been  part  of  indigenous  healing  and  so  are  their  practices  (Kpobi  &  Swartz;  2019;  Odejide  et  al.,  1989).  The  latter  role players were useful in the treatment of mental illness then, they are useful now, and will  likely  continue  to  be  useful  in  the  future  as  evidenced  by  the  percentage  of  people  who  do  not  only  consult  them  but  use  them  as  their  first  point  of  mental  healthcare (Burns & Tomita, 2015; Gureje et al., 2015; Ngobe et al., 2021; Seedat et al., 2009; Sorsdahl et  al.,  2013;  Whiteford  et  al.,  2013).  Most  of  those  who  consult  indigenous  healers  as  the  first line of treatment for mental healthcare were found by Barlow and Durand (2005) and Odejide  et  al.  (1989)  in  their  studies  conducted  in  various  African  countries  to  attribute  mental illness to supernatural forces in the form of possession by evil spirits, witchcraft, and wrath of the ancestors. Despite limited pre-colonial writings on the history of mental illness  in  African  culture(s),  there  is  some  ‘therapeutic’  (archaeological)  evidence  that  supports the belief that mental illness was attributed to supernatural forces, for example, skulls that were drilled in the cranial region which date back to 5000 BCE. Such practices, based on the belief that drilling could release spirits responsible for mental difficulties (Cartwright,  2008),  further  reinforce  the  idea  that  understanding  and  treating  mental  illness  has  always  been  an  integral  part  of  human  history,  including  among  indigenous  African peoples.

Earlier, it was mentioned that traditional healers are often the first point of consultation before  medical  practitioners  in  certain  African  contexts.  Further  expanding  on  this,  research  by  Shai  and  Sodi  (2015)  indicates  a  trend  where  acute  symptoms  are  typically  addressed  through  Western  medicine.  However,  for  chronic  but  manageable  symptoms,  there is a noticeable shift towards traditional medicine, a practice also reflected in the limitations  of  psychiatry,  as  discussed  by  Read  (2012).  Read’s  (2012)  study  in  rural  Ghana  highlights  that  while  biomedicine  is  often  regarded  as  the  gold  standard,  the reality  of  its  limitations  and  the  incomplete  understanding  of  mental  health  often  led to  dissatisfaction,  thereby  reinforcing  supernatural  belief  systems.  Consequently,  when  biomedicine  does  not  yield  the  desired  results,  people  tend  to  revert  to  other  methods,  seeking a more comprehensive and lasting healing.

This  inclination  towards  traditional  methods  and  the  resulting  efficacy  further underscores   the   trust   that   indigenous   African   people   place   in   the   expertise   of   traditional  healers  to  bring  them  relief,  as  highlighted  by  Ngobe  et  al.  (2021).  This  not  only  demonstrates  a  deep-rooted  confidence  in  indigenous  knowledge  systems,  but also  suggests  a  pressing  need  for  psychology  to  understand  and  integrate  these  belief  systems  into  its  framework.  Importantly,  this  integration  should  be  done  respectfully  and  thoughtfully,  avoiding  the  pathologisation  of  such  beliefs  as  mere  symptoms  of   a   Diagnostic   and   Statistical   Manual   of   Mental   Disorders   (American   Psychiatric   Association, 2013) diagnosis. Acknowledging and valuing these traditional perspectives can   pave   way   for   a   more   holistic   and   culturally   sensitive   approach   to   mental   healthcare, one that resonates more deeply with the lived experiences and worldviews of African communities.

While  we  acknowledge  and  advocate  for  the  respectful  integration  of  traditional  belief  systems into psychological frameworks, it is also crucial to differentiate between cultural beliefs  and  pathological  symptoms.  We  do  not  refute  the  importance  of  diagnosis  and  the  treatment  of  associated  symptoms  in  the  context  of  mental  healthcare.  However,  it  is important to recognise that supernatural beliefs, prevalent and deeply rooted in many cultures,  are  not  inherently  pathological.  Psychology,  at  times,  tends  to  misconstrue  such ideas shared by clients as delusions. For example, in many cultures in South Africa, the  belief  in  bewitchment  is  an  integral  part  of  the  belief  system.  This  cultural  belief, while differing markedly from Western medical paradigms, should not be dismissed or pathologised, but  rather  understood  within  its  cultural  context.  Witches  are  believed  to  have the capacity to cause harm, and misfortunes and mental and physical illnesses are therewith  associated.  Typically,  a  traditional  healer  can  assist  a  person  being  bewitched  and  would  often  include  a  consultation  (where  the  client  shares  with  the  healer  their experiences),  the  use  of  herbs  and  natural  substances  (healers  usually  prescribe  the  use  of  certain  potions  or  mixtures,  that  are  made  from  natural  elements,  like  plants),  rituals  and  ceremonies  (it  is  likely  that  a  person  would  have  to  slaughter  an  animal,  talk  to  the  ancestors – essentially, engaging in behaviour to counter the misfortunes). While some of these  medicines  and  potions  might  have  counter-reactions  with  medication  (Adorisio  et  al., 2016), there are minimally reported violations. Important to note from this is that the belief a person holds will direct the behaviours they attach to healing. All  cultures  have  a  theoretical  system  that  is  used  as  a  base  to  explain  the  causality  of  illness, in this case, mental illness (Chipfakacha, 1994). That is, although mental illness is common in all societies, the causes, the different types, and the way they are diagnosed and treated differ from one culture to the other. Therefore, for a better understanding of  how  various  cultures  appraise  mental  illness,  one  must  take  time  and  appreciate  the   cosmological   assumptions   of   that   culture   (Ngobe   et   al.,   2021).   The   latter   was   comprehensively captured by Amuyunzu-Nyamongo (2013, p. 59):Mental  health  is  a  socially  constructed  and  defined  concept,  implying  that different  societies,  groups,  cultures,  institutions,  and  professions  have  diverse ways  of  conceptualising  its  nature  and  causes,  determining  what  is  mentally  healthy and unhealthy, and deciding what interventions, if any, are appropriate.

We  found  through  a  collation  of  studies  that  causes  of  mental  illness  across  various  cultural   groups   in   Africa   fall   within   two   broad   categories,   namely   bewitchment   or   possession  by  evil  spirits  (i.e.,  stepping  over  a  dangerous  track;  poisoning  with  soil  and  ants from the grave) and the effects of the ancestors [such as failure to perform a ritual or refusing to accept an ancestral calling] (Amuyunzu-Nyamongo, 2013; Ensink & Robertson, 1996; Ngobe et al., 2021; Sorsdahl et al., 2013). The above-mentioned causes are briefly explained below:

• Bewitchment  –  it  is  believed  that  witches  possess  the  ability  to  mobilise  and  use  evil  powers  to  harm  other  people.  Amafufunyana  (Zulu)  or  mafufunyana (Northern Sotho) are the terms used amongst these two South African cultural groups to denote mental illness due to witchcraft.

• Effects of the ancestors – it is believed that when ancestors want someone to become  a  traditional  healer  and  the  chosen  person  does  not  listen  or  refuses,  they  (ancestors)  can  cause  problems  for  that  person  and  the  person  might  behave like they are mentally ill and if not attended, this can lead to permanent mental  illness.  The  common  term  used  to  describe  this  amongst  the  Xhosa  ethnic group in South Africa is Ukuthwasa.

While  the  concepts  of  bewitchment  and  the  effects  of  the  ancestors,  as  seen  in  the examples  of  Amafufunyana  (Zulu)  or  mafufunyane  (Northern  Sotho)  and  Ukuthwasa (Xhosa),  primarily  focus  on  what  might  be  categorised  as  severe  mental  illness,  it  is  crucial  to  recognise  that  the  spectrum  of  mental  health  in  African  cultures  extends  beyond  these  intense  manifestations.  An  illustrative  example  of  this  broader  spectrum  can  be  found  in  the  Shona  concept  of  kufungisisa,  meaning  ‘thinking  too  much’,  which  represents  a  form  of  mental  distress  that  may  not  necessarily  fit  into  the  category of   severe   mental   illness.   This   highlights   an   important   aspect   of   mental   health   conceptualisation  in  African  cultures  –  the  recognition  and  inclusion  of  less  severe,  yet  significant mental health concerns. It is a reminder that while certain indigenous terms might  initially  appear  to  align  with  severe  mental  illness,  the  scope  of  these  terms  and  concepts can be quite broad and encompass a range of mental health experiences.

Considering this, our article argues for a flexible and sensitive approach to understanding how  mental  illness  is  conceptualised  within  African  cultures.  Indigenous  names  and  terms  should  not  be  interpreted  rigidly  and  fixedly,  but  rather  viewed  as  categories that  provide  diverse  explanations  and  insights  into  mental  health.  This  understanding,  as   suggested   by   Ensink   and   Robertson   (1996),   allows   for   a   more   nuanced   and   comprehensive   appreciation   of   the   various   ways   mental   health   is   understood   and   addressed within African cultural contexts.

Treatment of Mental Illness from an African Perspective

Although theories of mental illness causality differ between Western and African cultures, commonality  is  observed  in  the  manifestation  of  core  symptoms  across  these  cultural  contexts  (Jablensky  et  al.,  1992;  Ngobe  et  al.,  2021;  Sartorius  et  al.,  1974).  For  example,  persecutory  delusions  (the  belief  that  others  are  plotting  against  or  planning  to  harm  an  individual in one way or the other) which is one of the positive symptoms of mental illness was found to cut across all cultures and this was underpinned by trans-cultural and cross-cultural international studies (Connell et al., 2015; Kalra et al., 2012; Stompe et al., 1999).Despite   similarities   noted   regarding   the   core   symptoms   of   mental   illness   across   both  cultures  (Western  and  African),  differences  were  noted  in  what  some  of  these symptoms  mean  or  are  indicative  of.  One  such  area  was  in  the  content  of  the  delusions  and  hallucinations  and  the  meaning  thereof.  In  a  study  conducted  by  Ngobe  et  al. (2021)  among  Xhosa  traditional  healers  in  South  Africa,  it  was  found  that  auditory  hallucinations  were  believed  to  be  indicative  of  two  things  (a)  either  a  visitation  by  the ancestors to offer some guidance or (b) intrusions by evil spirits. The latter beliefs contrast  with  the  belief  in  Western  culture,  whereby  hearing  of  voices  is  viewed  as  an  indication that something went haywire biologically (Freitas-Silva & Ortega, 2016)which, if  it  is  the  case,  medication  will  be  the  solution.  The  former  and  the  latter  indicate  that  explanations   of   mental   illness   in   both   cultures   are   underpinned   by   each   culture’s   beliefs,  which  inform  the  treatment  approach  thereof  and  the  potential  first  point  of consultation, strengthening the need for both cultures to formally work side by side. Treatment  of  mental  illness  among  African  culture(s)  depends  on  what  is  believed  to  be  the  cause,  and  it  is  also  holistic  in  nature  (Koç  &  Kafa,  2019;  Ngobe  et  al.,  2021).  The  most  common  methods  used  to  treat  mental  illness  include  among  others,  cleansing,  the  performance  of  rituals  (i.e.,  slaughtering  of  a  goat),  burning  of  herbs,  offering  of sacrifices and practices of purification. While this article touches on the various methods employed  by  traditional  healers  in  addressing  mental  health  issues,  such  as  the  use  of  nasal  inhalations,  herbs,  and  other  substances,  it  is  not  our  primary  focus  to  delve  into  the  specifics  of  these  practices.  The  detailed  description  of  methods  like  the  use  of animal  substances  (tinsiti),  powdered  roots  (emakhatsakhatsa),  boiled  roots,  leaves,  or  barks (timbita), and the role of divination bones (ditaola in Northern Sotho) for guidance in traditional healing, as documented by researchers like Abbo et al. (2019) and Ngobe et al.  (2021),  is  beyond  the  scope  of  this  article.  However,  for  readers  interested  in  a  more  in-depth  understanding  of  these  specific  traditional  methods  and  their  application  in mental healthcare, we recommend referring to the works of these authors.

Our  main  argument  is  to  advocate  for  a  broader  reconsideration  of  what  is  deemed  appropriate  care  in  mental  health,  particularly  in  the  context  of  African  cultures.  This  includes   acknowledging   and   respecting   the   diverse   array   of   practices   and   beliefs   that  exist  within  these  cultures  and  understanding  their  significance  in  the  mental health  landscape.  In  doing  so,  we  aim  to  highlight  the  importance  of  integrating  these  indigenous approaches into a more holistic and culturally sensitive framework of mental healthcare, rather than focusing solely on the specifics of each method.

A   common   treatment   method   used   for   those   who   have   mental   illness   because   of   ancestral  calling  is  initiation  (Ngobe  et  al.,  2021).  Individuals  who  receive  this  treatment  do  so  because  their  ancestors  want  them  to  become  traditional  healers.  However,  for  one  to  get  better  in  this  case,  s/he  must  accept  the  calling  and  complete  the  initiation,  failure  of  which  will  result  in  severe  mental  illness  and,  in  the  worst  cases,  even  death.  The  training  occurs  under  the  guidance  of  another  traditional  healer,  mostly  a  senior  traditional  healer  (gobela)  and  the  training  can  take  months  and,  in  some  cases,  even  years  (Ngobe  et  al.,  2021).  Throughout  the  training,  the  initiate  will  not  only  learn humility,  traditional  herbs  (muti)  and  respect  for  the  ancestors,  but  they  also  undergo  other traditional rituals as deemed necessary (Ngobe et al., 2021). For mental illness due to bewitchment and breaking of taboos, cleansing, incisions (kugata in Xhosa), sacrifices and rituals are used to repel and appease the ancestors. Having  explored  the  distinct  treatment  methods  prevalent  in  both  African  and  Western  cultures,  we  are  now  prompted  to  consider  the  potential  for  an  integrative  approach.  This  approach  could  synergistically  combine  the  strengths  of  each  culture’s  perspective  on  mental  illness  treatment.  Taking  a  deconstructed  view  of  the  biomedical  further  informs our belief that mental illness can be assessed, diagnosed, and treated (Mapaling & Naidu, 2023) holistically in an integrative approach.

A Call for an Urgent Integrative Approach

In   many   African   countries,   including   South   Africa,   Kenya,   Ghana,   and   Uganda,   a   significant  portion  of  the  population  prefers  traditional  healers  as  their  primary healthcare  providers  for  various  ailments  (Abbo  et  al.,  2008;  Ae-Ngibise  et  al.,  2010;  Freitas-Silva & Ortega, 2016; Letsoalo et al., 2021; Mothibe & Sibanda, 2019; Ndetei et al., 2013; Sorsdahle et al., 2013; Van Niekerk et al., 2014). This preference is rooted in factors such as familiarity, accessibility, affordability, and a deep alignment with cultural belief systems  (Burns  &  Tomita,  2015;  Gureje  et  al.,  2015;  Mothibe  &  Sibanda,  2019;  Ngobe  et  al., 2021; Seedat et al., 2009; Sorsdahl et al., 2013; Whiteford et al., 2013). The widespread trust   and   reliance   on   indigenous   healers   underscore   a   critical   aspect   of   African   healthcare: the inextricable link between cultural beliefs and treatment methods.

Considering the historical and cultural context of African psychology and the influence of Western  urbanisation,  an  integrative  approach  to  mental  healthcare  is  crucial.  Such  an  approach  would  not  only  respect  and  incorporate  traditional  African  methods,  but  also  blend  them  with  effective  Western  psychological  practices.  This  synergy  can  create  a holistic  and  culturally  sensitive  mental  healthcare  system,  one  that  truly  addresses  the  diverse needs and beliefs of African populations.

However,  the  path  to  integration  is  not  without  its  challenges.  It  requires  overcoming  systemic  biases,  addressing  logistical  hurdles,  and  ensuring  that  both  traditional  and  Western methods are given equal respect and consideration. If the integration of African treatment  approaches  into  the  formal  healthcare  sector  continues  to  be  sidelined,  the  goal of inclusive and responsive healthcare will remain elusive.

The benefits of integrating both African and Western approaches to mental healthcare are  manifold.  It  would  not  only  honour  the  deeply  held  beliefs  of  African  people,  but  also  provide  a  more  comprehensive  and  effective  form  of  care.  The  benefit  of  African approaches,  backed  by  evidence  and  theory,  is  indeed  significant  and  should  not be  dismissed.  Conversely,  failure  to  do  so  risks  perpetuating  the  marginalisation  of  indigenous  practices  and  alienating  a  significant  portion  of  the  population  who  rely on  these  methods.  However,  it  is  crucial  to  consider  the  diversity  within  South  Africa,  encompassing  various  cultural  beliefs,  including  those  related  to  traditional  medicine.  Prolonged  delays  in  this  integration  will  only  serve  to  disadvantage  those  who  trust  in  indigenous  healing  methods.  It  is  time  to  acknowledge  the  value  of  these  practices  and  embrace a more inclusive and effective approach to mental healthcare in Africa.

Conclusion

This article has navigated the complex landscape of mental health treatment, contrasting and  comparing  the  Western  and  African  approaches.  It  has  become  increasingly  evident  that  a  synergistic  integration  of  these  diverse  perspectives  is  not  just  beneficial,  but essential  to  address  the  unique  mental  healthcare  needs  within  African  contexts.  The  convergence  of  these  approaches  can  pave  the  way  for  a  more  inclusive,  culturally  sensitive,  and  effective  mental  healthcare  system.  By  embracing  both  Western  and African methods, we can create a more holistic and responsive healthcare paradigm that honours  the  cultural  values,  beliefs,  and  traditions  of  African  communities,  while  also  leveraging the advancements in Western medical practices. It is time to move beyond the binary of Western versus African approaches and foster a collaborative model that brings the  best  of  both  worlds  to  the  forefront  of  mental  health  treatment.  Such  an  integrative  approach will not only respect the diverse cultural landscape of Africa but will also mark a significant step towards addressing mental healthcare needs in a manner that is both culturally relevant and scientifically sound.

At the same time, it is important to acknowledge the need for researchers from Africa to produce their own theories and guidelines, rather than solely relying on integration. The development of African-centred approaches, grounded in local knowledge and practices, is  crucial  for  addressing  the  unique  mental  health  challenges  faced  by  African  people.  However, we firmly believe the best approach would be for researchers to work closely with  traditional  healers  to  generate  integrated  theories  and  guidelines  that  can  inform  mental  healthcare  practices.  This  collaborative  effort  is  a  crucial  step  in  empowering African  researchers  and  practitioners  to  take  the  lead  in  shaping  mental  healthcare  solutions tailored to the specific needs and cultural contexts of their communities. The lack of African-centred theory and evidence-based approaches is a significant gap that must be addressed.

By  embracing  this  integrative  approach,  we  can  challenge  the  nexus  between  Western  and  African  approaches,  moving  beyond  the  binary  of  either/or  and  towards  a  more  inclusive  model  that  honours  the  diversity  of  African  cultures  and  traditions.  This  is  a  crucial  step  in  developing  mental  healthcare  solutions  that  are  both  culturally  relevant  and scientifically sound.

Source: https://doi.org/10.17159/pins2024Vol66iss2a6320

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