Pluralism and practicality

Village health workers’ responses to contested meanings of mental illness in Southern Malawi

Datos Bibliográficos

ID7640775
AutoresJerome Wright (0000-0001-9740-0534, University of York, autor de correspondencia), Limbika Maliwichi-Senganimalunje (University of Malawi), Limbika Maliwichi (0000-0002-9026-4282, University of Malawi)
Año2020
Volumen27
Número1
Páginas32-48
Fecha de publicación2020-01-02
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaAnthropology and Medicine (JOURNAL)
Identificadores de la revistaISSN: 1364-8470 • E-ISSN: 1469-2910
EditorialInforma UK Limited (PUBLISHER • GB)
DOI10.1080/13648470.2018.1507103
PMID30714836
OpenAlexW2913192702
IdiomaEN
Citas recibidas1
Referencias citadas42

The individual and social construction of psychological distress is fundamental to help-seeking and the extent to which interventions are seen as credible. Where pluralistic attributions for mental health problems predominate, the development of global mental health (GMH) interventions in the form of task-shifting approaches create increased access to new ways of understanding and responding to distress. However, little is known about how participants in these initiatives manage these encounters. This qualitative study in Malawi explored village-based health workers' (HSAs) and patients' and carers' views of the causes of distress and how these beliefs influenced help-seeking and the health workers' response.Eight HSAs and nine paired patients/carers were interviewed separately to enable each of nine experiences of distress to be explored. Findings revealed a complex set of personal, social and cultural influences that informed causative attributions and help-seeking decisions. Patients/carers viewed psychosocial stresses as compelling explanations and readily reported others attributing their distress to supernatural causes (bewitchment). Yet attributional beliefs alone were not the only influence over help-seeking, which evolved pragmatically in response to the impact of treatments and social pressure for conformity. In turn HSAs navigated the interactions with patients/carers by emphasising the biomedical approach and discrediting bewitchment attributions. This caused tensions when biomedical interventions were unhelpful or the traditional healers' approach proved beneficial.Conclusions add to the call for such task-shifting approaches to work with communities to discern authentic and practical responses to mental distress that mirror the 'pluralism and pragmatism' found in the communities they serve

Attribution · Distress · Mental health · Mental illness · Pluralism (philosophy · Psychiatry · Psychological intervention · Psychosocial · Psychotherapist · Qualitative research · Social science · Sociology · Community Health and Development · Medicine · Mental Health and Patient Involvement · Mental Health Treatment and Access · Psychology · Social Psychology