Published on January 2, 2008
Psychiatric Illness and Stigma in Tanzania: A Qualitative Study: Psychiatric Illness and Stigma in Tanzania: A Qualitative Study PI: Aunali Khaku Mentors: Dr. Laurence Guttmacher, Dr. Nancy Chin, Dr. Norah Hogan, Prof. Karim Manji University of Rochester School of Medicine, Rochester, NY and Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania Introduction: Introduction Mental illness is accompanied by a greater degree of social stigma than somatic illness. Stigma harms patients Neither healthcare providers nor patients themselves are immune from the effects of stigma The best way to alleviate stigma is to understand it in order to then design programs to counter it Stigma associated with mental illness has not been extensively studied and documented in the third world Culture plays a great role in this phenomenon; it would be unwise to superimpose the current Western models in non-Western settings. Hence this study sought to understand the sociological frameworks that underlie stigma towards the mentally ill in Tanzania. Methods: Methods Results: Results Theme 1: Mental illness as a correlate of drug/alcohol abuse, with an increased prevalence of disorders among youth “Mental disorders are caused by drug abuse such as smoking marijuana. Alcoholism causes mental excitation and so a person becomes insane.” n2ms “excessive alcohol, or some drugs, those drugs seems to be overdosed so that they become nervous and start shouting until ending into psychiatric condition. All in all I think it is being caused by drugs abuse. Drugs abuse and opium, when somebody is overdosed he ends up with such abnormal behaviors....” n5ms Theme 2: Mentally ill persons as permanently disabled by their condition due to the chronic nature of the disease and the propensity for frequent relapses leading to neglect of the patient: Theme 2: Mentally ill persons as permanently disabled by their condition due to the chronic nature of the disease and the propensity for frequent relapses leading to neglect of the patient “I become useless! I will not be a complete human being.” n3ms “they think that you are not supposed to do any work…you are not supposed to do anything you just have to stay there…..... they will neglect you”… md4fe “When it comes to dad he doesn’t want me to do what I really like” p3fe “Communication wise, you cannot talk anything with him/her” n3ms “In general they see him as someone who won’t be able to do anything of importance” p6fs Theme 3: Labeling of the patient, leading to every subsequent action being judged by the label: Theme 3: Labeling of the patient, leading to every subsequent action being judged by the label “whatever they want to do…those people around them, feel that this is abnormal behavior…they bring him back to the hospital…but when we test the patient, he was stable…maybe he is just complaining that this is not enough “ md4fe “maybe she was yr friend, but now you start taking her as a different person.” md5fe Sometimes maybe someone who is known to have a mental disorder wants to explain something, but instead of listening …” nifs “Don’t throw out all words of psychiatric patient some time they have a meaning.” R6fs Theme 4: Teasing, calling names, and subjecting the mentally ill to humiliation as a source of entertainment : Theme 4: Teasing, calling names, and subjecting the mentally ill to humiliation as a source of entertainment “sometimes you see a “mad man” (psych patient) who has taken off all his clothes and exposed himself, and people stop what they are doing and gather around to laugh at him.” nifs “Sometimes even when you are just walking by they start to shout nonsense concerning your mental condition, instead of it seeming to be a sad thing it start to be as if a comedy to everybody around you…” n5ms “many are pin pointed and given names like mwenda wazimu, kichaa. Family members are also taunted. The patient is provoked.” md1fs Theme 5 : Relatives hiding the diagnosis from others, and hiding the patient from the public: Theme 5 : Relatives hiding the diagnosis from others, and hiding the patient from the public “they hide them in their houses; just tie them” md2me “like prisoners…even prisoners can move out, they can see others…he cant be with others” md3fe “Others hide it. Like I have a friend of mine with a child with psychological problems, but they hide it, when people ask they say he’s okay” nifs Acknowledgements : Acknowledgements I extend my deepest gratitude to all those who assisted me in this project. It is impossible to list everyone here but a few will be mentioned: Al-Rahman, my mentors, family, friends, Adrienne Morgan, Mary Christian, the CACHED/OME staff, the faculty and staff of the University of Rochester School of Medicine, and of Muhimbili University College of Health Sciences, Dr. F. Masao, Prof. Kilonzo, Dr. S. Kaaya, Dr. Lyness , Dr. F. Philip, Dr Schultz, Dr. Shelly, the second year medical school class at Muhimbili, Faheem Sheriff, JAMSAA, Prof. Muhsin Alidina, Abbas Rhemtulla, Asgher Hirji, Salim Bhimji, Amir Taslimi and many others. Any errors in this endeavor remain solely mine. Slide13: Questions? Thanks for your time and attention References: References Goffman, E (1963) Stigma: The Management of Spoiled identity. Penguin, Harmondsworth Goffman E. Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs (NJ): Prentice-Hall; 1963. Corrigan PW, River L, Lundin RK, et al: Stigmatizing Attributions about Mental Illness. Journal of Community Psychology 28:91–102, 2000) Weiner B, Perry RP, Magnusson J: An Attributional Analysis of Reactions to Stigmas. Journal of Personality and Social Psychology 55:738–748, 1988 S-A. Lee et al: Factors Contributing to the Stigma of Epilepsy. Seizure (2005) 14, 157—163 Corrigan, P et al: How Adolescents Perceive the Stigma of Mental Illness and Alcohol Abuse. Psychiatric Services. May 2005 Vol. 544 56 No. 5 Pg 545-550 Dinos et al: Stigma: The Feelings and Experiences of 46 People with Mental Illness. A Qualitative study. British Journal of Psychiatry (2004), 184, 176-181 Angermeyer, M et al: The Stigma of Mental Illness: Patient’s Anticipations and experiences. International Journal of Social psychiatry Vol 50(2): 153-162. Sirey, J, et al: Perceived Stigma and Patient-Rated Severity of Illness as Predictors of Antidepressant Drug Adherence, Psychiatric Services _ December 2001 Vol. 1620 52 No. 12 Sher et al: Caregivers’ Attitudes to Mental Illness and Patients’ Adherence to Antidepressant Treatment. Psychiatric Services May 2005 Vol. 56 No. 5 pg 564… 10b. Pyne, J et al: Relationship Between Perceived Stigma and Depression Severity. The Journal of Nervous and Mental Disease. (2004) 192(4):278-283) Fabrega, H Jr. Psychiatric Stigma in non-Western societies. Comprehensive Psychiatry.1991 Nov-Dec; 32(6):534-51. Ngoma et al: Common Mental Disorders among Those Attending Primary Health Clinics and Traditional Healers in Urban Tanzania. British Journal of Psychiatry (2003), 183, 349-355 Chee, C et al: Comparing the Stigma of Mental Illness in a General hospital with a State Mental Hospital. A Singapore study. Soc Psychiatry Psychiatr Epidemiol (2005) 40: 648–653 "Tanzania." Encyclopædia Britannica. 2006. Encyclopædia Britannica Online. 2 Jan. 2006 <http://search.eb.com/eb/article-9108365>. Baumgartner, J and Kaaya S: Adults with Psychotic Disorders in Dar es Salaam, Tanzania: Factors that Hinder or Facilitate Utilization of Public Mental Health Services. British Journal of Psychiatry (2003) 183: 349-355 Joshua Fogel; Daniel E Ford: Stigma Beliefs of Asian Americans With Depression in an Internet Sample. Canadian Journal of Psychiatry; Jul 2005; 50, 8; Research Library pg. 470 Corrigan, P: Target-Specific Stigma Change: A Strategy for Impacting Mental Illness Stigma. Psychiatric Rehabilitation Journal; Fall 2004; 28, 2; Research Library pg. 113 Liggins, J and Hatcher, S: Stigma toward the Mentally Ill in the General Hospital: A Qualitative Study. General Hospital Psychiatry 27 (2005) 360 359– 364 Corrigan, P: Don’t Call Me Nuts: An International Perspective on the Stigma of Mental Illness. Editorial: Acta Psychiatr Scand 2004: 109: 403–404 Diagnostic and Statistical Manual - Text Revision (DSM-IV-TR™, 2000), American Psychiatric Association, ED. Michael B. First, MD (page xxi) Katz MM, Marsella A, Dube KC, Olatawura M, Takashi R, Nakane Y, Wynne LC, Gift T, Brennan J, Sartorius N, et al: On the Expression of Psychosis in Different Cultures: Schizophrenia in an Indian and in a Nigerian community. Culture, Medicine & Psychiatry. 12(3):331-55, 1988 Sep. Leff J, Sartorius N, Jablensky A, Korten A, Emberg G et al: The International Pilot Study of Schizophrenia: five-year follow-up findings. Psychological Medicine. 22(1):131-45, 1992 Feb. Dr. Guttmacher: Personal Commentary Dr. Fausta Philip MD (Dar), Stigma Towards Mental Illness: The Experiences of Mentally Ill Patients and Relatives Attending The Psychiatric Unit, Muhimbili National Hospital. Med RC467. PS 2003
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