9.2.2  Explanatory models and cultural context

In the communities where you work, local people may have different explanations for why mental illness occurs. The way people explain an illness is called an explanatory model. Healthworkers often have different explanatory models (e.g. the biopsychosocial model) when compared with the local cultural model used by community members. See Table 9.2 for an example of this. It is very important to try to understand a person’s explanatory model for mental illness even if you don’t agree with it. This will help you to support the person better. You will learn more about how to manage competing explanatory models of mental illness in Study Session 18 on mental health promotion and Study Session 19 on disability and community rehabilitation.

Table 9.2  Comparing explanatory models.

QuestionsBiopsychosocial modelLocal cultural model
Why did I get ill?Because I was drinking and had lost my family and friends.Because my neighbour bewitched me.
Will I get better?Things could get better if I stopped drinking.This is a serious thing. I might even die unless this curse is removed from me.
What treatment might help?If I had help to stop drinking, and was able to talk about my problems to somebody.Going to see the witch doctor (tanquaye) and slaughtering a sheep.

Box 9.3 presents a list of some of the cultural explanations of mental illness found in Ethiopia. Beside those in Box 9.3, you could write down other causes that you know of in your area.

Box 9.3  Cultural explanations for mental illness

Spirit possession (likift, zar, wuqabi)

Punishment for sins

Evil eye

Bewitched/cursed

Thinking too much

Exposure to cold air (berrd)

Exposure to sun rays (mitch).

9.2  What causes mental illness?

9.3  The treatment gap