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S48 F. Napo et al. / European Psychiatry 27 (2012) / supplement n°2 / S44-S49
isolation, stigmatisation and social exclusion of psychiatric
patients. In fact, social isolation may further augment mental
disorders: Makanjoula and Olaifa (1987) reported in their study
on negative mood states among Nigerians that “depression in
particular, may be then considered both as a reaction to the loss
of the position of the subject in the group to which the person
belongs and as a reaction to the threat of a catastrophe” [27].
Prof. Baba Koumaré, the head of the department, explained
that the existence of beliefs in external evil agents enables
patients e.g. suffering from major depression to externalize
their feelings of guilt and shame and thus to blame evil outside
agents for their suffering, which then may be misdiagnosed by
psychiatrists as paranoia or a psychotic rather than an affective
disorder. On the other hand, a salutogenetic perspective
emphasizes mechanisms that facilitate “resistance to psychotic
symptoms”: external agents can evoke “self resistance” and
power of the patient. It appears that the attribution of misery and
pain to external agents also mobilizes group and family support.
Explanatory models and concepts that are supported by a common
belief may thus facilitate that the patient and accompanying
family work together against the perceived threat.
The interviewed experts also suggested that the apparent
resistance of their patients against a perceived “external source
causing illness” can reduce suicidal tendencies. A common
enemy which often appears in the role of an “outsider” to the
family clan may thus strengthen or reunite the family bond.
The Malian experts emphasized that professionals should not
deny the cultural influence on illness concepts and rather
integrate traditional and local explanatory models of suffering
as an important resource for the therapeutic treatment for
the patients. This includes respect for traditional ways to heal
mental illness, which were explicitely named by all patients as
a necessary step for recovery.
Altogether, our study underlines the importance of a culturally
sensitive diagnostic process and of strengthening family
bonds and social inclusion. Regularly involving relatives in a
communal psychiatric setting offers an important perspective
of integrating and transforming the subjective conceptions of
patients suffering from psychotic symptoms. This African treatment
perspective includes systematic approaches as well as
transculturally relevant aspects and focuses on the resilience
of patients and their families within a practical, salutogenetic
approach.
Confl ict of interest statement
None.
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