Chapter 2 Literature Review Literature Review
3.3. African Indigenous Views of Illness and Mental Illness
3.3.3. African worldview: implications for health and illness
Prior to a consideration of the influence of the African worldview on key conceptualisation issues of health, such as aetiology, diagnosis and treatment, it is imperative to examine how health and illness are defined in both the Western and African perspectives. Truter (2007) argues that Western medicine is often contrasted with the approach taken by traditional medicine because the former
is usually associated with diseases of the physical body and is based on principles of science, yet traditional medicine has its roots in ancient traditions of healing that are still relevant and complementary to modern medical practice. It remains important to pay attention to the influence of culture in constructing an identity of health and illness because this in turn affects people’s health and illness behaviours. According to Corbin (2003), the construction of health or illness refers to the means that people use to arrive at conceptions of self as either well or ill, based on a particular worldview. Ross and Deverell (2010) argue that in terms of worldviews, there are two main types of constructions of health and illness, namely the traditional approach, which is based on indigenous belief systems, and the so- called modern approach that is located within a Western medical paradigm. Both the cultural and medical conceptualisations of health and illness differ, even though similarities may be detected. Cultural conceptions of health are more holistic than the biomedical models.
3.3.3.1. Western and African models’ definition of health.
Western or biomedical models, according to Piko and Bak (2006), define health as the lack of disease or illness. Boddington and Raisanen (2009) argue that defining health as lack of disease or illness tunnels the vision too much to the physical body, leaving out reference to other dimensions of health such as mental, emotional and social aspects. A much more inclusive definition of health that might be considered ‘holistic’ is provided by the WHO. According to the WHO (2001), health can be defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (p. 1). This definition indicates that health is considered to be multidimensional, and encompasses both biomedical and psychosocial aspects of health. Although this definition of health by the WHO is not far off from the African conception of health, what is missing, from this definition is the spiritual aspect, which is vital and relevant to the African conception of health.
What is apparent from the WHO’s definition of health is that it focuses mainly on the individual. The African notion of health expands on that of the WHO and yet differs in some ways. Indigenous African perceptions of health encompass both the individual and his or her society, the environment as a whole, as well as the spiritual world. The fact that, according to an African worldview, the individual is
surrounded by members of the family and clan, both the living and the living-dead community, and that their personhood is anchored in such a network of relationships is a primordial source of that person’s physical, psychic and spiritual security and well-being (De Craemer, 1983). Good health means much more than just a healthy body. Just like with personhood, health in an African context is viewed not only as a bodily process, but is also viewed in terms of life processes.
This shows the artificial divisions of ‘physical health’ from ‘mental health’ common in the Western developed world, which is not shared by traditional cultures (Sturgeon, 2007). According to Nelms and Gorski (2006), Africans view health as transcending the mere absence of a disease, and recognise that the body and the mind must be in a harmonious state of wellness that is recognised and accepted by the individual and society. However, the spiritual component is missing in this model. Nevertheless, this is in harmony with the biopsychosocial model, as stated by Sturgeon (2007), which suggests that mental well-being, social support and social networks are protective factors for physical health. The opposite would also be true, which is to say, that physical health impacts positively on mental health. Health in the African worldview is also defined and influenced by the harmonious relationships between human beings and their environment (surroundings), between human beings and the spiritual world, and between human beings and their communities (Honwana, 2001). Although the term illness refers to the experience of a sick person, according to Peu et al. (2001), all diseases, from a traditional view, are determined by how a particular society defines them.
This will be shown in the definitions of illness below.
3.3.3.2. Western and African models’ definition of illness.
The concept of an illness is the subject of vast debate that taps into complex cultural and philosophical issues and does not lend itself to a simplistic definition. This concept, when examined from the Western perspective, is further problematised by the evolution of medicine throughout human history. For the purpose of the current study, although the concepts illness, sickness and disease could be defined differently, they will be used interchangeably. To show the differences between these concepts, Boyd (2000) defines disease as a pathological process that deviates from a biological norm, while illness is an experience of being unhealthy, and sickness is an external and public mode of being unhealthy. To sum up these differences, disease reflects a malfunctioning of
biological and/or psychological processes, while illness is the psychosocial experience and meaning of perceived disease (Kleinman, 1980). However, these concepts will be used interchangeably because they usually occur together. For an example, Ross and Deverell (2010) write that people are ill because they have a disease and are labelled as sick. Many patients, in most instances, are probably classified as having a disease, or feeling ill, or recognised as sick (Boyd, 2000).
According to Hofmann (2001), ancient medicine defined disease as the disturbance of humoral homeostasis, and medicine of the third millennium seeks to define disease in the language of microscopic or radiographic morphology, biochemistry and molecular biology. From the Western biomedical perspective, Nordenfelt (2006) defines disease as a type of internal state which is either an impairment of normal functioning ability or a limitation of functional ability. Lester King (as cited in Hofmann, 2001) provides a more holistic Western approach that acknowledges a cultural imperative and defines a disease as “the aggregate of those conditions which, judged by the prevailing culture, are deemed painful, or disabling, and which, at the same time, deviate from either the statistical norm or from some idealized status” (p. 220). Although this definition acknowledges cultural imperatives, similar to the Western definition of health, the Western definition of a disease is largely focused on the individual, where the term disease is used to refer to a particular physical experience of the body.
It is clear that African culture is not homogeneous. It would therefore be expected that different African cultures would have different beliefs about causation and treatment of ill-health and that there would be differences in the way in which illnesses are conceptualised and dealt with (Honwana, 2001). Thus, illness or disease would be defined differently in different contexts, by placing varying emphases on various aspects of cultural understanding. For example, on the one hand, Kamsu-Foguem, Diallo and Fuguem (2013) define disease or illness in an African tradition as a failure of complex physical, social and spiritual relationships. On the other hand, according to Kale (1995) and Truter (2007), disease, in some African cultures, is considered a supernatural phenomenon governed by a hierarchy of powers beginning with the most powerful deity followed by lesser spiritual entities, ancestral spirits, living persons, animals, plants and other objects. According to Botha and Moletsane (2012), if one or more, or indeed all, of these levels is or are not held firmly, then the person comes to exist in a state of disequilibrium. As it has already been stated, harmonious relationships
within this hierarchy are important for good health. Some authors (Edwards, 2011;
Mkhize, 2013; Ross & Deverell, 2010) also agree that should this harmonious relationship be interrupted or thrown into a state of imbalance or disequilibrium, from an African point of view, illness would befall an individual.
From an African perspective, Semenya and Mokwena (2012) assert that illness can occur as a result of upsetting the interdependence of things or people;
the balance is upset and things fall out of harmony. While in a state of disequilibrium, the person becomes unhappy and gets sick often because the relationship or bond between the levels is weak (Botha & Moletsane, 2012). For example, ailments could be due to the ancestors’ withdrawal of their protection because they are angry that the person concerned did not perform certain rituals.
Semenya and Mokwena (2012) state, for instance, that if a person dies, relatives of the deceased need to perform specific rituals and if these rituals are not performed, the flow of the relationship between the family, ancestors and God is broken. It is commonly believed, in African cultures, that when ancestors withdraw their protection, a space for vulnerability is created for misfortune or illness to occur.
Mkhize (2013) also argues that it is possible for unknown forces to intervene without people’s awareness and to cause disequilibrium, and thus an illness. This stems from the belief that the creative life force may be manipulated for sinister purposes (Mkhize, 2004). An example of this would be an illness caused by witchcraft.