Chapter 6 Results: Part I Results: Part I
6.2. Conceptions and Causes of Mental Disorders
randomly assigned to one of the three vignettes. A test of significant differences shows no significant differences between how the vignettes were distributed between Kokstad and Kwa Sani Municipalities. Table 6.3 shows these results in detail.
Table 6.3: Distribution of the vignettes between Kokstad and Kwa Sani Characteristics Kokstad
N= 606 (77%)
Kwa Sani N= 181 (23.0%)
Total N= 787
χ2 / Fisher’s exact test
Vignette
Depression 197 (32.5%) 62 (34.3%) 259 (32.9%) 0.213
Schizophrenia 199 (32.8%) 57 (31.5%) 256 (32.5%)
Alcohol dependency
210 (34.7%) 62 (34.2%) 272 (34.6%)
*p < 0.05, **p < 0.01, ***p < 0.001
losing the mind, stressed, not in the right frame of mind, hallucinations etc.); 3) social (e.g. isolating oneself, having no one to talk to, lack of family or social support, financial problems etc.); 4) traditional (e.g. being troubled by ancestors, failure to perform traditional rituals, possession by ancestral spirits etc.); and 5) not indicated (e.g. these are all those who did not answer this question). Table 6.4 below presents a more detailed list of categories used to conceptualise mental illness and examples of responses that participants gave to any of the three vignettes presented to them. Three registered clinical psychologists were asked separately to verify the five categories, and they were all in agreement with these.
Categories created for other responses or questions to be presented in this chapter as well as in the next chapter were also checked by these psychologists and agreed upon.
Table 6.4: Categories used to conceptualise mental illness and examples of responses
Category of explanation Examples of responses
Medical HIV positive, TB, fever, physically sick, AIDS, always tired, some sort of an illness, suffering from health problems, not feeling well, drinking too much because of AIDS, no appetite, ill, unwell, life has come to an end maybe because of HIV, weight loss, too much alcohol in the body, etc.
Psychological Low self-esteem, depression, mentally disturbed, losing the mind, abused, becoming mentally ill, change of behaviour, depressed, drinking too much, failure to accept grandmother’s death, feeling sad, shy, not well mentally, seeing unreal people, lack of confidence, hearing voices, miserable, etc.
Social Isolating oneself, having no one to talk to, lack of social or family support, financial problems, being alone, not treated well by community, family problems, life is not going well, problems at work, relationship difficulties, etc.
Traditional Being troubled by ancestors, failure to perform traditional rituals, possession by ancestral spirits, ancestors want a cow to be slaughtered, ancestral spirit entering, probably did things that people did not like, etc.
More than half of the total participants (n = 480, 61%) reported that the person presented in any of the vignettes suffered from a psychological problem, followed by problems that were social (n = 167, 21.2%) and medical (n = 107, 13.6%) in nature. These results are shown in Table 6.5 below. An analysis according to a
specific disorder showed a similar explanation trend for schizophrenia and alcohol dependency where these conditions were largely explained as psychological and social in nature. However, the third explanation given for schizophrenia was traditional and for depression was medical in nature.
It is apparent from Table 6.5 that for schizophrenia, 133 (52%) participants in the sample thought that this condition was a psychological problem, followed by 85 (33.2%) and 21 (8.2%) who thought that the condition was social and traditional, respectively. However, depression was conceptualised as a psychological problem by 97 (37.5%) participants followed by 93 (35.9%) who conceptualised it as a medical condition and 68 (26.3%) who explained it as a social problem. The overwhelming majority of participants (n = 250, 91.9%) explained alcohol dependency as a psychological problem, followed by 14 (5.1%) and 4 (1.5%) who explained this condition as social and medical problems, respectively. Figure 6.2 below presents a visual summary of respondents’ recognition beliefs of the three disorders. For a clearer understanding, Table 6.6 below provides specific examples that participants used to explain different mental disorders. It becomes noticeable from this table that similar explanations for mental disorders were used across different disorders. For example, AIDS and TB were used as medical explanations for both depression and alcohol dependency, and financial difficulty was used as a social explanation across the three disorders.
Chi-square analysis shows significant differences between explanations of mental disorders and specific mental disorders (vignettes), thus showing that more participants in this study, c2 (8, N = 250) = 313.27, p < 0.001 were likely to conceptualise alcohol dependency as a psychological problem.
Table 6.5: Percentages of respondents’ recognition of the disorder
Category of
explanation
Disorder, N (%)
Total (%) Depression Schizophrenia Alcohol
Dependency
Medical 93 (35.9%) 10 (3.9%) 4 (1.5%) 107 (13.6%)
Psychological 97 (37.5%) 133 (52.0%) 250 (91.9%)*** 480 (61.0%)
Social 68 (26.3%) 85 (33.2%) 14 (5.1%) 167 (21.2%)
Traditional 0 (0.0%) 21 (8.2%) 0 (0.0%) 21 (2.7%)
Not indicated 1 (0.4%) 7 (2.7%) 4 (1.5%) 12 (1.5%)
Total 259 256 272 787 (100%)
*p < 0.05, **p < 0.01, ***p < 0.001
Figure 6.2: Recognition beliefs of the three disorders
Table 6.6: Examples used to explain mental disorders
Disorder Category of
explanation Depression Schizophrenia Alcohol dependency
Medical AIDS, fever, a gall problem, HIV positive, feeling unwell, being sick or ill, no appetite, physically sick, weight loss, TB, poor health, some illness troubling him, always tired, not feeling well, ill, life has come to an end maybe because of HIV
Feeling unwell, being sick,
some sort of an illness He is sick, suffering from health problems, TB, too much alcohol in the body, drinking too much because of AIDS
Psychological Abused, suicidal, being worried, sleeping difficulties, feeling miserable, feeling sad, low self- esteem, feeling depressed, shy, stressed, forgetful, mentally disturbed, depression
Affected badly by
grandmother’s death, becoming psychologically ill, losing the mind, beginning to be mad, being traumatised, depressed, emotional problems, not accepting death of a grandmother, mentally disturbed, being delusional, stressed, thinking too much, lost his mind, mental illness, change of behaviour,
Abusing alcohol, addicted to alcohol, alcohol intoxication, difficult to control alcohol drinking, drinking too much alcohol, facing
some depressing
situation, stressed, lost his mind, mentally disturbed, not well mentally
Social Family problems,
keeping a secret from others, failing to do daily tasks, not living within budget, unresolved family issues, not getting enough love from family, financial problems, no support from parents
Being lonely, community not treating this person well, family not supportive, financial problems, there is a big problem, isolating self from other people
There is a problem that forces this person to drink alcohol, starting an alcoholic lifestyle, personal problems, thinking too much about his problems, having no one to talk to, problems at work, financial problems
Traditional None Troubled by ancestors,
ancestors want a goat to be slaughtered, ancestral spirit entering this person, probably did things that people did not like, bewitchment, ukuthwasa,
None 10% 0%
20% 30%
40% 50%
60% 70%
80% 90%
100%
35,9
37,5 26,3
0,0 0,4
3,9
52,0
33,2
8,2
2,7 1,5
91,9
5,1 0,0
1,5
Alcohol dependency Schizophrenia Depression
6.2.1.1. Explanations of mental illness and demographic variables.
Chi-square analysis using age, gender and education variables showed no significant results with regard to explanations of mental illness. However, it is evident that participants of all age groups explained mental illness as psychological in nature. As depicted in Figure 6.3 below, about 33 (15.8%) participants between the ages of 35 - 49 used medical explanations for mental illness. Social explanations for mental illness were used more by participants over the ages of 65 (n = 8, 28.6%). Traditional explanations for mental illness were used more by participants between the ages of 50 - 60 (n = 3, 4.5%).
Figure 6.3: Explanations of mental illness according to age
Regarding gender, both male and female participants used psychological followed by social explanations for mental illness. However, medical explanations for mental illness were used by more females (n = 72, 14.7%), and traditional explanations were used more by males (n = 13, 4.4%). Figure 6.4 below provides a visual presentation of these results.
10% 0%
20% 30%
40% 50%
60% 70%
80% 90%
100%
13,8 59,9 21,5 2,7
2,1 15,8
62,7 19,1 1,9
0,5 9,1
62,1 22,7 4,5
1,5
3,6 64,3 28,6 3,6
0
18-34 35-49 50-64 65+