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8.3 Convergences and divergences from the findings
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practitioners and clinicians are aware of stress and somehow have a more or less similar understanding of it.
8.3.1.2 The benefits of the collaboration between the western and the african healing systems
The results of this study have revealed a consensus that exists in the views of both traditional health practitioners and clinical psychologists about the benefits of collaboration of the two systems. They have supported this assertion by indicating that the collaboration with help with, among others, a learning opportunity of one system and its way of doing things by another, the incorporation of spirituality in the holistic treatment of individuals with mental illness and the opportunity of referrals between the two systems for the improvement of care.
In support of this argument, the study that was conducted by Hlabano (2013) has found a positive outcome of collaboration between traditional health practitioners and clinical psychologists. From these findings, traditional health practitioners experienced transformation through the gain of knowledge, particularly on HIV-TB epidemiology through the training they received from allopathic health practitioners. The idea of strengthening traditional health practitioners‟ capacity and the collaboration of traditional health practitioners and allopathic health practitioners have also been found to be contributing positively to building a stronger health care system (Rainatou, Souleymane, Salfo, Mohamadi, Rene, Alimata & Sylvin, 2021). Mokgobi (2014) indicate the successes that collaborative initiatives had in other African countries, particularly as a result of favourable perceptions and attitudes that western health care professionals have towards traditional health practitioners.
8.3.2 Divergences
8.3.2.1 The causal factors of mental health conditions
The findings of the study have revealed that the aetiology of mental health conditions is viewed differently by both clinical psychologists and traditional health practitioners. The perception of the former is more in keeping with the biopsychosocial model as
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discussed in chapter five while the perceptions of the latter can be associated with African cultural and spiritual factors. The findings of the study by Belayneh, Abebaw, Amare, Haile and Abebe (2019) further associate other factors such as being female, lack of formal education, an age of 25 years and above, unemployed and living in extended families with the causes of schizophrenia. Another study by Worku and Shiferaw (2014) emphasizes social and psychological factors such as unemployment, mental health treatment defaults, substance use, socioeconomic problems, family conflict, loss of family members, poor social support, academic failure and repeated chronic illnesses among others as contributory factors to the aetiology of mental illness.
These factors are associated with the causation of schizophrenia, major depression disorder, brief psychosis and anxiety disorders.
In opposition to the views of clinical psychologists, traditional health practitioners held different perceptions about the causes of mental illness. The findings revealed that, in their view, mental illness may emanate from bewitchment, hereditary factors, the disregard of ancestral calling and other factors. These findings are supported by the results of the study by Sigida (2016) that has shown that being bewitched or cursed, smoking dagga or being involved in accidents, experiencing stressful life events and heredity is associated with the causation of mental illness. Ngobe (2015) supports this argument by maintaining that supernatural powers such as witchcraft, spirit possession, evil mechanisation, disregarding of ancestors and cultural customs, substance use, genetic predisposition and life stressors among others are responsible for the causation of mental illness. Monama and Basson (2015) agree with other authors who associated mental illness with ancestral dissatisfaction, further arguing that mental illness associated with ancestral dissatisfaction is not life-threatening, and health is restored once the relationship with the ancestors is mended through rituals and offerings.
8.3.2.2 The initial methods of enquiry
There have been some discrepancies that were revealed by the study about the methods of inquiry between traditional health practitioners and clinical psychologists.
According to Mokgobi (2014) diviners, a speciality within traditional health practice uses
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bones and the spirits of their ancestors in the process of diagnosing, prescribing medications for various physical, psychiatric and spiritual ailments. Schizophrenia and spiritual possession are also reportedly some of the conditions that they treat through the same processes. Haque, Chowdhury, Shahjahan and Harun (2018) have revealed in their study that was conducted in Bangladesh that the processes used by African traditional practitioners in their diagnostic and treatment process involve spirituality and communication with sacred spirits. Mothibe and Sibanda (2019) supported this argument by emphasising the traditional health practitioners‟ reliance on spirit possession, the use of divination bones and dreams as their main diagnostic methods On the other hand, according to Oluwatosin and Popoola (2018), clinical psychologists strive to assist their clients, whereas psychologists always have to understand their clients and their presenting concerns. Their level of understanding of their clients is determined by the depth of information they acquire from and about their clients through interviews, testing and assessment procedures. Segal, June and Marty, (2010) supports this assertion by arguing that it is the ability to conduct an effective and efficient clinical and diagnostic interview that determines the level of skill required in mental health practitioners. It is in this interview that the clinician can make some inferences about the client, further being able to determine intervention and the professional relationship that is required. Doyle (2016) adds to the argument by indicating that a clinical interview, generally a semi-structured interview and specific psychometric assessments form a comprehensive set that helps in addressing the referral question
8.3.2.3 The management of mental health conditions
Due to the utilisation of both the western and the African health modalities by service users, traditional health practitioners expressed positivity in the proposed collaborative initiative. They have also expressed their willingness to learn the operations of the western treatment modality for the benefit of their service recipients (Campbell-Hall, Petersen, Bhana, Mjadu, Hosegood, Flisher & MHaPP Research Programme Consortium, 2010). Even though traditional health practitioners welcome the idea of collaboration, and are willing and looking forward to it, they acknowledge the disregard
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of the authenticity of their services by allopathic health practitioners (Akol, Moland, Babirye & Engebretsen, 2018). The outcomes of the study by Solera-Deuchar, Mussa, Ali, Haji and McGovern (2020) also revealed that some traditional health practitioners welcomed the idea of collaboration with allopathic health practitioners as it would provide a platform for learning additional skills from the allopathic practitioners.
On the contrary, there seems to be some resistance from the allopathic practitioners about the collaboration (Campbell-Hall, Petersen, Bhana, Mjadu, Hosegood, Flisher &
MHaPP Research Programme Consortium, 2010). Although the patients understand the need for this collaboration, the resistance between the two systems gives rise to the need for both systems to get to an understanding of the possible institutionalisation of the traditional health system into the mainstream health system (Hardy, 2008). Oseni and Shannon (2020) further acknowledge the discrepancies between the two systems and state that the power struggle between the two systems may serve as a hindrance in the efforts to foster success in the collaboration of the two systems.