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As can be seen from the examples above, there are positive views about the collaboration of traditional health practitioners and clinical psychologists in the management of mental health conditions. The only limitations that have been highlighted, which may need to be looked at in the implementation of the collaboration include the referral processes, location of operation and procedures. In their view, the collaboration will assist in the two systems complementing each other‟s limitations to the benefit of their service recipients as well as enhancing the holistic approach to treatment that acknowledges the spiritual element in human beings.
PART C: CONVERGENCES AND DIVERGENCES FROM THE FINDINGS
This study has managed to uncover the similarities and the differences in the formulations of mental disorders by clinical psychologists and traditional health practitioners, which will be presented below.
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“These are the classical symptoms of depression. If there is now two weeks or more with her presenting with the symptoms she is presenting with, then it is clearly a major depressive disorder and not any other mood disorder.” (Participant CP4)
According to the traditional health practitioners, the symptoms of the case that was stated above are typical of stress-related and depressive disorders. This is demonstrated by the extracts that are below.
“..and then when she comes to us, you will find that we say she has
“stress. Then I will tell her to go to the hospital. She must talk to them (hospital staff). Then when she comes back, and I check her, I will see that indeed this person has stress.” (Participant THP8)
“I may be troubled by my husband, taking me up and down until I have stress. If he does not change, it may no longer be stress, but change to become depression. (Participant THP7)
“By the way, “stress” can make you confused. The stress due to the separation with her husband, that makes her tired, stressed and a different person”. (Participant THP12)
This indication shows the similarity in the understanding and formulation of stress- related disorders by these practitioners from two diverse systems; the western and the African healing systems.
7.4.2 Western system as the most appropriate in the management of stress- related and depressive disorders
According to most participants, both clinical psychologists and traditional health practitioners, the symptoms that are illustrated in the first case as those of stress-related and depressive disorders are best managed through the western approach. In formulation by clinical psychologists, the best place for these people to be referred to is the hospital where they will be treated. They further believe that stress-related and
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depressive disorders are best treated through psychotherapy by psychologists and pharmacotherapy by doctors and pharmacists either in a hospital setting as inpatients or on regular visits to the hospital as outpatients. This is illustrated in the extracts that follow.
“Depression is mostly treated pharmacologically and also psychotherapeutically. Someone will be subjected to medication first of all to stabilize their mood. Then when their mood is stable, we are able to provide them with psychotherapy” (Participant CP2)
“..with depression, depending on the risk assessment, the patient might be kept as an inpatient if suicide risk is high, or patient would be treated as an outpatient with the support of family members in the event of a low risk and the mental status of the patient.”
(Participant CP5)
“..usually, my intervention also involves risk assessment. After my suicide risk assessment, if I find that the patient is of a high risk, I would admit and treat as an inpatient. If the patient is of a low risk, I would treat her as an outpatient.” (Participant CP3)
In addition to these assertions, traditional health practitioners also argued that the patient with symptoms similar to those in the first case of a stress-related and depressive condition is usually best treated through the western approach. They assert that when a patient with similar symptoms comes to them, once they realise that it is stress-related, they refer them to the hospital for treatment. They hold the view that the hospital personnel have the necessary expertise to manage such patients following which they can only treat the other related presented symptoms. These assertions are illustrated below.
“..and then when she comes to us, you will find that we say it is
“stress”. And when she is like that, we take her to the hospital. When a person has stress, they want to be put well (rearranged). I can try to
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put her well. But there will be where my abilities end.” (Participant THP8).
“..she has kgatelelo ya monagano, (oppression of the mind / stress).
The other thing is that conditions such as Mologadi‟s, we will not be able to help. They want her to go for “counselling”. She will sit down and explain everything that is happening to her so that she can be helped. Now with us, things like “counselling” we are not able to do.
From there we will consult the divination bones to find out if there are things that are remaining, which I can help her with.” (Participant THP11)
From the findings, it thus appears that there seems to be consensus in the understanding of stress-related and depressive conditions between clinical psychologists and traditional health practitioners. from these illustrations, the western health system is considered by both clinical psychologists and traditional health practitioners as the appropriate place where stress-related conditions can be managed.
7.4.3 The benefits of the collaboration between the western and the african healing systems
The results of the study have shown that there is consensus in the appreciation of the envisaged collaboration between the western and African healing systems by both clinical psychologists and traditional health practitioners alike. The participants have further reported the likely benefits of the collaboration between the two systems which includes the holistic approach in the management of mental disorders and the acknowledgement of spiritual factors that are involved in the causation of mental disorders. The collaboration may create space for either of the two systems to learn how the other system operates. Below are the extracts that support these assertions by clinical psychologists.
“..looking at our people, you know, our people have a different way of life.
We cannot rule out the issue of cultural or traditional issues. Even if we
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do, they must still go on with their beliefs, you know, their treatment with their traditional healers or their religious system. If they bring them under one umbrella, one group will have the opportunity to learn how one group does their things vice versa. They might come to a stage where they work well together. Maybe that might help.” (Participant CP1)
“Well, I think it is a very good idea. I have already spoken about the biopsychosocial perspective, and I have realized that the perspective has been missing an element, that is the spiritual element. There are authors who are currently coming up with what is called the extended biopsychosocial model which then encompasses the spiritual element with our patients. That is, if we treat these patients from the three domains, we might miss out on the spiritual domain which may be a major contributing factor on how people interpret what they are going through. Therefore, I do not have any problem with the collaboration.”
(Participant CP2)
“Psychology heals the mind and behaviour challenges which do not include spiritual problems. Referral to traditional healers will resolve the spiritual problems. There is therefore a need to work on research together which will help to understand conditions which have been difficult to manage, in a holistic way. Challenges will be found, but specific plans and rules will reduce them. There are some practitioners who have started to address these challenges, who are already referring.”
(Participant CP6)
In addition to the arguments by clinical psychologists, traditional health practitioners that were consulted in the study seem positive about the idea of the collaboration of the two systems with the idea of enhancing the management of mental disorders with particular consideration of the patients‟ spiritual needs. In some cases, as they argue, their inclusion in the management of mental disorders may compensate for the shortfalls of
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the western healing system in the management of patients. This is supported by the illustrations below.
“We wish the collaboration can happen because there are many people in hospitals who do not require the western medications but the African traditional medicines in their treatment.” (Participant THP7)
“We will be happy about that. Because, even though we know that there are certain conditions that can best be treated at the hospital, there are those which cannot be treated at the hospital, which are best treated by us. Then, if we work together, we can help the nation.” (Participant THP8)
The findings seem to suggest that both systems concur with the idea of collaboration and hope for the better management of patients in a more holistic manner that also addresses their spiritual domains.