Chapter 2 Literature Review Literature Review
3.3. African Indigenous Views of Illness and Mental Illness
3.3.4. Views on aetiology
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.
inclined explanations stems from the view that life force can be manipulated.
Eagle (2005) agrees and writes that in most African societies, if misfortune befalls an individual the search for causality generally excludes the possibility of such an act being random or fortuitous. To substantiate this view, Nwoye (2015) also asserts that when a sudden or strange illness befalls a family member, the tendency within the Afrocentric paradigm is to see such an illness as carrying a hidden message or meaning that must first be decoded before a decisive solution to achieving a cure can be found. This desire for explanations in the African worldview forms a fundamental human drive.
The African conceptualisation of sickness is generally attributed to causes beyond the parameters of the patient’s illness and is either not or very rarely considered to be simply due to some physical disorder or malfunctioning of the body (Seape & Drennan, 2007). It is important to state that this does not by any means imply that the African worldview denies psychosocial causal explanation.
Nwoye (2015) makes it clear that, instead, the African worldview recognises the possibility of the origin of an illness arising not only from the illness of the body, or that of the mind, or social context, but also, at times, originating from the spiritual or other life forces. Disease causation is often understood by Africans through the holistic explanatory model based on the belief that harmony must exist within the body and between people and the physical environment (Tjale, 2004). In line with Honwana’s (2001) definition of health, as previously stated, Matoane (2012) posits that from an indigenous African perspective, illness hinges on the interrelational element between different parts of the life forces. According to this author, a harmonious relationship between and within these forces signifies a state of wholeness and good health, while disharmony between any of the three levels leads to a state of disintegration, either within the individual or between individuals.
Consistent with teleological orientations, Peu et al. (2001) state that African people who view illness from an indigenous point of view believe that illness can be intentionally caused by a malevolent agency which has control over supernatural (mystical) forces. A cause is described as a thing, person or set of circumstances that give rise to a condition of ill-health (Herselman, 2004). The aetiology of the disease is also considered a supernatural phenomenon governed by a hierarchy of vital powers beginning with a most powerful deity followed by lesser spiritual entities, ancestral spirits, living persons, animals, plants and other objects, and disharmony between these vital powers can cause illness (Kale, 1995).
When an illness strikes, it also prompts the search for causality, including why the person has been affected in a particular way at a particular time (Eagle, 2005).
Illness and sickness is often attributed to three major influences on the human condition, namely: a supreme being (God); the ancestors (spirits of the dead); and witches (Shizha & Charema, 2011). The underlying idea, according to Ramose (2005), is that there must be a correlation between the illness experienced in the body and the disturbance of harmony and balance between the body and the ancestors and/or God.
There is literature to support the notion that Africans traditionally believe that practitioners of witchcraft and sorcery can also cause certain kinds of illness (Peu et al., 2001). For example, the Shona and the Zulu people believe that varoyi and abathakathi (wizards and witches, respectively), may cause an illness through the use of their destructive and evil spirits (Shizha & Charema, 2011). Sorcery is believed to occur through procedures such as uttering spells, manipulating medicines to poison people, or by obtaining body parts such as nail parings and hair clippings, and mixing them with medicines and administering them to victims to harm them (de Villiers & Herselman, 2004). Furthermore, Straker’s (1994) writing adds that, traditionally, Africans believed that illness and distress may also be caused not only by persons in this world but also by those in the world beyond. As previously stated, the ancestors may withdraw their protection should they not be attended to (Berg, 2003a), or if the patient or his/her family members have committed an immoral act such as incest (Mzimkulu & Simbayi, 2006). To support this view, Buhrmann and Gqomfa (1981) state that it is believed that the ancestors usually express their displeasure by withdrawing their protection, thus exposing the living kin to the powers of evil which can then cause misfortune, unhappiness, sickness and even death. Therefore, according to these authors, if disturbing, puzzling, painful events or illness occur in the life of an individual or a family, it is regarded as an indication that the equilibrium between the living and the deceased has been disturbed. Aetiology, from traditional views, therefore, helps people ‘make sense’ of what is happening to themselves or to others (Herselman, 2004).
Regarding mental illness, firstly, it is important to note that it should always be borne in mind that in terms of worldviews, there are two main types of health conventions or social constructions of illness. These are: 1) the holistic approach
based on indigenous belief systems; and 2) the so-called modern approach that is located within a Western medical paradigm (Ross & Deverell, 2010). However, it has already been stated that the review presented here will be limited to the focus of this chapter, which is the cultural or traditional perspective. According to indigenous African beliefs, mental illness can be caused by conflict between an individual and the ancestors or by God, a witch, spirit or sorcerer (Ross & Deverll, 2010). To be more specific, Sow (1977, cited in Botha & Moletsane, 2012) provides the following examples of illnesses cause by different conflicts: a conflict between individuals and their ancestors which leads to serious chronic psychotic states;
conflict between the person and the family which leads to organic illness and conflict between the person and the community which leads to more benign organic and psychosomatic illnesses, as well as neurotic states. Herselman (2004) also reports that the possibility of inflicting mental illness upon oneself is also recognised in an African worldview. According to this author, from an indigenous African view, sleeplessness, depression, irrational behaviour or mental distress are possibly caused by a guilty conscience about harm caused to others. For example, an individual may experience guilt for a prolonged period for causing someone, intentionally or unintentionally, physical or psychological pain.
Abbo (2011) reports that a few studies have shown that some traditional healers in Africa, for example the Yoruba native leaders, use both aetiological and symptom logical concepts, mostly interchangeably, to describe psychotic illness.
According to this author, the most common diagnostic label is referred to as
‘were’, which refers to a person who is chronically psychotic, careless in dressing, vagrant in behaviour, talks irrationally, and suffers from auditory and visual hallucinations. While ‘were’ denotes chronic psychosis in Yoruba, in South Africa the equivalence seems to be amafufunyana. It is interesting to note that, according to Mzimkulu and Simbayi (2006), similar traditional conceptualisations and beliefs about causes of psychosis exist in cultures found in other African countries. These authors report that the most common types of spirits that are thought to cause psychosis are known as ‘ngozi’. This clearly shows that mental illness is a socially constructed phenomenon in an African context.