The Ghanaian non-medical conceptualization of mood disorders

Abstract

•47• Chapter 5 The Ghanaian Non-Medical Conceptualization of Mood Disorders Sammy Ohene and Selassie Addom Depressive disorders constitute a great proportion of mental disorders that affect human beings worldwide. Unipolar and bipolar depression are responsible for a significant amount of morbidity and distress. Sadness as a state of feeling or mood has always been recognized as part of human emotions. Prolonged grief from loss or adversity, akin to descriptions of the depressive state can be found in ancient texts such as the book of Job in the Holy Bible. Whilst depression as a disease entity gained recognition in psychiatric literature, early Western psychiatrists doubted the occurrence of depression among Africans. Carothers (1947) categorically stated that depression did not exist among Africans. This view was seriously challenged by Fields (1955) who suggested that most of the women she studied in the then Gold Coast (now Ghana), who confessed to witchcraft, were exhibiting the self-accusatory symptoms often seen in depressed British women. Her belief was confirmed by Osei (2001) who found all 17 women in three shrines who had confessed to witchcraft, suffered from depression according to ICD-10 criteria. Fields, in fact, declared depression to be the commonest mental disorder among rural Akan women (Fields, 1960). Majodina and Johnson (1983) demonstrated that depression could be diagnosed among Ghanaians utilizing the same instruments as in Western cultures. Using the Schedule of Affective and Depressive Disorders (SADD), they found in a small study of 50 patients, 40 reported somatic symptoms like headaches, body heat and general bodily pains. Many respondents in the study also reported anxiety, tension, guilt, loss of interest, inability to enjoy themselves and sadness. In another study, Turkson and Dua (1997) utilized the MontgomeryAsberg Depressive Rating Scale (M-ADRS) with 131 depressed female patients at the Accra Psychiatric Hospital. They found a high level of •48• Chapter 5 somatic complaints like headaches (77.9 percent) and sleeplessness (68.7 percent), but relatively low incidence of psychological symptoms like sadness(13 percent) and pessimistic thoughts (20.6 percent), with 7.3 percent of the depressed women admitting to suicidal ideas. Perez and Junot (1998) stated that depression in Africans presented in a mode specific to African culture involving the individual and his relationship to others. In their view, the Western model of depression was irrelevant to Africa, but predicted that with increasing modernization , features of the disorder would tend to look more like, and have outcomes similar to those seen in Western countries. Depression is characterized by the presence of symptoms like sadness, loss of interest, loss of self-confidence, inappropriate guilt feelings as well as thoughts of death and suicide. Invariably, depressed individuals have disturbances of sleep, appetite and impaired concentration . Additionally in many populations including among Ghanaians, depressed individuals present with multiple bodily complaints. In fact, the somatic symptoms may be so overwhelming they may appear to obscure the core depressive symptoms. Whilst many of these symptoms may sometimes occur after adverse life events, a diagnosis of clinical depression is made only after persistence of the symptoms over a minimum of two weeks. (American Psychiatric Association, 2006; World Health Organization, 1992). Depression may be mild, moderate or severe in intensity and often runs a recurrent course. However, up to 20% of patients have depression that is chronic and non-remitting, (Thornicroft & Sartorious, 1993). To understand the effects of depression on the human being, it is helpful to think of depression as a disease that affects the brain and disrupts all cerebral functions. Depressed patients often have slowed heart rate and blood pressure leading to dizziness. Digestive secretions reduce causing constipation. Frequent complaints of various types of pain and irritability occur due to reduced pain and noise threshold. Slowed motor activity and muscle fatigue is often seen. Sleep and hormonal functions are disrupted leading to menstrual abnormalities in women for example. Higher cognitive functions such as memory, attention and reasoning capacity are all compromised. (Moussaoui, 2012). •49• The Ghanaian Non-Medical Conceptualization of Mood Disorders Depression occurs all over the world. Analysis of the Global burden of disease 2000 study, estimates the point prevalence of depression worldwide to be 1.9 percent in men and 3.2 percent in women. Over a twelve- month period, 5.8 percent of men and 9.5 percent of women would be expected to experience depression. Unipolar depression is the fourth leading cause of burden among all diseases. It is responsible for a huge proportion of working time...