The influence of culture on mental illness has been the subject of considerable academic investigation and debate in recent years. This debate has provoked concerns about the validity and reliability of older methodologies which emphasised either universal characteristics of disorders which were heavily biased towards Euro-American systems, or the culturally relativist approach which saw psychological disorders as products largely of their own culture. The "new" cross-cultural psychiatry proposed that the integration of ethnographic and epidemiological techniques be required to enable a culture sensitive psychiatric model to emerge. This monograph describes a series of research studies conducted in primary care in Harare, Zimbabwe, focusing on the most frequent of all psychological disorders, Common Mental Disorders (CMD). The four consecutive studies are unique in several respects, most notably, the involvement of both biomedical and traditional health care providers at all stages, the development of an indigenous measure of CMD for use in epidemiological investigations, the examination of the relationship between local and biomedical models of psychological disorder and the sociodemographic and economic risk factors for CMD. The experiences and findings of these studies provide new directions in our understanding of the contribution of culture to the presentation, assessment, classification and risk factors for CMD in primary care in an urban African setting. The methodology used also sets out a model for epidemiological research in other areas of mental health in different cultural settings.
Part I: Introduction. The "New" Cross-cultural Psychiatry. Common Mental Disorders (CMD). Culture and Common Mental Disorders. Assessment of Mental Disorders Across Cultures. Epidemiology of Mental Illness in Sub-Saharan Africa. Explanatory Models of Mental Illness in Sub-Saharan Africa. The Study Setting. Medical Pluralism in Zimbabwe. Part II: The Studies. Objectives. The Ethnographic Study. The Phenomenology Study. The Shona Symptom Questionnaire Study. The Case-Control Study. Part III: Results of the Studies. Concepts of Mental Illness of Primary Care Providers. Symptoms and Explanatory Models of CMD. Development of the Shona Symptom Questionnaire. Relationship Between Biomedical and Indigenous Models of Illness. Prevalence, Associations, and Risk Factors of CMD. Part IV: Discussion. Limitations of the Research Methodology. Presentation and Assessment of CMD. Relevance of Indigenous Models of Illness. Epidemiology of Common Mental Disorders. Directions for Future Research. Part V: Conclusions.