The concept of mental disorder: an African perspective.

Abstract

The concept of mental disorder is determined by many factors, including historical context, cultural influence, level of scientific knowledge and capacity to carry out scientific enquiry, level of education certain circumstances, as well as many others. In putting together a method of classification of mental disorders, expert's duty is primarily that of capturing and remaining faithful to current level of knowledge subject, acknowledging that, a matter of time, some or all above factors could change to variable degrees, making what was clear as a mental disorder a few decades previously less clear next edition of classification system. In earlier editions of DSM, homosexuality was clearly categorized as a mental disorder and, by extension, a condition demanding or at least requiring medical treatment. In Western cultures, any suggestion that being gay or lesbian is anything but would now attract wrath of society. The situation Africa is quite opposite, and many Africans still view gay and lesbian people as mentally sick, because their sexual orientation is against order of nature. In this regard, one could view Africans as uncivilized or as holding a cultural belief that may or may not change course of time, much as it did Western countries. A similar but opposite position holds with respect to circumcision of women, a practice also described as female genital mutilation (FGM). There are still very strong pockets of Africans who practice FGM, presumably part as a cure for what Victorian physicians would have called clitoral orgasm, a condition then requiring preventive surgery. Many Africans defend cultural position with equal vigor to those who find it abnormal. There are those who would consider it a mental aberration to mutilate genitalia of young women and children. Anorexia nervosa is one of leading causes of morbidity and mortality adolescent girls Western countries. Crisp et al (1) found a prevalence of one severe case 200 girls independent schools, while, among girls aged 16 years and over, rate rose to one a hundred for severe cases. In Africa, condition is hardly known. Njenga and Kang'ethe (2) reported on a study Kenya and concluded that in a cumulative period of 320 years of practice, Kenyan psychiatrists had seen twenty cases of anorexia nervosa. Hulley et al (3) studied a sample of Kenyan and British female athletes and concluded that the effects of cul- ture were clear, women UK were more dissatisfied with their weight and shape and demonstrated significantly more eating disorder cases and associated psychopathology compared with Kenyan women. So, who is deluding who? Is refusal to eat food by spoilt white girls a disease or simple foolishness?. Trying to explain to hungry African mother and child that there are girls who die Western countries because they refuse to eat food goes beyond reason and logic and would not make sense as a mental disorder, and yet West, there is no room for such a discussion. Anorexia nervosa raises many questions regarding its cause and origins. Is it primarily genetic, or is it a social construct of a search of thinness as required of females Western societies, or is it a combination of both? Should we conclude that pursuit of a cultural belief, such as belief that to be thin is good, is evidence of a mental disorder because it causes mortality and morbidity? How much is desire for a thin body normal and how much of same is abnormal, and who decides anyway? Are these cultural or biological conditions? The issue of dimensional and categorical systems of classification comes sharply into focus. The African is however clear! When food is available, one must eat to full! Historically, African were believed to function as lobotomized Europeans (4), because of a smaller brain, and desire to free himself from French colonialist rule was evidence of a mental disorder, a fact taught French Universities 1960s (5). Few if any psychiatrists would now believe the as stated above, but 1950s and 1960s, these were facts as understood by well educated, well meaning men and women of science. It is therefore with this knowledge that we must approach subject of mental disorders with caution and humility, as we could, a generation or two, be viewed much as Carothers is now viewed by many. That said, however, we must pick up courage of our conviction and do what man has done through years, which is to create order from chaos, which is, after all, whole purpose and function of a classification system. Our duty to posterity, therefore, is to use best available tools, to carry out ordering process and, even if we get it wrong eyes of next generation, we will be able to stand firm and tall knowledge that no system of classification will remain unchanged for all time. It therefore stands to reason that concept of what is and what is not a mental disorder is a dynamic one, which will change from time to time, from culture to culture and, as case of homosexuality, from generation to generation.

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