Department of Anthropology, University College London, 14 Taviton Street, London, UK.
Transcult Psychiatry. 2012 Jul;49(3-4):438-60. doi: 10.1177/1363461512447070. Epub 2012 Jun 21.
Campaigns to scale up mental health services in low-income countries emphasise the need to improve access to psychotropic medication as part of effective treatment yet there is little acknowledgement of the limitations of psychotropic drugs as perceived by those who use them. This paper considers responses to treatment with antipsychotics by people with mental illness and their families in rural Ghana, drawing on an anthropological study of family experiences and help seeking for mental illness. Despite a perception among health workers that there was little popular awareness of biomedical treatment for mental disorders, psychiatric services had been used by almost all informants. However, in many cases antipsychotic treatment had been discontinued, even where it had been recognised to have beneficial effects such as controlling aggression or inducing sleep. Unpleasant side effects such as feelings of weakness and prolonged drowsiness conflicted with notions of health as strength and were seen to reduce the ability to work. The reduction of perceptual experiences such as visions was less valued than a return to social functioning. The failure of antipsychotics to achieve a permanent cure also cast doubt on their efficacy and strengthened suspicions of a spiritual illness which would resist medical treatment. These findings suggest that efforts to improve the treatment of mental disorders in low-income countries should take into account the limitations of antipsychotic drugs for those who use them and consider how local resources and concepts of recovery can be used to maximise treatment and support families.
在低收入国家扩大精神卫生服务的活动强调，必须增加精神药物的可及性，作为有效治疗的一部分，然而，几乎没有人承认精神药物存在局限性，而这些局限性是使用者所感知到的。本文考虑了在加纳农村，精神疾病患者及其家属对使用抗精神病药物治疗的反应，研究依据是对家庭经历和寻求精神疾病帮助的人类学研究。尽管卫生工作者认为，民众对精神障碍的生物医学治疗几乎没有什么认识，但几乎所有的受访者都曾使用过精神科服务。然而，在许多情况下，抗精神病药物治疗已经停止，即使在它被认为有有益效果的情况下，如控制攻击或诱导睡眠。令人不快的副作用，如乏力和长时间嗜睡，与健康的力量观念相冲突，被认为会降低工作能力。感知体验的减少，如幻觉，不如社会功能的恢复那么有价值。抗精神病药物未能实现永久性治愈，这也使人对其疗效产生怀疑，并加强了对精神疾病的怀疑，这种疾病会抵制药物治疗。这些发现表明，在努力改善低收入国家精神障碍治疗的过程中，应考虑到抗精神病药物对使用者的局限性，并考虑如何利用当地资源和康复概念，以最大限度地提高治疗效果并为家庭提供支持。
