Patel V, Musara T, Butau T, Maramba P, Fuyane S
Department of Psychiatry, University of Zimbabwe Medical School, Harare.
Psychol Med. 1995 May;25(3):485-93. doi: 10.1017/s0033291700033407.
The Focus Group Discussions (FGD) described in this paper are the first step of a study aiming to develop an 'emic' case-finding instrument. In keeping with the realities of primary care in Zimbabwe, nine FGD were held with 76 care providers including 30 village community workers, 22 traditional and faith healers (collectively referred to as traditional healers in this paper), 15 relatives of patients and 9 community psychiatric nurses. In addition to the general facets of concepts of mental illness, three 'etic' case vignettes were also presented. A change in behaviour or ability to care for oneself emerged as the central definition of mental illness. Both the head and the heart were regarded as playing an important role in the mediation of emotions. The types of mental illness described were intimately related to beliefs about spiritual causation. Angered ancestral spirits, evil spirits and witchcraft were seen as potent causes of mental illness. Families not only bore the burden of caring for the patient and all financial expenses involved, but were also ostracized and isolated. Both biomedical and traditional healers could help mentally ill persons by resolving different issues relating to the same illness episode. All case vignettes were recognized by the care providers in their communities though many felt that the descriptions did not reflect 'illnesses' but social problems and that accordingly, the treatment for these was social, rather than medical. The data enabled us to develop screening criteria for mental illness to be used by traditional healers and primary care nurses in the next stage of the study in which patients selected by these care providers on the grounds of suspicion of suffering from mental illness will be interviewed to elicit their explanatory models of illness and phenomenology.
本文所述的焦点小组讨论（FGD）是一项旨在开发“主位”病例发现工具的研究的第一步。为了符合津巴布韦初级保健的实际情况，我们与76名护理人员进行了9次焦点小组讨论，其中包括30名乡村社区工作者、22名传统治疗师和信仰治疗师（本文统称为传统治疗师）、15名患者亲属和9名社区精神科护士。除了精神疾病概念的一般方面外，还展示了三个“客位”病例 vignettes。行为或自我照顾能力的变化成为精神疾病的核心定义。人们认为头脑和心灵在情绪调节中都起着重要作用。所描述的精神疾病类型与关于精神病因的信仰密切相关。愤怒的祖先灵魂、恶灵和巫术被视为精神疾病的有力病因。家庭不仅承担照顾患者和所有相关财务费用的负担，还会被排斥和孤立。生物医学治疗师和传统治疗师都可以通过解决与同一疾病发作相关的不同问题来帮助精神疾病患者。所有病例 vignettes 在其社区的护理人员中都得到了认可，尽管许多人认为这些描述没有反映“疾病”，而是社会问题，因此，对这些问题的治疗是社会性的，而不是医学性的。这些数据使我们能够制定精神疾病的筛查标准，供传统治疗师和初级保健护士在研究的下一阶段使用，在该阶段，将对这些护理人员因怀疑患有精神疾病而挑选出的患者进行访谈，以引出他们对疾病的解释模型和现象学。
