Explanatory models of mental illness in sub-Saharan Africa.

Knowledge of explanatory models of illness can be used to conduct cross-cultural epidemiological studies which, while being culturally sensitive, are also comparable with other studies. This paper reviews studies from sub-Saharan Africa which examine beliefs relating to mental illness. There is a rich diversity of beliefs, but within this diversity are a number of shared concepts. Thus, many African cultures do distinguish between the mind and body. The mind is cited as residing in the head as well as the heart or abdominal region. Spiritual causes are frequent explanations for mental illness. Though there are some similarities with biomedical concepts of mental illness, there are also significant variations. Psychotic illness is often recognized as 'madness' though emphasis is on behavioural symptoms rather than delusions; neurotic presentations are much more varied, often somatically defined and may not be considered to be mental illnesses at all. Emic psychiatric instruments need to be developed if future cross-cultural psychiatric research is to be both comparable and culturally valid.