Traditional and Modern Psychiatry: a Survey of Opinions and Beliefs Amongst People in Plateau State, Nigeria

Some aspects of traditional psychiatry were investigated in a sample of 80 Nigerians, varying in terms of sex, educational level and locality (rural or urban). The results suggest that at titudes towards traditional healers are generally favourable, that mystical causes of madness are the most popular; and that traditional healers are felt to have an important role to play in treating mad people. These conclusions apply regardless of educational level or locality. What people consider to be causing an abnormal behaviour is determined by their knowledge and belief systems. Our knowledge and belief systems are acquired through day to day infor mal education and, if one attends school, through formal education. It has been suggested that for African villagers, all diseases and misfortunes are religious experiences. Indeed, tradi tional informal education in Nigeria appears to teach people that psychiatric disorders are often caused by mystical means, which include spirit possession, witchcraft, black magic (often referred to as 'poisoning') and cursing. For example, a man who was hallucinating claimed it was because someone he owed money had cursed him; and a seriously depressed woman thought she was that way because her mother-in-law had gone to a magician to make black magic against her. It would seem reasonable to suppose that beliefs in mystical causes of psychiatric disorders would be strongest amongst uneducated people and those living in the more isolated rural areas. In contrast, people who have attended formal schools, or who are living in urban areas, might be expected to have more knowledge about other possible reasons for psychiatric disorders, e.g. medical, sociological or psychological. When a Nigerian is exhibiting a psychiatric disorder, he may be taken either to a medical doctor or to a traditional healer for treatment. Since the traditional healer may be considered the expert in mystical matters, and the medical doctor the expert in medical and psychological matters, one might expect some consistency between the perceived causes of psychiatric disorders and the type of treatment sought. Thus, if the disorders are seen as basically due to the intervention of spirits or to black magic, then the traditional healer's help would be ex pected to be enlisted. But if they are seen as caused by other means such as medical ones, it might be supposed that the aid of a medical doctor would be sought. However, it is possible that this analysis is somewhat of an oversimplification, for the following reasons. First, people may simultaneously hold conflicting beliefs about the causes of a psychiatric disorder. Second, regardless of one's beliefs, treatment may be sought because of its familiarity and availability. And third, people may simply have more confidence in one type of treatment over another. When considering psychiatric disorders, there is much scope for conflicting, inconsistent and confusing beliefs and actions. This is probably due partly to the fact that most abnormal behaviours are such that it is not possible to provide a single explanation or treatment for them. With this in mind, the present study was designed to investigate beliefs amongst a group of Nigerians about the causes of madness, and the types of treatment considered appropriate for a mad person.