INTRODUCTION
This book is designed to give voice to Jamaican psychiatric patients who are being treated in medical facilities in urban and rural Jamaica, that use Western biomedical approaches to treat mental illnesses (Lindo et al. 2006).
The work is based on research I conducted between 2005 and 2007 in pursuit of a doctorate in clinical psychology at the University of the West Indies, Mona, Jamaica. During this period, I operated between an urban hospital with psychiatric inpatients and outpatients, and a rural outpatient clinic at a rural hospital. The process outlined here is intended to assist others who have an interest in broadening their vision of the approach to treatment models, particularly as these relate to the use of traditional methods, alongside Western biomedical techniques.
Some 97 per cent of the population of Jamaica is of partial or total African descent (Encyclopedia of the Nations 2007). It is therefore understandable that psychiatric patients would hold on to their African heritage as this impacts on their experiences of their mental illness. Wedenoja (1983) has noted the paucity of literature on the culture of the people and their cultural worldview, beliefs and values. The African heritage has immediate relevance to how patients cope with their “behaviour, symptomology and psychodynamics” (Wedenoja 1983, 254–55). He implored researchers to examine folk healers, cults, sects and illness beliefs so as to better inform practice. A tension exists between the Western biomedical approach being used to treat psychiatric patients and the views of the patients who have an endemic belief in traditional rituals and cures that originate in Africa. My desire to understand patients’ experiences on the ward and Wedenoja’s imploration for more research to be done in the area, have been the driving force behind my journey.
The purpose of my work and therefore of this book, is to give voice to the patients’ understanding of themselves as psychiatric patients in these urban and rural contexts. I value the patients’ stories in uncovering this understanding, as only they can reveal the meanings of this lived experience. Grasping the themes that are present in their understanding is useful, as this information can be used to complement Western biomedicine and help us as practitioners to better meet the needs of the patients.
The stories of the six participants on whom the book focuses reflect the lived experience of their illnesses, in the context of the Western biomedical setting of the psychiatric ward and outpatient clinics at these two hospitals. I examine the patients’ perception of their experiences and that of their practitioners. In becoming storytellers, the patients are finally given the opportunity to share their lived experiences of mental illness, allowing others to see what lies beyond the label of “major depressive, bipolar or a paranoid schizophrenic”.
Chapter 1 highlights the background to the patients’ perception of the experiences and the perception of the practitioners’ experience of patients’ illnesses. It gives a description of my journey as a researcher, gathering information from the storied lives of these participants and examining any gaps in the existing research by using the research questions I formulated. The reader will gain an understanding of the direction that I have decided to take. My quest is to be the narrator, giving voice to the patient’s experiences, and through the use of hermeneutic phenomenology, learn about the intersubjective truth that exists between this narrator and the storyteller. The terms used throughout the research are operationalized so as to give clarity to the reader.
Chapter 2 consists of the extensive work that has been done in the area. It explores the position of the patient and that of the practitioner. In this chapter, I examine work done by other researchers that speak to the importance of highlighting the patients’ understanding of their experiences and the value of listening to their stories. It examines how the historical and cultural beliefs in Western and traditional medicine can impact on the causes, explanation and treatment of mental illnesses. The relationship that psychiatric patients have had with Western and traditional medicine is examined. The work done in this chapter is placed within the theoretical framework of the Common-Sense Model (Leventhal, Brissette and Leventhal 2003) and Goffman’s (1959) theory of the total institution.
Chapter 3 gives an explanation of the different phases of the study from the first phase where I gain entry, to the final phase where I collect the data from both practitioners and patients. The quantitative approach marked only the beginning of the quest to further understand and uncover the truth, as it existed for each patient. The trends and major themes that emerge from the interviews are explained as well as any additional or unexpected themes which show up.
In chapter 4, I share the perspectives of sixty psychiatric patients regarding their specific diagnosis, what they believed the problem to be, whether or not it aligned with the treatment they received and what they were hoping to gain from the practitioners. This chapter also highlights thirty Western practitioners’ views on traditional medicine and their perspectives on their patients’ desire to speak about and access this type of care.
In chapter 5, I share in the intersubjective truths of the participants, exploring the true essences of their stories.
Finally, in chapter 6, the findings from both the quantitative (sixty psychiatric patients and thirty Western practitioners) and qualitative (six psychiatric patients) are triangulated and discussed as these relate to previous research in the area. The way forward is also presented.
The findings of this study are limited to the specific social and cultural contexts of Jamaican psychiatric wards and could not be generalized to other patients with other stages or types of disorders. As the patients were on the psychiatric ward, interviews had to be done in a timely manner when individuals were sufficiently cogent to participate. There were interviews that had to be discarded for several reasons, including the emotional and psychological state of the individuals while discussing issues that were difficult, the psychiatric routine, administration of medication, the discharge rates or patients not turning up for appointments, which meant that the interviews could not be completed. Also, some patients gave substantial information about the traditional mode of treatment but did not feel comfortable having this included in the study although they had signed an informed consent. The results were therefore limited in the number of patients that were included. Because of the focus of the study and the scope of the data collected, the vignettes, open-ended questions and other qualitative data collected from the instruments were not included here as those fall beyond the scope of this study. They form part of another work.
