Different explanations of mental illness in Jamaica: can we combine the traditional and biomedical to heal body and spirit?

  Gordon Town Health Centre
Gordon Town Health Centre, Kingston, Jamaica. Image: H. Schwartz

Today is World Mental Health Day [October 10th 2016], whose theme is "psychological first aid and the support people can provide to those in distress". An apt moment to publish the insights into Jamaican community mental health of our summer intern, Harpur Schwartz. In her opinion piece below, Harpur addresses the role of traditional health beliefs in expressing mental distress, and identifies a role for traditional medicine in supporting recovery.

Have you been hearing any voices by Harpur Schwartz, edited by Wendie Norris

I could barely make out his answer to the question, “Have you been hearing any voices”, as he was speaking an English based creole language commonly known as Patwa. From what I could understand, spirits come to him during the night and tell him the ‘truth’ of the world around him. He said that his madness was caused by a spirit or Obeah. It was clear that this man had a mental illness that he strongly believed was caused by supernatural factors. The psychiatrist in the room asked patient number 23, “But you understand these voices are not real, right?” His response was “Yes”. Satisfied with his answer, the psychiatrist administered his medicine and handed him his appointment card without a second thought.

While working with the mental health services unit at the Gordon Town Health Centre in Kingston, I noticed a pattern to each patient’s appointment: the patient would be called in by number, he or she would be asked a series of questions about mood and symptoms, an injection of medicine was always administered, and the patient would leave with an appointment card stating the date for when he or she should return the following month. There was a rhythm to this process, one with emphasis placed on drug administration.

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Angry and sad at Xmas: victims of adolescent bullying

FACES_Tiny_with_creditThere have been far too many stories recently of desperate teenagers committing suicide, and an unknown number of families today will be reeling from the discovery that their teenager is seriously self-harming because of bullying. Mobile phones and social networking sites have exacerbated an age-old problem so that there is nowhere to hide. 

Poison-pen letter writers are no longer adults in detective stories. They have been brought right up-to-date, and are alive and well reincarnated in teenagers. Incapable of empathy with their victim, remote bullying via texts, phones, videoclips and the internet makes it so easy & so much more devastating, reaching  beyond a school, covering entire towns & counties,  and as its not face-to-face, even less likely for the teenage bully to empathise.

There also seems to be more serious consequences to bullying these days:  beyond loss of confidence, our society is experiencing a rise in self-harming and suicide amongst teenagers. Is it because teenagers these days are so interested in relationships & celebrity, following soaps avidly, that they are posting the minutiae of their lives online for all to see as if they were part of a soap opera?

What is the research evidence available to understand what’s going on?

I took a look and discovered to my horror that being bullied in primary schools can set you up to self-harm when you are a teenager in your next school.  Being Bullied During Childhood and the Prospective Pathways to Self-Harm in Late Adolescence ,  was co-authored at Warwick University, UK. Their press release reveals that 16.5% of 16-17 year olds had self-harmed in the previous year, and 26.9% of these did so because they felt as though they ‘wanted to die’. Those who were subjected to chronic bullying over a number of years at primary school were nearly five times more likely to self-harm six to seven years later in adolescence.[see press

Furthermore, other research shows being both the bully and the bully-victim is linked to an increased risk of suicide or mental illness. I also discovered that self-harming is a very difficult habit to break.

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