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Vorgelegt Von Afaf Gadh Eldam Geb TENDENCY OF PATIENTS TOWARDS MEDICAL TREATMENT AND TRADITIONAL HEALING IN SUDAN Dissertation zur Erlangung des Grades einer Doktorin der Psychologie an der Carl von Ossietzky Univerität Oldenburg FAKULTÄT IV Human- und Gesellschaftswissenschaften Institut für Psychologie Abt. Gesundheits- und Klinische Psychologie Vorgelegt von Afaf Gadh Eldam geb. am 3.11.1975 in Khartoum/Sudan Betreuender Gutachter Prof. Dr. Wilfried Belschner 2.Gutachterin PD Dr. Petra Scheibler Oldenburg, Juni 2003 Table of Contents ABSTRACT...........................................................................................................................9 Dedications...........................................................................................................................11 Acknowledgements..............................................................................................................12 1.INTRODUCTION AND RESEARCH FOCUS................................................................14 1.1 Background to traditional medicine ..........................................................................14 1.2 Background of the study.............................................................................................15 1.3 Research question.......................................................................................................17 1.4 Problem statement......................................................................................................17 1.5 Objective of the research............................................................................................18 1.6 Hypotheses of the research.........................................................................................19 1.7 Focus of the research..................................................................................................19 1.8 Set-up of the thesis.....................................................................................................22 2.Literature review...............................................................................................................24 Introduction..................................................................................................................24 2.1 History of psychiatry..................................................................................................24 2.2 History of psychiatry in Sudan...................................................................................36 2.3 Traditional medicine...................................................................................................37 2.3.1 History of traditional medicine in Islamic countries..........................................38 2.3.2 Traditional medicine and its different types.......................................................40 2.3.3 Traditional healers..............................................................................................47 2.4. Therapeutic options...................................................................................................49 2.4.1 Social and cultural aspects of medical systems..................................................49 2.4.2 Health care systems............................................................................................50 2.4.2.1 The popular health care system....................................................................50 2.4.2.2 The folk health care system..........................................................................52 2.4.2.3 The professional health care system.............................................................54 2.4.3 Patients: Therapeutic network............................................................................56 2.5. Belief systems in Sudan.............................................................................................57 2.5.1 Social belief.........................................................................................................57 2.5.2 Religious belief....................................................................................................59 2.5.3 Cultural beliefs of reproductive health care.......................................................61 Mushahra......................................................................................................62 2.6 Country experience and official policies....................................................................65 2.6.1 Other countries policies .....................................................................................66 2.7 Spiritual dimension and mental health.......................................................................67 2.7.1 The fact................................................................................................................68 2.7.2 Ideological approaches.......................................................................................68 2.7.3 The integrated model..........................................................................................69 2.7.4 The religious search............................................................................................69 2.7.5 The Islamic approach..........................................................................................73 2.8 Collaborations between traditional and modern medicine.........................................74 3.METHODOLOGICAL FRAMEWORK...........................................................................76 Introduction..................................................................................................................76 3.1 Operationalisation of the conceptual framework.......................................................76 3.2 Methodologies of studying patients' tendency towards health systems......................77 3.2.1 Quantification and qualitative experience..........................................................77 3.2.2 Qualitative methods............................................................................................78 3.2.2.1 Approaches to qualitative data.....................................................................79 3.2.2.2 Analysis of qualitative content.....................................................................79 3.2.3 Reliability and validity........................................................................................80 3.3 Variables and measurements using the structured questionnaires..............................80 3.3.1 Variables and measurements included in the patients’ questionnaire...............80 3.3.2 Variables and measurements included in the practitioners’ questionnaire.......84 3.4 Data collection............................................................................................................85 3.4.1 Research area.....................................................................................................85 3.4.2 Choice of the research area................................................................................86 3.4.3 General description of the three hospitals and the seven masseds, where the samples of this study were selected and the research was done..................................87 3.5 Sampling and interview procedure.............................................................................91 3.5.1 Patients' sampling and interview procedure.......................................................93 3.5.2 Practitioners sampling and interview procedure................................................95 3.6 Summary.....................................................................................................................95 4 Doctor-Healer.Interaction: Results....................................................................................97 4.1 Mental Disorders: The Psychiatric Doctors’ Perspective...........................................97 Introduction..........................................................................................97 4.1.1 Characteristics of the sampled psychiatric doctors............................................98 4.1.2 An aetiology and causes of mental disorders......................................................98 4.1.2.1 Concept of mental disorders ........................................................................99 4.1.2.2 Theories of mental disorders cause............................................................100 4.1.2.2.1 Precipitating causes.............................................................................100 4.1.2.2.2 Predisposing factors............................................................................102 4.1.2.3 Summary.....................................................................................................104 4.1.3 Classification of mental disorders ...................................................................105 4.1.3.1 Purpose of classification.............................................................................106 4.1.3.2 System of classification..............................................................................106 4.1.3.3 Classes of mental disorders........................................................................109 4.1.3.4 Summary.....................................................................................................114 4.1.4 Assessment and diagnosis of mental disorders.................................................115 4.1.4.1 Concept of clinical assessment and diagnosis ...........................................115 4.1.4.2 Purpose of assessment
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