University of Nebraska - Lincoln DigitalCommons@University of Nebraska - Lincoln Public Access Theses and Dissertations from the Education and Human Sciences, College of (CEHS) College of Education and Human Sciences Spring 4-8-2015 Perceptions of psychological distress and treatment among the Ovambo in Northern Namibia: A multiple method study Theodore T. Bartholomew University of Nebraska - Lincoln, [email protected] Follow this and additional works at: http://digitalcommons.unl.edu/cehsdiss Part of the African Studies Commons, Counseling Psychology Commons, and the Multicultural Psychology Commons Bartholomew, Theodore T., "Perceptions of psychological distress and treatment among the Ovambo in Northern Namibia: A multiple method study" (2015). Public Access Theses and Dissertations from the College of Education and Human Sciences. 226. http://digitalcommons.unl.edu/cehsdiss/226 This Article is brought to you for free and open access by the Education and Human Sciences, College of (CEHS) at DigitalCommons@University of Nebraska - Lincoln. It has been accepted for inclusion in Public Access Theses and Dissertations from the College of Education and Human Sciences by an authorized administrator of DigitalCommons@University of Nebraska - Lincoln. PERCEPTIONS OF PSYCHOLOGICAL DISTRESS AND TREATMENT AMONG THE OVAMBO IN NORTHERN NAMIBIA: A MULTIPLE METHOD STUDY By Theodore T. Bartholomew A DISSERTATION Presented to the faculty of The Graduate College at the University of Nebraska In Partial Fulfillment of Requirements For the Degree of Doctor of Philosophy Major: Psychological Studies in Education (Counseling Psychology) Under the Supervision of Professor Michael J. Scheel Lincoln, Nebraska April, 2015 PERCEPTIONS OF PSYCHOLOGICAL DISTRESS AND TREATMENT AMONG THE OVAMBO IN NORTHERN NAMIBIA: A MULTIPLE METHOD STUDY Theodore T. Bartholomew, Ph.D. University of Nebraska, 2016 Adviser: Michael J. Scheel The biomedical model of psychiatric care and psychological distress has dominated the Western world’s approaches to psychological treatment (Wampold, 2001; 2007). Moreover, psychology has, historically, been exported wholesale beyond its Western base of development. Such exportation lends itself to the overshadowing of local psychologies in favor of dominant, universal psychology. Imposition of Western theory is further true in applied psychology insofar as how clinical practice and mental illness are defined. This study intended to understand the nature of psychological distress and treatment in a non-Western context – the Ovambo people of Northern Namibia. Little is known about the perceptions of mental illness in this context. A two-phase qualitative design was used to explore Ovambo beliefs about and experiences of mental illness and its treatment. The first ethnographic phase (N = 22) was analyzed in two portions – one thematic analysis for general Ovambo participants and a second for practitioners. Six themes, (a) Where Madness Comes From: Witches, Sickness, and Other Explanations, (b) Omananamwengu and Eemwengu, (c) The Role of Families and Communities for Omananamwengu and Distress, (d) Witchdoctors, Frauds, and Odudu, (e) Counseling, Medicine, and Religion as means for Healing, and (f) Seeking Care: Decisions Based on Belief and Need, for the general Ovambo were identified, and four themes were identified in the data from practitioners, (a) Mental Health Services in the North, (b) Traditional Beliefs and Healing, (c) Explaining Mental Illness through Modern and Traditional Lenses, and (d) Integration of Treatment Modalities. An ethnographically contextualized multiple case-study followed in which four cases were sampled to understand experiences of mental illness beliefs identified in the ethnographic phase. Four cross-case themes emerged: (a) Symptoms of Mental Illness, (b) Marginalization and Omananamwengu, (c) Family Roles in Treatment, and (d) Belief in Treatment. The results describe culturally-pertinent psychological symptoms and the perceptions of treatment within Ovambo culture. Understanding beliefs about mental illness in Ovambo culture may help shape integration of tradition and Westernized psychological practice in meaningful and helpful ways. These results also add to the growing international literature base in Counseling Psychology and highlight the need for attention to within- culture perspectives of mental health. i Acknowledgements Accomplishing this dissertation project and my training was not an individual endeavor. I would not have completed this work without the help of several people, to whom I am immensely thankful. The members of my doctoral committee have been an exceptional source of support and guidance throughout my academic progress. Cherry, you have provided a great deal of support to me in writing letters of recommendation that ultimately contributed to my ability to accomplish this research. Ian, when I first met with you to discuss you joining my committee, you offered a definition of health based on human adaptability. This perspective has shaped my approach to the intersection of culture and mental health. Wayne, you have always expressed a sense of enthusiasm that is refreshing and motivating. You have truly extended yourself as a committee member in the advice you have offered me regarding this project and others. Jill, you have been committed to my academic and personal development for more years than I could have ever imagined. You have consistently encouraged me, been a positive influence, and introduced me to a new family and a new country, both of which have changed me in numerous ways. Mike, I could not have asked for a better mentor during the course of my graduate career. You have always been in my corner and encouraged me to pursue those phenomena that interest me. Moreover, you have provided me with one of the best examples on how to balance life and work, and this example will stay with me forever. Completing this project and graduate school were also made possible by the people I have been fortunate enough to count as friends. Morgan, John S., John Z., Alana, Jeff, and several others have helped me remember that the world continues to turn even if ii I shut a book or computer for an evening or more. I am lucky to call you my friends. I am also forever grateful to Sesilia and Likius Nakamwe. You housed me and guided me while I was in Namibia and accepted me into your family in a way that was immensely moving for me. I must also thank Timo for helping me during my few months in the North and for translating. I have also been fortunate enough to find one person during my time in Nebraska who has become so central to and impactful on my life. Brittany, we have navigated graduate school together, collaborated in and out of academics, and have grown with one another. Your influence on my life is immensely positive and has helped make me the person I am. I am extremely grateful for our shared experiences. Your support sustained me from around the world during the course of this research. Lastly, I want to thank my family. Grandpa Nick and Grandma Mable, I am grateful for the support you have provided to me and the interest you have always taken in my work and life. To my parents, Mary and Tom, you have instilled in me resilience, determination, and an appreciation for education that have brought me to where I am today. Though the work that interests me may make you nervous at times, the values you have imparted to me have led me to ask the types of questions I do today. I cannot thank you enough for the efforts you have both put forth in the interest of me and my brothers. I would not be here without you. iii Contents Page Chapter 1: Introduction 1 Purpose 2 Indigenous Psychology & Mental Health 3 Namibian Context 5 Current Research 8 Chapter 2: Literature Review 14 Mental Health in the South: Oppression & Indigenous 16 Perspectives Evidence of Western-Defined Distress in Southern Africa 25 Integration of Western Approaches & Culturally Relevant Care 37 Conclusion 41 Chapter 3: Research Design & Methodology 44 Ethnographic Research 45 Ethnographically Contextualized Case Study 51 Setting 55 Participants 57 Procedure 60 Data Analysis 66 Chapter 4: Results 70 Ethnographic Phase: General Ovambo Thematic Findings 71 Ethnographic Phase: Practitioner Thematic Findings 96 iv Ethnographic Cultural Portrait: Ovambo Mental Illness and 111 Psychological Treatment Ethnographically Contextualized Case Study Phase Results 112 Integration of Ethnographic and Case-Study Findings 127 Chapter 5: Discussion 128 Ovambo Beliefs about Mental Illness and Treatment 130 Western Treatment Modalities in the Ovambo Context 140 Ovambo Traditional Healing 143 Living with Mental Illness in Northern Namibia 146 Limitations and Future Research 148 Conclusion 150 References 153 v Tables, Figures, and Appendices Page Table 1: Themes, Sample Meaning Units, and Sample Significant 174 Statements from General Ovambo Participants (Phase 1) Table 2: Themes, Sample Meaning Units, and Sample Significant 178 Statements from Westernized Practitioners and Traditional Healer (Phase 1) Table 3: Particular & Situational Details of Cases in Phase 2 179 Table 4: Themes, Sample Meaning Units, and Sample Significant 181 Statements from Cross-Case Analysis (Phase 2) Table 5: Symptoms of Omananamwengu as Derived from Phase 1 and 183 Phase 2 Figure 1: Demographic Map of Namibia 184 Figure 2: Research Design 185 Appendix A: Ethnographic Interview Protocol 186 Appendix B: Ethnographic Interview Protocol (Oshiwambo