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