LETS BEGIN WITH

EXPLORING

.
A MULTIDIMENSIONAL APPROACH TO
PSYCHOPATHOLOGY: BELIEFS
VALUES AND CULTURE
PRESENTED BY TAYLA OWEN-JONES,
ALISHA MOONSAMY AND ZELDAH
MAKHUBELE
 WHAT WE WILL BE COVERING TODAY

WHAT IS THE MULTI COMPARE THE EXPLORING BELIEFS,

1. DIMENSIONAL 2. PERSPECTIVES 3. VALUES AND CULTURE
APPROACH?
 WHAT IS THE
MULTIDIMENSIONAL
APPROACH?
One-dimensional perspective attempts to show that a psychological disorder is
originated from a single cause; ignoring other factors that can have an influence
on the disorder (Barlow et al., 2018).

A multidimensional approach considers and views how systems interact and

contribute to the pathology of mental disorders.

A multidimensional approach takes into account the biological ,psychological,

and social factors in viewing disorders.

To have a good understanding of the causes of psychological disorders, we

must adopt a multidimensional perspective which emphasizes on multiple
interacting causal factors (Paris, 1999).

The Biopsychosocial Model (BPS) has been found to be the most effective
within such an approach. The model differs from the contemporary medical
model, which emphasizes mental illness as disease, rather it is aimed at a more
holistic approach by recognizing that each patient has their own thoughts,
feelings, and history.
WHAT IS PATHOLOGY?
● The scientific study of focus of functional and structural changes involved in
physical and mental disorders and diseases.
● Focus is given to understanding courses, components, course, and
consequences of psychological disorders. These are categorized by abnormality
and dysfunction.
● By gain a better understanding of what causes such disturbances, it guages a
way toward providing suitable intervention.
● More broadly any departure from what is considered healthy or adaptive is
considered pathology.
● Pathology is the bridge between science and medicine.
● It underpins all aspects of patient care which include diagnostic testing and
treatment advised to using newer technologies in helping prevent and treat
diseases.
 HOW DO WE CONSIDER
PATHOLOGY?
Pathology places emphasis on four key features of the illness process.

ETIOLOGY
The causes of the illness

1.
PATHOPHYSIOLOGY
PATHOGENESIS The alterations of an illness
The mechanisms of development of
the illness
2. 4.

3. MORPHOLOGY
The structures and forms of the illness
WHAT APPROACHES DO WE CONSIDER?

WESTERN

AFRICAN
 THE WESTERN
PERSPECTIVE
Influenced by the Eurocentric paradigm, Western psychology sees
psychopathology as arising in three main ways:
● Biomedical model or the somatic or biogenetic perspective: psychopathology as
a ‘disease’ of the mind that originates from abnormality in the patient’s
anatomy and nervous system.

● Psychological model which sees psychopathology as originating from an

individual’s faulty cognitions, which is said to give rise to an individual’s
behaviour being dominated by irrational thinking and beliefs, biases,
assumptions, and fears.

● Social–cultural model of psychopathology which sees psychopathology as a

product of stressful life-worlds or social contexts in which people live and
work.
 THE BPS FRAMEWORK
● In an attempt to emphasize that none of the above three conceptualizations operating alone is
sufficient to serve as a complete model of explanation in psychological practice, a more inclusive
model of psychopathology was introduced.

● The BPS framework (biological, the psychological, and the social domains).

● The BPS model has come to be adopted in Western psychology, particularly in South Africa, as
the most comprehensive way of understanding psychopathology.
 OTHER POINTS TO
CONSIDER
Psychopathology from a Western Perspective is also heavily influenced and valued
by the medical model, which argues that Psychological Disorders are a result of
psychosocial factors and require medication (Fisher, 2020).

This model is also heavily individualistic, not taking into account the impact of
factors outside of that of the individual
 TREATMENT
OPTIONS

Diagnosis - using DSM 5TR and ICD 11

● Psychotherapy
● Psychopharmacology

.
 THE AFROCENTRIC
PERSPECTIVE
● The missing dimension in the Eurocentric paradigm of mental illness is
the Spiritualist perspective encompassed in the Africentric paradigm and
accounting for the origin of certain instances of mental illness.

● There are four possible sources of human disturbance according to the

African perspective namely: biological; psychological; social and;
spiritual.

● Psychopathology is not only linked to mental illness, but also strange

behaviour or behavioural presentations that have mysterious origins
according to the African perspective.
 INSTANCES OF ABNORMAL
BEHAVIOUR ENCOUNTERED IN
AFRICA

In Africa, the following examples are taken as other instances of psychopathology often ignored in Western
psychology:

1. Women who changed partners and could not stick in marriage

2. Young men with strange behaviour like disappearing into the bush and refusing to talk or eat for several days, or
climbing up a high rock and refusing to come down.

3. A woman with the sickness of ‘running’ or hysteria.

4. Men who were unable to maintain marital relationships, despite the fact that they were wealthy.

5. People reporting fits or seizures, fainting, signs of spiritual possession, and unexplainable psychosis.

6. School girls found to remove their clothes in public (an incidence that occurs frequently in Mombasa, Kenya, and
also supported by research among the Bunyole of Uganda by Whyten (1997). A similar incidence has been found
among people in South Africa by Wittstock, Rozenthal, and Henn (1991).
 THE AFROCENTRIC PARADIGM
CONTINUED
● In Africa, psychopathology does not refer only to the key problems of mental illness, such as
psychosis or schizophrenia, but also to irregular or strange behavioural presentations that
often arise from mysterious origins.
● Understand/see any particular illness, physical or psychological, as a ‘symbolic illness’ or one
with a hidden meaning.
● When faced with such strange behavioural manifestations, indigenous African elders
routinely assume that they must go beyond the ‘information given’.
● To determine ‘who’ is speaking through such illnesses and what the relatives or family
members are expected to do on behalf of the sick individual to effect healing.
 VALUES WITHIN THE
AFROCENTRIC PERSPECTIVE

● Values play a pivotal role in identifying when actions and values do not match, as well as to understanding a culture or
community.
● Health promotion needs to be interwoven with these values (Helm, 2003). Hence factoring the essentiality of
viewing a person holistically and taking a community approach when understanding indigenous clients.
● Community psychology is an example of such paradigm.
● According to Kloos et al., ( 2007), the 7 core values are found within ; individual and family wellness, empowerment
and citizen participation, sense of community, collaboration and community strengths, respect for human diversity,
empirical grounding, and social justice.

● The Afrocentric perspective on pathology shares such values with the inclusion of spirituality. The sense of community
herein includes what is commonly referred to as the other , such as ancestry influence and bewitching

.
 APPROACHES TO DIAGNOSIS
WITHIN THE AFRICENTRIC
PARADIGM
● The notion of clinical or psychological diagnosis within the Africentric paradigm is used to
refer to the interventive action that is taken to determine the source of a difficult illness.

● As a way of ascertaining the hidden meaning in a particular illness, or whether a particular

ancestor or spirit being is at the root cause of that illness, relatives of the sick individual
engage, where necessary, in more than one approach to questioning misfortune.

● The major search or diagnostic questions in the face of a difficult illness, in the African
perspective, becomes ‘Who is speaking?’ ‘And for what intended message?’
 THE RITUAL OF QUESTIONING
MISFORTUNE
● The diviner known in South African communities by different names, such as the iSangoma (among the Zulu)
or Nyanga (among the Tsonga) is consulted with the aim of gaining concrete answers to the presenting
misfortune.
● In this process, a major diagnostic mechanism followed is divination.
● Divination process ascertain the hidden infuriation and demands of ancestors or other spiritual agencies,
underlying a given illness.
● Divination sessions in Africa are always conducted in public, not in secret, in the presence of an observer-
witness.
● A divination session proceeds on the assumption that the ancestors of both the client and the diviner are present
or, at least, ‘on call’ in support of the search for a diagnosis of the client’s illness.
● The process is usually accompanied by drumming, singing, and sometimes smoking in order to induce trance
to communicate with and through spirit.
● During diagnosis, hidden messages are interpreted from the ancestors to the family of the sick person.
● The Africentric perspective offers a solution-focused approach, practical and action oriented .
 CULTURE
DYNAMICS AND
PATHOLOGY

● The Africentric paradigm of mental illness equally teaches that there are intermediaries
to spiritual forces that could be approached for a solution when such illnesses are
encountered.
● Misfortune can be traced beyond the visible world or world of the senses
● To the invisible world of the spirits and the ancestors from where the problem may arise.
● In African culture, the visible and the invisible worlds are highly interconnected and
influence one another
 CULTURE AND SOCIAL
STRUCTURAL ISSUES
● Culture plays a role in the way we view mental health disorders and their corresponding features.
● Cultural contexts shape the experience and expression of the symptoms, signs, behaviors, and
thresholds of severity that constitute criteria for diagnosis.
● Sociocultural contexts also shape aspects of identity (such as ethnicity or race) that confer specific
social positions and differentially expose individuals to social determinants of health, including
mental health.
● Diagnostic assessment should include how an individual’s experiences, symptoms, and behaviors
differ from relevant sociocultural norms and lead to difficulties in adaptation in his or her current
life context.
● Clinicians should also take into account how individuals’ clinical presentations are influenced by
their position within social structures and hierarchies that shape exposure to adversity and access
to resources.
 IMPACT OF CULTURE
NORMS AND PRACTICES

● Thresholds of tolerance for specific symptoms or behaviors differ across cultural

contexts, social settings, and families.

● The judgment that a given behavior, experience, or concern requires clinical attention
depends on cultural norms that are internalized by the individual and applied by others
around him or her, including family members and clinicians.

● To accurately assess potential signs and symptoms of psychopathology, clinicians should

routinely consider the impact of cultural meanings, identities, and practices on the causes
and course of illness
 CULTURAL BELIEFS

● There are cultures in South Africa even around the world, who do not perceive features of certain
mental disorders as abnormal.
● Schizophrenia is one of the common examples
● Persecutory delusions from a study by Campell et al. (2017).
● They found that with respect to persecutory delusions, participants drew from cultural explanations of
illness and a bewitchment framework.
● For example, of those who reported persecutory delusions from the above study, 72.5% (n = 125)
believed that others had bewitched them to bring about their mental illness, through evil spirits,
“amafufunyana” or the “Tikoloshe”.
 CULTURAL BELIEFS
CONTINUED

● Traditional healing interventions were sought to repel the bewitchment and protect against further
attack.
● Such interventions included acts aimed at cleansing the patient and their family of evil spirits.
● Psychiatric assessment, hospitalization and medication were also accepted by some as effective ways
of managing psychotic symptoms thought to be induced by witchcraft.
 CONCLUSION

●
The different perspectives to psychopathology are not seen as either or neither one is right or superior than the other.
● The Eurocentric paradigm is not the only possible diagnostic system for understanding clients with difficult mental
illness, other approaches to psychopathology should be considered based on the context.
● Tools such as the DSM 5 cultural formulation are important aides in bridging the gap between Western and African
conceptualisations of psychotic illness experiences.
● Similarly expanding the bio-psycho-social approach towards illness conceptualization, to include a spiritual element,
may play a helpful role in patient recovery.
● The multidimensional approach does not dispute that certain, specific ,illnesses may bear resemblance to mental
disorders and can be ascribed to a singular, unified etiological factors.
● Rather, it integrates multiple causes of psychopathology and affirms that each cause comes to affect other causes
over time.
 “Mental Health is not a
destination, but a process. It’s
about how you drive, not
where you're going”
 References
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Campbell, M. M., Sibeko, G., Mall, S., Baldinger, A., Nagdee, M., Susser, E., & Stein, D. J. (2017). The content of
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Wittstock, B., Rozenthal, L., & Henn, C. (1991). Mass phenomena at a Black South African primary school. Hospital
and Community Psychiatry, 42, 851–853.
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