Impact of Socio-Cultural Discursive Construction of Mental Illness on Diagnosis and Management: Insights from Kenya

A report by the WHO states that 1 out of every 4 people seeking medical attention in Kenya has a mental illness. This stark outlook is shared by the Taskforce on Mental Health 2020 whose report showed that mental disorders account for 13% of the burden of disease in Kenya. Yet any attempt to understand these statistics needs to take into account the social context in which the mentally sick in Kenya live. Mental illnesses attract a lot of religious and cultural stigma. This is because mental illness afflicts the brain – a culturally and socially constructed organ. Consequently, the mentally sick are labeled as ‘possessed’, ‘bewitched’ or ‘cursed’ and are therefore believed to be in need of religious and/or cultural rites to end their affliction. Yet, Kenya boasts of a well-established training in psychiatry medicine based on Western bio-psycho explanatory model for mental illness. This paper sought to tease out the socio-culturally situated health narratives that psychiatrics have to deal with as they diagnose and manage patients with mental conditions. The data were narratives by the practitioners about their experiences in dealing with mentally ill patients and their relatives. The data reveal the competing discourses on mental health. The explanations and expectations of patients and family members can be incompatible with the discourse of modern medicine. We sought to understand the place of the psychiatrist in a context that labels disease and treatment from a viewpoint of culture and religion. Our preliminary analysis reveals that whereas psychiatrists remain faithful to their training, many are also conscious of the fact that socio-cultural factors cannot be divorced from the diagnosis and management of mental disorder. However, the analysis reveals varied views on the degree to which a bio-psycho-socio-cultural explanatory model to mental illness can work in modern medicine.