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Correspondence |
Institute of Psychiatry, London SE5 8AF,UK. Email: derek.summerfield{at}slam.nhs.uk
EDITED BY KIRIAKOS XENITIDIS and COLIN CAMPBELL
Mogga et al (2006) like the majority of published studies of people from low- and middle-income countries rely exclusively on Western measures of psychopathology (Hollifield et al, 2002). Culture is seen as mere packaging and is disregarded while standardised methodologies (`reliability') applied to universal psychobiological man get at the `real' problem (Summerfield, 2004). This is a form of imperialism.
`Reliablity' cannot redeem a study that commits a category error: the assumption that because phenomena can be identified from one setting to another, they mean the same everywhere. African cultures emphatically do not share a Western ethnopsychology that defines `emotion' as a feature of individuals rather than situations, being internal, often biological, involuntary, distinct from cognition, a cause of pathology and targetable by technical interventions (Lutz, 1985). `Major depression' is not a timeless, free-standing, internally coherent, universally valid, pathological entity requiring medical intervention (Summerfield, 2006).
The hard truth, which if owned would totally disrupt business as usual, is that psychiatric measures are the products of a Western epistemology, including models of mind and definition of personhood. They simply cannot be turned into universally valid instruments – no matter how much tinkering with criteria and translation.
Noting the raised `disability' scores and increased attendance at traditional healers, I do not doubt that something was ailing some of those with `persistent depression'. However, it is likely that this was a very heterogeneous group and that undiagnosed physical illness, particularly the diseases of poverty, was a major determinant. The only solution offered was antidepressants and it is no surprise that adherence was poor.
In the last few lines Mogga et al state that `more information is needed regarding the characteristics, beliefs, knowledge and illness attributes' of the population. These domains should have been the point of departure of the study, not a mere after-thought. What can emerge when researchers know so little of the lived lives of participants?
REFERENCES
Hollifield, M., Warner, T., Lian, N., et al
(2002) Measuring trauma and health status in refugees: a
critical review. JAMA,
288, 611
-616.
Lutz, C. (1985) Depression and the translation of emotional worlds. In Culture and Depression. Studies in the Anthropology and Cross-Cultural Psychiatry of Affect and Disorder (eds A. Kleinman & B. Good), pp. 63-100. University of California Press.
Mogga, S., Prince, M., Alem, A., et al
(2006) Outcome of major depression in Ethiopia.
Population-based study. British Journal of Psychiatry,
189, 241
-246.
Summerfield, D. (2004) Cross-cultural perspectives on the medicalisation of human suffering. In Posttraumatic Stress Disorder. Issues and Controversies (ed.G. Rosen), pp. 233 -245. John Wiley.
Summerfield, D. (2006) Depression: epidemic or
pseudo-epidemic? Journal of the Royal Society of
Medicine, 99, 161
-162.
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