Dissociation - a preliminary contextual model

BACKGROUND: The Diagnostic and Statistical Manual of Mental Disorders (DSM) system has certain limitations when applied to two South African examples of dissociation, because it is descriptive (non-explanatory) and focuses on intrapsychic (non-communal)processes. Even the existing Western explanatory models of dissociation fail to accommodate fully the communal aspects of dissociation in our South African context. OBJECTIVES AND METHODS: The aim was to explore an expanded perspective on dissociation that does not limit it to an intrapsychic phenomenon, but that accounts for the interrelatedness of individuals within their social context. Autoethnography was used. In this article a collective, socially orientated, contextual hermeneutic was applied to two local examples of dissociation. Three existing Western models were expanded along multicontextual, collective lines, for them to be more useful in the pluralistic South African context. RESULTS: This preliminary contextual model of dissociation includes a person's interpersonal, socio-cultural, and spiritual contexts, in addition to the intrapsychic context. Dissociationis considered to be a normal information-processing tool that maintains balanced, coherent selves-in-society, i.e. individuals connected to each other. In the South African context dissociation appears mostly as a normal phenomenon and seldom as a sign of mental illness. Dissociation is pivotal for the normal construction of individual and communal identities in the face of conflicting sets of information from various contexts. Dissociation may help individuals or communities to survive in a world of conflicting messages, where conflict is often interpersonal / cultural / societal in nature, rather than primarily intrapsychic. CONCLUSIONS: This model should be developed and evaluated further. Such evaluation would require suitable new local terminology

In touch with reality

Objective: A descriptive study in which the audience profile of patients suffering from schizophrenia, their families and caregivers was determined to establish whether information on schizophrenia is disseminated effectively. This is an ongoing project aimed at designing appropriate psychoeducational material on schizophrenia using the audience-based media production approach. Method: A Qualitative research method using screening interviews, focus groups discussions and participant observation. Undertaken at Weskoppies Hospital, Pretoria, Tshwane, South Africa. Using Sotho-speaking patients and their families from the greater Tshwane region. Three researchers from the Departments of Psychiatry and Information Science at the University of Pretoria facilitated four focus groups comprising of 18 participants. A schedule was used to guide the discussions and after each focus group, emergent themes were identified and analysed. Tape recordings and written notes were used to capture information. These were later transcribed and used for data analysis. The participants were asked to indicate how they understand schizophrenia and how living with this disorder influences their lives. Results: It seems that information about schizophrenia is not effectively disseminated to this group. Myths about the disorder prevail. The majority of the participants did not understand what schizophrenia is. The participants' perceptions regarding schizophrenia reflected the influence of their culture, religion and their experiences of stigmatization by the society in which they live. Conclusion: In the endeavor to effectively disseminate information about schizophrenia to patients and care givers, the prevalent top-down approach should be replaced by a more participatory approach where the target audience is consulted and involved in the process of psycho-education. Declaration of interest: None

Testing the effectiveness of existing psycho-educational material (The Alliance Programme) for patients suffering from schizophrenia in the South African context

OBJECTIVE: The objective of this study was to test the effectiveness of the existing psycho-educational material (The Alliance Programme) for patients suffering from schizophrenia in the South African context. METHOD: A qualitative research approach was used. Fifteen Setswana speaking participants, with a diagnosis of schizophrenia were exposed to the programme. Semi-structured and screening interviews were used to collect demographic and clinical data. The participants were divided into two groups and were exposed to either the Alliance Programme or on adapted version of the programme. Participatory communication instruments including focus groups, were used to assess comprehension and knowledge retention of the material over time. RESULTS: Participants who were exposed to the original Alliance Programme experienced the contents of the programme to be technical, difficult to read or recall. They were unable to relate their previous symptoms to the psycho-education given. Participants who were exposed to the adapted version faired much better, gained more insight and were able to relate better to their illnesses. Participants preferred booklets with examples and illustrations, video clips and films over formal lectures. CONCLUSION: Psycho-education material given to people suffering from schizophrenia and their caregivers has to be adapted to their context to be effective