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Article Review: “Lay concepts of depression among the Baganda of Uganda: a pilot study”

How do Bagandan people perceive and react to depression, and is this any different from the perceptions and reactions of the Western interpretation of depression? This article addresses the first part of this question, and the latter is addressed implicitly by the paper’s purpose and results. It seems Okello and Ekblad vaguely hypothesize that there is a cultural discrepancy between depression amongst Bagandans and other culturally-varying forms of depression (like that of the West). The hypothesis is vague as the researchers chose a method of data analysis based on ground theory, where there is no clearly defined research question (Okello and Ekblad 16). This hypothesis is well supported by contrasting etic and emic theoretical frameworks. Numerous studies throughout abnormal psychology have reliably shown that abnormal behavior varies across cultures, as definitions of abnormality change across cultures; this also applies to depression (Gotlib 467). Okello’s study further supports this principle of the sociocultural level of analysis by revealing the major differences in Bagandan perception of depression.

Background

Okello and Ekblad utilize a qualitative approach to gather research on Bagandan ‘lay explanations’ of the causes and effects of depression, as well as Bagandan methods of seeking treatment for depression; specifically, five sub-types of depression were addressed: depression with psychotic features, depression without psychotic features, manic illness, adjustment disorder with depressed mood, and dysthymia. A ‘lay explanation’ as it is used in the article can be defined as a general interpretation of a phenomenon that is not necessarily scientific, but which is usually how the common person interprets said phenomenon. In order to obtain the desired lay explanations, interviews served as the method of data collection. Four group discussion-based interviews incorporating lay explanations from 25 interviewees and four individual interviews were conducted. Of the 29 interviewees, 16 were men and 13 were women; all were allegedly of similar socioeconomic backgrounds. These interviewees consisted of traditional Bagandan healers, villagers, secondary school students and primary school teachers. In order to ensure the validity of the anecdotal ‘vignettes’ given by the interviewees, a third party-psychiatrist was chosen as a reviewer. As another validity check, the vignettes and interview sessions were translated to Luganda (Bagandan language), translated back to English, and finally reviewed by two third-party bilingual English-Lugandan speakers (here, back-translation serves as a validity check by testing if the meaning of what the interviewees were saying is preserved as it is translated). Within group interviews, vignettes were read in a manner so that the meaning was clear to all. Results from vignettes were compared to DSM IV diagnostic criteria.

Results

As a research paper of depression on lay explanations, three varied results were reached, all supporting the research hypothesis. Bagandan parallels to Western sub-types of depression are addressed. An ‘illness of thoughts’ would be considered Major Depression without psychotic features as well as Adjustment Disorder with depressed mood. A ‘clan illness’ or ‘ancestral illness’ (eByekika) would be the DSM IV equivalent of Major Depressive Disorder with psychotic features. Other illnesses not defined by Bagandans fell under the diagnostic criteria for Dysthymia.

Traditional Bagandan Diagnosis and Treatment

Traditional explanations were unveiled in addition to the Bagandan nomenclature given to each of these mental abnormalities. The illness of thoughts was considered as a non-physical disorder difficult to explain to strangers, untreatable by medication but treatable by ‘lay help’ from those close to the affected. eByekika illness was considered to be caused by Misambwa or mizimu, which are angry ancestral spirits. Depressive behavior was considered eByekika if symptoms were reoccurring and resulted in an estrangement from reality. For eByekika, a traditional healer’s help and several rituals were considered viable treatment by Bagandans. For the rest of the undefined chronic illnesses characterized by mild depressive symptoms, a causative explanation based on witchcraft or chronic physiological disease (like syphilis) was given. To treat unidentified chronic illness, an integration of both traditional and modern medical practices is utilized. It is important to note that based on the results, it is evident that the determining factors of whether medical treatment is needed is based on whether an illness is chronic or not. An illness of thoughts (non-chronic) needs no medical attention, while the other two categories do.

Analysis of Conclusion

The overarching conclusion that Okello and Ekblad make are that the Bagandan conceptualizations of depression contrast with ‘biomedical models of depression’, a model which has mainly Western psychological influence. Within this conclusion, several sub-conclusions are made. One sub-conclusion is directly derived from the results, that the Bagandan equivalent of Major Depression with psychotic features is considered a separate disorder than the Bagandan equivalent of Major Depression without psychotic features. Even more intriguing is that Bagandans culturally conceptualize their equivalent of Major Depression without psychotic features as a disorder that does not need more than lay treatment to subside. Because many forms of traditional treatment are based on some level of perceived effectiveness, major implications of this finding may be that Major Depression without psychotic features may not need clinical treatment, or that any physiologically based treatment of Major Depression without psychotic features is not necessarily more efficacious than lay treatment by friends and family (or acts a placebo effect). This would be a groundbreaking finding if it were consistently confirmed, as it would change the face of clinical psychology.

Herein lays one of the strengths of the paper: its groundbreaking implications. The paper provides a large amount of data and fairly conclusive qualitative results that form a base for many new experiments in the field of cross cultural psychology. As far as qualitative research goes, ethical measures were adequately considered and several checks of validity ensured the research was focused and applicable. Overall, the study revealed much of the cultural nuances of lay interpretations of depressive disorders. Aside from the scaffold of data it presents for new studies to be conducted, “Lay concepts of depression among the Baganda of Uganda: a pilot study” presents yet another support for the sociocultural principle that abnormal behavior varies across cultures. The method in which research was conducted also fit well in the framework of the data collection; the qualitative, emic approach garnered much seemingly pertinent information. One might even argue that the selection of participants for the study was well varied and (at least in terms of the background of the participants) fairly representative of the Bagandan population.

Limitations

However, the article presented several inherent and largely unavoidable limitations pertaining to its methodological framework and its results. In terms of the procedure the research, only 29 people overall were interviewed. Considering that Buganda has a significantly larger ethnic population (about 4.1 million people), one must question the extent to which the sample selected was representative of Buganda’s populations. A future study with more resources and time may perform a similar experiment but with a larger, perhaps more representative sample and assimilate all of the results into an aggregate Bagandan conceptualization.

In terms of the results, limitations are explicitly presented in the article itself. As the research was based on a modified version of ground theory, findings were of exploratory nature; in other words, relatively new ground was being covered that had not been covered before in the field of sociocultural abnormal psychology. Because the findings were of exploratory nature, no results or findings were conclusive, as there were no direct sources to give prior external reliability; “…one cannot draw definitive final empirical generalisations, where data may be assumed to represent a wider population in probabilistic sense” (Okello and Ekblad 37). There is no direct, quantitative predictive power presented by this research, as it is qualitative in nature. As a final major bound, the study is limited by its cultural specificity. As only participants of the Bagandan culture were interviewed, generalizing to other African (or even Ugandan) cultures would not be possible from just the information collected in this article.

Value

Despite the limitations present in the article, “Lay concepts of depression among the Baganda of Uganda: a pilot study” has great value for the sociocultural approach to psychology. Perhaps most importantly of all, the article provides qualitative data useful for formulating new experiments in the future. The article suggests future research might include empirical tests of the efficacy of Bagandan lay treatment of illness of thoughts (Major Depression without psychotic features) and a subsequent comparison of this to the equivalent biomedical treatment. This research of Bagandan conceptualization of depression based mental disorders implicitly challenges Western methods of treating Major Depression without psychotic features. What if the current clinical treatments of said sub-type of depression have some invalidity? What if current clinical treatments only have an effect equivalent to that of a placebo on treating depression? The findings of this article could be the basis for future studies that may change the face of psychology as a scientific field and the face of pharmaceuticals as an industry.

Sources

Gotlib, Ian H., and Constance L. Hammen. Handbook of Depression. New York: Guilford, 2002. Print.

Okello, E. S. “Lay Concepts of Depression among the Baganda of Uganda: A Pilot Study.” Transcultural Psychiatry 43.2 (2006): 287-313. Print.


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