Transcultural studies of psychological states may be seen as falling within two schools, one adopting a position in which universal criteria of "mental health" are assumed, the other a cultural relativist position in which phenomena are understood in terms of the context in which they occur. The present study, in adopting the latter position, examines categories of experience amongst the Xhosa in terms of their meaning within Xhosa cosmology. The thoughts and practices of a Xhosa Iqgira (diviner) were extensively examined using an idiographic approach. This was corroborated by in-depth interviews with his consultees who were undergoing the categories being studied. Three categories, thwasa, phambana and amafufunyana are explicated. Thwasa is seen to be related to the individual- shade communion. Phambana is predominantly related to custom and witchcraft. Amafufunyana is related to disharmonious interpersonal situations within the community. The universalist position, derived from descriptive psychiatry, has often viewed the mental status of amaqgira {diviners) as neurotic or even psychotic. This finding is not supported in the present study. The implications of the research for community mental health in Southern Africa are discussed.

Essential hypertension has a complex and multiple biological, psychological and social aetiology and remains one of the most serious physical disorders affecting the Black population of South Africa today. Pharmacological treatment has been the predominant approach to blood pressure reduction, but considering that the greater part of essential hypertension has its origin in biobehavioural and cognitive functioning a non-pharmacological treatment approach to essential hypertension is receiving extensive interest both in research and therapeutic practice. This study attempted to implement a specific cognitive-behavioural treatment "package' which was tailored to the emergent aetiology in an urban Xhosa woman suffering from Mild hypertension who was on antihypertensive medication and to evaluate the treatment using a single case-study methodology. A combination of relaxation training and cognitive-behavioural modification was provided over a fifteen week period and evaluated both quantitatively and qualitatively. It was found that a combination of over-weight, occupational stress and anger could have contributed and/or caused the patient's hypertension. The results also show a significant reduction in blood pressure during the treatment phase as well as a reduction in weight, experienced anxiety and angry emotion, and by the end of the study the patient's blood pressure had been reduced to normal levels. Finally the feasibility of using such a treatment approach is discussed in relation to the South African context and the case study method is evaluated as a research tool in light of the findings.

Social change in South Africa brings to light the multiplicity of world-views operating in our society, which individuals encountering a variety of social contexts are faced with. This raises questions about the choices black South Africans face in response to influences from Western and traditional African culture. This issue was approached through examining helpseeking choices made between different health care sectors that stem from different world-views. This would indicate whether individuals are drawing on a variety of belief systems. The sources of their beliefs are put into context by looking at the communities of practice that influence their local knowledge. Help-seeking is also influenced by the identities the individual may ascribe to, which are derived from the multiple positions held by them in different social contexts. In this research the use of health-care sectors by four black women attending psychotherapy is examined. Their use of these sectors reflects a potential multiplicity of world views. Semistructured interviews were conducted, focusing on participants' prior experience of different help options, and their current perceptions of traditional African healing and psychology. The texts were analysed using a qualitative hermeneutic method, the reading guide. Data was looked at through three main themes, the individual's relationship to the health care sectors, their knowledge of different world views, and the identities they adopted which may be influential in their choice of a healer. It was found that in two participants there was some movement away from traditional beliefs, with one rejecting the traditional healers who did not help her, once she has discovered therapy, and another identifying herself completely with Western medicine. In contrast, one participant illustrated a rediscovery of traditional healing, whilst still attending psychotherapy. This suggests that shifts in knowledge are not necessarily away from traditional beliefs. It was also found that the two participants who had experienced a broader variety of social contexts and identified with multiple belief systems, tended to use a variety of Western and traditional healing sources and selected the healing option they felt was most appropriate to a particular problem. It is argued therefore that having a variety of knowledge and beliefs places individuals in a more powerful position to determine their choice of action than those with a limited range of knowledge.

In order to investigate certain anomalies evident in the literature, the performances of three Xhosa groups (rural dwellers, urban dwellers, and undergraduates) of varying degrees of acculturation and a White undergraduate group, each group consisting of 30 subjects, were measured on tests of mode of field approach and susceptibility to the Müller- Lyer and Ponzo illusions. In addition, the effect of the introduction of a mental set, which facilitated the perception of perspective in the Ponzo figure, on susceptibility to the illusion was ascertained. Mode of field approach was measured by a portable version of the Rod-and-Frame Test. Susceptibility to the Müller-Lyer illusion was measured by a conventional movable- slide, subject-adjustable device, while a piece of apparatus which also worked on the movable slide principle and was subject-adjustable was developed to measure susceptibility to the Ponzo illusion. The set to facilitate the perception of perspective in the Ponzo figure was introduced by having subjects match the length of Ponzo contrast lines embodied in a photograph and a line-drawing of a bridge, both of these pictures having strong perspective cues. The subjects were required to perform the tasks in prescribed order. Standardised English or Xhosa instructions were ensured by the use of "programmed" worksheets for each task. Prior to each experimental task, the more unacculturated subjects performed comprehension checks to ensure that they understood the concepts of equal length and verticality. The results of the study suggested that: (i) When groups of differing acculturation levels are tested, there may be a pronounced negative association of field dependence with susceptibility to the Müller-Lyer and Ponzo illusions. In general, the more unacculturated the subject, the more field dependent and the less susceptible to illusions he was. However, there was no evidence which either strongly supported or refuted the relationship between these attributes at the intra-group level. (ii) There is no intra- group association between susceptibility to the Müller-Lyer and to the Ponzo illusions. This would indicate that they are not necessarily generated by similar inference habits or by similar contour properties. (iii) The introduction of a "perspective set" increases susceptibility to the Ponzo illusion only among acculturated subjects, who have well-developed pictorial depth perception skills and who habitually infer depth in inverted - V configurations. (iv) There is a significant association between acculturation and field independence. The unacculturated subjects, presumably because they lack the skills of visual analysis which are engendered by Western culture, were more field dependent than the acculturated subjects. (v) Provided that their degrees of acculturation are more-or-less equivalent, as were those of the two undergraduate groups, there are no differences in mode of field approach or susceptibility to the Müller-Lyer and Ponzo illusion among Xhosa and White subjects. Summary, p. 112.

Narcissism, often linked to a sense of entitlement and inflated sense of self, is a complex condition that has been studied for approximately a century. It is typically associated with individualistic cultures, which place emphasis on the self. Although much is known about narcissism, there is far less knowledge on narcissism in collectivist cultures. The Xhosa culture is commonly seen as a collectivist culture. No research to date has been conducted on this construct with Xhosa-speaking South Africans. The aim of the study was to explore and describe therapist perceptions of narcissism in traditional cultural contexts. The objectives of the study included an investigation into how narcissism presents in the Xhosa culture, and an exploration of the narcissistic elements that manifest more prominently. A qualitative, exploratory descriptive research design was employed, and snowball sampling was used to identify psychologists from the Nelson Mandela Metropole for inclusion in the study. Semi-structured interviews were used to gather data, and data was analysed by thematic analysis. The findings of the thematic analysis consisted of six themes, which are thoughts on the Xhosa culture, culture and personality, contemporary Western theory lacking, traits, parenting, and interpersonal and personal difficulties. These themes reflect the participants’ experience, thoughts, and opinions on narcissism in individuals from the Xhosa culture.

Among the Xhosas, the healing sickness called intwaso is interptreted as a call by the ancestors to become a healer. Transpersonalists also see these initiatory illnesses as spiritual crises, while according to the widely accepted Western psychiatric view, illness is purely perceived in physical and psychological terms. A case study was conducted where a single participant who has undergone the process of ukuthwasa and is functioning as a traditional healer was interviewed. A series of interviews were done where information was gathered about significant experiences related to ukuthwasa process. Tapes were transcribed and a case narrative was written and interpreted using the traditional Xhosa beliefs, the western psychiatric and the transpersonal psychology perspectives. Strengths and weaknesses of each perspective were then examined.

This study explores severe mental illness in a South African ru~al district, moving, as with a zoom lens, from the macroperspectives of (i) Xhosa culture, and (ii) biomedicine, to the lived experience of the individual. Its methodology, predominantly qualitative, employed anthropological and psychological procedures. The fieldwork (1988-1989)encompassed a three month stay in the village of Msobomvu. Patients continued to be tracked informally until June, 1995. The empirical research has three parts. In part one, the person with a mental illness was contextualized within Xhosa cosmology and social attitudes. The cognitive and social ecologies were tapped through the narratives of high school and university students at different stages of a Western-biased education. Social attitudes regarding mental illness, and confidence in treatment by traditional healers and the hospital, were also evaluated. Traditional attitudes and supernatural beliefs of illness causation persisted in spite of Eurocentric education, with a concurrent increase in the acceptance of Western-type causal explanations commensurate with continued education. Part two considered the the patients in relation to (i) the biomedical framework (the mental and local hospitals), and (ii) their readjustment to the community after hospitalization. Data came from patient charts, interviews with medical staff, and follow-up visits in the villages. Socio-political and economic issues were salient. Part three case-studied people identified by the village residents as having a mental illness. Resources for treatment - traditional healers, mobile clinic, and village health workers - were the focus. The traditional healing system, and biomedicine, were compared for effectiveness, through the course of illness events. While biomedicine was more effective in containing acute psychotic episodes than treatment by the traditional healer, lack of appropriate resources within the biomedical setting had disastrous results for patient compliance and long-term management of the illness, particularly in people with obvious symptoms of bipolar disorder. The mental hospital emerged as an agent of control. While Xhosa culture provided a more tolerant setting for people with a mental illness, the course of severe mental illness was by no means benign, despite research suggesting a more positive outcome for such conditions in the developing world.

This study was undertaken in an attempt to investigate the analogy between the Crisis Intervention Model and the Funeral Rites of the amaXhosa. The latter group includes both traditional as well as Western Christian elements. The study was confined to the geographical area of Ciskei and more specifically the villages in and around Peddie and Ndevana near Zwelitsha, as regards traditional people, and the Black townships of Zwelitsha and Whittlesea,as regards more Westernized people. It is, however, the contention of the study that experiences discussed here are common to Blacks in South Africa irrespective of ethnicity. The justification for this generalisation is based on anthropological commonalities as well as historical vicissitudes among Blacks in Southern Africa. For instance, ritual slaughter performed after death in propitiation with the ancestors is known among all Blacks in South Africa. Also the Politico-historical events as well as socio-economic developments in the country affect Blacks in a more or less similar manner. For example, the changing family structure among Blacks, because of changes from one type of economy to another, is a social process affecting all Blacks in Southern Africa - in particular the working class (Colin Murray, 1980). The Funeral rites under study are postulated as possessing elements of therapeutic and practical value which result in the alleviation of grief and the encouragement of full acceptable means of mourning. The study is chiefly descriptive and anthropological material has been used. Recordings were made from participant observation whenever there was a funeral in the area studied. Information about funerals is easily obtainable as these are announced over Radio Ciskei and Radio Xhosa every evening. Mourners and interveners were interviewed. The former to elicit the needs they had felt, the latter to elicit the needs they had perceived the former to have. The Crisis Intervention Model is fairly simple to understand and uses practical theory. Therefore, it is not surprising that there should be elements of similarity between this model and the funeral rites of the amaXhosa as both deal with people in need of support. These funeral rites are rooted in a culture which has as one of its crucial aspects intimate, face-to-face interaction of its members in constant exchange as regards both emotional support and services. These "credit networks" ensure that a person is never bereft of emotional support. Moreover, temporary services are always accorded to a person in crisis. An effort has been made to relate the Crisis Intervention Model to the South African context of Blacks (both traditional as well as Christian). By necessity this has meant looking at all cultural dimensions of Black society - historical, political, economic and cultural, in order to provide a clearer picture of the people under study. That is, human psychological experiences of grief and mourning are seen as processes related to and developing within the concrete everyday realities. Some of the experiences described have been personally witnessed by the researcher in her personal involvement with cultural practices. Funerals are, of necessity, sad occasions and this study, using participant observation methods sometimes brought on sad memories of the researcher's own losses of loved ones. In the discussion a comparison was made between the traditional methods of grief work, the Crisis Intervention theory and the mourner studied and it was found that these rites do indeed, contain therapeutic and practical elements of dealing with grief and mourning, comparable to the Crisis Intervention Model. Finally in the conclusior a proposal for further areas of study in this field was suggested.

The quality of the Bender-Gestalt performance of 22, normal, white South African male adolescents and 22, normal, Xhosa male adolescents, aged between 17 and 22 years, was investigated. The Pascal-Suttell scoring system was used. The mean score of the white adolescents was significantly below that of the Xhosa adolescents. It was found that while the mean score of the Xhosa adolescents was within one standard deviation of Pascal and Suttell's normative 'high school' mean, the mean score of the white adolescents was below that of the normative mean and not within one standard deviation of the mean. The results lend support to the findings that Bender performance is related to cultural background. It is suggested that the Pascal-Suttell tables may be in need of revision. The advisability of standardising tables, which are culture specific, for clinical use· in the Southern African context, is indicated. / KMBT_363 / Adobe Acrobat 9.54 Paper Capture Plug-in

This study sought to explore the perceptions of mental health care practitioners’ perceptions on mental illness within the isiXhosa cultural context. A qualitative exploratory descriptive and contextual design was used for the study. A non-probability purposive sampling method was used to select eight participants from Komani Hospital in Queenstown. Data was collected through semi-structured interviews. The services of an Independent Interviewer were used to avoid any bias as interviews took place where the researcher is employed. All interviews were transcribed verbatim and the data collected was analyzed according to Tesch’s eight steps of data analysis as described in Cresswell (1994:155). The researcher utilized services of an Independent Coder who verified the identified major themes. Four major themes emerged from the analysis of the interview: Mental health care practitioner’s perceptions of mental illness, perception of the causes of mental illness within the isiXhosa cultural context, mental health care practitioners’ views in the management and treatment of mental illness and suggestions put forward to improve the services to mental health care users. The major findings of this study were the lack of knowledge of culture of mental health care users. It is recommended that it would be proper if there could be co-operation between mental health care practitioners and traditional healers by working together as a team.