Severe invalidism--the dominant feature of Third-World psychiatry in southern Africa

In present-day African psychiatry, there is a sharp differentiation between serious mental illness, which requires medically orientated treatment and chemotherapy, and the more superficial disturbances of personality for which psychological, sociological and educational measures are indicated. With the severe shortage of Western psychiatrists who are prepared to undertake this work, it is providential that black traditional healers address themselves to the latter group of mental abnormalities with a measure of success comparable to psychotherapy in First-World practice. In the back wards of a mental hospital (run on First-World lines) and in outpatient clinics in periurban Durban townships, one meets a large number of patients with severe and chronic disease. All those conditions (mental retardation, organic brain syndromes, schizophrenia and affective disorders) with positive symptomatology (excitement, restlessness and aggression) are found to respond to neuroleptic drugs. Possible reasons why patients with negative symptoms (emotional withdrawal, poverty of ideas and speech), especially in schizophrenia, do not react, are discussed, and administrative and socio-economic implications are reviewed.