Zulu cultural perspectives and experiences of mental health and occupational therapy in KwaZulu Natal, South Africa.

Abstract

Background: Healthcare systems are formulated utilising worldviews, specifically in mental health, where norms are created dictating what is normal versus abnormal. The era of coloniality promoted western dogma over collectivist cultures. Occupational therapy practice must consider the client’s context during assessment and intervention for the process to be client centred. Methods: A qualitative descriptive design was utilised. Purposive sampling was used to recruit 10 participants. Data was collected through semi-structured interviews. Analysis was guided by utilising Braun and Clark’s six phases of thematic analysis. Findings: Three themes emerged from the data, personal perceptions, cultural perceptions, and health-seeking behaviour. Sub-themes accompanied each. Personal perceptions explored how Zulu people made sense of mental illness or related behaviours through a modern or traditional lens. It also explored the importance of the strength of the Zulu individual. A dissonance occurs when faced with cultural norms and personal needs. Finally, their perspectives were altered through their experience with mental illness. Cultural perceptions were that problems were solved internally in families or communities, and progress was promoted as necessary for the Zulu individual. It also explored spiritual beliefs regarding mental illness, which could range between God, Ancestors or both and could be causal factors or healing mechanisms. Suicidality is seen as a weakness in the culture, and stigma was attached to mental illness. The final theme concerns the experience of the Zulu mental health care user dealing with their mental illness. Cognitive dissonance is prevalent in all three aspects not merely due to the difference between westernised mental health treatment and traditional healing systems but also due to the value found in each. The method of sharing vulnerability or issues with an individual outside the family contradicts cultural norms. However, participants expressed that being understood in group discussions and sharing vulnerability significantly improved their healing. Conclusion: Zulu individuals create their sense of self in an interdependent manner. The family and community are intertwined in their participation, reputation, and healing. There is an emphasis on strength and the following of norms in the Zulu culture, perpetuated by the importance of consulting elders or close family when faced with conflict. Disregarding these norms can outcast the Zulu individual who thrives on being included in the community. The study was conducted with a limited sample size and in an urban area. Further research within rural communities and diverse facilities would be beneficial. Occupational therapists working in communities such as KwaZulu Natal should understand the causal factors of mental illness for the Zulu mental health care user and their personal beliefs around healing when designing an intervention.