4. Electronic Theses and Dissertations (ETDs) - Faculties submissions
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Item A Philosophical Examination of Thomas Szasz on Mental Illness as a Myth(University of the Witwatersrand, Johannesburg, 2024) Fenderico, Alex; Vice, SamanthaThe field of psychiatry has encountered substantial scrutiny pertaining to its diagnostic and therapeutic modalities since the inception of the antipsychiatry movement in the 1960s. A prominent figure within this movement was Thomas Szasz, a Hungarian-American psychiatrist whose influence looms large. Szasz, inspired by the ideas of Michel Foucault, posited that psychiatry functions as a ‘locus of control’ designed to subjugate and pacify societal masses into compliance. His seminal work, "The Myth of Mental Illness," expressed the argument that the medicalisation of mental illness is inherently problematic, constituting a category error of profound significance and resulting in harmful stigmatisation. Szasz advocated for the extrication of mental illness, or as he preferred, 'problems in living,' from the view of the medical domain. Instead, he proposed a paradigm shift towards addressing these issues through social frameworks, particularly emphasizing psychotherapy or counselling as opposed to reliance on psychiatric medications. Szasz's perspectives yielded both enthusiastic support and strong criticism, and contemporary theorists, such as Gabor Maté, persist in echoing his sentiments to this day. The objective of this report is to critically examine Szasz's theoretical position, as well as to present a concerted effort to substantiate its enduring relevance in the current intellectual milieu.Item Exploring attitudes, aetiology and help-seeking behaviours for Mental illness in the community of Diepsloot(University of the Witwatersrand, Johannesburg, 2023-02) Mkhize, Sandile Dionne; Laher, SumayaMental illness is a serious nation-wide health concern, with many individuals suffering from mental disorders. This study explored the attitudes of Diepsloot community members towards mental illness, their beliefs about the aetiology of mental illness and their help-seeking behaviours. Further the study explored whether attitudes and aetiology beliefs predict help-seeking behaviours in Diepsloot community members. Furthermore, issues of stigma and poverty were explored as factors contributing to understanding of and help-seeking behaviours for mental illnesses. A convenience sample of 154 community members in Diepsloot completed a questionnaire consisting of a demographics section, the Living Standards Measure, the Public Perceptions of Mental Illness questionnaire and two open ended questions asking about the factors that contribute to mental illness and the kind of advice the participants would give to a person who has mental illness. Quantitative data were analysed using descriptive statistics and multiple regression analyses. The open-ended questions were analysed qualitatively using thematic analysis. The results indicated that the participants had more neutral attitudes towards mental illness overall but an item-by-item analysis of the attitudes scale indicated negative attitudes. The participants perceived mental illness to be caused by biological and stress related causes but did identify other causes in their responses to the open ended question. In particular, psychological factors, substance use, social components/aspects in their community, financial challenges, biological influences and cultural influences were all identified. Among the participants, there was an endorsement of help-seeking behaviours that were aligned with western medicine, hospitalization, consulting with family and friends, and religion in both the quantitative and qualitative analyses. Seeking help from traditional healers was less dominant in the responses to the open ended question. The multiple regression results, with regard to predicting attitudes towards mental illness, suggested that the participants had positive attitudes towards mental illness if their level of knowledge was higher. A variety of predictors were revealed regarding the various help-seeking behaviours. An overlap was observed among the stress aetiology and the cultural beliefs aetiology as predictors. These results are discussed within the broader context of access to mental healthcare in South Africa as well as the need for more collaborative interventions.Item First-year psychology students' understanding of traditional healing and treatment of mental illness(University of the Witwatersrand, Johannesburg, 2022-07) Mkansi, Akani Patience; Human, LeonieMental illness has shown high prevalence in local South African communities, however, the lack of knowledge and understanding of mental illness has an impact on the treatments that patients choose. Research shows that most individuals understand mental illness and define mental illness somatically and as resulting from biological causes (Memon et al., 2016), whereas there are other reasons for developing mental illness. Although patients consult psychologists and psychiatrists there is still a high number of individuals that consult traditional healers for the treatment of mental disorders (Zingela, 2019). Culture, beliefs, and the value placed on traditional healers results in continued consultation with traditional healers. A shared understanding of culture can help address barriers related to resistance due help-seeking behaviour (Zhou et al., 2021). The objective of the study is to explore first-year psychology students' understanding of mental illness and treatments. The data was collected using phenomenological interviews with ten first year psychology students registered with the University of the Witwatersrand, aged 18 and above. Semi-structured and open-ended interviews were conducted virtually using the Zoom meeting platform and lasted about 45 minutes to one hour. The data was analysed using thematic content analysis. The following themes were identified from the collected data: (1) understanding of mental illness (2) Healing of mental illness (3) role of traditional healers (4) reasons for consulting with traditional healer (5) The role of indigenous South African Cultural Understanding of mental illness (6) African cosmology and mental illness (7) challenges to understanding mental illness. The results presented various understandings of mental illness and treatments. Participants have identified culture, beliefs and several challenges as having an impact on access to mental healthcare services, therefore, it is noteworthy to have future interventions that consider a culturally accommodative and comprehensive framework for understanding mental illness.Item The occurrence of hyponatraemia amongst patients with severe mental illness admitted at Solomon Stix Morewa Memorial Hospital, Johannesburg(2024) Nhiwatiwa, Natsai Marjory SekaiBackground: Morbidity in patients with severe mental illness is known to be higher than in the general population. Numerous factors contribute to this, including the propensity to have comorbid conditions and the effects of long-term treatment with psychotropics. Hyponatraemia is the most common electrolyte abnormality found in hospitalised patients. Patients with severe mental illness are vulnerable to the development of hyponatraemia due to psychogenic polydipsia, comorbid conditions and the long-term use of psychotropics. Aim: To evaluate the occurrence of hyponatraemia in patients with severe mental illness that are admitted at Solomon Stix Morewa Memorial Hospital and to determine the associations between the hyponatraemia and the patients’ demographic and clinical variables. Objectives: To assess and quantify the occurrence of hyponatraemia in patients with severe mental illness. To establish the cases, grades of severity and the trends of hyponatraemia in the study sample. To make possible associations between the development of hyponatraemia and the various clinical profiles. To analyse the trends of sodium testing in the study participants. Results: 32% of the patients had hyponatraemia on admission to Solomon Stix Morewa Memorial Hospital, significantly higher than that of the general population. Female patients and patients on antihypertensive medications were more likely to have hyponatraemia. Other medical conditions such as hypertension, type 2 diabetes mellitus and chronic obstructive pulmonary disease were significant predictors for the development of hyponatraemia. Patients on combination antipsychotics (first- and second-generation antipsychotics) were also more likely to develop hyponatraemia than those not on combination antipsychotics. Conclusion: Hyponatraemia was found in a significant proportion of the study participants. Patients with severe mental illness are more likely to have co-morbid illnesses that can be overlooked. The comorbid illnesses render the patients more likely to develop complications such as hyponatraemia that worsens their outcomes and mortality. More research is required to establish the role of combination antipsychotics as a possible cause of the development of hyponatraemia in psychiatric patients. Definitive monitoring guidelines are required in the long-term management of patients with severe mental illness. More recognition of hyponatraemia as a significant adverse effect of comorbid illness, psychiatric illness and chronic medication is required in patients with severe mental illness.