Psychotherapy in Africa
Authors: Adeoye Lambo
Journal: Psychotherapy and Psychosomatics (1974)

Psychotherapy in Africa, especially in the traditional era, formed part and parcel of the social fabric. It is therefore as old as any of the institutional aspects of African civilization. It pervades almost every aspect of life and today constitutes an important and built-in component of the African social and religious life. It must not be forgotten that <i>Reik</i> (1931), in his psychoanalytical studies of ritual, regards the mythological world of the primitives as 'older than religion', and, according to him, 'it is one of the oldest wish-compensations of mankind in its eternal struggle with external and internal forces'. Historically, <i>Reik</i> considers the mythological approach as 'of the highest importance for our understanding of the first psychological conflicts of primitive peoples'. In this context and within the African social, cultural, and historical life, psychotherapy can be broadly defined as <i>specific</i> and specialized efforts directed towards, or actions taken for the purpose of, <i>positively</i> influencing the human mind, especially his thought, feeling and behaviour with the object of promoting good mental health and human well-being. Its ultimate objective is to effect a <i>measurable</i> change in the personality. The methods employed for this purpose are multiple and they vary from individual to group, from a variety of magico-religious rites to well-formulated and articulated quasi-mathematical procedures, invested with a fanciful, poetic, and most attractive gab, known as <i>Ifa</i>; from the use of hypnosis, trances, suggestion and persuasion to mystic invocations to the spirits. Thus men and spirits are brought together in mystic and emotional relationship 'in a joint endeavour to conserve and promote good mental health by a ritualistic technique as the link with the providential sources of life...' The cultures of Africa recognize the different layers of the human psyche and, consequently, the existence of, and distinction between, 'conscious' and 'unconscious' forces which determine human behaviour. There is, in many of these cultures, a bewildering array of vast and complicated systems of psychotherapeutic practices which, in spite of their diversity, emphasize that <i>reality</i> consists in the relation not of men with things, but of men with other men, and of all men with spirits. The attitudes towards disease in general, and mental illness in particular, and the methods of coping with it, vary from culture to culture. In Africa, the concepts of health and disease can be regarded as constituting a <i>continuous transition</i> with almost imperceptible gradations. In these and related cultures, the <i>determinants of health and disease are conceptualized holistically</i>. Psychotherapy, therefore, within the African context, is an indispensable phase of a variety of institutionalized processes to promote human well-being: 'averting the wrath of gods or spirits, making rain, purifying streams or habitations, improving sex potency or fecundity or the fertility of fields and crops – in short, <i>it is bound up with the whole interpretation of life</i>' (my own italics). Thus, it is important to realize that psychological medicine has more clearly a function of the culture than of environmental conditions. According to <i>Ackerknecht</i> (1942), primitive medicine, of which psychotherapy is its cardinal and most powerful armamentarium, 'is not a queer collection of errors and superstitions, but a number of living unities in living cultural patterns, quite able to function through the centuries in spite of their fundamental differences from the Western pattern ...' The diagnosis of psychological or emotional disorder in tribal Africa involves many complicated processes. In these and related cultures, the patient is usually the centre of a whole system of social and interpersonal tensions. The entire management of the patient is, as a result, dictated by diagnosis which is deemed to unravel: (1) the immediate cause of the illness; (2) the remote cause, and (3) the form of therapy that should be followed: expiatory sacrifice and/or other psychotherapeutic manoeuvres, usually <i>involving the practitioner, the patient, his family and the community</i>. With this important historical and cultural background, it is important to appreciate that psychotherapy in Africa remains a <i>sine qua non</i> in all activities in which human suffering or distress has to be alleviated. It is a system of specialized techniques practised by men and women who are greatly respected within the community – men and women who, through self-denial, dedication, prolonged meditation and training, have 'discovered' the secrets of the healing art and its magic. These practitioners are thought to possess mystical characteristics, charisma and affectionate eccentricity. A good many of them who have worked in close contact with us have been known to display extraordinary qualities of mind – common-sense, great eloquence, tough-mindedness, great boldness and unrivalled capacity for deep insight into human problems. In the presence of incontrovertible empirical evidence, they are regarded as an expert in almost every facet of individual and community life. It is within this cultural background that modern and scientifically geared psychotherapy has been practised in Africa with the introduction of modern psychiatric practice. This paper deals, therefore, with many aspects of group psychotherapy which contrasts in many ways with that of Western group psychotherapy. Group psychotherapy, according to our theory and practice, considers the family and the peer group as the strategic focus, and both are regarded as carriers and transmitters of societal mores and social values. Group psychotherapeutic activities are normal, but scientifically 'structured', extensions of group interactions in the normal life of individuals. These activities mobilize all internal and external dynamic forces for reintegration and normalization of the personality.