Concepts of madness in diverse settings: a qualitative study from the INTREPID project.
BACKGROUND
In order to facilitate case identification of incident (untreated and recent onset) cases of psychosis and controls in three sites in India, Nigeria and Trinidad, we sought to understand how psychoses (or madness) were conceptualized locally. The evidence we gathered also contributes to a long history of research on concepts of madness in diverse settings.


METHODS
We conducted focus group discussions and individual interviews to collect information about how informants in each site make sense of and respond to madness. A coding framework was developed and analyses of transcripts from the FGDs and interviews were conducted.


RESULTS
Analyses suggest the following: a) disturbed behaviors are the primary sign of madness; b) madness is attributed to a wide range of causes; and, c) responses to madness are dictated by cultural and pragmatic factors. These findings are congruent with similar research that has been conducted over the past 50 years.


CONCLUSIONS
The INTREPID research suggests that concepts about madness share similar features across diverse settings: a) terms for madness are often derived from a common understanding that involves disruptions in mental processes and capacities; b) madness is recognized mostly by disruptive behaviours or marked declines in functioning; c) causal attributions are varied; and, d) help-seeking is a complex process.
Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Alex
A
Cohen
Schizophrenia Research Foundation, Chennai, India.
Ramachandran
R
Padmavati
Department of Psychiatry, University of the West Indies, St Augustine, Trinidad.
Maia
M
Hibben
Department of Psychiatry, University of Ibadan, Ibadan, Nigeria.
Samuel
S
Oyewusi
Schizophrenia Research Foundation, Chennai, India.
Sujit
S
John
Department of Psychiatry, University of Ibadan, Ibadan, Nigeria.
Oluyomi
O
Esan
Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Vikram
V
Patel
Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Helen
H
Weiss
Psychosis Studies Department, Institute of Psychiatry, King's College London, London, UK.|National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK.
Robin
R
Murray
Department of Psychiatry, University of the West Indies, St Augustine, Trinidad.
Gerard
G
Hutchinson
Department of Psychiatry, University of Ibadan, Ibadan, Nigeria.
Oye
O
Gureje
Schizophrenia Research Foundation, Chennai, India.
Rangaswamy
R
Thara
National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK. craig.morgan@kcl.ac.uk.|Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK. craig.morgan@kcl.ac.uk.
Craig
C
Morgan
D001291:Attitude of Health Personnel; D017028:Caregivers; D017144:Focus Groups; D006801:Humans; D007194:India; D009549:Nigeria; D011618:Psychotic Disorders / Q000175:diagnosis*; D036301:Qualitative Research; D014300:Trinidad and Tobago
Cross-cultural research; Explanatory models; Help-seeking; India; Nigeria; Psychosis; Trinidad