[For a social psychiatry (author's transl)]. / Pour une psychiatrie sociale.

The mental patient liberated from his chains, is now considered as a patient resorting to a specialized branch of medicine. So, he has entered into the rigid and compelling structures of the modern medicine. The better he will adapt himself to the medical world, the more easily he will be considered as cured. This approach has the advantage to present madness with a securing image of a disease as plain as the somatic ones. On the other side, it deprives madness of its questioning aspects: relations with social structures, culture habits, problems of the personal and specific experience gained by each patient, questions of borders between mental illness and "normal" behaviours. Mental practice in african societies gives a new approach toward mental illness, demonstrating the value of a collective action through symbolic forms, in the traditional social environment. This approach may give precious indications to be taken into account by the occidental psychiatry.

Mastering change: epidemiological and case studies in Senegal, West Africa.

While it has often been assumed that persons exposed to rapid social change incur a risk to their mental health, research results have been inconsistent. The authors found that 269 urban migrants in Senegal, West Africa, did not demonstrate worse mental health than did 300 rural nonmigrants. Case studies suggest that outcome is determined not by change per se but by social contingencies which modify the situations, as well as by personal assets which individuals bring with them. Critical factors include the persistence of familiar cultural forms within the new environment and skills such as literacy and the ability to creatively integrate elements of the old and new cultures.

Measuring psychoneurotic behavior in cross-cultural surveys.

In recent years, a number of studies have appeared which attempt to measure neurotic disorders among population samples in different cultural settings. The problem of how to define and measure psychiatric disorders in untreated groups, and especially in cultures to which the investigators are not native, is, however, far from resolved. The present report describes an effort to study psychological stress among the Serer of Senegal. We describe a method we used to develop a questionnaire to tap symptoms of psychiatric distress, and which would be geared to the realities of place and setting. By means of a factor analysis of the responses to this questionnaire by more than 400 subjects, we identify four dimensions by which the Serer express neurotic disturbance. Further analyses presented in the report demonstrate that these are not merely ways of expressing symptoms based on physical illness, that they are able to discriminate between ill and well people in the Serer frame of reference, that they possess domain validity, and that they demonstrate important similarities and differences with factors obtained using similar techniques in different cultural settings. From a methodological point of view, we illustrate the importance of using a multidimensional approach in such studies.

[Cerebral metastasis in Blacks in Senegal]. / Métastases cérébrales chez le noir au Sénégal.

Twenty-six brain-metastases in black patients, appearing for most of them as primitive, were observed during a period of 11 years in the Neurological Clinic of the Fann U.H.C. in Dakar. They represent 13.9% of brain-tumours and 11.81% of intracranial space occupying lesions. Their etiology is very diversified: lung cancer (4, 15.4%); breast (0); liver (3, 11.5%); digestive tract (3, 11.5%); prostate gland (1); ovaries (1); parotid gland (1); thyroid gland (2); lympho-reticulosarcoma (2); melano-sarcoma (1); chorio carcinoma (3); undetermined (5, 11.5%). This series enables us to appreciate differences with African statistics, which are not numerous and with other foreign statistics. The difference of division of cancer in Africa, particularly in Senegal, explains some results such as the relative high frequency of liver-cancer in the etiology of this metastasis. But it is surprising to learn that lung-cancer is frequent and breast-cancer absent. Also to be marked is the non-negligible influence of the choriocarcinoma metastasis. Progress in approaching diagnosis, by developing scintigraphy, might facilitate extraction of solitary metastasis more often.

Migrants' health and adjustment to urban life--Senegal.

PIP: During 1970-1973, a study was done on the Serer, a Senegalese tribe known to have difficulty in adapting to new situations. The study was done by the World Health Organization and the University in Dakar to determine the health differences, if any, of those still living in their rural environment and those residing in the city. 262 adults were surveyed in the rural area of Niakhar and 225 Serer natives living in the urban area of Dakir were also surveyed. Questionnaires were prepared dealing with sociodemographic, biomedical, mental health, housing and hygiene data. It was found that urban dwellers tended to be younger than their rural counterparts. There was also a greater percentage of Serer women who live in the city. Education was higher among those who lived in Dakar with male urban dwellers having a 13% higher ratio than women. Serer men who live in the city tend to socialize more with other groups while women mixed poorly saying that other cultures had "doubtful morality." Women who moved to Dakir trusted modern medicine, while urban dwelling men believed both in modern and folk medicine. 3 areas of medical concern were studied: precursors to heart disease, anemia, and infectious diseases. Little difference was observed between rural and urban populations for precursors to heart disease. Anemia was common in the rural area for both sexes. More malaria, intestinal parasites and tuberculosis were found in rural households. In regard to mental health, depression and anxiety are approximately the same for urban and rural dwellers while psychiatric syndrome, cerebral syndromes and personality disorders do appear more frequently in urban dwellers. The authors discuss the practical implications of their study and suggest further research that can be done to extend their analysis.^ieng

[Psychotic masked depression or black mask for depression]. / Dépressions masquées psychotiques ou masque noir de la dépression

We have used as depression criteria those of Pichot and Hassan, described during the Sint-Moritz Symposium in 1973 on masked depression. According to their clinical experience in Zaïre and Senegal, the authors consider the possibility that the "bouffée délirante" (acute psychotic reaction), frequent in black Africa, is in fact a manifestation of depression. They remind the five criterias of Pichot and Hassan, i.e.: 1 degree evidence of depression symptoms; 2 degrees a background and a particular underlying personality; 3 degrees evolutional characteristics; 4 degrees familial antecedents and hereditary factors; 5 degrees the response to antidepressive treatment. They present ten cases of acute psychosis: five from Zaïre and five from Senegal. These ten patients have been successfully treated with antidepressive drugs imipramine type, without any neuroleptic drugs; the outcome has always been a rapid remission. Some socio-cultural references are described; it permits to better comprehend the psychological frame of African people. An attempt to psychodynamically interpret the results ends the article.

[Use of a rating scale in transcultural psychiatry]. / A propos de l'utilisation d'une échelle d'évaluation en psychiatrie transculturelle

The Psychopharmacological Studies Group of Fann, Dakar, considered the cultural expression of mental illness as it would help for a new definition of the nosographic frames, and inside of them, the appreciation of symptoms. This new definition would be applied "universally" if it may be considered that some symptoms are "culture-free" and others deeply marked by the discourse held by the person or by his social group. The use of valuation scales for symptomatic change during a treatment (here anti-depressive one) become harder by the undifferenciation of these two types of symptoms. Further, it may exist nosographic masks which can hide more curable substructures ; as often happens here, in masked depressions when the presented symptoms are those of acute or chronic psychotic manifestations. The efficacy of depressive treatment is then remarkable.