Paper short abstract:

This paper explores the stories 28 African psychiatrists told about the mental health 'treatment gap'. Despite the dominance of a biomedical paradigm, there were cracks in this master narrative which offer important alternative insights into mental health care provision in Africa.

Paper long abstract:

A key focus of the movement for 'global mental health' has been on highlighting the high levels of untreated mental illness in Africa and making proposals for reducing this 'gap'. This movement has been criticised for insufficiently attending to the epistemologies embedded in its recommendations, and inadequately considering the views of practitioners 'on the ground'. Employing a narrative-based approach, I accessed the practice-based stories about the 'gap' in treatment amongst 28 psychiatrists working at the rock-face of public mental health care provision in four African countries: South Africa, Uganda, Nigeria and Ethiopia. Dominant thinking amongst these psychiatrists was heavily informed by a medico-scientific paradigm, one which is based upon many questionable assumptions, binary oppositions and Eurocentric tendencies. There were, however, cracks within this master narrative, which crystalised in the stories that were told by three particular psychiatrists. Their narratives operated within an alternative paradigm, one which I argue is informed by the tradition of phenomenology, and particularly the ideas associated with French philosopher Merleau-Ponty. Focusing primarily on the ethical and hermeneutic aspects of their work, these three psychiatrists' stories revealed the complexities around understanding and responding to the hierarchies of values and socio-cultural systems that shape the nature of their patients' suffering and associated behaviours. Here the notion of uncertainty emerged as a key conceptual resource. This more marginalised way of knowing may offer important conceptual and practical insights into enhancing mental health care in Africa in ways very different from those created by current seats of power.