In Nicaragua, Trauma and Faith Shape Understanding of Psychosis

by Raj Das

Psychosis, a mental disorder characterized by a loss of touch with reality, has long been viewed and studied through a biomedical lens in the Global North. However, a recent study published in the Journal of Mental Health sheds light on the perspective of Nicaraguan individuals, who attribute psychosis to external factors such as trauma and regional conflict.

The researchers, Minna Lyons and Patrick Evison from the University of Liverpool’s School of Psychology, along with Roberto Berrios and Sara Castro from Cuenta Conmigo in Matagalpa, Nicaragua, and Helen Brooks from the University of Liverpool’s Department of Health Services Research, aimed to explore how individuals in Nicaragua perceive and experience psychosis.

Nicaragua offers a unique context for studying psychosis, given the potential external triggers such as political instability, remnants of the revolution, natural disasters, violence, and poverty. The study aimed to understand the experiences of individuals living with psychosis in this setting and to examine their perspectives on its causes, management strategies, and barriers to effective treatment.

The researchers organized three focus groups with 28 participants who had lived experience of psychosis. The discussions revolved around topics such as living with psychosis, its triggers, and coping mechanisms. The findings revealed a stark contrast to the prevalent biomedical approach in high-income countries (HICs).

In Nicaragua, individuals often attribute the onset of psychosis to external triggers such as trauma and long-term regional conflict. Medications were generally well-received when available, but participants emphasized the importance of community support, engagement in meaningful activities, and drawing strength from religious beliefs and magical forces. They found that interventions that are not culturally adapted are unlikely to have direct relevance in low- and middle-income country (LMIC) settings, where daily struggles with poverty are pressing concerns.

Religion played a significant role in the management and recovery from psychosis for many participants. Activities such as reading the Bible, attending church, and praying were frequently mentioned as instrumental in coping with symptoms. Some individuals even trusted in their religion’s healing power to the extent that they discontinued medication. The church also provided a communal space that facilitated social interaction, which was vital for their well-being.

Additionally, participants associated psychosis with traumas such as domestic abuse, childhood neglect, homelessness, relationship breakups, and the aftermath of the Nicaraguan Revolution. These external factors were seen as major contributors to the development of their condition.

Managing psychosis involved a combination of medications, community and lay support, relaxation techniques, and professional mental health services. However, participants faced barriers such as limited access to care, social exclusion, and discrimination in employment due to their condition. The prohibitive cost and scarcity of medications were also significant concerns.

The study highlights the importance of understanding the lived experiences of psychosis within specific cultural milieus. The findings suggest that cultural adaptations of psychological interventions are crucial in LMIC settings, where the sociocultural context and daily struggles of poverty shape individuals’ experiences with psychosis. Community support, engagement in meaningful activities, and drawing strength from religious beliefs often play pivotal roles in the management and recovery process.

It is important to recognize the diverse perspectives on psychosis and move beyond a one-size-fits-all biomedical approach. Taking into account the cultural and contextual factors can lead to more effective and culturally appropriate interventions for individuals living with psychosis worldwide.

Overall, this study offers valuable insights into the experiences and perceptions of individuals with psychosis in Nicaragua. It serves as a reminder that a comprehensive understanding of mental health requires acknowledging and incorporating diverse cultural perspectives and contexts.

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