ABSTRACT

Abnormal behaviour is on the increase globally, with one in every four persons in the world expected to be afflicted by one form of a mental or neurological disorder at some point in their lives. Although great advancements have been made in its understanding and treatment, abnormal behaviour is still misconceptualised by many individuals, sub-cultures and cultures world-wide. The purpose of this study was to investigate how abnormal behaviour is conceptualised by residents of Kibera informal settlement in Nairobi County, Kenya; and how this conceptualisation influences the mental health interventions sought by the residents. The Biopsychosocial (BPS) model of abnormal behaviour and the Fourth Edition (revised text) of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) informed the formulation of research objectives and instruments. A cross-sectional survey design employing a mixed concurrent triangulation method of data collection was adopted for the study. Quantitative data was gathered via a researcher-generated questionnaire while qualitative data was generated via a focus group discussion (FGD) guide. Purposive, stratified, simple random and snowball sampling techniques were used to select 433 study participants. The Statistical Package for Social Sciences (SPSS) aided in the analysis of quantitative data from the questionnaire; which were subjected to descriptive analysis using percentages, frequencies and mean scores; and inferential statistical analysis using Independent T-tests, one way Analysis of Variance (ANOVA) test and subsequent Post-Hoc test; and Pearson Correlation Coefficient (r) test. Textual thematic analysis was done for qualitative data from FGDs. The study established a substantial misconception of the nature of abnormal behaviour (Mean=29.36); an average support for scientific psychosocial causes (Mean=54.39) and a causal misconception (Mean=74.07). Gender variable significantly influenced how the nature of child developmental disorders was conceptualised (t=2.639,df=382,p=0.009). Gender, age, and level of education variables significantly influenced how scientific causes of abnormal behaviour were conceptualised (t=-3.983,df=383,p<0.001), (F(3,381)=5.547,p=0.001), F(3,381)=4.240,p=0.006); while age

variable significantly influenced how non-scientific causes of abnormal behaviour were conceptualised (F(3,381)=3.551,p=0.015). A treatment intervention misconception (Mean=59.78) was also established. A correlation was found between support for scientific/non-scientific causes and use of scientific/non-scientific treatment interventions (r=0.258;p<0.001;r=0.178,p<0.001); and between support for scientific/non scientific causes and use of non-scientific/scientific treatment interventions (r=0.199,p<0.001; r=0.125,p=0.014). The two most highly supported measures to mitigate abnormal behaviour were ‗building of mental hospital‘ and ‗educating residents on issues of mental health.‘ The study concluded that there is a misconception of abnormal behaviour among residents of Kibera informal settlement especially in relation to its psychosocial causes which is likely to lead to delayed or improper interventions. Moreover, there is a possibility that residents of Kibera do not use an integrated approach in treatment of abnormal behaviour due to this misconception. The study recommends structured educational programmes on mental health for residents of Kibera informal settlement aimed at correcting the established misconception.

CHAPTER ONE INTRODUCTION

                        Background to the Study

Across history and cultures, people have attempted for years to explain and treat abnormal behaviour (Berrios, 1996; Lefley, 1998; Roy, 2002; Sue & Sue 2004). This natural trend has resulted to multifaceted culture-based beliefs and assumptions about what abnormal behaviour is, what causes abnormal behaviour and what treatment interventions should be adopted for abnormal behaviour (Berrios, 1996; Lefley, 1998; Roy, 2002; Sue & Sue 2004). For example, behaviours predominantly conceptualised as abnormal by ancient Egyptians included hysteria, disordered attention and melancholia, which they attributed to demon possession. Treatment interventions adopted included drugs, applying of bodily fluid, therapeutic retreats, music and exorcism (Mohit, 2001; Millon, 2004). On the other hand, behaviours predominantly conceptualised as abnormal by ancient Greeks included aimless wondering, delusions and violence which they attributed to gods, imbalanced humors or circumstances. Treatment interventions adopted included drugs, talking therapy, blood- letting, incubation, exorcism and torture methods such as stoning, starvation and beatings (Mohit, 2001; Millon, 2004). While these culture-based views and assumptions on the nature, causes and interventions for abnormal behaviour were and are still important in helping societies to deal with the problem of mental illness (Roy, 2002), they do not capture the holistic scientific essence of abnormal behaviour due their contextualised nature (Berrios, 1996; Roy, 2002; Sue & Sue, 2004) hence they amount to misconception.

Though  abnormal  behaviour  still  remains  a  contentious  issue  even  in  modern abnormal

psychology (Bennett, 2003; Comer, 2006; David & Vincent, 2004; Davidson, 2008; Hansell

& Lisa 2005; Sue & Sue 2004), great scientific advancements have been made in understanding of the concept. Modern science has defined, explained and highlighted treatment interventions for abnormal behaviour; and huge success in its diagnosis and treatment based on the scientific criterion continue to be recorded (Bennett, 2003; Comer, 2006; Davison, 2008; Hansell & Lisa 2005; Sue & Sue, 2004). Proper conceptualisation of abnormal behaviour therefore entails an understanding of the nature and causes of abnormal behaviour on the basis of the established scientific criterion; while misconception means an understanding of the nature and causes of abnormal behaviour that deviates from the established scientific criterion (Bennett, 2003; Comer, 2006; David & Vincent, 2004; Davidson, 2008; Hansell & Lisa 2005; Sue & Sue, 2004). The World Health Organisation (WHO, 2005) observed that mostly due to lack of knowledge on the scientific basis of abnormal behaviour and deeply-rooted cultural beliefs, misconception of abnormal behaviour is common in many cultures of the world especially in the low and middle income countries (LMICs). Regrettably, misconception of the concept is associated with seeking of improper treatment interventions, belated scientific intervention and non-intervention for mental illness (Aino, 2004; Deribew & Tamirat, 2005; Martin, Andreoli, Pinto, Hourneaux, Barreira, 2011; Nsereko, Kizza, Kigozi, Ssebunnya, Flisher, Cooper, 2011; Sorsdahl, Flisher, Wilson &Stein, 2000) which heightens the suffering for victims of mental illness.

Abnormal psychologists recognise some definitions of abnormal behaviour that enjoy widespread use by mental health professionals across the world (Sue & Sue, 2004). These include the conceptual definition which views abnormal behaviour as deviations from what is considered normal or most prevalent in a sociocultural context; the practical definition which conceptualises  abnormal  behaviour  on  the  basis  of  discomfort,  deviance  (bizarreness) or

dysfunction   (inefficiency  in   behavioural,   affective  and/or  cognitive  domains);   and the

integrated definition which views abnormal behaviour from three vintage points: that of the individual, that of the society and that of the mental health professional (Sue & Sue, 2004). Abnormal psychologists however agree that though each of these definitions give an insight on what constitutes abnormal behaviour, none of them can provide a holistic basis for conceptualising the nature of abnormal behaviour as none is complete in itself (Sue & Sue, 2004; Comer, 2006; Davidson, 2008). Yet, a holistic conceptualisation of the nature of abnormal behaviour is essential in curbing non-intervention for mental illness (de Boer et al., 2008; WHO, 2008).