Kufungisisa

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Kufungisisa is a culture bound syndrome prevalent in Zimbabwe similar to anxiety disorders and depression. [1]

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Among the Shona, who make up a large part of Zimbabwe's population, kufungisisa is characterized by thinking too much or overthinking a situation. There is a widespread belief that such behavior not only contributes to mental illnesses, but also causes physical discomfort. [2]

Kufungisisa is not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). [1]

Origin

It is unclear when the term Kunfungisisa first appeared but it translates to the term "thinking too much". [3]

The concept of "thinking too much" has significant cultural and historical roots in Sub-Saharan Africa, particularly within the Shona language in Zimbabwe. Since the mid-1990s the idiom is used by people across the world to communicate distress. [4]

One of the earliest references to the idiom of "too much thinking" in Sub-Saharan Africa can be found in Peltzer's (1989) research in Malawi on the spirit disorder of vimbuza. [5] The research done by Patel on the Shona idiom of kufungisisa, which was published 1995, represents one of the first in-depth analyses of the idiom as both a cause and a symptom of mental illness and distress. [3]

Symptoms

Kufungisisa presents with symptoms similar to those of depression and anxiety. Affected individuals often find themselves in a poor emotional state. [6]

Psychologically, they may experience persistent fatigue [4] , sadness [4] , forgetfulness [4] , and apathy [4] . Additional symptoms include grief [4] , chronic stress or burnout [4] , low self-esteem [4] , solitude [4] , increased irritability [4] , and a sense of not being oneself [4] . Agitation [6] and inattentiveness [6] is also very common. In more severe cases, symptoms can expand to suicidal thoughts [4] , hallucinations [4] , substance abuse [4] , and psychosis.

Physically, individuals with kufungisisa often report body aches [1] , pain [1] , headaches [1] , insomnia [1] , stomach ulcers [1] , and unintended weight loss. [4]

Cultural implications

In Zimbabwe, kufungisisa translates to “thinking too much” in Shona and is considered a fundamental aspect of mental illness, with 80% of Zimbabweans with common mental illness experiencing it. [7] This concept of “overthinking” as a key experience of different mental illnesses has been observed in various other countries around the world, such as Uganda, [7] Tanzania, [7] Australia (“kulini-kulini”), [8] Nepal, [7] Nicaragua (“pensando much”), [8] Cambodia, [7] and Haiti (“kalkile twop”). [8] Kufungisisa is an idiom that often suggests both interpersonal and social issues and can manifest as a range of physical and mental ailments, such as feelings of negative rumination, pain, irritability, depression, and anxiety. [8]

The term kufungisisa describes both the causes and symptoms of an illness and can encompass afflictions of a mental, spiritual, and social nature. While the term is associated with biomedical constructs of non-psychotic mental illness, it is not simply an equivalent term for anxiety or depression. [3] In psychiatric settings, it has been referred to as a non-specific neurotic mental illness, while the base description is simply “feeling stressed.” Increased usage of kufungisisa can help with acceptance and awareness of the condition. [3]

Symptoms of illnesses such as anxiety and depression can be commonly understood in Zimbabwe using terms such as kufungisisa (‘thinking too much’), kusuwisisa (‘deep sadness’), and moyo unorwadza (‘painful heart’). These cultural terms have been used since the mid-1990s to further research in understanding individuals' experiences with common mental disorders. [6]

Impact on female communities

Kufungisisa often also presents within female communities in Zimbabwe. The presence of both poverty and patriarchal structures in Zimbabwe can place significant pressure on women in these communities, which can result in the development of mental disorders or kufungisisa. In a study done in the rural area of the Shurugwi District in Zimbabwe, it appeared that the convergence of poverty and patriarchy is where women tend to experience kufungisisa. [6] While women in rural areas of Zimbabwe are no longer physically restricted by colonial rule, they are still confined to their communal areas due to cultural customs and laws that maintain patriarchy as a system of domination within the community. These restrictions and practices help mold women’s experience or development of kufungisisa, as they have little control over their household and resources even while their husbands are often absent. Participants described this patriarchal system as obstructing them from being able to play a part in providing household provisioning. [6]

Clinical significance

While similar idioms and phrases can be found around the globe to describe the general concept of overthinking, there are still notable differences in the scale of what people experience, as well as the different cultural nuances present within different countries and communities. Grouping together terms such as kufungisisa under the umbrella term of “thinking too much” can mean that the different cultural nuances of these terms become lost. [4] Understanding the cultural implications of kufungisisa can be essential for clinicians in understanding the extent of what individuals are experiencing and therefore being able to provide them with care and treatment that is culturally informed. The cultural nuances of kufungisisa are relevant in understanding how cultures and communities deal with mental illness in terms of support and management. [4]

Kufungisisa shares many symptoms with common mental disorders, namely anxiety disorders and depression. [7] The belief that supernatural factors caused the symptoms is also linked closely to depression. [9]

In low to middle-income countries, common mental disorders are often linked to diagnoses of chronic illnesses, like HIV/AIDS and diabetes. Poor mental health also predicts a faster HIV progression, as common mental disorders, especially depression, make it hard to adhere to regular medication schedules, as are needed in HIV treatment. [7]

Severe forms of common mental disorders, like PTSD, amongst people living with HIV who have a history of trauma are also called “kufungisisa kwe njodzi”, meaning "thinking too much due to trauma". Njodzi is seen as both the cause of these mental health issues and as being linked to ongoing stigma due to their HIV diagnosis. [10] In a Zimbabwean cross-sectional study of people living with HIV, 45% exhibited PTSD symptoms. [11] Generally, the presence of PTSD symptoms, for example intrusion and hyper-arousal, are often acknowledged but treated as a severe form of kufungisisa. [10]

In people with HIV, kufungisisa has also been linked to substance abuse as a coping mechanism. [10]

Related Research Articles

A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disability, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in a social context. Such disturbances may occur as single episodes, may be persistent, or may be relapsing–remitting. There are many different types of mental disorders, with signs and symptoms that vary widely between specific disorders. A mental disorder is one aspect of mental health.

<span class="mw-page-title-main">Causes of mental disorders</span> Etiology of psychopathology

A mental disorder is an impairment of the mind disrupting normal thinking, feeling, mood, behavior, or social interactions, and accompanied by significant distress or dysfunction. The causes of mental disorders are very complex and vary depending on the particular disorder and the individual. Although the causes of most mental disorders are not fully understood, researchers have identified a variety of biological, psychological, and environmental factors that can contribute to the development or progression of mental disorders. Most mental disorders result in a combination of several different factors rather than just a single factor.

<span class="mw-page-title-main">Anxiety disorder</span> Cognitive disorder with an excessive, irrational dread of everyday situations

Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal functions are significantly impaired. Anxiety may cause physical and cognitive symptoms, such as restlessness, irritability, easy fatigue, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and a variety of other symptoms that may vary based on the individual.

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

<span class="mw-page-title-main">Hypochondriasis</span> Medical condition

Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. Hypochondria is an old concept whose meaning has repeatedly changed over its lifespan. It has been claimed that this debilitating condition results from an inaccurate perception of the condition of body or mind despite the absence of an actual medical diagnosis. An individual with hypochondriasis is known as a hypochondriac. Hypochondriacs become unduly alarmed about any physical or psychological symptoms they detect, no matter how minor the symptom may be, and are convinced that they have, or are about to be diagnosed with, a serious illness.

<span class="mw-page-title-main">Postpartum depression</span> Mood disorder experienced after childbirth

Postpartum depression (PPD), also called postnatal depression, is a mood disorder experienced after childbirth, which can affect both sexes. Symptoms may include extreme sadness, low energy, anxiety, crying episodes, irritability, and changes in sleeping or eating patterns. PPD can also negatively affect the newborn child.

"these disease are derived from variables such as genetics, biological, socio-cultural, systematic, and biopsychosocial factors"

Psychopathology is the study of mental illness. It includes the signs and symptoms of all mental disorders. The field includes abnormal cognition, maladaptive behavior, and experiences which differ according to social norms. This discipline is an in-depth look into symptoms, behaviors, causes, course, development, categorization, treatments, strategies, and more.

<span class="mw-page-title-main">Depression (mood)</span> State of low mood and aversion to activity

Depression is a mental state of low mood and aversion to activity. It affects more than 280 million people of all ages. Depression affects a person's thoughts, behavior, feelings, and sense of well-being. Depressed people often experience loss of motivation or interest in, or reduced pleasure or joy from, experiences that would normally bring them pleasure or joy.

Adjustment disorder is a maladaptive response to a psychosocial stressor. It is classified as a mental disorder. The maladaptive response usually involves otherwise normal emotional and behavioral reactions that manifest more intensely than usual, causing marked distress, preoccupation with the stressor and its consequences, and functional impairment.

In medicine and medical anthropology, a culture-bound syndrome, culture-specific syndrome, or folk illness is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or culture. There are no objective biochemical or structural alterations of body organs or functions, and the disease is not recognized in other cultures. The term culture-bound syndrome was included in the fourth version of the Diagnostic and Statistical Manual of Mental Disorders which also includes a list of the most common culture-bound conditions. Counterpart within the framework of ICD-10 are the culture-specific disorders defined in Annex 2 of the Diagnostic criteria for research.

Mental health in China is a growing issue. Experts have estimated that about 130 million adults living in China are suffering from a mental disorder. The desire to seek treatment is largely hindered by China's strict social norms, as well as religious and cultural beliefs regarding personal reputation and social harmony.

Gender is correlated with the prevalence of certain mental disorders, including depression, anxiety and somatic complaints. For example, women are more likely to be diagnosed with major depression, while men are more likely to be diagnosed with substance abuse and antisocial personality disorder. There are no marked gender differences in the diagnosis rates of disorders like schizophrenia and bipolar disorder. Men are at risk to suffer from post-traumatic stress disorder (PTSD) due to past violent experiences such as accidents, wars and witnessing death, and women are diagnosed with PTSD at higher rates due to experiences with sexual assault, rape and child sexual abuse. Nonbinary or genderqueer identification describes people who do not identify as either male or female. People who identify as nonbinary or gender queer show increased risk for depression, anxiety and post-traumatic stress disorder. People who identify as transgender demonstrate increased risk for depression, anxiety, and post-traumatic stress disorder.

<span class="mw-page-title-main">Friendship bench</span> Zimbabwean mental health program

The Friendship Bench programme is a Zimbabwean community-based mental health intervention where trained community health workers sit on wooden park "Friendship Benches" set up at primary health care clinics or safe community spaces and provide structured problem-solving talk therapy to community members who come looking for mental health support or are referred by nurses or other community members.

Mental distress or psychological distress encompasses the symptoms and experiences of a person's internal life that are commonly held to be troubling, confusing or out of the ordinary. Mental distress can potentially lead to a change of behavior, affect a person's emotions in a negative way, and affect their relationships with the people around them.

Derealization is an alteration in the perception of the external world, causing those with the condition to perceive it as unreal, distant, distorted or in other words falsified. Other symptoms include feeling as if one's environment is lacking in spontaneity, emotional coloring, and depth. It is a dissociative symptom that may appear in moments of severe stress.

Mixed anxiety–depressive disorder (MADD) is a diagnostic category that defines patients who have both anxiety and depressive symptoms of limited and equal intensity accompanied by at least some autonomic nervous system features. Autonomic features are involuntary physical symptoms usually caused by an overactive nervous system, such as panic attacks or intestinal distress. The World Health Organization's ICD-10 describes Mixed anxiety and depressive disorder: "...when symptoms of anxiety and depression are both present, but neither is clearly predominant, and neither type of symptom is present to the extent that justifies a diagnosis if considered separately. When both anxiety and depressive symptoms are present and severe enough to justify individual diagnoses, both diagnoses should be recorded and this category should not be used."

Somatic symptom disorder, also known as somatoform disorder, is defined by one or more chronic physical symptoms that coincide with excessive and maladaptive thoughts, emotions, and behaviors connected to those symptoms. The symptoms are not deliberately produced or feigned, and they may or may not coexist with a known medical ailment.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Metacognitive therapy (MCT) is a psychotherapy focused on modifying metacognitive beliefs that perpetuate states of worry, rumination and attention fixation. It was created by Adrian Wells based on an information processing model by Wells and Gerald Matthews. It is supported by scientific evidence from a large number of studies.

References

  1. 1 2 3 4 5 6 7 Gandhi, Dr Vishal Anilkumar (2023-12-18). "What Is Kufungisisa?". www.icliniq.com. Retrieved 2024-05-15.
  2. ↑ "Kufungisisa - oder die Gefahr, zu viel nachzudenken". Gedankenwelt (in German). 2019-03-09. Retrieved 2024-05-15.
  3. 1 2 3 4 Patel, V.; Simunyu, E.; Gwanzura, F. (July 1995). "Kufungisisa (thinking too much): a Shona idiom for non-psychotic mental illness". The Central African Journal of Medicine. 41 (7): 209–215. ISSN   0008-9176. PMID   7553793.
  4. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Backe, Emma Louise; Bosire, Edna N.; Kim, Andrew Wooyoung; Mendenhall, Emily (2021-12-01). ""Thinking Too Much": A Systematic Review of the Idiom of Distress in Sub-Saharan Africa". Culture, Medicine, and Psychiatry. 45 (4): 655–682. doi:10.1007/s11013-020-09697-z. ISSN   1573-076X. PMID   33387159.
  5. ↑ Peltzer, Karl (1989). "Nosology and Etiology of a Spirit Disorder (Vimbuza) in Malawi". Psychopathology. 22 (2–3): 145–151. doi:10.1159/000284588. ISSN   1423-033X. PMID   2762473.
  6. 1 2 3 4 5 6 Brown, Tim; Datta, Kavita; Fernando, Shamiso (November 2022). "Gender, caring work, and the embodiment of kufungisisa: Findings from a global health intervention in Shurugwi District, Zimbabwe". Health & Place. 78: 102935. doi:10.1016/j.healthplace.2022.102935. ISSN   1353-8292. PMID   36356381.
  7. 1 2 3 4 5 6 7 Gandhi, Dr Vishal Anilkumar (2023-12-18). "What Is Kufungisisa?". www.icliniq.com. Retrieved 2024-05-13.
  8. 1 2 3 4 Teodoro, Tomás; Afonso, Pedro (2020-12-30). "Culture‑Bound Syndromes and Cultural Concepts of Distress in Psychiatry". Revista Portuguesa de Psiquiatria e Saúde Mental. 6 (3): 118–126. doi:10.51338/rppsm.2020.v6.i3.139. ISSN   2184-5417.
  9. ↑ Patel, Vikram; Abas, Melanie; Broadhead, Jeremy; Todd, Charles; Reeler, Anthony (2001-02-24). "Depression in developing countries: lessons from Zimbabwe". BMJ. 322 (7284): 482–484. doi:10.1136/bmj.322.7284.482. ISSN   0959-8138. PMC   1119689 . PMID   11222428.
  10. 1 2 3 Verhey, Ruth; Chibanda, Dixon; Vera, Aquila; Manda, Ethel; Brakarsh, Jonathan; Seedat, Soraya (February 2020). "Perceptions of HIV-related trauma in people living with HIV in Zimbabwe's Friendship Bench Program: A qualitative analysis of counselors' and clients' experiences". Transcultural Psychiatry. 57 (1): 161–172. doi:10.1177/1363461519850337. ISSN   1363-4615. PMID   31180824.
  11. ↑ Verhey, Ruth; Chibanda, Dixon; Gibson, Lorna; Brakarsh, Jonathan; Seedat, Soraya (December 2018). "Validation of the posttraumatic stress disorder checklist – 5 (PCL-5) in a primary care population with high HIV prevalence in Zimbabwe". BMC Psychiatry. 18 (1): 109. doi: 10.1186/s12888-018-1688-9 . ISSN   1471-244X. PMC   5913864 . PMID   29685117.
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