Biomedical and Spiritual Approaches to Mental Health in Tanzania: How Power and the Struggle for Public Authority Shaped Care

Abstract

Roughly 80 percent of people with mental illness live in low- and middle-income countries (LMIC). This inductive analysis examines the ways power and the struggle for public authority affect mental health care in the LMIC of Tanzania. It investigates two mental health approaches: the biomedical approach, backed by state actors and donors and manifest in psychotropic medications, therapy, and/or hospitalization, and the spiritual approach, supported by many religious leaders and traditional healers and manifest in prayer, healing ceremonies, and traditional medications. The work demonstrates how various forms and levels of power undergirded these two approaches and influenced their abilities to improve the well-being of Tanzanians living with mental illness. Although the biomedical approach had more economic power and institutional power relative to the spiritual approach, these powers were insufficient to ensure effective patient care. The widespread presence of spiritual leaders and institutions led many to seek spiritual help, but the spiritual approach also was limited because of its proponents’ narrow view of other-worldly power and their internal competition. Based on forty-six key informant interviews, the analysis elucidates how proponents of both approaches sought public authority in processes of competition and collaboration that emphasized individual solutions while downplaying social determinants that could affect mental health.