Exploring How Cultural Narratives Shape Recovery: Insights from Substance-Induced Psychosis Outpatients in Harare, Zimbabwe.

Abstract

Substance-Induced psychosis (SIP) imposes an incrementally significant clinical challenge in Zimbabwe. While biomedical models focus on neurobiological mechanisms, culturally constructed narratives’ influence on the psychological experience of recovery remains critically underexplored, creating a gap in competent care.
Objective: This qualitative study aimed to explore the prevalent cultural narratives held by men recovering from SIP and to examine how these narratives function as psychological determinants of the recovery processes and therapeutic engagement.
Method: Utilising a phenomenological design, in-depth semi-structured interviews and a focus group discussion were conducted with eight male SIP outpatients of a central hospital in Harare to collect data. The data was analysed using thematic analysis.
Results: Findings revealed six key cultural narratives which included (1) supernatural attribution (including the “prophetic gift”), (2) attitudes surrounding substance use i.e. normalisation, medicinal and taboo, (3) stigmatisation, (4) collectivism, (5) masculinity concepts, (6) peer influence. These narratives function as internalised cognitive schemas that shape identity, dictate help-seeking behaviour, create psychological conflicts (e.g cognitive dissonance, internalised stigma). Participants navigated a therapeutic double bind between collectivist familial control and masculine self-reliance, which both individually and collectively directly influenced treatment adherence. A culturally sensitive treatment model that recognises explanatory frameworks, a multi-disciplinary approach, leverages community support and challenges stigma, was suggested based on feedback from participants.
Conclusion: Recovery from SIP is psychologically mediated through a powerful ecosystem of cultural meaning-making systems. The findings advocate for the development of responsive healthcare policies, services and culturally sensitive, collaborative care models that integrate study insights into clinical practise to build stronger therapeutic alliances, as well as improve recovery outcomes