Aspects of stress among traditionally living people in a developing country.

Stress situations are present in a developing country, and a few of the common problems usually seen by a GP are briefly described. Causes of emotional stress include: (a) interpersonal differences between family members, neighbours, etc.; (b) differences with ancestral spirits; (c) going against accepted traditional taboos; (d) differences with traditional leaders, chiefs, traditional healers (inyangas) and people who cast spells. The clinical presentation includes (a) conversion syndrome (hysteria); (b) headache; (c) inexplicable pains; (d) 'something moving up and down in one's body; (e) palpitations; (f) pain in the heart; (g) symptoms of depression; and (h) frank psychosis. Diagnosis may be difficult and is usually by exclusion. Gaining the confidence of the patient is important; ignorance of the patient's language and customs puts the doctor at a disadvantage. Where symptoms are of long standing, treatment is difficult, prognosis poor, and most cases need to be referred to a psychiatrist.