Endeavour, endurance, entrapment: Recovery narratives of people living with psychosis in rural Ethiopia

Personal recovery is a mainstream concept in mental health research and practice in the West. The applicability of personal recovery to other cultural and economic contexts is not well understood. This study aimed to characterise the recovery narratives of people living with psychosis in rural Ethiopia. We carried out in-depth interviews with 13 individuals with psychosis, and repeated interviews after 12 months. We conducted an inductive narrative analysis. We first read transcripts to create a case history for each participant. We then identified text which spoke to the dimensions: (i) narrative form (genre and tone); (ii) narrative structure; and (iii) narrative ‘voices’ (characters and meta-narratives). We created a typology of narratives by grouping them into genres, before comparing findings between participants. Whilst there were some stories of change and hope (endeavour narratives), the majority were characterised by struggle (endurance narratives) or despair (entrapment narratives). The narratives were shaped by key characters (family, community, God, medication) and five meta-narratives: supporting family is the priority in life; working makes you well; people with mental illness are less than human; traumatic life events cause or worsen mental illness; and it is God's will that ultimately determines events. Contextual circumstances- poverty, lack of work opportunities, limited access to mental healthcare, and gender norms- were critically important in shaping the lives of our participants. These findings resonate with the critique that some recovery frameworks may be too positive, neat and individualistic to speak to the range of experiences of people with psychosis. Supporting mental health recovery in contexts such as Ethiopia involves addressing structural factors that impede recovery, such as poverty, poor access to medication, and stigma, in ways that are congruent with cultural norms. • People with psychosis in Ethiopia tell of struggle, despair and sometimes hope. • Supporting family is the priority in life for most. • Poverty, limited mental healthcare, stigma and gender norms shape peoples' lives. • Addressing these factors may support personal recovery.