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Mental Health Concepts and Techniques For The Occupational Therapy Assistant 5th Edition Ebook PDF
Mental Health Concepts and Techniques For The Occupational Therapy Assistant 5th Edition Ebook PDF
LWW.com
8
Reviewers
9
Nancy Dooley, OTR/L, MA, PhD
Program Director
Occupational Therapy and Occupational Therapy Assistant Programs
New England Institute of Technology in Warwick
East Greenwich, Rhode Island
10
Maureen Matthews, BS, OTR/L
Occupational Therapist III
Behavioral Health
Good Samaritan Hospital
San Jose, California
11
Preface
The fifth edition of Mental Health Concepts and Techniques aims to provide the
occupational therapy assistant (OTA) student with a comprehensive and contemporary
foundation for the practice of occupational therapy for persons with mental health
problems. The book may also be useful to experienced occupational therapy assistants
entering or reentering mental health practice. Occupational therapists with supervisory and
administrative roles with an interest in exploring the delineation and relationships between
the professional and technical levels of responsibility may use the book as a resource. It is
assumed that readers of this text have a background in human growth and development,
general psychology, group process, and activities used in occupational therapy.
Much has changed in mental health care since the first edition. New medications may
better target specific disorders, making improved functioning possible and reducing adverse
effects. Many people with mental disorders have become more assertive about their rights,
alert and proactive as consumers of services. Recovery is the dominant paradigm in
interventions for persons with mental disorders, and the text reflects this. The terms used to
refer to “recipients of services” in the fifth edition correspond to current usage. Box 7-1
identifies some of the names given to the recipient of occupational therapy services in a
range of settings: patient, client, consumer, member, inmate, resident, service user,
survivor, and so on. The student and reader are encouraged to appreciate the ambiguity and
subtle distinctions of these terms, and to be alert to new ones. It is important to develop a
sense for which is the best term for a specific situation, and to cultivate an empathic feel for
the stigma that attaches to labels of any kind.
The text has been updated to reflect the Occupational Therapy Practice Framework, 3rd
edition (OTPF-3E), and the Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition (DSM-5).
12
Overall Changes in the Text
Some chapters from the previous edition have been deleted, on the recommendation of
reviewers of the proposal for this new edition. Their argument was that information from
those chapters (the OTPF-3E, the OT process, documentation, supervision, and personal
organization) is accessible in textbook and online resources that have been developed for
occupational therapy assistants over the past 15 years. This was not the case when the first
three editions of the book published.
The sequence of the remaining chapters has been revised (consumers placed before
contexts, and the activity analysis chapter moved earlier in the book). It is the individual
instructor’s prerogative to determine the optimal sequence for assigning the chapters,
depending on the desired content of a course of study.
Evidence-based practice (EBP) content has been enhanced. Boxes within chapters, and
a new Appendix C, invite the curiosity of the reader. It is assumed that the student will
encounter a thorough exposition of EBP elsewhere in the curriculum. In this text the
purpose is to pose questions that suggest a need for thoughtful answers. The answers may
be multiple, argumentative, and sometimes contradictory. In many cases, no one answer is
correct (to the exclusion of others). Our profession is developing its body of evidence
despite some challenges, explained further in Appendix C.
Other changes include the following:
13
Organization of Content
The content is arranged into five sections. Section I (Chapters 1 to 4) establishes a
framework, discussing the historical origins of psychiatric occupational therapy and the past
and current theoretical foundations on which mental health practice is based. Case
examples are included to illustrate how each theory can be applied.
Section II (Chapters 5 to 8) addresses the context of the occupational therapy
intervention process and includes chapters on psychiatric diagnosis (DSM-5), settings,
medications, and consumers. Content on practice with children, adolescents, families,
veterans, victims of trauma, and other groups has been increased. The purpose of gathering
chapters on such disparate topics under the heading “context” is to suggest the effects of
these factors on the occupational therapy process.
Section III (Chapters 9 to 12) focuses on relationships with patients/clients/consumers.
The therapeutic relationship with the mental health worker is a primary force in motivating
recovery, restoring the patient’s sense of direction, and supporting ability to function.
Logically this material should precede any discipline-specific content. In addition, past
students have expressed a desire to know what to do with the clients whom they meet on
level I fieldwork, which may run concurrently with the mental health coursework in some
curricula. A chapter on safety is included in this section, as is the chapter on groups.
Section IV (Chapters 13 and 14) describes the evaluation, planning, and intervention,
stages of the occupational therapy process. Some information on clinical reasoning (from
the deleted OT process chapter) has been integrated with the evaluation and intervention
chapters. Evaluation instruments cited have been updated to reflect current practice,
consistent with reasonable expectations of service competency for the OTA. The chapters
in this section correspond to the terminology and concepts of the OTPF-3E and official
documents of the American Occupational Therapy Association, at the time of this writing.
Occupational therapy methods and activities are the focus of Section V (Chapters 15 to
20). At the suggestion of reviewers, the chapter on activity analysis has been relocated and
appears as the first in this section. The other five chapters detail specific activities and
methods in the areas of daily living skills, education and work, leisure and social
participation, emotional regulation and management of emotional needs, and cognitive and
sensory and motor factors and skills.
Appendix A contains case examples, some of which are referred to in the text.
Additional case examples appear within the chapters. Appendix B gives sample group
protocols to supplement Chapter 12. Appendix C provides a brief introduction to
evidence-based practice (EBP) in mental health occupational therapy, and EBP boxes can
be found in many chapters. The end papers list abbreviations that students and
practitioners may encounter in mental health settings and medical records.
Popular text features are retained. Chapter objectives direct readers to the learning goals
14
for the chapter, and chapter review questions test the readers’ comprehension. Point-of-
view boxes in selected chapters provide perspectives of consumers and other stakeholders.
Additional retained features include concepts summary and vocabulary review (found
throughout selected chapters in Section I) that reinforce important concepts and provide
definitions for key terms.
With each edition, we (author and publisher) try to move more perfectly toward
gender-neutral language. However, the third person plural is not always appropriate and in
such cases masculine or feminine names or pronouns have been employed.
15
Acknowledgments
No project of this size is ever the work of one person. Many people have helped in direct
and indirect ways throughout the five editions. I remain deeply grateful to Professor JoAnn
Romeo Anderson, Dean Irwin Feifer, and former Dean of Faculty Martin Moed for their
encouragement and mentorship during the T.A.R. project at LaGuardia Community
College in 1980 and 1981; participation in that project enabled me to develop the course
manual from which the first edition evolved. I am grateful to my colleagues and students at
LaGuardia Community College for their companionship and inspiration.
I am most appreciative of the careful suggestions and collegial encouragement of past
and present reviewers. Those for previous editions included Claudia Allen, Linda Barnes,
Alfred Blake, Jody Bortone, Terry Brittell, Anne Brown, Leita Chalfin, Phyllis Clements,
Carol Endebrock-Lee, Edith Fenton, Gloria Graham, Yvette Hachtel, Florence Hannes,
Diane Harlowe, Noel Hepler, Carlotta Kip, Lorna Jean King, Tom Lawton, Siri Marken,
Maureen Matthews, Ann Neville-Jan, Elizabeth Nyberg, Gertrude Pinto, Hermine D.
Plotnick, Margaret D. Rerek, Anne Hiller Scott, Esther Simon, Scott Trudeau, Susan
Voorhies, and Marla Wonser.
I am greatly indebted to the reviewers of the present edition. Their commitment to the
project and their willingness to share their expertise were invaluable. The present text is
very much a collaboration with them. I thank especially the following three individuals who
gave many hours of thoughtful reading and commentary: Myrl Manley, MD; Lynnette
Dagrosa, MA OTR/L; and Maureen Matthews, OTR/L. All the reviewers of the present
edition are listed on page v.
I am grateful to the staff at Wolters Kluwer Health, Lippincott Williams & Wilkins,
and their predecessor, Raven Press, for editorial and other support over the years. Vickie
Thaw was especially encouraging in her stewardship of the project during the development
of the second edition. For the third edition, Margaret Biblis, Linda Napora, Amy Amico,
Lisa Franko, and Mario Fernandez created wonderful text features and a beautiful design,
which live on in altered form in the current edition. For the fourth edition, Elizabeth
Connolly provided careful and thoughtful guidance as managing editor. I am also indebted
to Kim Battista (artist) and Jennifer Clements (art director) for enhancing the look of the
book and the images within it.
The development of the current edition was managed with great patience and care by
Amy Millholen. Her receptivity, flexibility, creativity, and concern were immensely helpful.
Mike Nobel met with me and discussed the project via phone and e-mail for what seemed
like several years, and encouraged me in countless ways. This project would not have
happened without his and Amy’s support. Others in the publication process who
contributed their labors to this edition included Shauna Kelley, Marketing Manager; David
16
Saltzberg, Production Product Manager; and Stephen Druding, Design Coordinator.
My husband, Bob, always assured me that I would manage to complete this edition just
as I have completed others. To that end, he did not let me waste away but frequently
offered treats and nurturance of all kinds, insisted that I go for a walk when I was tired, and
distracted me appropriately (and sometimes inappropriately but hilariously) when I needed
a break. He read passages for clarity and for student readability, a job for which he is well
suited given his decades of teaching high school English. Most of all, he was there for me
when I needed him. What more can one ask? Thank you, Bob.
17
Contents
Reviewers
Preface
Acknowledgments
18
4 Human Occupation and Mental Health Throughout the
Life Span
Motivation Toward Occupation
Changes in Occupation over the Life Span
Mental Health Factors Throughout the Life Span
19
8 Psychotropic Medications and Other Biological Treatments
Psychotropic Medications
Consumer Concerns Related to Medications
Other Biological Treatments
Herbal and Alternative Therapies
Concerns Related to the Internet
11 Safety Techniques
Universal Precautions
Controlling the Clinic Environment
Medical Emergencies and First Aid
Psychiatric Emergencies
Addressing Safety in the Community
20
Starting a New Group
Adaptations of Groups for Low-Functioning Individuals
Other Models for Groups
Program Evaluation
22
Appendix B: Sample Group Protocols
Index
23
List of Figures
1.1 Timeline.
3.1 Some people find social behavior very hard to understand.
3.2 Task checklist.
3.3 Allen’s level 3.
3.4 The process of occupational adaptation.
3.5 Person–Environment–Occupation Model.
4.1 The balance and interrelationship of work and play during the life span.
6.1 Marine Gunnery Sgt. Aaron Tam (Ret.), holding the mask he made to illustrate his
feelings about his traumatic brain injury.
6.2 Homeless persons may establish encampments under highway overpasses.
6.3 Visual analog scale.
7.1 OT client drawing reflecting on obstacles to changing behavior.
7.2 Townhouses such as these in Brooklyn, NY, may contain supported apartments.
7.3 A drawing by a child showing how different body parts feel when she is angry.
7.4 Three levels of environment.
8.1 Aging individuals and those with arthritis or diminished sensation will have difficulty
opening medication containers.
8.2 Storing several medications in the same container makes it difficult to remember the
name, purpose, dosage, and schedule for each one.
9.1 Eye contact, leaning forward, and facial expression convey empathy, sensitivity,
respect, and warmth.
10.1 Postural habits associated with depression (left) and anxiety (right).
10.2 A. Cluttered environment. B. Clarified environment.
11.1 Always use a stairway to evacuate during a fire or smoke condition.
11.2 Hunting is a valued occupation for many individuals and families across the United
States.
12.1 Interaction patterns in groups showing leader and members.
12.2 Group interaction skills survey.
12.3 Typical elements of a group protocol.
12.4 Sample group protocol: self-care group.
12.5 Sample group protocol: caregiver education and support group.
12.6 Sample group protocol: therapeutic activities (acute care unit).
13.1 Empathy and pacing help the client trust the therapy practitioner.
24
13.2 Occupational Performance History Interview version-II.
13.3 Comprehensive Occupational Therapy Evaluation scale.
13.4 Definitions for the Comprehensive Occupational Therapy Evaluation scale.
13.5 The Allen Cognitive Level screening test.
14.1 Reasoning with the model of human occupation.
14.2 Working with plants requires basic task skills and provides a link with nature, a sense
of responsibility, and hope.
14.3 Assembling a wood project provides feedback about the effectiveness of actions and the
sequence of steps, and is adaptable to many goals.
14.4 A guided discussion after a group activity helps the members process what has
occurred.
14.5 Examples of questionnaire statements related to patients’ satisfaction with the delivery
of occupational therapy care.
15.1 Gradation of decision-making.
15.2 Dynamic performance analysis decision tree.
15.3 Making a simple sandwich is a task-specific activity.
16.1 Proposed sequential adherence process.
16.2 Using an umbrella and wearing a well-fitting coat suitable for rain creates a positive
impression.
16.3 Preparing a grocery list and using it help save time and money.
16.4 The immense size, bright lights, and visual stimulation of a large store may be
overwhelming to someone with sensory issues or a cognitive disability.
17.1 Stocking shelves in a supermarket or health aids store requires skills that are within the
range of high school students and persons with mental disabilities who are
beginning to explore the world of work.
17.2 Working alone and at night or other time when few workers are present may be an
effective accommodation from someone with social anxiety or high distractibility.
18.1 Here, a woman instructs her granddaughter in knitting, a leisure activity that she
enjoys, and a social participation experience for both of them.
18.2 Many people enjoy spending their leisure time experiencing nature directly.
18.3 A. Solitary computer gaming activity may interfere with social participation and with
success in school. B. Enjoying an Internet activity with others is different from
doing it alone. In this case, each person has the social proximity of friends.
18.4 Social participation may include pets and other animals.
19.1 The modal model of emotion.
19.2 The process model of emotion regulation.
19.3 Maslow’s hierarchy of needs.
20.1 Postures associated with chronic schizophrenia.
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20.2 Volleyball elicits spinal extension and open postures.
20.3 Multisensory room.
26
List of Tables
27
17.3 Examples of Accommodations that Have Been Considered Reasonable
19.1 Emotion Regulation Processes and Foundation Skills
19.2 Stress Management Techniques
20.1 Examples of Cognitive Impairments
20.2 Sensory Room Equipment Considerations
28
List of Boxes
2.1 Six Dimensions of Rehabilitation Readiness
2.2 Three Examples of Cultural Syndromes
3.1 Mode 4.2: Engaging Abilities and Following Safety Precautions When the Person
Can Differentiate the Parts of the Activity
4.1 Sample Statements of Persons Anticipating Retirement
5.1 ICD-9 and ICD-10 Codes for Schizophrenia
5.2 DSM-5 Diagnosis, “Ozone Layer”
5.3 Brief Occupational Therapy Interventions Related to Substance Use (For the OTA)
6.1 Children with Psychosocial Problems: Focus of Intervention
6.2 Adolescents with Psychosocial Problems: Focus of Intervention
6.3 Elders with Psychosocial Problems: Focus of Intervention
6.4 Veterans with Psychosocial Problems: Focus of Intervention
6.5 Questions for Effective Liaisons with Caregivers
6.6 Four Types of Interactions with Caregivers
6.7 Examples of Cultural Norms for Behavior in the United States
6.8 Behaviors That May Indicate Low Levels of Literacy or Health Literacy
6.9 Homeless Persons: Goals and Areas of Intervention
7.1 The Recipient of Mental Health Services: What’s in a Name?
7.2 Ten Guiding Principles of Recovery
7.3 Guidelines and Strategies for Supporting Recovery
7.4 Short-Term Inpatient Programs: Focus of Intervention
7.5 Longer-Term Inpatient Programs: Focus of Intervention
7.6 Community Programs: Focus of Intervention
7.7 Psychosocial Clubhouse: Focus of Services
7.8 The Nuclear Task Approach to Crisis Intervention
7.9 Psychiatric Home Care: Focus of Intervention
8.1 Recommended Internet Sources for Drug Information
9.1 A 21st-Century Definition of Therapeutic Relationship
9.2 Improving Understanding of Self and Others Through ALOR
9.3 Communication Techniques
9.4 The Six Guiding Principles of the Occupational Therapy Code of Ethics
10.1 Anxiety: Examples of Appropriate Activities
10.2 Depression: Examples of Appropriate Activities
29
10.3 Mania: Examples of Appropriate Activities
10.4 Hallucinations: Examples of Appropriate Activities
10.5 Delusions: Examples of Appropriate Activities
10.6 Paranoia: Examples of Appropriate Activities
10.7 Anger, Hostility, and Aggression: Examples of Appropriate Activities
10.8 Seductive Behavior and Sexual Acting Out: Examples of Appropriate Activities
10.9 Cognitive Deficits: Examples of Appropriate Activities
10.10 Attention Deficits and Disorganization: Examples of Appropriate Activities
11.1 Hand Washing: The First Defense Against Infection
11.2 Some Risk Factors for Suicide
11.3 Signs of Suicidal Intent
11.4 Recommended Home Modifications for Consumer Safety
11.5 NAMI’s Position on Violence, Mental Illness, and Gun Reporting Laws
12.1 Techniques to Promote Interaction in a Group
12.2 Sample Group Session Plan: Grocery Shopping
12.3A Sample Notes from a Project-Level Group
12.3B Sample Notes from a Project-Level Group, Reflecting on Goals of Individuals
13.1 Guide to Observing and Describing Behavior
14.1 The Focus of Clinical Inquiry
14.2 Steps in Planning Intervention
14.3 Making Goals Measurable and Time Limited
15.1 Activity Analysis Following the Model of Human Occupation
16.1 Activities of Daily Living
16.2 Instrumental Activities of Daily Living
16.3 Focus: Relapse Prevention
17.1 Education
17.2 Structures for Homework Success
17.3 Work
30
SECTION One
31
History and Basic Concepts 1
Occupational therapy has a great deal to learn from its history. The profession was founded on
the visionary idea that human beings need, and are nurtured by, their activity as by food and
drink and that every human being possesses potential that can be achieved through engagement
in occupation.
CHAPTER OBJECTIVES
The popular view is that people with mental health problems have trouble controlling
their feelings, thoughts, and behavior. What is less obvious is that many people with mental
disorders also have trouble doing everyday activities, things the rest of us take for granted.
Occupational therapy practitioners address this part of human life—how people carry out
the tasks that are important to them, how well they do these tasks, and how satisfied they
feel about them. Occupation has been defined as “man’s goal-directed use of time, interest,
energy, and attention” (5). Occupation is activity with a purpose, with a meaning unique to
the person performing it (6). Occupational therapy views engagement in occupation as
essential to both physical and mental health. Occupational therapy practitioners evaluate
occupational functioning; work with consumers and caregivers (patients, clients, families)
to identify goals; and intervene to help troubled individuals, families, and communities
learn new skills, engage in occupation, maintain successful and adaptive habits and
routines, explore their feelings and interests, and control their lives and destinies.
32
Mental Health and Mental Illness
Before we look at how occupational therapy approaches the intervention process for
persons with mental health problems, it is useful to examine what we mean by the terms
mental health and mental illness. The World Health Organization has defined mental
health as “a state of well-being in which every individual realizes his or her own potential,
can cope with the normal stresses of life, can work productively and fruitfully, and is able to
make a contribution to her or his community” (67). The mentally healthy person can
manage daily affairs despite the stresses of the real external world and is able to respond
constructively and creatively to the changing demands and opportunities of real life.
If mental health is relative, defined in relation to changing life conditions, at what
point can we say that someone has mental health problems? Throughout recorded history,
mental illness has been defined and redefined, reflecting increases in knowledge and
understanding and changes in cultural beliefs and values. The American Psychiatric
Association has defined mental disorder as follows:
33
Relation of Occupation to Mental Health
The notion that involvement in occupation can improve mental health is not new; it
appears in records of ancient civilizations from China to Rome. It is such an excellent idea
that it is continually rediscovered and acclaimed. At the 1961 annual conference of the
American Occupational Therapy Association, Mary Reilly expressed it this way: “That
man, through the use of his hands as they are energized by mind and will, can influence the
state of his own health” (54, p. 1).
Every person is born with a drive to act on the environment, to change things, to
produce things, to work, to be engaged with life, and to use hands and mind. The
satisfaction of having an effect and the challenge and pleasure of solving problems give life
meaning and purpose. We know that both the unemployed and those employed in routine
jobs experience stress and may develop mental disorders because they lack the stimulation
of challenging activity. Their drive to act is denied, frustrated, and weakened. We know too
that those diagnosed with mental disorders grieve because they cannot do what they once
did; disease and social stigma have obstructed their capacity to engage in valued
occupations as they would like. Unhappiness and inactivity reinforce each other; those who
fail to act become less able to do so.
Occupational therapy uses occupation to reverse the negative cycle of inactivity and
disease. Occupation requires attention and energy; it has a unique meaning to the person
performing it (33). Activity that engages the entire human being—heart, mind, and body
—is powerful therapy. Not every activity is therapeutic, only those that ignite the person’s
interest and empower the will, that strengthen skills, and improve the ability to act.
Helping the client explore, discover, master, and manage the occupations that give that
individual’s life purpose and direction is the essence of psychiatric occupational therapy.
34
A Few Words About Language
In this chapter, we will use the phrase “persons with mental disorders” to refer to the
patients and consumers we encounter in mental health practice. This “person-first” phrase
limits the stigma associated with having a psychiatric diagnosis. It puts the person first, and
the disorder second. Historically, however, different words were used that would be highly
stigmatizing today:
Moron, imbecile, idiot—these were historical descriptors through the 1970s with
specific meanings for persons who today would be diagnosed with intellectual
disabilities
Mad, lunatic, crazy—now used casually, but once had specific meanings
Of unsound mind, mentally ill—terms that were historically accurate in their eras
This is not an exhaustive list. To avoid confusing the reader and generating more stigma,
we have not used any of these terms in the history that follows.
35
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DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI
I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.