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<p>In pluralistic-care settings, people with severe mental illness may move between traditional/spiritual healing and psychiatric services, while stigma shapes disclosure, delay, and engagement. This narrative case study examined a 25-year-old male with major depressive disorder with psychotic features (psychotic depression) to clarify his pathway to care and stigma-related turning points. Life history and care trajectory were reconstructed from patient- and family-informed accounts and available clinical documentation, organised into four chronological phases (Acts 1–4). Early relational disruption coincided with self-silencing and constrained emotional expression. Later romantic loss and repeated occupational failure intensified shame and functional decline. In the week prior to admission, the presentation escalated to severe depressive symptoms with moralised guilt (“sins”), likely mood-congruent psychotic content, marked insomnia, reduced intake, and impairment in activities of daily living. Help-seeking unfolded within a pluralistic system: a family explanatory model of “possession” led to prolonged <i>ruqyah</i> and exposure to coercive practices before transition to psychiatric care. Across phases, public, family, and self-stigma operated through concealment, moralisation, and adult-role shame, prolonging untreated illness and compounding distress. Findings support early psychoeducation, family-centred stigma-reduction, trauma-informed assessment of pathway experiences, and culturally responsive collaboration with community or religious figures to enable safe referral, treatment, and relapse-prevention follow-up.</p>

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From Traditional Healing to Psychiatric Care: A Narrative Case Study of Help-Seeking and Stigma in Major Depressive Disorder With Psychotic Features

  • 期刊论文

  • 发表日期：

    2026年4月13日

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  • Triantoro Safaria,
  • Abdul Karim Amirullah

摘要

In pluralistic-care settings, people with severe mental illness may move between traditional/spiritual healing and psychiatric services, while stigma shapes disclosure, delay, and engagement. This narrative case study examined a 25-year-old male with major depressive disorder with psychotic features (psychotic depression) to clarify his pathway to care and stigma-related turning points. Life history and care trajectory were reconstructed from patient- and family-informed accounts and available clinical documentation, organised into four chronological phases (Acts 1–4). Early relational disruption coincided with self-silencing and constrained emotional expression. Later romantic loss and repeated occupational failure intensified shame and functional decline. In the week prior to admission, the presentation escalated to severe depressive symptoms with moralised guilt (“sins”), likely mood-congruent psychotic content, marked insomnia, reduced intake, and impairment in activities of daily living. Help-seeking unfolded within a pluralistic system: a family explanatory model of “possession” led to prolonged ruqyah and exposure to coercive practices before transition to psychiatric care. Across phases, public, family, and self-stigma operated through concealment, moralisation, and adult-role shame, prolonging untreated illness and compounding distress. Findings support early psychoeducation, family-centred stigma-reduction, trauma-informed assessment of pathway experiences, and culturally responsive collaboration with community or religious figures to enable safe referral, treatment, and relapse-prevention follow-up.