[Clinical aspects of witchcraft delusions]

To distinguish clinical variants and to specify nosologic entity of witchcraft delusions, 69 patients (10 males, aged 15-72 years) have been examined. It was found that witchcraft delusions exist in passive and active forms. In a passive form, the patient is sure that unknown (mystic) power damaged him/her; in an active form the patient, possessing a gift for unusual abilities, can influence the others (bewitches, heals, etc). Five clinical syndromes, in the structure of which the above delusions were found, namely, paranoiac-hypochondriac, hallucination-paranoid, depressive-paranoid, paraphrenic and delirious, were identified. Psychoses of schizophrenia spectrum were diagnosed in 52 patients, organic--in 8, alcoholic--in 7 and recurrent depressive disorder--in 2. Clinical significance of witchcraft delusions is closely related to its social aspect. Being combined with ideas of persecution, poisoning and damage, it results in the brutal forms of delusions defense and may be considered as an unfavorable prognostic trait.

[Knowledge-attitudes-practices survey of the Songololo population (D.R. Congo) about Buruli ulcers]

The Buruli ulcer (B. U.) is rampant in many tropical and subtropical countries. In D.R. of Congo, some cases of Buruli ulcer have been reported between 1950 and 1970 in the endemic focus of Songololo-Kimpese (Lower-Congo Province). The objective of this study was to provide some anthropological knowledge for better treatment of this pathology; to confirm the presence of Buruli ulcer in that focus and to describe general caracteristics of the subjects. This disease looked upon as "mbasu" (in the Ndibu population in majority in that focus) is experienced as a malediction, or punishment. The success of a program to fight against Buruli ulcer lies on health education which takes into account the representation systems of diseases.

The social diagnostics of stroke-like symptoms: healers, doctors and prophets in Agincourt, Limpopo Province, South Africa

This paper focuses on the clinical and social diagnostics of stroke-like symptoms in Limpopo Province, South Africa. The research questions addressed here are: what are the lay understandings of stroke-like symptoms and what are the health-seeking behaviours of Tsongan Mozambican refugees and South Africans in this area? The study site is ten villages in the Agincourt sub-district of Limpopo Province which are within the health surveillance area of the Agincourt Health and Population Unit (AHPU) of the University of Witwatersrand. The population are Tsongan who speak Shangaan and comprise self-settled Mozambican refugees who fled to this area during the 1980s across the nearby border and displaced South African citizens. The latter were forcibly displaced from their villages to make way for game reserves or agricultural development and moved to this area when it was the former 'homeland' of Gazankulu. The team collected data using rapid ethnographic assessment and household interviews as part of the Southern Africa Stroke Prevention Initiative (SASPI). The main findings are that stroke-like symptoms are considered to be both a physical and social condition, and in consequence plural healing using clinical and social diagnostics is sought to address both these dimensions. People with stroke-like symptoms maintain their physical, mental and social well-being and deal with this affliction and misfortune by visiting doctors, healers, prophets and churches.

A Nova Vida: The Commoditization of Reproduction in Central Mozambique

In Central Mozambique economic austerity and shifts in domestic organization have transformed kinship and gender relations in ways that reinforce reproductive demands on women. Against this backdrop of economic and social restructuring, commodification of long-standing reproductive practices has intensified. This paper examines the influence of commodification and female economic marginalization on virginity reviews, seduction fees, bride wealth payments, and childbirth assistance. Constructions of reproductive risk as human or spirit-induced threats of witchcraft, sorcery, or spirit possession resonate in this atmosphere of competition and instability. Rather than disappearing, occult practices may be increasing in response to the new inequalities associated with "modernity." This pressure contributes to women's reproductive vulnerability and informs new strategies to manage risk during pregnancy. Life history and pregnancy case study data reveal how women facing growing inequality and increasing danger to reproductive health mobilize cultural resources in ways that, paradoxically, both reinforce and contest dominant relations of reproduction.

The importance of cultural factors in the planning of rehabilitation services in a remote area of Papua New Guinea

PURPOSE

The aim of this study in the Middle Ramu, Papua New Guinea, was to gain a better understanding of how cultural factors work to influence the lives of persons with disability in a remote area. The study also explores how this information can be used for the planning of rehabilitation services.

METHOD

Two phase screening identified persons with disability in the study area and questionnaires were completed for all those identified. Information documented included the nature of the disability, a biomedical cause (where appropriate), the perceived cause of the disability, as well as some indication as to where help had been sought for the disability. In depth interviews were later done with disabled individuals and their families, to determine how they explained their disability.

RESULTS

Thirty-two per cent of persons with disability and their families attributed disability to sorcery or other supernatural causes, a greater proportion than for any other category of perceived aetiology. There was widespread acceptance of Western medicine, although help was more likely to be sought from sources in the community for disabilities believed to have a supernatural origin.

CONCLUSIONS

This study demonstrates that an understanding of cultural factors is fundamental to implementing rehabilitation services that are culturally appropriate and address the social dimension of disability.

Dying peacefully: considering good death and bad death in Kwahu-Tafo, Ghana

People in Kwahu-Tafo, a rural town in Southern Ghana, regard a peaceful death as a 'good death'. 'Peaceful' refers to the dying person having finished all business and made peace with others before his/her death and implies being at peace with his/her own death. It further refers to the manner of dying: not by violence, an accident or a fearsome disease, not by foul means and without much pain. A good and peaceful death comes 'naturally' after a long and well-spent life. Such a death preferably takes place at home, which is the epitome of peacefulness, surrounded by children and grandchildren. Finally, a good death is a death which is accepted by the relatives. This 'definition' of good death--'bad death' is its opposite--does not imply, however, that it is a fixed category. The quality of one's death is liable to social and political manoeuvre and, therefore, inherently ambiguous. The good death of a very old and successful person can be decried by the younger generation as the death of a witch who managed to live long at the expense of young people who died prematurely. The article is based on anthropological fieldwork carried out intermittently from 1971 to the present day.

Traditional Healing and Its Discontents: Efficacy and Traditional Therapies of Neuropsychiatric Disorders in Bali

In a discussion of patients suffering from obsessive-compulsive disorder (OCD) and/or Tourettes's Syndrome (TS), in Bali, Indonesia, traditional healing and psychiatric perspectives are used to highlight the power and weakness of each to treat these conditions. Given they are drawn from the same culture, should not indigenous explanatory models provide meaning and be more efficacious at relieving the suffering of people with OCD and TS-like symptoms? What if they provide an understandable meaning for patients but these meanings have no efficacy? Ethnographic data on Balinese models for illness are presented. Multiple data sources were used to frame the complex Balinese traditional healing systems. Forty patients were interviewed regarding their utilization of traditional healers, and healers were observed treating patients and interviewed regarding their treatment regimens and explanatory models. Traditional explanatory models for illness provide an understandable and integrated system of meaning for these disorders but are not successful in relieving symptomatology. Neurobiological approaches, traditional healing, and ethnographic methods are compared and contrasted to highlight the strengths and weaknesses of each in relation to issues of exegesis and efficacy.

The good, the bad, and the unresolved death in Kaliai

Lusi-Kaliai speakers in West New Britain, Papua New Guinea consider death to be either good or bad depending on whether it is the consequence of bad social relationships and causes social upheaval. A good death is under the control of the dying person and is the result of the natural process of aging. Good deaths are the ideal, but are rare in Kaliai. Bad death is more common and implies a rupture of social relations and results in the destruction of peace and social order. A death may be unresolved because people disagree as to its cause and its meaning for others. Strife resulting from an unresolved death may be irreparable, making closure impossible. The resulting social dysfunction can lead to further death and the breakdown of the community. However, when people understand the cause of death and can identify the causative agent, it is possible to resolve the problems leading to the death and restore order. Case studies illustrate how particular deaths fit these categories and how the people of Kaliai struggle to explain death, to cope with its inevitability, and to repair the social disruption in its wake.

Alleged lethal sorcery in East Timor

A wide range of cultural and social perspectives exists on the concept of sudden and unexpected death. In countries, without a formal system of death investigation, sudden death is shrouded in mysticism often based on traditional belief systems. This cultural perspective on sudden death is often at variance with medical and forensic concepts and may include explanations such as sorcery, magic, and voodoo. In this case report, the postmortem findings in an alleged victim of lethal 'black magic', known as ema halo by the indigenous people of East Timor, is described. The alleged victim died suddenly in front of witnesses. At autopsy, marked dilation of a bicuspid aortic valve with annuloaortic ectasia and a sinus of Valsalva aneurysm was found after exhumation of the body. The findings mitigated the local belief in witchcraft and established a natural manner of death.

Mycolactones and Mycobacterium ulcerans disease

CONTEXT

Mycobacterium ulcerans causes devastating necrotic lesions in affected individuals. The disease, commonly called Buruli ulcer, is increasing in prevalance in western African countries. Treatment is mainly surgical; no clinical trials have been done to support the use of antimycobacterial drugs. A secreted polyketide toxin, mycolactone, is responsible for the tissue damage; its chemical structure has been elucidated.

STARTING POINT

Although the main treatment is surgical, many patients with Buruli ulcer present late because of unusual beliefs about the disease and its treatment. Isabelle Aujoulat and colleagues recently showed, in a study in southern Bénin, Africa (Trop Med Int Health 2003; 8: 750-59), that although the ulcer is well recognised, the cause is often seen as environmental or because of witchcraft. In addition, treatment is thought to be destructive, costly, and ineffective. WHERE NEXT? Antimycobacterial drug regimens that hold promise based on animal and preliminary human studies will soon be tested in large well-designed controlled clinical trials. Information gleaned from the genomic sequence of M ulcerans could be used to design more effective vaccines, or new drug targets (eg, that knock out the enzymes of M ulcerans that synthesise mycolactone species).

Paranormal phenomena in the medical literature sufficient smoke to warrant a search for fire

Paranormal phenomena - events that cannot be explained by existing science - are regularly reported in medicine. Surveys have shown that a majority of the population of the United States and Great Britain hold at least one paranormal belief. Information was retrieved by MEDLINE searches using keywords 'paranormal' and 'psychic', and from the author's own collection. Reports are predominantly by physicians, and from peer-reviewed, MEDLINE-indexed literature. This is a representative sample, as there is no database for paranormal medical phenomena. Presented and discussed are: a case of systemic lupus erythematosis ameliorated by witchcraft; an analysis of studies on distant healing; acupuncture, as a bridge between what is now accepted but recently would have been deemed paranormal; a carefully-done study of a psychic; auditory hallucinations informing a patient, correctly, that she had a brain tumor; two nearly-identical lay press reports of self-predicted death; lycanthropy (the delusion of being an animal); the development of Carl Jung's collective unconscious; hypnosis - still questioned despite documented therapeutic benefit, and a well-researched report of a person speaking a foreign language, apparently unlearned (xenoglossy) while hypnotized; and multiple examples of children who spout the details of the life of an unknown, deceased person. The inability of existing paradigms to explain these observations does not negate them; rather, it elucidates a need for more research.

Beliefs and attitudes toward Buruli ulcer in Ghana

Buruli ulcer is a devastating emerging disease in tropical countries. Quantitative and qualitative data were obtained by interviewing patients with this disease and control subjects in Ghana. Common perceived causes were witchcraft and curses. Other reported causes were personal hygiene, environment, and close contact with a patient with this disease. Financial difficulties, fear of the mutilating aspects of treatment, and social stigma were the main reasons found for delay in obtaining treatment. Patients are reluctant to seek treatment outside their own community. Patients often expected medical treatment instead of surgery, and underestimated the duration of hospital admission. The stigma of the disease is huge, and is strongly associated with the mysterious nature of the condition, the lack of knowledge about its mode of transmission, and the lack of proper treatment. Stigma scores were higher in unaffected respondents and in a less endemic location. Education on the disease, usually propagated for early case detection, might be useful in reducing stigma.

Burden of mental illness on family members, care-givers and the community

OBJECTIVE

To determine the burden of mental illness in the family/caregiver and the community.

DESIGN

A cross-sectional descriptive study.

SETTING

Rehabilitation centres, community day centres, resettlement villages and in the community in three provinces (Harare, Bulawayo and Masvingo), Zimbabwe.

SUBJECTS

A sample size comprising sixty six care-givers and 126 patients were consecutively interviewed for the study.

RESULTS

The care-givers had a mean +/- s.d. age of 48.8 +/- 15.7 years. The majority were females (80.3%), married males, 76.9% (p=0.073), unemployed females, 94.3% (p=0.0004) and parents of the patients accounted for 51.5%. Many respondents believed that the cause of mental illness was witchcraft (31%), they experienced financial constraints (63.6%), and spent a lot of money on food (56.1%). Patients were younger than their caregivers, with a mean +/- s.d. age of 37.7 +/- 12.8 years and mostly on medications (91.3%).

CONCLUSION

The caregivers were mainly women and unemployed, whereas patients were mostly male. Caregivers were faced with multiple problems, but they were more tolerant to patients' behaviour than the community at large.

Use of indigenous and indigenised medicines to enhance personal well-being: a South African case study

An estimated 27 million South Africans use indigenous medicines (Mander, 1997, Medicinal plant marketing and strategies for sustaining the plant supply in the Bushbuckridge area and Mpumalanga Province. Institute for Natural Resources, University of Natal. Pietermaritzburg, South Africa). Although herbal remedies are freely available in amayeza stores, or Xhosa chemists, for self-medication, little is known about the motivations of consumers. According to African belief systems, good health is holistic and extends to the person's social environment. The paper makes a distinction between traditional medicines which are used to enhance personal well-being generally and for cultural purposes, on the one hand, and medicines used to treat physical conditions only, on the other. Drawing on an eight-month study of Xhosa chemists in Eastern Cape Province, South Africa, in 1996, the paper identifies 90 medicines in stock which are used to enhance personal well-being. Just under one-third of all purchases were of medicines to enhance well-being. Remedies particularly popular included medicines believed to ward off evil spirits and bring good luck. The protection of infants with medicines which repel evil spirits is a common practice. Consumer behaviours indicate that the range of medicines available is increased by indigenisation of manufactured traditional medicines and cross-cultural borrowing. Case studies confirm that self- and infant medication with indigenous remedies augmented by indigenised medicines plays an important role in primary health care by allaying the fears and anxieties of everyday life within the Xhosa belief system. thereby promoting personal well-being.

The opinion of caregivers on aspects of schizophrenia and major affective disorders in a Nigerian setting

BACKGROUND

In Nigeria the burden of caring for persons with severe mental disorders rests largely on families whose attitudes to these conditions have not been explored.

OBJECTIVES

To assess the opinion of relatives of 75 schizophrenics and 20 major affective disorder cases on aspects of the disease and compare with the responses of relatives of cancer, infertility and sickle cell disease (SCD) cases.

METHOD

Caregivers were assessed using a burden questionnaire that contained items on etiological beliefs and attitudes to illness.

RESULTS

The responses of relatives of the two psychiatric illness groups were similar. The single most important etiological factors were that "it is Satan's work" (35.8%) and "it is a natural illness" (23.2%). Other factors were "genetic" (9.5%), "witchcraft" (10.5%) and "curse by enemies" (10.5%). This was similar to the opinion of cancer and infertility caregivers; but different from SCD where the most important causative factors were "genetic" (41.5%) and "natural" (21.5%). Psychiatric caregivers had higher frequency of anger and stigma. Over two-thirds of psychiatric caregivers felt glad caring for the patient and would not like the patient institutionalized. Most families were thought to be supportive and there was an impression that caring had made family emotional ties closer.

CONCLUSIONS

These families were tolerant and would cooperate with health authorities. Causative models are influenced by available knowledge and practices in the culture. To actualize the potential of families to play useful community psychosocial roles, there is a need for public mental health literacy and welfare support.

Flight and abduction in witchcraft and UFO lore

The lore surrounding the mythical Witches' Sabbat and contemporary reports of UFO abductions share three main characteristics: the use of masks, the appearance of "Men in Black," and references to flight and abduction. We review these three commonalities with particular focus on the aspect of flight and abduction. We argue that narratives of the Witches' Sabbat and UFO abductions share the same basic structure, common symbolism, and serve the same psychological needs of providing a coherent explanation for anomalous (ambiguous) experiences while simultaneously giving the experient a sense of freedom, release, and escape from the self. This pattern of similarities suggests the possibility that UFO abductions are a modern version of tales of flight to the Sabbat.

Sorcery and science: responses to kuru and other epidemics

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Physical 'disability' in Bantu languages: understanding the relativity of classification and meaning

The terminology related to 'physical disability' in proto-Bantu and in contemporary Bantu languages of Zone L are examined for a better understanding of African classification and meaning. The methods used in the examination include 'words and things' and ethnographic fieldwork. In proto-Bantu, nominal classes are used to categorize disability as both human and non-human. Based on the distribution of terminology, a support for differing regional and historical meaning is developed. The most ancient meaning links physical disability to 'becoming heavy' out of which variants developed. In contemporary Bantu languages in Zone L, the widespread use of the term -lema reemphasizes categorization in both human and non-human, and the use of meaning found in proto-Bantu is evident. However, ethnographic work in the same language area indicates that other terms are important to an understanding of classification and meaning related to physical disability in Zone L. These terms relate to sorcery or reincarnation as meanings attached to disability.

Witchcraft's syndrome: Munchausen's syndrome by proxy

A 28-year-old man presented to the Dermatology Outpatient Department with a complaint of a burning sensation and soreness over his left cheek and left ear of 10 days duration. It had started suddenly one morning when he woke up from sleep. He noticed a large blister with intense redness over his left cheek, associated with a burning sensation. There was a history of similar episodes over the past year, and all were sudden in onset, involved the cheeks, and were noticed after waking up from sleep. The patient volunteered that the episodes were always associated with a drinking spree the previous night. The individual was a healthy man with a wife and two children. The patient had been dependent on alcohol for the past year, and had been consuming alcohol for many years. On examination, there was an eschar occupying almost the entire cheek, with a few scattered lesions over the left tragus and left external ear. Peripheral scarring was noted with hyperpigmentation. While the angle of the mouth was superficially involved on the left side, the oral mucosa was normal. The right cheek also showed a few areas of scarring with patches of alopecia. There were no similar lesions elsewhere on the body. The peculiar history and the morphology of the lesion, that defied any classical diagnosis description, prompted us to interrogate both the man and his wife with regard to any serious differences. After much persuasion and on assurance of secrecy, the wife admitted that her husband was an alcoholic and was neglecting his family. When her efforts to prevent his drinking failed, she resorted to this drastic measure. Each time he passed out after a drinking bout, she poured acid on his cheek, hoping that the sequelae would frighten him from drinking. The acid was readily available to her as she used it for domestic cleaning. The couple were sent for psychiatric evaluation as Munchausen's syndrome by proxy (MSBP) or witchcraft's syndrome (WS) was suspected. Detailed psychiatric evaluation, together with psychometric assessment, revealed that the patient had an alcohol dependence (Axis-I diagnosis) and had a cyclothymic personality. Severe marital discord due to alcohol dependence had been present for the past 2 years. Evaluation of the patient's wife revealed that she was under significant psychologic distress. She showed major depressive symptoms with a histrionic personality. She revealed that she had resorted to using the corrosive out of frustration and anger over the behavior of the patient while he was in an inebriated state. The couple are currently undergoing psychiatric treatment.