Witchcraft and psychotherapy

Perceived barriers on utilization of mental health services among adults in Dodoma Municipality – Tanzania

Purpose

– The purpose of this paper is to determine perceived barriers to utilization of mental health services among adults in Dodoma Municipality, Tanzania. To improve the use of mental health services, identifying related perceived barriers is a key step.

Design/methodology/approach

– A concurrent mixed method model was used. Data were collected through face-to-face interviews (n=152) using a structured survey questionnaire. In addition in-depth interviews were conducted (n=10). The quantitative data were analyzed by using Epi info version 2002. Content analysis was used for analyzing qualitative data.

Findings

– The majority of respondents opted to use modern mental health facilities for mental illness treatment. They also used spiritual healing and other forms traditional methods including herbal medicines. The most frequently identified causes of mental illness were: drug abuse, being cursed and witchcraft, demons or evil spirit possession. The reported significant perceived barriers were stigma, economic, lack of transport, witchcraft, lack of awareness of mental health services, unemployment, and negative believes about professional cure.

Originality/value

– The option for mental health service utilization is influenced by the existing barriers on community and clients’ perception. There is a need for mental health professionals and policy makers to integrate mental health into primary care. Mutual sharing of knowledge between mental health professionals and tradition healers is warranted. Further research on the attitudes toward mental health professional services and on effectiveness of traditional healers’ services is indicated.

Witchcraft beliefs and witch hunts: an interdisciplinary explanation

This paper proposes an interdisciplinary explanation of the cross-cultural similarities and evolutionary patterns of witchcraft beliefs. It argues that human social dilemmas have led to the evolution of a fear system that is sensitive to signs of deceit and envy. This was adapted in the evolutionary environment of small foraging bands but became overstimulated by the consequences of the Agricultural Revolution, leading to witch paranoia. State formation, civilization, and economic development abated the fear of witches and replaced it in part with more collectivist forms of social paranoia. However, demographic-economic crises could rekindle fear of witches-resulting, for example, in the witch craze of early modern Europe. The Industrial Revolution broke the Malthusian shackles, but modern economic growth requires agricultural development as a starting point. In sub-Saharan Africa, witch paranoia has resurged because the conditions for agricultural development are lacking, leading to fighting for opportunities and an erosion of intergenerational reciprocity.

The Psychology of Bewitchment (Part I): A Phenomenological Study of the Experience of Bewitchment

The first of two articles on bewitchment reports the findings of a qualitative study based on interviews with a small sample of individuals who believed they had been bewitched. A phenomenological analysis of the data provided a descriptive account of the psychic reality of bewitchment. Those understanding their experience in this way attribute misfortune to the malicious intentions and actions of hated others, who are believed to employ supernatural means to harm their ‘victims’, with real symptomatic consequences. This supernatural interpretive framework relies on a discursive network of witchcraft-related gossip, media reports, folklore, and diagnostic confirmation by traditional healers. Bewitchment beliefs arise within a context of hostile and envious familial and social relations. Despite the distress accompanying the experience of bewitchment, this supernatural understanding was found to offer participants a meaningful explanation for negative life events, especially during times of transition. Muti featured prominently in accounts of ways in which bewitchment is effected and provides the grounds for the experience of being poisoned or possessed by an evil entity. Treatment of bewitchment symptoms by sangomas and spiritual leaders is considered to be superior to that offered by Western medicine.

A psychiatric ward in an African district hospital

In most African district hospitals there are no separate facilities for psychiatric patients. Aformer general medical officer describes how a ward for these patients was set up at a rural district hospital in Zimbabwe using the already available resources. The effects on the psychiatric care at the hospital and the district are illustrated by two case reports. It is concluded that psychiatric care integrated in primary healthcare, with due regard for the cultural aspects and with cooperation of local healers is feasible, provided that it is supported by additional diagnostic and treatment facilities at the district hospital.

Development of mental health services in Tanzania: a reappraisal for the future

The article traces the historical development of mental health services in Tanzania from traditional practices through custodial institutions during the colonial period, efforts towards decentralization, including the development of innovative agricultural rehabilitation villages during the 60s and the introduction of primary mental health care during the 80s right up to the present. Available resources in Tanzania, including the traditional healing system, the family and ample arable land were examined as to how these might be used in the care of mental patients and the promotion of mental health in general. The article points to real opportunities and a possible course of action for the future.

The effect of social change on causal beliefs of mental disorders and treatment preferences in Ghana

The present study investigated the associations between social change, personality, causal beliefs and treatment style and goal preferences of 375 Ghanaian teachers. The index of social change (ISC) was conceptualized as the average percentile rank of a person's income, education and acculturation. The self-report measures (greatly modified after two pilot studies) were subscales of the SuinnLew Acculturation Scale, the Depressive Experiences Questionnaire (dependency), the Sociotropy-Autonomy Scale (autonomy), the Symptom Checklist '90 (paranoid ideation), the Spheres of Control Scale, and the Cognitive Somatic Anxiety Questionnaire. Respondents also completed a questionnaire on causal beliefs and treatment preferences pertaining to mental disorders. Results indicated that beliefs and treatment preferences were affected by the index of social change (ISC) and were specific to type of disorder. High ISC teachers endorsed significantly higher ratings on belief in an internal cause for Depression and Dependent Personality Disorder, and indicated greater preference for participation in treatment than lower ISC teachers. Contrary to prediction, lower ISC teachers indicated a greater preference for greater individual goals in treatment for depression and schizophrenia. High ISC teachers also reported greater perception of interpersonal control and emotional support, less dependency and less interpersonal sensitivity than lower ISC teachers. Little support was found for the commonly observed somatization of distress among non-Western peoples.

Psychological responses to war and atrocity: the limitations of current concepts

Because of the prevalence of wars, political violence and other forms of man-made disaster in Third World countries many individuals and communities suffer prolonged and often multiple traumas. In Western psychiatry certain conceptions of the response to violence and trauma have been developed, including the widely used category of post-traumatic stress disorder (PTSD). We argue that because concepts such as PTSD implicitly endorse a Western ontology and value system, their use in non-Western groups should be, atmost, tentative.

White liver: a cultural disorder resembling AIDS

Hoodoo is a folk belief system common among black Americans. Conjuration and rootwork are other terms used to describe this system which includes the casting of spells and witchcraft. This paper describes the black folk concept of 'white liver', an aspect of hoodoo which bears striking resemblance to AIDS. White liver refers to a condition characterized by sexual excess and a wasting to death of sexual partners. Although clearly antedating by many years the current AIDS epidemic, white liver is important as a contemporary black cultural entity that may be used to describe AIDS or to articulate a fear of AIDS.

Helping victims of violence in Uganda

We report on a project to assist victims of war and violence in Uganda. The original aim of this project, set up by the Medical Foundation for the Care of Victims of Torture, was to establish a centre for the assessment and treatment of torture victims who had suffered during previous regimes in that country. We found, however, that a specialist centre was not the most appropriate response in a country like Uganda. We argue for the need to respect local initiatives and systems of support and against the notion that there is a single model of care which is universally relevant. Following much investigation and involvement with local personnel, we have developed a programme of training and discussion for health workers, and a service to reach the many women who have suffered rape, and whose suffering has continued, largely ignored.

Schizophrenia:

In Zanzibar, as in many "third world" places, there are two health care systems, one traditional and the other "European." Among the Swahili people of East Africa spirits are believed to be the cause of disturbed behavior or "madness." Data and observations gathered during one year of mental health practice in Zanzibar and over many years of practice in the U.S. are compared to examine how cultural values shape beliefs, practices and attitudes related to "madness." Implications for occupational therapy theory and practice are drawn.

Interface between shamanism and psychiatry in Miyako Islands, Okinawa, Japan: a viewpoint from medical and psychiatric anthropology

This study is the first report regarding the borderland between psychiatry and shamanism in Miyako Islands, Okinawa, Japan. Folk healing practices are still flourishing on the islands. Most mentally ill persons we examined admitted to having consulted shamans. Although there is a need to assess the positive and negative effects of shamanistic practices on Miyako Islands' health care system as a whole, this report indicates the urgent need to come to terms with the interaction between shamanism and psychiatry on a multidimensional level. We describe here psychotic illness attributed to kandaari. These cases underline the importance of understanding "the explanatory model" (Kleinman 1979) of people as regards the causes and the effective healing of illness. From the viewpoint of medical and psychiatric anthropology, aspects of the treatment of such patients in the biocultural context are described.

On the advantages of cross-culture psychotherapy: the minority therapist/mainstream patient dyad

The personal quality of the therapist is a key element in therapy. In the case of the minority therapist, the difference in language and cultural background offers the patient unique benefits. Value orientations amongst cultures are similar enough for the minority therapist to acculturate. Through acculturation, the therapist becomes aware of a new set of value orientations. This cultural objectivity better enables the therapist to help the mainstream patient to see alternatives in coping with stresses of life, and to fortify the patient's adaptive skills. Because Western psychiatry and psychotherapy are culture-bound, mainstream therapists may easily be "culturally addicted," whereas a minority therapist can maintain cultural neutrality. Advantages discussed include language independence, culture independence, positive transference and analogous experiences.

'Bhanamati' sorcery and psychopathology in south India. A clinical study

We describe the patterns of illness attributed to sorcery among 209 patients who attended a special clinic in south India. Somatisation and conversion disorders accounted for the majority of patients, although several other psychiatric and medical disorders were also seen. Aspects of treatment of such patients in the sociocultural context are discussed.