Not You: Addiction, Relapse, and Release in Uganda

In recent years, alcohol abuse and dependence have become topics of increasing concern in Uganda, but the chronic relapsing brain disease model of addiction remains only one of many ways of understanding and addressing alcohol-related problems there. For many Ugandan Pentecostals and spirit mediums to be addicted is to be under the control of a being that comes from outside the self. Where these two groups differ, and here they differ strongly, is in regard to the moral valence of these external spirits and what ought to be done about them. This article draws on four years of collaborative ethnographic fieldwork to explore the affordances of these ways of viewing and experiencing addiction and recovery for Ugandans attempting to leave alcohol behind. While the idioms of bondage, dedication, and possession are at times severe, this article argues that they contain within them concepts and practices that point away from models of addiction as a chronic relapsing brain disease and towards the possibility of release.

Spirit Mediumship and Mental Health: Therapeutic Self-transformation Among Dang-kis in Singapore

While some early studies suggested that spirit mediums were psychiatrically ill individuals who found a culturally sanctioned role, subsequent work has found that they are generally in good physical and mental health. While the calling to be a healer often involves an initiatory illness, practitioners go on to play demanding social roles, suggesting that involvement in mediumship may be therapeutic for the practitioner. This study focuses on dang-ki healing, a form of Chinese spirit mediumship practiced in Singapore to explore whether participation in dang-ki healing is therapeutic for the mediums. We interviewed eight dang-kis from five temples about their life trajectories and assessed their mental health status with standardized psychological questionnaires. Most of the dang-kis did not appear to suffer from clinically significant emotional distress. Their narratives suggest that involvement in dang-ki mediumship may have therapeutic effects in which the embodied experience of self plays a central role. The dang-kis experienced changes in social identity, bodily experiences during spirit possession, and their overall sense of self through recurrent possession rituals. In general, the practice of spirit mediumship illustrates how the experiences and meanings of the self are constructed and reconstructed through body-world relations in ways that may confer a sense of wellness and social efficacy.

Corpus callosum size, hypnotic susceptibility and empathy in women with alleged mediumship: a controlled study

AIM

Evidence indicates that highly hypnotizable subjects may have larger area of the rostrum of the corpus callosum (CC). Mediumship can be defined as the alleged ability to communicate regularly with deceased personalities, and self-hypnosis is postulated as an underlying mechanism for this ability. Therefore, we aimed to investigate the CC area, hypnotic susceptibility, self-reported dissociation, and empathy in alleged mediums in comparison with healthy, non-medium controls.

METHODS

The study sample consisted of 16 Spiritist mediums (medium group (MG)) and 16 non-medium controls. Magnetic resonance imaging scans were performed to measure the CC areas (total and subdivisions). The Harvard Group Scale of Hypnotic Susceptibility was used to assess hypnotizability, and self-reported measures were used to investigate anomalous experiences, mental health using the Self-Reporting Questionnaire-SRQ, dissociative experiences using the Dissociative Experiences Scale, and empathy using the Interpersonal Reactivity Index.

RESULTS

No between-group differences were found in the total or subdivided CC areas or in hypnotizability, with both groups showing intermediate levels. The rostrum of the CC area and hypnotizability were not correlated. The MG presented with significantly more anomalous experiences, but the two groups had similar scores for dissociation, empathy, and mental health.

CONCLUSION

The normal CC areas found in the MG are in contrast with the abnormal results typically observed in subjects with psychotic and dissociative disorders. Although hypnotizability was not different between groups, further studies are needed to replicate these findings in other samples.

Borderline well-being: Mental health in a development zone

Mental illness contributes hugely to global disease burden. Inadequate resources, limited access to services and pervasive stigma jointly foster its increasing severity, especially in resource-poor countries. Despite recognition that social determinants such as poverty, inequality and marginalization aggravate mental distress, minimal scrutiny has focused on the negative impact of targeted development schemes creating social and economic change that exacerbates mental health risks for poor people. This article examines the rise of mental disorders as an unwanted consequence of a new special economic zone being built in a border district in Northwest Thailand. Ethnographic data from villages surrounding the intended industrial hub was collected during six-months fieldwork in 2017 and 2018. Informants included public health staff in the community and district hospitals, villagers who had lost farming land, health volunteers and spirit healers. Using local narratives and hospital data to show an emergent vulnerability to anxiety, depression and suicide, I argue that global public health approaches seeking to decentralise mental health services and donor-driven mitigation guidelines fail to alleviate stressors for locals caught up in development's slipstream. In turn, distressed by land reclamation, debt, gambling and substance abuse, villagers turn to reinvigorated forms of spirit-healing for assistance in regaining a sense of well-being. In this context, I demonstrate that development schemes potential to affect the epidemiology of behavioral pathologies remains significantly under-addressed within rubrics of 'border-health'.

Differential executive functioning in the topology of Spirit possession or dissociative disorders: an explorative cultural study

BACKGROUND

In Oman, anecdotal and impressionistic observation have helped parse and categorize various manifestations of spirit possession into two broad and distinct categories: intermittent dissociative phenomenon and transitory dissociative phenomenon. The primary aim of the present study was to compare the performance of participants on neuropsychological tests among different grades of possession. Other correlates were also sought.

METHODS

Assessment criteria for the two groups included measures examining executive functioning: controlled oral word association test Verbal Fluency, Wisconsin Card Sorting Test (Perseverative error and the number of categories achieved), Trail Making Test and the Tower of London Test (number of correctly solved problems). Sociodemographic variables and the history of trauma were also sought.

RESULT

Among 84 participants, one third of them presented the intermittent possession type and two thirds, the transitory possession type. Their mean age was 34.17 ± 11.82 and 56% of them were female. Nearly 35% of them endorsed a history of a traumatic experience. Both the multivariate models showed statistical significance (F (5, 78) = 5.57, p < 0.001, R² = 0.22), F (5, 78) = 11.38, p < 0.001, R² = 0.39) with an independent predictor of intermittent dissociative phenomenon (β = - 3.408, p < 0.001), (β = 63.88, p < 0.001) for Verbal Fluency and Trail Making Test, respectively. The history of the traumatic event was also statistically significant with the results of the Trail Making Test (β = - 26.01, p < 0.041. Furthermore, the subtype of Pathogenic Possession turned out to be an independent predictor across all models: Wisconsin Card Sorting Test perseverative error, Wisconsin card sorting test categories achieved and the number of problems solved in the Tower of London Test (OR = 3.70, 95% C.I. 2.97-4.61; p < 0.001), (OR = 0.57, 95% C.I.0.39-0.84; p = 0.004) and (OR = 0.80, 95% C.I. 0.65-0.99; p < 0.037) respectively.

CONCLUSIONS

This study suggests that typology of spirit possession found in Oman tends to differ on indices of executive function. Those with 'diagnosis' of intermittent possession showed impairment in many indices of executive functioning. Despite its wide prevalence, spirit possession has not been examined in terms of its neuropsychological functioning. We believe that this study will be instrumental in laying the groundwork for a more robust methodology.

Refracting Affects: Affect, Psychotherapy, and Spirit Dis-Possession

The notion of affect has generated much confusion in anthropology given its focus on that which seems to escape our language. The evanescent features of affects have irritated many anthropologists who consider affect theory as an empirically weak or esoteric hermeneutics. In this article, I respond to these critiques by developing an anthropology of therapy that foregrounds the role of affects. My intent is to explore the possible contribution of affect theory to medical and psychological anthropology. I draw from my ethnography on couple's therapy in Argentina to suggest that we cannot understand therapeutic efficacy if we focus only on language and discourse. I ask what it means to regard affects as late modern spirits and take psychotherapy as a modern ritual of "affect dispossession." I propose to ask how affects, like spirits, can haunt our present rendering our lives barely livable. Focusing on a session of therapy in Buenos Aires, I describe how a therapist channels the spirit of impasse that colonizes the lives of her patients. Developing an enchanted hermeneutics, I engage with Eve Sedgwick's call for an other-than-paranoid social theory by engaging the imagination as an important organ of perception in the medical anthropology of affects.

Transformation in Dang-ki Healing: The Embodied Self and Perceived Legitimacy

Since spirit possession in mediumship and shamanism resembles psychotic symptoms, early researchers perceived spirit mediums and shamans as psychiatric patients whose psychopathology was culturally sanctioned. However, other researchers have not only challenged this assumption, but also proposed that spirit possession has transformative benefits. The idiom of spirit possession provides cultural meanings for spirit mediums and shamans to express and transform their personal experiences. The present case study focuses on dang-ki healing, a form of Chinese mediumship practiced in Singapore, in which a deity possesses a human (i.e., dang-ki) to offer aid to supplicants. This study seeks to explore whether involvement in dang-ki healing is transformative; and if so, how the dang-ki's transformation is related to his self and the perceived legitimacy of his mediumship. At a shrine, I interviewed 20 participants, including a male dang-ki, 10 temple assistants, and nine clients. The results obtained were supportive of the therapeutic nature of spirit possession. First, there is a relationship between his self-transformation and the perceived legitimacy of his mediumship. As his clients and community have recognized his spirit possession as genuine, and the healing power of his possessing god, he is able to make use of mediumship as a means for spiritual development. Second, he has developed his spirituality by internalizing his god's positive traits (e.g., compassion). Deities worshipped in dang-ki healing can be conceptualized as ideal selves who represent a wide range of positive traits and moral values of Chinese culture. Thus, the possession of a deity is the embodiment of an ideal self. Finally, the dang-ki's transformation may run parallel to his god's transformation. In Chinese religions, gods have to constantly develop their spirituality even though they are already gods. An understanding of the god's spiritual development further sheds light on the dang-ki's self-transformation.

Traumatic Experience and Somatoform Dissociation Among Spirit Possession Practitioners in the Dominican Republic

Recent studies in African contexts have revealed a strong association between spirit possession and severe trauma, with inclusion into a possession cult serving at times a therapeutic function. Research on spirit possession in the Dominican Republic has so far not included quantitative studies of trauma and dissociation. This study evaluated demographic variables, somatoform dissociative symptoms, and potentially traumatizing events in the Dominican Republic with a group of Vodou practitioners that either do or do not experience spirit possession. Inter-group comparisons revealed that in contrast to non-possessed participants (n = 38), those experiencing spirit possession (n = 47) reported greater somatoform dissociation, more problems with sleep, and previous exposure to mortal danger such as assaults, accidents, or diseases. The two groups did not differ significantly in other types of trauma. The best predictor variable for group classification was somatoform dissociation, although those items could also reflect the experience of followers during a possession episode. A factor analysis across variables resulted in three factors: having to take responsibility early on in life and taking on a professional spiritual role; traumatic events and pain; and distress/dissociation. In comparison with the non-possessed individuals, the possessed ones did not seem to overall have a remarkably more severe story of trauma and seemed to derive economic gains from possession practice.

Fighting with Spirits: Migration Trauma, Acculturative Stress, and New Sibling Transition-A Clinical Case Study of an 8-Year-Old Girl with Absence Epilepsy

In this article, we discuss the impact of migration and acculturation processes on the cultural, personal identity, and mental health of children who immigrate to a Western, multicultural environment, and the challenges clinicians in such environments face, when confronted with non-Western idioms of distress and healing practices. We do that by presenting a challenging clinical case of an 8-year-old girl who presented with very disorganized behavior, which matches a culturally accepted construct of spirit possession, in the context of migration trauma, acculturative stress, and new sibling transition. We identify cultural conflict in school and bullying as major mediators between acculturative stress and mental distress. We also aim at identifying vulnerability, risk and protective factors, and the importance of cultural coping resources. We explore in depth the patient's cultural background and the family's belief system and culturally shaped narratives, in order to arrive at a cultural formulation, which focuses on the significance of idioms of distress in shaping psychopathology and influencing the personal and interpersonal course of trauma- and stress-related disorders. We also call attention to the finding that in children, idioms of distress may manifest themselves in a somatic manner. We argue, together with other researchers, that spirit possession deserves more interest as an idiom of distress and a culture-specific response to traumatizing events. We finally emphasize the importance of an anti-reductionist clinical stance, that is able to use different levels of understanding processes of distress and healing, and seeks to reconciliate cultural divides and integrate different explanatory frameworks and help-seeking practices.

Unravelling the spirits' message: a study of help-seeking steps and explanatory models among patients suffering from spirit possession in Uganda

As in many cultures, also in Uganda spirit possession is a common idiom of distress associated with traumatic experiences. In the DSM-IV and -5, possession trance disorders can be classified as dissociative disorders. Dissociation in Western countries is associated with complicated, time-consuming and costly therapies. Patients with spirit possession in SW Uganda, however, often report partial or full recovery after treatment by traditional healers.

The aim of this study is to explore how the development of symptoms concomitant help-seeking steps, and explanatory models (EM) eventually contributed to healing of patients with spirit possession in SW Uganda. Illness narratives of 119 patients with spirit possession referred by traditional healers were analysed using a mixed-method approach.

Treatments of two-thirds of the patients were unsuccessful when first seeking help in the medical sector. Their initially physical symptoms subsequently developed into dissociative possession symptoms. After an average of two help-seeking steps, patients reached a healing place where 99% of them found satisfactory EM and effective healing. During healing sessions, possessing agents were summoned to identify themselves and underlying problems were addressed. Often-mentioned explanations were the following: neglect of rituals and of responsibilities towards relatives and inheritance, the call to become a healer, witchcraft, grief, and land conflicts.

The results demonstrate that traditional healing processes of spirit possession can play a role in restoring connections with the supra-, inter-, intra-, and extra-human worlds. It does not always seem necessary to address individual traumatic experiences per se, which is in line with other research in this field. The study leads to additional perspectives on treatment of trauma-related dissociation in Western countries and on developing effective mental health services in low -and middle-income countries.

Modelling psychiatric and cultural possession phenomena with suggestion and fMRI

Involuntary movements occur in a variety of neuropsychiatric disorders and culturally influenced dissociative states (e.g., delusions of alien control and attributions of spirit possession). However, the underlying brain processes are poorly understood. We combined suggestion and fMRI in 15 highly hypnotically susceptible volunteers to investigate changes in brain activity accompanying different experiences of loss of self-control of movement. Suggestions of external personal control and internal personal control over involuntary movements modelled delusions of control and spirit possession respectively. A suggestion of impersonal control by a malfunctioning machine modelled technical delusions of control, where involuntary movements are attributed to the influence of machines. We found that (i) brain activity and/or connectivity significantly varied with different experiences and attributions of loss of agency; (ii) compared to the impersonal control condition, both external and internal personal alien control were associated with increased connectivity between primary motor cortex (M1) and brain regions involved in attribution of mental states and representing the self in relation to others; (iii) compared to both personal alien control conditions, impersonal control of movement was associated with increased activity in brain regions involved in error detection and object imagery; (iv) there were no significant differences in brain activity, and minor differences in M1 connectivity, between the external and internal personal alien control conditions. Brain networks supporting error detection and object imagery, together with representation of self and others, are differentially recruited to support experiences of impersonal and personal control of involuntary movements. However, similar brain systems underpin attributions and experiences of external and internal alien control of movement. Loss of self-agency for movement can therefore accompany different kinds of experience of alien control supported by distinct brain mechanisms. These findings caution against generalization about single cognitive processes or brain systems underpinning different experiences of loss of self-control of movement.