Course of psychotic experiences and disorders among apprentice traditional health practitioners in rural South Africa: 3-year follow-up study

Abstract

BackgroundCulture is inevitably linked with the experience, interpretation and course of what modern biomedicine understands to be psychotic symptoms. However, data on psychoses in low- and middle-income countries are sparse. Our previous study showed that psychotic and mood-related experiences, symptoms and disorders are common among individuals who had received the ancestral calling to become a traditional health practitioner (THP) in rural KwaZulu-Natal, South Africa. Our related ethnographic study suggested that ukuthwasa (the training to become a THP) may positively moderate these calling-related symptoms. As far as we know, no research has been conducted into the course of psychiatric symptoms among apprentice THPs.ObjectiveWe studied the course of psychotic experiences, symptoms and disorders among apprentice THPs. We also assessed their level of functioning and expanded our knowledge on ukuthwasa.Materials and methodsWe performed a 3-year follow-up of a baseline sample of apprentice THPs (n = 48). Psychiatric assessments (CAPE, SCAN), assessment of functioning (WHODAS) and a semi-structured qualitative questionnaire were completed for 42 individuals.ResultsAt 3-year follow-up, psychotic experiences were associated with significantly less distress and there was a reduction in frequency of psychotic symptoms compared to baseline. The number of participants with psychotic disorders had decreased from 7 (17%) to 4 (10%). Six out of seven participants (86%) with a psychotic disorder at baseline no longer had a psychiatric diagnosis at follow-up. Although the mean level of disability among the (apprentice) THPs corresponded with the 78th percentile found in the general population, 37 participants (88%) reported no or mild disability. Forty-one participants (98%) reported that ukuthwasa had positively influenced their psychiatric symptoms.ConclusionIn rural KwaZulu-Natal, psychotic experiences, symptoms and disorders have a benign course in most individuals who are undergoing the process of becoming a THP. Ukuthwasa may be an effective, culturally sanctioned, healing intervention for some selected individuals, potentially because it reframes distressing experiences into positive and highly valued experiences, reduces stigma, and enhances social empowerment and identity construction. This implies that cultural and spiritual interventions can have a positive influence on the course of psychosis.

Traditional and faith-based healthcare in the management of psychotic disorders in Africa: in search for synergy

“…In a series of qualitative and quantitative studies from rural KwaZulu-Natal, South Africa [ 25 ▪ , 34 ▪ , 43 ], a locally available intervention for individuals with psychotic disturbances was explored. This intervention is called ‘ukuthwasa’ in isiZulu, and can be translated as ‘the process of becoming a traditional healer’.…”

“…Van der Zeijst et al [ 25 ▪ ] conducted a follow-up study among 42 South African apprentice traditional healers who had followed the process of ukuthwasa, the training to become a traditional healer. Nearly all individuals had completed ukuthwasa (95%) and reported a positive influence of ukuthwasa on their calling-related symptoms (98%).…”

“…Nearly all individuals had completed ukuthwasa (95%) and reported a positive influence of ukuthwasa on their calling-related symptoms (98%). On the basis of thorough psychiatric assessments, the authors found a benign course of psychotic experiences and disorders after a follow-up period of 3 years, and concluded that these findings all together, suggest that ukuthwasa may be an effective, culturally sanctioned healing intervention for some selected individuals, potentially because it reframes distressing experiences into positive and highly valued experiences, reduces stigma and enhances social empowerment and identity construction [ 25 ▪ ]. Ayinde et al [ 22 ▪▪ ] reported that most patients who had been treated for psychosis by TFH in Nigeria, Kenya and Ghana, were content with this treatment and would advise the same treatment to other persons suffering from psychosis.…”

“…Many studies have shown that TFH are playing a role in the treatment of mental illness in Africa [ 5 , 10 , 11 ▪ , 24 ]. There are also indications that traditional treatment might improve symptoms in patients with psychosis [ 13 ▪ , 17 , 25 ▪ , 26 ], maybe especially during the acute phase of schizophrenia [ 17 , 26 ]. However, the (biomedical) evidence is sparce and the quality of the research evidence is rated as low [ 13 ▪ , 17 ].…”

“…of the currently reviewed articles reported that some biomedical practitioners from Ghana, Nigeria and Ethiopia were even referring patients with psychosis to a TFH[20 …”