Explanatory models of mental disorders and treatment practices among traditional healers in Mpumulanga, South Africa

Abstract

Objective: In many traditional belief systems in Africa, including South Africa, mental health problems may be attributed to the influence of ancestors or to bewitchment. Traditional healers are viewed as having the expertise to address these causes. However, there is limited information on their explanatory models and consequent treatment practices. The present study examines traditional healers' explanatory models (EMs) and treatment practices for psychotic and non-psychotic mental illnesses. Method: 4 focus group discussions (8 healers in each group) and 18 in-depth interviews were conducted. Four vignettes were presented (schizophrenia, depression, panic and somatization) and traditional healers' views on the nature of the problem, cause, consequence, treatment and patient expectations were elicited. Results: Traditional healers held multiple explanatory models for psychotic and non-psychotic disorders. Psychotic illnesses appear to be the main exemplar of mental illness and were treated with traditional medicine, while nonpsychotic illnesses were not viewed as a mental illness at all. Additionally, traditional healers do not only use herbs and substances solely from "traditional" sources but rather have incorporated into their treatment practices modern ingredients that are potentially toxic. Conclusion: Interventions aimed at increasing the mental health literacy of traditional healers are essential. In addition, investigations of the effectiveness of traditional healer treatment for psychiatric disorders should be conducted.

Traditional healers and provision of mental health services in cosmopolitan informal settlements in Nairobi, Kenya

“…From the focus group discussion, the traditional healers mentioned patients who think too much, however few had a concept of depression. These findings are similar to those found by Sorsdahl et al 15 At the same time, in our African context, there was no name for depression. The only obvious mental illness was "madness" which could be easily detected from the behaviour of the patient.…”

The treatment outcome of psychotic disorders by traditional healers in central Sudan

“…Sorketti, Zuraida and Habil (2010) stated that collaboration between psychiatrists and traditional healers could help to end harmful methods of practice by the traditional healers, such as: isolating patients in an unhealthy, non-hygienic environment; depriving patients of nutritional food; beating patients; misdiagnosis; and mismanagement. Sorsdahl, Flisher, Wilson and Stein (2010) stated that, in many traditional belief systems in Africa, including South Africa, mental health problems may be attributed to the influence of ancestors or to bewitchment. Traditional healers are viewed as having the expertise to address these causes.…”

The role of global traditional and complementary systems of medicine in the treatment of mental health disorders

“…Diagnostic approaches used include a combination of history taking, examination or observation of the patient and divination 52,53,54,55 . Divination refers to the revelation of knowledge from supernatural sources such as spirits or ancestors, using a variety of methods including tossing of artefacts such as shells or bones, use of mirrors, animal sacrifice, drumming, trance, or prayer 56,55,57,35,58 . Although TM may sometimes attribute ill-health to physical causes, there is typically an accompanying supernatural explanation of why a person has become ill, and which spirits, earthly sorcerers or neglected rituals are responsible.…”