Global mental health and trauma exposure: the current evidence for the relationship between traumatic experiences and spirit possession

Abstract

BackgroundWe present a literature review on trauma exposure and spirit possession in low- and middle-income countries (LMICs). Despite the World Health Organization's objective of culturally appropriate mental health care in the Mental Health Action Plan 2013–2020, and the recommendations of the Inter-Agency Standing Committee to consider local idioms of distress and to collaborate with local resources, this topic still receives very little attention. Pathological spirit possession is commonly defined as involuntary, uncontrollable, and occurring outside of ritual settings. It is often associated with stigmatization, suffering, and dysfunctional behavior. While spirit possession has been discussed as an idiom of distress in anthropological literature, recent quantitative studies have presented support for a strong relationship between traumatic experiences and pathological possession states.ObjectiveThe aim of this review was to investigate this relationship systematically in LMICs, in view of the debate on how to address the mental health gap in LMICs.MethodsTwenty-one articles, published in peer-reviewed English-language journals between 1994 and 2013, were identified and analyzed with regard to prevalence of possessive trance disorders, patients’ sociodemographic characteristics, and its relation to traumatic experiences.ResultsThe review and analysis of 917 patients with symptoms of possessive trance disorders from 14 LMICs indicated that it is a phenomenon occurring worldwide and with global relevance. This literature review suggests a strong relationship between trauma exposure and spirit possession with high prevalence rates found especially in postwar areas in African countries.ConclusionsMore attention for possessive trance disorders in mental health and psychosocial intervention programs in humanitarian emergency settings as well as in societies in transition in LMICs is needed and justified by the results of this systematic literature review.

Spirit possession: Perspectives on pastoral assessment and care

“…Anti-gravitational abilities (i.e., levitation) have also been reported as a rare sign. Large scale recent research in Low and Middle Income Countries (LMIC) has shown that people with a history of childhood abuse or severe trauma are particularly vulnerable (Hecker et al, 2015) as are those who dabble in occult practices (e.g. Ouija boards, cultic groups, etc.…”

Challenges in the early assessment and protection of refugee survivors of torture and extreme violence

“…Rituals to appease the ghost and resolve the internal conflict and feeling of unfulfilled obligation are consequently common and would be added to or replace treatment (105,106) but might be interrupted in war or displacement. Culture specific explanatory models for symptoms or illness must also be considered (111), as symptoms for example of PTSD might be attributed not to torture, but to other including metaphysical problems like witches or spirits (112). Illness behaviour including primary presentation of physical symptoms is common in many cultures and could be argued to be rather a culture based presentation of illness rather than Somatoform Disorder in the common ICD or DSM definition.…”

Global mental health and trauma: the current evidence and the long road ahead

“…The relation between traumatic experiences and spirit possession in LMICs is analyzed in a systematic review of 21 articles undertaken by Hecker et al Pathological spirit possession is a phenomenon occurring globally and has particular relevance in LMICs. Reported prevalence rates differed conspicuously depending on cultural background and the particular study populations (Hecker et al, 2015 ), for example, high rates were found in post-war areas, confirming the connection between traumatic experiences and pathological spirit possession.…”

“…This special issue of the European Journal of Psychotraumatology collected some of the work that has been done so far in LMICs. Manuscripts address important issues such as the quantification of effects of cumulative trauma exposure in war survivors (Wilker et al, 2015 ); factors related to psychological distress in orphans living in Tanzania (Hermenau, Eggert, Landolt, & Hecker, 2015 ); the relationship between trauma exposure and spirit possession (Hecker, Braitmayer, & Van Duijl, 2015 ); trauma-related mental health problems in humanitarian staff (Strohmeier & Scholte, 2015 ); and sociotherapy approach developed and implemented in Rwanda (Jansen et al, 2015 ).…”