Traditional healing

In keeping with beliefs in low- and middle-income countries, people who are experiencing any kind of illness usually initially choose indigenous expertise over Western medicine (Leff, Reference Leff1988). While undoubtedly charlatans exist, the strategies of traditional healers should not be scoffed at. They share the same ideology as their clients, who consist of not an isolated patient but the entire family or even clan. Whereas Western consultations tend to be private, confidential between the patient and doctor, traditional examinations take place with all relevant family members present. The best healers are very attuned to the cultural background of their clients and can ‘divine’ interpersonal relationships that are disguised as bodily complaints. For instance, a healer I encountered in Nigeria told me that if a man came to him with erectile problems, he would say suggestively, ‘Here's the medicine, drink it daily and whatever you do stay away from your sister-in-law!’ This tantalising injunction, referring to a local sexual taboo, is evidence of a psychologically astute understanding of erotic dynamics.

Much mental illness is ascribed to witchcraft, ancestral spirits or possession by harmful demons. Various local remedies and practices are used to engage with these, to placate or extract them. However, most healers I interviewed (through interpreters) distinguished between illnesses originating in local understandings and those necessitating Western medicine. For example, a healer I interviewed in Agra, India, told me that if a patient continued to be miserable despite indigenous treatments he would be sent for electroconvulsive therapy at the local hospital (where the family camped out in the grounds to provide meals and support for their ill relative). This shows that families are usually quite willing to accept a pragmatic composite of traditional and modern treatments. This flexible approach is more sophisticated than that of the Western-educated then-president of South Africa, who banned antiretroviral drugs in hospitals and advocated African onions as a cure for AIDS.

Similarly, a patient I saw in Ethiopia was brought in a catatonic state by his family, who had walked for many days from their far-off village. They said they had previously taken him to the Coptic church, where he was given holy water and beaten to exorcise the demon. When that did not seem to help, they put him in a cart and walked with him to Addis Ababa, to the one psychiatric hospital in the country, which serves 99 million people. Once given antipsychotic medication he rapidly recovered.

During my time in the IPSS, I was fortunate to see films and slides made by colleagues who had had access to indigenous ceremonies from many societies across the world. However weird some practices may seem, including trance states and exorcisms, they make sense in terms of local traditions, shared wisdom and beliefs about the source of illness and its extraction. For example, a film from Sri Lanka showed the exorcism of a demon which was held responsible for the illness of a woman in labour. The family of the patient called in a healer to perform this exorcism, which involved a very costly ritual of insistent drumming lasting from dawn to dusk. The patient was in fact suffering from pre-eclampsia. When the ceremony was completed to the satisfaction of the whole village, they took the patient to the local antenatal clinic, where she gave birth.

The family alone could not have afforded this ceremony, so their friends and neighbours contributed. This kind of solidarity is typical of many lower-income societies. Throughout Africa it is known as Ubuntu, meaning ‘togetherness’ or, as the locals put it, ‘I am because you are’. A sentiment we seem to have forgotten.