Cross-cultural perceptions – traditional/ culturally specific interventions

Traditional Healers

Why Work with Traditional Healers?

High % of forced migrants who believe in and utilize traditional healers (both for cultural reasons, and perhaps partially due to limited access to other types of medical support services).

UN Manuals emphasize the importance of working with traditional healers

World Health Organization (1996). Mental health of refugees. Traditional Medicine and Traditional Healers – Unit 6, pgs 89-100.

UNAIDS (2000). Collaboration with traditional healers in HIV/AIDS prevention and care.

Types of Common Traditional Healers

1. Plant prescriptions for symptom tx;

2. Trance-induced advice from spirits;

3. Shaman – soul return;

4. Magical protection/ counteracting black magic (evil eye, voodoo, hexes);

5. Fortune tellers;

6. Massage practitioners (acupuncture, reflexology, reiki, etc).

Some examples of traditional interventions:

1. Exorcisms with trance components;2. Cleansing/rebirth ceremonies;3. Offering to the gods on behalf of the person suffering;4. Prayer circles and spontaneous healing;5. Elder council;6. “Magic” ceremonies;7. Council with deceased ancestors or spirits.

Note: some of the above may also involve herbal remedies, monetary or other exchange, animal sacrifice, etc.

Traditional Healers: Iran

Asefzadeh, S. and Sameefar F. (2001). Traditional healers in the Qazvin region of the Islamic Republic of Iran: a qualitative study. Eastern Mediterranean Health Journal, Volume 7, No. 3, 544-551.

Origin of the Zar

The Zar is an ancient "trance dance" which most scholars agree originated in the Sudan.

From there its practice spread to many regions including ancient Egypt. Over time, each group of people practicing the Zar added their own interpretations and methods.

ZAR RITUALSThe zar is a ritual used to perform a cathartic sort of emotional healing or "exorcism" on behalf of someone, usually a woman, who has been possessed. The Zar is an ancient form of purification rite. It is meant to pacify spirits and to harmonize the inner lives of the participants with them.

The accompaniment to the zar consists of strong drum rhythms, each being specific to a certain spirit.

A critical part of the zar is finding the rhythm required to drive out the particular spirit possessing the individual.

Where is it practiced?

Although technically forbidden by Islam (primarily Islamic religious leaders in Egypt and Sudan), it continues to be an essential part of some cultures.

It appears mostly in Egypt, Sudan, Somalia, and Ethiopia.

Sometimes the zar leader sacrifices a chicken, pigeon, sheep, or other animal as part of the ritual.

The role of women in Zar

Zar is one of the few still existing ancient healing ceremonies performed mainly by women for women.

The Zar is one of the rare musical traditions in which women play the leading role.

The ritual is lead by a woman called kudeyit.

And the role of Zar in healing women…

Researchers have suggested that these kind of ancient healing rituals are most popular among women as they constitute one of the few accepted venues for them to release pent up emotions and frustrations while consciously seeking healing powers.

Particularly for women in socially subordinate positions, possession often forms a “therapeutic escape valve”.

Traditional healers in Tanzania are typically inducted through one of four routes:

1. Inheritance within a family kinship; 2. Ancestor-spirits (midzimu) contacted through dreams; 3. The experience of having an illness cured by traditional medicine; 4. A personal decision, followed by a period of apprenticeship.

In 1995 Tanzanian traditional healers formed an association called CHAWATIATA (the Tanzania Traditional Health Practitioners Association).

The theory underlying traditional medicine in the several black ethnic groups of South Africa is essentially as follows:

Disease is a supernatural phenomenon governed by a hierarchy of vital powers beginning with a most powerful deity followed by lesser spiritual entities, ancestral spirits, living persons, animals, plants, and other objects.

These powers can interact, and they can reduce or enhance the power of a person. Disharmony in these vital powers can cause illness. Thus, ancestral spirits can make a person ill.

Traditional medicine In South Africa is utilized by an estimated 80% of the Black Population

Traditional systems of medicine are widely practiced in other areas beyond the African continent.

For example, India runs hospitals that offer ayurvedic treatment and conduct formal university courses in ayurvedic medicine. One such course leads to the Bachelor of Ayurvedic Medicine and Surgery (BAMS) degree. Graduates often set up general practice and dispense natural medicines.

Traditional Healers in India: Ayurvedic Medicine

In Italy a religious group called “Renewal in the Spirit”, counts almost three hundred thousand faithful who gather for religious healing purposes.

The healing is lead by animators who, upon completion of a long spiritual journey within the community, have the following gifts (“charisma”), which are specific to charismatic prayer: prophecy, the “gift of language”, the gift of interpretation, the language of knowledge and science, discernment, and healing.

Italy: Religious Healing

Traditional Healing of Indigenous Populations in the Americas

Indigenous Peoples’ mental health initiatives seem to favor the collaboration of healers and doctors as a key element for building culturally appropriate mental health services for Amerindian communities.

Jambihuasi is an innovative health care service in the Andes that combines Quichua traditional medicine with Western medicine, and enjoys broad acceptance by Quichua communities.

Pros and cons of traditional healing systems:

Case 1: A young Nepalese girl is sold to a local Hindu temple (“married to the god”), and is considered as sacred from this point forward.

Men who are HIV + have been told by the temple priest that if they have sex with the girl she will “cure” their HIV…a local man has sex with her, and formerly suicidally depressed, afterwards he reports feeling much more optimistic about the future, confident that he will be now be cured.

Pros and cons of traditional healing systems:

Case 2: the family of a woman with symptoms of psychosis (incoherent thoughts, hallucinations, etc) following a rape hires a local shaman to exorcise the demons through an elaborate ceremony following which she sleeps for a full day and then wakes up seemingly fully recovered. The family rejoices and she is accepted back into society.

Case 3: Another woman in the same community undergoes a similar ceremony and emerges severely frightened and seemingly much worse than before.

Pros and cons of traditional healing systems:

Case 4: A former child soldier in Liberia is ostracized by the community out of fear that he has been corrupted by his experience of having been kidnapped, drugged and trained to kill. He lives at a local shelter run by an NGO and is not even visited by his family. A local healer comes to the shelter to perform a cleansing ceremony, sacrificing a chicken in the process and rubbing the blood all over the boy’s body.

Following this his family begins visiting him regularly and eventually allows him back home.

Small group discussion:

1. Can you think of examples from your own culture (or work experiences) of traditional healing systems?

2. Examine your own cultural and religious biases (we all have them). Will it be difficult for you to collaborate with some types of traditional healers?

*Physical force (of any kind);

*Scare tactics;

*Family consent but no explicit individual consent;

Animal sacrifice;

Smearing urine or feces on the body;

Accusing someone of misdeeds or being polluted/ needing the person to agree to this premise first, as a prerequisite to healing them.

Some Traditional Healers use the Tactics below:

Are these compatible with your value system?

Some Biomedical Healers use the Tactics below:

Can you imagine how these might not be compatible with someone’s value system?

Sticking people with needles; Cutting people open/ interacting with

organs or transplanting the organs from one person into another;

Radiating people, making them sick in order to make them better…

Large Group Discussion:

1. What are some of the benefits of becoming knowledgeable re the traditional beliefs and approaches of other cultures?

2. How do controversial or dangerous traditional practices compare with potentially damaging practices from a more Western cultural medical approach?

3. Is it possible to combine the best elements of both and create “hybrid interventions”, or are the ideals incompatible as some suggest?