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28 May 2009

By Eddie Botha

Newspaper headlines told the story: Fatal concoction kills family of four. It related how 13 family members from Port Shepstone died last year after they had allegedly taken a concoction which one family member, a trainee traditional healer, had given them.

It is stories like these that often cast a shadow of suspicion over the role of traditional healers in society, specifically in the treatment of the mentally ill. T he question arises whether there is still a role for traditional healers to play in the world of modern psychiatry.

Larry Fricks, a member of the board of Mental Health America and the Advisory Board for The Carter Centre Mental Health Journalism Fellowships in Atlanta, Georgia, who has recovered from mental illness, seems to think so.

He identifies two factors as being key to his recovery. First, "relocating from Atlanta to my Appalachian mountain roots where I have a greater sense of natural support".

Second was the role that a Maori mental health provider played as his mentor, giving himself insight into recovery from a Maori perspective.

Hmuya Mani ("Walks With a Roaring"), whose English name is Richard Two Dogs, is a Native American traditional healer. I met him through his wife, Ethleen Iron Cloud-Two Dogs, an education specialist with the US Bureau of Indian Education, who attended the Carter Fellowships conference in Atlanta last year. He is critical of psychiatrists, who he says often misdiagnose mental illness and fail to understand or take cognisance of the spiritual.

Mani says his training as a traditional healer began when he was old enough to understand what he was being told by his grandfather and uncle, who were both traditional healers. Mani's grandfather taught him herbal medicine.

"I also heard voices at an early age after a very compelling dream. After this I would isolate myself and not play with other children. What this was, I later learned, was a prelude to me becoming a traditional healer.

"If I had gone to psychiatrists I probably would be diagnosed as having some type of psychosis."

Mani's entrée into the world of traditional healers tallies with the explanation given in Livingstone Mqotsi's book, A Study of Ukuthwasa.

Mqotsi, who is from Keiskammahoek and obtained his masters in social anthropology from Wits University, says ukuthwasa is the phenomenon in Xhosa society seen as a qualification for being initiated as a doctor (igqira).

Ukuthwasa is essentially a manifestation of a psychological disturbance – individuals characterised with emotional instability, says Mqotsi. "A person who shows signs of ukuthwasa is said to be sick, to have inkathazo (trouble) or have umshologu (a spirit)."
Evidently, it is not only in their diagnosis, but in their treatment that traditional healers and psychiatrists differ – and seem unlikely to meet.

Mani says Native American traditional healers always prescribe traditional medication, not pharmaceutical drugs, and a traditional healer will not refer a mentally ill patient to a psychiatrist if there is a way to treat the patient.

He ascribes any disputes between the American Society of Psychiatrists and the work done by traditional healers in the treatment of mental illnesses to a misunderstanding by society of indigenous people, or a lack of respect for their traditional healers.

In South Africa, the Department of Health's plan to incorporate traditional health practitioners into the formal health system has reportedly not gone unchallenged. Doctors for Life International made submissions to the department in November, calling for the prohibition of African traditional medicine that cannot be subjected to transparent and objective scientific tests.

"The proposed policy on African traditional medicine of the department must ensure the safety and efficacy of healthcare for all South Africans," read a statement by DFL.
Furthermore, the DFL insists that religious belief systems (such as ancestral worship and consultation of spirits) must be excluded from integration into public healthcare as it is based on individual beliefs and discriminates against all South Africans who do not share that belief system.

"The recent tragic deaths of 13 members of one family due to the use of medicine from a trainee traditional healer in the Port Shepstone area, highlights the urgent need for mechanisms and protocols to ensure safe and efficacious health care," it said.

In a study that analysed cases of acute poisoning in patients admitted over a five year period to the Ga- Rankuwa Hospital in Pretoria, poisoning by traditional medicines resulted in the highest mortality, accounting for 51.7 percent of all deaths due to acute poisoning.

Another study analysed the Johannesburg forensic database and found that African traditional medicines were involved in 43 percent of all poisoning cases.

However, the DFL at the same time said it was not ignorant of the role that plants and herbs have played and still play in developing useful, safe and effective medication. Research by institutions such as the Medical Research Council to document and conduct scientific tests of indigenous plants and herbs traditionally used for medicinal purposes, was a step in the right direction.

So, is there still a role for traditional healers to play?

Writing in the SA Medical Journal in 1987, Professor WH Wessels from the Nelson Mandela School of Medicine's psychiatry department, said successful psychiatric treatment for rural Africans should incorporate their traditional belief that illness should be viewed in terms of magical, social, physical and religious parameters. Where reputable traditional healers were consulted in therapy-resistant cases of culture-bound syndromes in Africans, their high rate of success in treating such cases was notable. "More recognition should be given to the reputable traditional healers," wrote Wessels.

However Mqotsi feels that the more Africans become integrated in and identify with modern institutions, the less they will tend to believe in witchcraft and sorcery and the magical powers of the igqira.

"The more neurotic among them will find a counterpart in the fortune teller, the family doctor, the consultant psychologist and the psychiatrist," he says.

Copyright 2009. Used with permission from Eddie Botha and The Daily Dispatch.