University of Venda: briefing on traditional healing

Chairperson: Dr M W Serote

Documents handed out:
Abstract: Challenges in the Collaboration between Indigenous and Western Therapists (see Appendix)

SUMMARY
Mental illness in certain African communities is interpreted as a call to healing, that is, as a call for one to become a healer himself or herself. In the western context mental illness is diagnosed as schizophrenia.

Currently traditional healing is relegated in the realm of mere magic and superstition and people who do research on African way of life tend to be biased against that way of life dubbing it primitive and savage. Because of these attacks African culture has resorted to 'secrecy' and there are many cultural practices that most people are ignorant of.

MINUTES
As an introduction Ms Mufamadi: University of Venda pointed out that about 80 percent of Africans in South Africa continue to consult traditional healers.

Most mental sicknesses in certain communities are not regarded as being related to psychiatry. One has to consider the cultural background of the patient when engaging in treatment proceedings. For example, people with the symptoms of schizophrenia in these communities are regarded as people who would become healers at a later stage

If one takes that patient to western-trained psychotherapists they are going to diagnose schizophrenia and the person would be institutionalised in the asylum. Whereas if you take the same patient to a traditional healer the diagnosis would be different.

Indigenous healing is of a holistic nature. For example, if one's arm is broken and you are taken to the hospital, the arm may be cut off to heal the whatever illness is affecting that arm whereas if one goes to the traditional healer, the cutting of the arm is not only physical but psychological as well. The traditional healer would either cut that arm off or find ways of healing that person but at the end they would counsel that person and find ways of integrating that person back to the community.

The healing in the African context takes place in the religious context because sickness is perceived as a religious matter and because of that people revert to religious practices to deal with it.

Western Perceptions of Traditional Healing
Practitioners of western medicine regard traditional healing as far remote from clinical procedures of logical thought. They base their diagnosis on the diagnostic manual of mental disorders relying on healing the sickness through books.

Whereas the indigenous healer would throw the bones and interpret the messages of the ancestors through those bones, far removed from western perception and clinical procedure.

The reason why indigenous healing has been ignored is that it is relegated to the realm of mere magic and superstition. This traditional black belief is also viewed as the result of primitive or savage process.

There is an assumption that when an African child is weaned the manner in which it is done is very aggressive. During the first few months it is believed the child would get 'bad' spirits and cannot differentiate between hate and love and as such they need surrogate mothers.

People who do not share that culture usually do research on African way of life and as such their interpretation would be biased against African way of life hence regarding African culture as involved in magic and superstition.

Ms Mufamadi quoted Dr Motlala as one of those western-trained doctors who regard traditional healing as "dangerous, superstitious, and meaningless pseudo-psychological mumbo-jumbo".

Because of these attacks African culture has resorted to 'secrecy'. There are many cultural practices which people are ignorant of because they have been led to believe that African culture is not valid and lacks civilisation.

Ms Mufamadi appealed to African intellectuals to start acknowledging African culture by leading the African communities in taking this standpoint.

If one has mental illness that is not illness in an African culture but a normal passage towards being a healer and one would become better informed and wiser than before. A traditional healer does everything for the community - he is a doctor, a therapist, marriage counselor who resolves family conflicts and a minister of religion. The healer shares the customs of the community and when one consults such a person one feels comfortable.

How can one talk about the innermost family problems with a stranger and how can one be free to open up to that person? But when one goes to a traditional healer, one would be greeted and discuss would ensue. On the other hand, how does one sit with a person who has a pen and a paper or a tape recorder?

African tradition can be regarded as a discipline of science, which studies, analyses and defines African people from an Afrocentric frame of reference. This diagnosis is a cultural patent process that is linked to ancestors. Such knowledge is therapeutic in the sense that it reassures one of imminent healing since the ancestors are involved.

When consulting a traditional healer one does not go there alone, one goes with a relative most of the times and gives people the opportunity to resolve tensions. A sick patient not only goes to the healer, but the healer also comes to where the sick person lives in order to conduct some rituals.

If one is ill and consults a western doctor, it ends there. Whatever caused the illness in the first place remains or the symptoms may reappear. The traditional healer brings together the whole family and this is an opportunity for conflicts to be resolved and whatever led to illness would disappear and to restore harmony in the family.

If one is called to become a traditional healer and is treated by western therapists who knows nothing about spirit possession one is not healed and would be placed in a mental institution. If traditional healers treated some of those patients in mental institutions it is probable that they would be out of those institutions in no time.

Methodologies
Traditional healers can learn a great deal from western therapists. The question is how can western therapists interact with traditional healers and how can they learn from one another?

Traditional healers work both in public and private functions. In public functions they give charms to departing warriors and preside over ceremonies, which in the western culture would be done by politicians or priests.

Western therapists treat the disease while traditional healers heal the patient within his environment including spiritual and physical. Ms Mufamadi said indigenous healing is in line with the World Health Organisation's (WHO) definition of health, which is a complete state of physical, psychological and social well being and not merely the absence of a disease.

Challenges
Practitioners should refer patients to each other but traditional healers are worried that while they refer patients to western-trained therapists, the latter do not refer patients to them.

The other challenge is the recognition of traditional healers by formal institutions such as work places, schools and universities. For instance an employer will not usually recognise a medical certificate from a traditional healer.

Indigenous healing should not be regarded as an "interim phase" that would fade away as more people become "civilised". On the contrary, it is there to stay because it is valid and scientific.

Another challenge is to stop regarding indigenous healing as involving magic

The University of Venda has introduced a module called "African Civilisation" which is compulsory to all first year students to get the background of African culture. When in Canada, Ms Mufamadi visited a certain college, which had employed indigenous healers and elders to teach pupils about their culture, which she felt, could be emulated here in South Africa. She said there was need to include the traditional therapy within the mainstream of healing.

Discussion
Mr MF Cassim (IFP) asked whether was there ways of protecting traditional plants in South Africa in a patent form so as not be exploited by outsiders who would get these plants, send them to laboratories and turn them into patent tablets?

Ms Mufamadi answered that the project at Vlakpaas was trying to incorporate the idea of promoting and protecting indigenous plants, which could be used for healing.

Ms NM Tsheole (ANC) asked whether indigenous healing was recognised at universities?

Ms Mufamadi responded that it was not and that there was fear of incorporating it in those institutions. She added that there are no books on the subject either but that western books and American literature on the subject were plenty.

Ms TJ Tshivhase (ANC) asked how far have traditional healers interacting with western-trained therapists to educate them about their methodologies of healing holistically rather than detecting the symptoms?

Ms Mufamadi replied that she doubted very much that the traditional healers could be in a position to educate their western-trained counterparts. She thought that a role could be played by the elite who understood traditional healing, but that too was questionable as not many universities in this country were willing to teach the African Civilisation module as introduced at the University of Venda.

Ms ON Mndende (UDM) asked how were they going to convince the "converts" that traditional healing was holistic? She observed that there was a tendency by those who call themselves Christians to look down upon African beliefs and traditional healing.

Ms Mufamadi felt that the conversion of the "converts" would not happen overnight. She went on that people interpret things according to their cultural background and added that science and research were not objective but had to do with one's belief due to cultural and training background.

Mr SE Opperman (DP) asked whether there was an international network of traditional healers that help educate people like him who did not understand such matters?

Ms Mufamadi replied that she did not know of any international network of traditional healers but that in South Africa they have widened the teaching of African Civilisation at tertiary level. So far this module is taught in the North-West, Northern Province and KwaZulu-Natal.

Ms A van Wyk (UDM) asked whether were there any black anthropologists to promote African culture.

Ms Mufamadi said she did not know. But researchers in the "field" bring their own perspective when conducting those researches and take away findings without verifying the facts with those they had interviewed. Researchers who conduct such studies should give feedback to research participants to verify facts.

The meeting was adjourned.

Appendix:

ABSTRACT: Challenges in the Collaboration between Indigenous and Western Therapists

This paper discusses the necessity for western therapists to respect the integrity and spirituality of African culture, traditions and relationships of indigenous peoples.
According to Kiev (1989) traditional healing rituals are culturally organised, meaningful events which provide standardised therapeutic experiences for the reduction of anxiety and emotional distress for suffering from a variety of psychiatric illness. This paper is an attempt to show how the effectiveness of therapy depends on the sharing of a common worldview with the client through certain personality characteristics and the expectations that the client has. Challenges that face the collaboration between indigenous therapists and western therapists will also be highlighted.

INTRODUCTION

Traditional/ Indigenous healing is used in this context to refer to the healing system that is often regarded as ...primitive, pre-literate, tribal or non-western (Spiegel and Boonzaier, 1988). Traditional healers are in a unique position to understand and heal the illness of their patients because they have thorough knowledge and understanding of the history of their patients and they share similar customs and beliefs. Netshiombo (1997) argues that the extent to which the therapist working within a culture share these beliefs, or can persuade their patients to accept their etiological theories, will significantly affect their effectiveness.

This paper focuses on the tensions that exist between western therapists and African patients in providing mental health assistance. These tensions are created by differences between insider and outsider ideologies. Insider is used to refer to knowledge systems and practices related to mental illness, held by the community, including the diagnosis and treatment procedure. Outsider ideology refers to those ideas held by persons from other ideological communities, including local people who have taken up a different ideological system to those in their community of origin. Different aspects causing the tension include differences in the cultural basis of mental illness, and healing procedures as well as the differences in the power to determine what is correct psychological knowledge and practice (Boyden and Gibbs, 1996).

CULTURE AND MENTAL HEALTH

There are several definitions of culture. Maclachlan (1997) defines culture as that which describes the way in which groups of people experience, think, feel and behave. Cushman (1995) perceives culture as that which infuses individuals by fundamentally shaping them and influencing how they conceive of themselves, others and the world, as well as how they make choices in their everyday world. Therefore, the following assumptions about culture can be made:
¨ Culture is not a purely individual attribute but always evolves in a social context.
¨ Culture shapes behaviour and is closely linked to traditions, customs and beliefs.
¨ Culture varies from community to community.
¨ Certain cultural practices may be viewed as normal or taken for granted by people practicing it, but may also be seen as bizarre or strange by people from a different cultural background (Gilbert, Selikow & Walker, 1996).
¨ Culture is never static, it changes over time.

Helman (1994) has the following to say about culture:

defines normality and abnormality in a particular society
may be part of the etiology or cause of certain illnesses
influences the clinical presentation and distribution of mental illness, and
determines the ways that mental illness is recognised, labeled and treated by other members of that culture.

Helman's summary suggests that culture is the main factor that shapes experiences, understandings and perceptions of health and illness. It is, therefore, important to understand the impact of the cultural belief systems of the individual that one is dealing with before engaging in any treatment procedure. On the basis of the above assumptions it can be argued that indigenous healers are in a good position to treat members of their communities since they share the socio-cultural values of their communities, including beliefs about the origins, significance and treatment of ill health.

However, culture is also perceived as a product and property of different people. It is believed that each society possesses its own culture which is a way of life for that particular society. This notion would then lead to subdivisions within a population into tribes or separate ethnic groups, each with its own legal system, lifestyle and political identity. Sharp (1988) argues that this notion constitute the discourse of domination which serves the interests of those wielding power. In South Africa, this was also used for the development of the policy of apartheid and segregation as a principle that whites should dominate blacks.

This notions distort the nature of culture and needs to be corrected because they have been used to justify repressive and brutal forms of government by arguing that a culture or a nation must defend itself against internal as well as external enemies. Culture, Thornton further contends, is not the information that people are born with but which they need in order to interact with each other in social life.

SPIRITUALITY OF AFRICAN CULTURE

Thornton and Ramphele (1988) argue that the discussion of traditional healers begins from the premise that Africans are 'irrational' and 'superstitious', and that these characteristics will diminish under the influence of scientific medicine. It is therefore, suprising to find that instead of decreasing in numbers and influence due to the expansion of western health services, the numbers of traditional healers is increasing drastically (Karlsson and Moloantoa (1984:43). It is estimated that 80% of Africans consult indigenous healers at certain points in their lives.

In Africa, the living and the dead have a duty towards each other, hence the performance of some rituals during treatment. Health is defined by the harmonious relationships between the individual, the natural environment, with the deceased ancestors, and with other community members (Dawes and Honwana, 1996). If this state fails to come about it is perceived to be the results of either malevolent intervention of witches and sorcerers or the intervention of the ancestral spirits who wish to correct inappropriate social behaviour. Healing therefore, is achieved through a double strategy of divination (address the social causes) and physical healing (management of bodily symptoms). This implies that the living world and that of the spirits plays a role in both the causation and healing process.


Most mental illnesses in developing countries, especially Schizophrenia manifest some spiritual problems. For example, a person who is 'called' to the healing profession will at first manifest some schizophrenic symptoms (Mufamadi & Sodi, 1999). A person called to become a traditional healer will present various physical and psychological complains which include numbness of some body parts, restlessness, irritability, aggression and social withdrawal (Buhrmann, 1982). These symptoms may be interpreted differently by therapists from a different cultural perspective which is currently western dominated.

Most indigenous African societies regard illness as a misfortune, which involves the whole person. The principle among Africans is that 'if part of me is sick, then the whole of me is sick'. This has a direct bearing on the relationship of the patient with the spiritual or supernatural world and with the members of his society. Healing, in the African setup, takes place in the context of religion. Sickness is perceived as a religious matter and people revert to religious practices in order to deal with it. The unfortunate division between mind and body, spiritual, physical and secular, has reduced the expected impact of modern medicine on the African population in terms of their understanding of health and disease (Gumede, 1990).

PERCEPTIONS OF WESTERN THERAPISTS ON INDIGENOUS HEALING

The term 'Western' is used in this context to refer to those healing approaches that are regarded as "modern", "progressive" or "rational"(Gumede, 1990). This refers to the world that is primarily scientific, rational and ego-oriented ( Buhrman,1984). 'Western' is also used to refer to the white culture which is regarded as dynamic, diverse and individualistic (Boonzaier & Sharp, 1988).
Indigenous healing approaches are perceived as far removed from the clinical procedures and logical thought sequences of the Western medicine. Western therapists base their diagnosis of mental illnesses on the Diagnostic and Statistical Manual of Mental Disorders. One reason why indigenous therapists and their techniques have been ignored is that they are relegated to the realm of mere magic and superstition (Torrey, 1986).It is important to challenge this stereotype of indigenous therapists using magic and psychiatrists using science if we want to see them as they really are. Traditional Black beliefs and practices are also viewed as the result of a primitive or savage thought process which is different from that of modern society. Several authors have dismissed traditional healing as unhealthy and dangerous (Van Eerden, 1993; Bourdillon, 1989). Motlana, in Freeman and Motsei (1992) condemned traditional healing as superstitious, "meaningless pseudo-psychological mumbo-jumbo, by dangerous charlatans". This shows the lack of Afrophone orientation by an African scholar, something Chinwezi (1975) referred to as Europhilia, that is, the love for Europe without thinking otherwise.

Every effort is made to bring the African person to admit the inferiority of his/her culture which has been transformed into instinctive patterns of behaviour, to recognise the unreality of his nation and the confused and imperfect characteristic of his own biological structure. The African culture, under the colonial domination, is a contested culture whose destruction is sought in a systematic fashion and this has quickly led it to become the culture condemned to secrecy. This has led to the African asking himself questions like 'who am I?' And while many people maintain intact tradition, the intellectual throws himself in the frantic acquisition of the culture of the occupying power and takes every opportunity of unfavourably criticising his own national culture. Pahrham & Helms (1985) argue that attitude that denigrate one's self as a Black person, while simultaneously promoting wishes to be White may be viewed as psychologically maladaptive.

Western theories of personality are organised systems of beliefs that help us to understand human nature from the Western-perspective, as propagated by Francis Bacon and Charles Darwin, and make sense out of scientific data and other bahavioural phenomena. Therefore, these theories are based on the philosophies, customs and norms of a given culture (White and Parham, 1990). What is regarded as normal or abnormal is always in comparison to how closely a particular behaviour is paralleled to that of Europeans. The philosophical basis of these theories and practice, which claims to explain and understand human nature is not applicable to all human groups (Nobles, 1986). White (1972) argues that it is difficult, if not impossible, to understand the lifestyles of Africans using western psychological theories, developed by white psychologists, to explain white behaviour. What constitute normal or abnormal behaviour differs according different cultures.

Furthermore, western therapies present some significant problems; namely, they do not always correspond to people's subjective perception of their own health. They rely on an idea of 'normality' that is not universally applicable. They also ignore the spiritual aspect of health that may be equally, or even more important to the people concerned. Peltzer & Ebigbo (1989) point out some problems encountered with psychotherapy with African patients as lack of acceptance of psychotherapy, reluctance to speak about family problems beyond the confines of the family, and lack of interest in introspection. Another problem encountered is that Africans complain of physical disturbances even in psychological cases and expect physical treatment.

A question that emerges is how therapists can become culturally sensitive in psychotherapy when it is recognised that theories and their application are culturally framed by the dominant group. Sue (1992) suggests that counseling have been used as …an instrument of oppression as it has been designed to transmit a certain set of individualistic cultural values. Traditional counseling has been wrongly used to harm minorities and women. Counseling and psychotherapies have been the handmaiden of the status quo, and as such, represents a political statement objectifying women and the poor. (p.6).

DIAGNOSIS AND TREATMENT OF MENTAL ILLNESS

The content of an African's complaints, symptoms, delusions and hallucinations, is often dependent on cultural values and beliefs, western trained therapists base their interpretation of biological and experimental events, genetic predisposition, biochemical and metabolic imbalances, infections and damage to the brain (Netshiombo, 1997). The African psychological perspective can be regarded as a discipline of science which is attempting to study, analyse and define appropriate and inappropriate behaviour of African people from an Afro-centric frame of reference.

Diagnosis is a culturally patterned process that is linked to the patient's culture. During this step the ancestors are perceived as playing a crucial role in helping the healer to prescribe the correct medicines. This diagnosis is formulated in a language that is culturally understandable to the patient (Mufamadi, 2001).

Traditional medicine is regarded by patients who have faith in its healing power as a 'psychological opium' that helps to alleviate pain and suffering by recreating a sense of belongingness. In this way the sufferer regains his/her sense of touch with reality in the fellowship of relatives and friends, traditional doctors and the community (Netshiombo, 1997). Medication is a powerful tool for healing the pain or physical disorders, which, if the socio-relational disorder is unhealthy, may reappear again.

The treatment offered by traditional healers is mainly administered at two levels, namely herbal treatment and rituals. Herbal treatment is mainly directed at the individual so as to restore his/her level of contact with reality. 'Malombo' (therapeutic dance) is an emotional and physical therapy that is believed to summon the ancestors to come closer so that their relationship with the patient is re-established and strengthened. 'Malombo', 'u thwasa' (the process of becoming a healer) and the performance of some rituals could be interpreted as facilitating the attainment of transcendence and connectedness with the spiritual realm (Mufamadi, 2001).

Problems encountered by western therapist when treating these disorders include, among others, the conceptualisation of the problem, the fact that the therapist uses a different frame of reference than their clients. For example, the treatment of a 'thwasa' patient who presents with schizophrenic-like symptoms or a patient who is ill because he/she has failed to observe some of the cultural taboos. If the therapist uses another method of diagnosis which is not understandable to the patient, the patient will be dissatisfied and as such can never be psychologically healthy. The tendency to misdiagnose and over-diagnose severe psychopathology has persisted despite the awareness of social-cultural differences between the therapist and the client. It is due to these reasons that Africans are admitted to psychiatric hospitals, usually as 'hopeless cases', faster than Westerners (Parham and Helms, 1985).

METHODOLOGIES IN INDIGENOUS HEALING PROCESSES.

For therapy to be effective, it is important that the community perspective be reflected in the design and delivery of services, and start working with the community, than do things for them. Traditional therapists, who are indigenous service providers, who have been teaching people how to settle family arguments, how to find a job and calming people down during periods of crisis should be consulted. These people are useful because they know what the community needs and also have been working with the people for a very long time. They have also gained credibility.

Provision of effective treatment relies on an effective diagnostic procedure. Therefore, the training of psychotherapists in South Africa needs to pay attention to spirituality because lack of this may render the treatment ineffective to clients who present with spiritual problems. A continent like Africa needs treatments or therapies that are tailored particularly for their environment because most of mental health problems are not psychiatric illnesses. Protocols and ethics that respect the nature and operation of traditional healers should be established in consultation with these practitioners

COMPARISON BETWEEN INDIGENOUS AND WESTERN THERAPISTS

Western cultures distingiush sharply between physical and mental illness and have separate therapists for both. One indigenous therapist, on the other hand, treats a wide variety of physical as well as mental and social problems. According to Torrey (1986) Indigenous therapists function in private and public functions, for example, public ceremonies like giving of charms to departing warriors and presiding over ceremonies. This, in western context, is done by politicians, priests and department of defence.

For western therapists diagnosis entails what germ caused the illness, but for the indigenous therapists, it is not only what caused the illness, but also who caused the illness. Western healer's treatment is specific, individualised and streamlined to meet the presenting problem, for example if an arm is broken you go to the particular specialist. In other words, their approach is to heal the affected part. An indigenous healer's approach, on the other hand, is holistic. They regard man as a total being including the body, mind and soul. Therefore healing is a total process involving the living and the dead, the natural, preternatural and the supernatural (Gumede, 1990).

Western therapists treats the disease, destroys the offending organism and the patient will be well. While the indigenous healer treats the patient within his/her environment, that is, physical, spiritual, and emotional. This is more economical when compared with western healers because in this case there are specialists for the natural, spiritual and emotional problems. This is in line with World Health Organisation's definition of health as a complete state of physical, psychological and social wellbeing, and not merely the absence of disease or infirmity.

CHALLENGES AND WAYFOWARD

Both practitioners need to know and understand enough to refer patients to relevant specialists. We need to come up with ways of acknowledging each other. Another challenge has to do with the economic issue, wherein broadening the base of accredited indigenous healers is perceived as eroding the fee schedule of those already in practice.
There is also a need to eradicate the belief that indigenous therapists are an interim arrangement until the other culture becomes appropriately civilised and start using western therapy. This clearly shows that there is a need to change the mindset of psychiatrists and the community at large.

Another challenge is to acknowledge and stop regarding indigenous healing as involving magic. If one appraoch uses magic so is the other, for example, if a western therapists tell an illitirate African that his/her problems originated from the fact that he/she has phobia, and an indigenous therapist tells an average American that he/she is ill because he/she possessed by the ancestral spirits. Both these healers will be met with blank stares and confusion from the patient. We need to stop competing with each other and focus on both our abilities to provide help for our people who are in crisis.

CONCLUDING REMARKS

Both Western and African approaches to therapy should be used with much emphasis on triangulating them. The conspicuous absence of indigenous research methods and epistemologies in the research on African traditional, artistic and cultural heritage is a note of concern when conducting research among indigenous peoples.

The paper also draws attention to the need for the inclusion of traditional therapy within the mainstream of healing social and individual sickness. It is out of an Afro centric approach and introspection that the psychic related social ills that faces our people can be cured.

Subjective beliefs greatly influence thinking about the cause, nature and consequences of the particular problem. Therefore, it can be concluded that both Western and African approaches to therapy, which are culturally constructed, are if utilised in their relevant contexts, valid.

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CHALLENGES IN THE COLLABORATION BETWEEN INDIGENOUS AND WESTERN THERAPISTS
BY JANE MUFAMADI
UNIVERSITY OF VENDA FOR SCIENCE AND TECHNOLOGY
DEPARTMENT OF PSYCHOLOGY
DATE: 23 OCTOBER 2001
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