Chapter 2 Literature Review Literature Review
3.3. African Indigenous Views of Illness and Mental Illness
3.3.6. Views on treatment
It is apparent that cultural factors not only influence the meanings attached to different health conditions and beliefs regarding causation, but are also likely to determine the persons who are consulted to restore health and well-being (Ross &
Deverell, 2010). In African traditional cultures, one of the most respected health components is the significant role played by traditional healers and the use of African traditional medicine in matters of health and wellness. The WHO (2004) defines traditional medicine as:
the sum total of the knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health and in the prevention, diagnosis, improvement or treatment of physical and mental illness (p. 6).
Traditional healers are established healthcare workers within their communities and are widely consulted by people who may be in search of causes and cures for various ailments, illnesses and misfortune (Shizha & Charema, 2011).
Traditional healers are respected members of the community and they function in multiple capacities. They provide healthcare by using methods based on social, cultural and religious backgrounds, as well as prevailing knowledge, attitudes and beliefs regarding physical, mental and social well-being and the causation of disease and disability in the community (Pretorius, 2001). This implies that traditional healers deal with the complete person and provide treatment for physical, psychological, spiritual and social symptoms (Truter, 2007). They do not separate the natural from the spiritual, or the physical from the supernatural, because these dimensions are viewed as intertwined.
Traditional healers interact very differently with their clients, when compared to their Western counterparts, and employ a more client-centred approach. They are regarded as interdimensional interceders who carry the responsibility and directions to intervene on people’s behalf, to help bring healing, balance, peace and harmony in the present, with the ancestors, and also for future generations (Solomon & Wane, 2005). Apart from their role in health-related issues, traditional healers’ leadership and services play a major role in the areas of governance, family disputes, marriages and divorce, sexuality and infertility, and guidance of children (Shizha & Charema, 2011). According to Ross and Deverell (2010), traditional healers’ skills are acquired by apprenticeship to an older healer, experience of certain techniques or conditions, or by a calling from the spirits or the ancestors. The calling, according to these authors, can take the form of a dream, a passion or a passing, or sometimes a condition which makes the person feel sick or brings him or her ill-fortune, so that he or she consults with a traditional healer who would then inform the person that he or she has been called. This process of a calling to become a traditional healer is referred to as ukuthwasa in isiZulu. Although the initiate must undergo training once being called to become a healer, ukuthwasa could be averted through animal sacrifices to the ancestors (O’Connell, 1982).
3.3.6.1. Categories of traditional healers.
Traditional healers, just like medical doctors, are not a homogenous group;
they do not all perform similar functions or fall in the same category. The term
‘traditional healer’, according to Mokgobi (2014), is an umbrella concept that encompasses different types of healers with different types of training. Each of them has their own field of expertise and their own ways of working using their own particular treatment regimen (Truter, 2007). What follows in the subsequent sections is an identification and description of different types of South African traditional healers, namely, izinyanga, izangoma, abathandazi, and traditional birth attendants.
3.3.6.1.1. Izinyanga.
Izinyanga are herbalists who possess extensive knowledge about curative herbs and medicines of animal origin. According to Kale (1995), they do not need to have a calling to be herbalists, but may have acquired competency through working closely with a herbalist, perhaps as an assistant, and are allowed to practice on their own once the herbalist feels that they are competent enough.
They are expected to diagnose and prescribe herbal medicines for everyday ailments and illnesses, to prevent and to alleviate misfortune or evil, to provide protection against witchcraft and misfortune, and to bring prosperity and happiness. The term ubulawu is widely used to refer to the roots of varieties of herbs and creepers used by izinyanga, but is also sometimes used to refer to the stems or bark of certain plants utilised to facilitate treatment among Xhosa indigenous healers (Sobiecki, 2008). These herbal medicines contain ingredients obtained from animals, plants, and other objects that have medicinal properties and can restore the decreased power in a sick person (Kale, 1995). However, if the patient’s illness does not respond to these medicines, the herbalist concludes that there is something else present in the sickness, a diviner is called, and causation is sought in a wider context (Nelms & Gorski, 2006).
3.3.6.1.2. Izangoma.
Izangoma are diviners and are the most senior of traditional healers.
Although they are mostly referred to as izangoma (isiZulu word), diviners are known by different names in South African cultures, such as amagqira in isiXhosa, ngaka in Setswana, selaoli in Sesotho, and mungome in Venda and Tsonga (Truter, 2007).
Diviners, according to Sobiecki (2012), are considered to be spiritual specialists, and use divination to communicate with ancestral spirits to diagnose their patients’
misfortunes or medical conditions. They tend to concentrate on diagnosing and interpreting unexplainable illnesses, and are therefore regarded as the most important intermediaries between humans and the supernatural (Kale, 1995). They are called by ancestors to training to became diviners where they learn to throw the bones, and control trance-like states where communication with the spirits takes place (Truter, 2007). Diviners make use of dreams during divination as a medium through which they establish contact with the ancestors and also consider these dreams to have ritual and medicinal significance in healing. In addition, it is common for diviners, after dreaming about a medicinal plant (iyeza or umuthi) in the bush to go and collect it from the place in which it was seen in the dream and to use it to treat patients (Hirst, 2005). Although both the herbalists and diviners prescribe and utilise herbs in their treatment, Sobiecki (2012) points out that the diviner has a specialised knowledge regarding particular species of ubulawu that are used for various purposes such as cleaning the body through vomiting and to bring good luck. According to Hirst (2005), diviners or initiates (abakhwetha in isiXhosa) also ingest ubulawu to enhance dreaming.
3.3.6.1.3. Abathandazi or abaprofiti.
Abathandazi or abaprofiti are faith healers or prophets, respectively. They are professed Christians who usually belong to one of the independent African churches and heal through prayer, by using holy water or ash, or by touching the patient (Kale 1995). Abaprofiti, in particular, are individuals who are possessed by the Holy Spirit and are able to foretell the future and advise on how to avert an undesirable event (Mokgobi, 2014). According to Hirst (2005), Christianity and traditional religion are considered to be related systems of thought and practice, and connections are drawn between Satan (uSathane) and witches or sorcerers.
Truter (2007) states that abathandazi or abaprofiti believe that their healing power
comes from God through ecstatic states and trance-contact with a spirit (umoya), or sometimes a combination of both Christian holy spirit and ancestral spirit. The treatment that they prescribe therefore usually involves a combination of prayers, herbs, remedies and holy water.
3.3.6.1.4. Traditional birth attendants.
Traditional birth attendants are described by Pretorius (2001) as traditional midwives. According to this author, they often serve communities located in very isolated and remote areas where they are consulted as a matter of necessity due to the unavailability of Western healthcare services. Traditional birth attendants are usually older women who have perfected the skill of midwifery over the years through experiencing, witnessing and assisting in many births throughout their adult lives (Mokgobi, 2014). They are responsible for duties such as the teaching of behavioural avoidance among pregnant women, ritual bathing of the mother, ritual disposal of the placenta, provision of healing medicine and traditional massage after delivery (Truter, 2007). Mokgobi (2014) is concerned about the survival of this important category of traditional healers as more African people now prefer to give birth in hospitals and not at home as was previously the case.
While it is apparent that traditional healers do not all perform the same functions and each of them has their own field of expertise, it is not unusual for healers to integrate aspects of more than one orientation into their practice (Ensink
& Robertson, 1999). Figure 3.2 below provides a summary of each of these healers with regard to the skills, method of services, nature of services offered and their accessibility. However, the generic term ‘traditional healer’ is commonly used to refer to all types of healers considered above (Kahn & Kelly, 2001).
Figure 3.2: Some of the traditional heralers and the methods of their services
Source: Kale (1995, p. 1182)
Each traditional healing practice is unique and healing takes different forms depending on a person’s individual situation (Solomon & Wane, 2005). For example, it is possible, on the one hand, for two people to receive the same diagnosis (e.g. bewitchment), but with quite different symptom patterns (Swartz, 1998). On the other hand, different people with the same illness may get different treatments because healing focuses on the person, not the illness (Shizha &
Charema, 2011). Traditional healing is holistic, which means illness and healing cannot be dealt with without taking into account the actual context in which they occur (Herselman, 2004). Healing seeks to restore harmony, balance and equilibrium, not only through alleviating physical and psychological symptoms, but also through reintegrating the person with his or her community, the earth and the spiritual world (Ross & Deverell, 2010). In practice, traditional healers treat mental disorders with various methods that include herbs, appeasing the spirits and divination, depending on the perceived cause (Abbo, 2011). According to Solomon and Wane (2005), some healers might prescribe a spiritual bath, which is a formal acknowledgement that something needs to be done about the physical, mental and emotional well-being. They add that sometimes songs, dances, ceremonies and sacred medicines could be used and these serve as the vehicle and tools of the healer. Such treatments often include rituals performed in the patient’s home while evocating evil spirits, which culminates with a feast involving the sacrifice of an animal to appease the spirits and drinking of traditional beer (Mzimkulu & Simbayi, 2006).
Furthermore, Shizha and Charema (2011) state that those who experience psychosocial disorders resulting from problems of unemployment, inability to find a spouse, infertility, bad luck and many others, may resort to faith healing and prayer.
According to these authors, where illness is attributed to spirit attack or possession, rituals involving dancing, incantations and prayer, induction of trances and exorcism are performed. In some cases, the spirits of the dead (ancestors) are called upon for protection or discipline. The ancestors are believed to work together with Unkulunkulu (God) and the healing is made possible through spiritual agents (Shizha & Charema, 2011). Ross and Deverell (2010) state that traditional healing has been shown to have several benefits including psychological relief from ailments and reduced anxiety through a shared, unquestionable belief in the powers of the healer. They emphasise that healing may be promoted by the personal meaning the patient derives from treatment, as well as the connection between the person seeking healing and the healer.
Consistent with the holistic conception of the person and illness, indigenous healing practices are directed at the whole person (Seape & Drennan, 2007) and embrace both the physical as well as the psychosocial aspects of disease (Pretorius, 2001). Illnesses perceived to be of supernatural origin are managed together with their physical manifestations so that the patient feels as if they have been treated holistically (Puckree, Mkhize, Mgobhozi & Lin, 2002). Abbo (2011) adds that the emphasis is on the need to look at the whole person, which includes an analysis of their physical, environmental, emotional, social and spiritual lifestyle values. According to this author health, from this holistic point of view, cannot be achieved without achieving a balance in life with others and with the environment.
A traditional healer never considers the patient as an isolated individual but as an integral component of a family and a community, and members of the patient’s family must therefore also participate in the treatment process (Kale, 1995). As a result, a consultation with a traditional healer is never conducted with the patient alone (Berg, 2003a). Instead, family members, relatives or people who know the patient well are called in to provide information regarding the patient’s illness. Rituals are always performed with members of the affected individual’s family and people from the community who are actively involved in the life of the person for whom the ritual is being performed (Berg, 2003a). Pretorius (2001) states that satisfactory healing involves not merely the recovery from bodily symptoms, but also the social and psychological reintegration of patients into their communities. To affirm this view, Berg (2003a) states that through rituals
connectedness is re-established, and links are concretely and actively made between the individual, the family and the community, between the body and mind, and between the conscious and unconscious dimensions of the psyche.
The African healing system sometimes requires the afflicted person to live at the healer’s home for months or even years (Pretorius, 1995). Although this could be equated to an inpatient hospital admission in Western healing, it raises serious ethical concerns regarding patient safety and healer-patient professional relational issues. For example, Ensink and Robertson (1999) report that allegations of sexual and physical abuse of patients by some indigenous healers were made by families interviewed during an exploratory study undertaken in Cape Town during 1993. In spite of traditional healers reportedly subscribing to a code of ethics, unfortunately there are no mechanisms to enforce this code (Pretorius, 2001) and this leaves open an opportunity for abuse, either intentional or unintentional.