Unravelling the spirits' message: a study of help-seeking steps and explanatory models among patients suffering from spirit possession in Uganda.

Marjolein Van Duijl,Joop De Jong,Wim Kleijn

doi:10.1186/1752-4458-8-24

Abstract

As in many cultures, also in Uganda spirit possession is a common idiom of distress associated with traumatic experiences. In the DSM-IV and -5, possession trance disorders can be classified as dissociative disorders. Dissociation in Western countries is associated with complicated, time-consuming and costly therapies. Patients with spirit possession in SW Uganda, however, often report partial or full recovery after treatment by traditional healers.The aim of this study is to explore how the development of symptoms concomitant help-seeking steps, and explanatory models (EM) eventually contributed to healing of patients with spirit possession in SW Uganda. Illness narratives of 119 patients with spirit possession referred by traditional healers were analysed using a mixed-method approach.Treatments of two-thirds of the patients were unsuccessful when first seeking help in the medical sector. Their initially physical symptoms subsequently developed into dissociative possession symptoms. After an average of two help-seeking steps, patients reached a healing place where 99% of them found satisfactory EM and effective healing. During healing sessions, possessing agents were summoned to identify themselves and underlying problems were addressed. Often-mentioned explanations were the following: neglect of rituals and of responsibilities towards relatives and inheritance, the call to become a healer, witchcraft, grief, and land conflicts.The results demonstrate that traditional healing processes of spirit possession can play a role in restoring connections with the supra-, inter-, intra-, and extra-human worlds. It does not always seem necessary to address individual traumatic experiences per se, which is in line with other research in this field. The study leads to additional perspectives on treatment of trauma-related dissociation in Western countries and on developing effective mental health services in low -and middle-income countries.

Highlights

Attribution and treatment of dissociative disorders in Western countries In DSM-5, possessive trance disorders are included under dissociative identity disorder (DID), owing to phenomenological similarities [1,2]
We suggested that spirit possession can be an idiom of distress in a context of suppression and societal disruption and that it is comparable to the role of an “emotional part of the personality” containing conflicting and traumatic experiences that are incompatible with the expected normal behaviour in a specific traditional, political, or religious context
Aim The aim of this study is to explore the pathways to healing of patients with spirit possession who visit traditional healers in SW Uganda, by exploring their help-seeking behaviour, the healing methods used by the healers, the explanatory models (EM) that endorsed the healing process, and the perceived subjective effectiveness of the healing process

Summary

Introduction

Attribution and treatment of dissociative disorders in Western countries In DSM-5, possessive trance disorders are included under dissociative identity disorder (DID), owing to phenomenological similarities [1,2]. In a subsequent case-control study in SW Uganda, patients (n = 119) with spirit possession in comparison with controls reported significantly higher levels of locally recognized dissociative symptoms, more severe psychoform dissociation and somatoform dissociation on scales developed in the West, as well as more potentially traumatizing events [13]. Traumatic experiences were not spontaneously mentioned prior to or during the treatment by healers, nor were they addressed during the healing process. This makes it interesting to look in more detail at how these patients with spirit possession, who according to Western measures suffered from severe trauma-related dissociative symptoms, evaluated the local treatment process. Which help-seeking steps did they undertake, and how were local explanatory models (EM) generated in the search for healing? How did they experience the final outcome?

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