Traditional healers.

Traditional healers are an important source of psychiatric support in many parts of the world, including Africa. They offer a parallel system of belief to conventional medicine regarding the origins, and hence the appropriate treatment of, mental health problems. In this issue we present a thematic review from three regions of Africa where traditional healers are still important - and probably far more numerous than psychiatrists trained in Western medicine. First, we discuss South Africa, in a report from Professor Tuviah Zabow. Some years ago it was estimated that there were nearly ten times as many traditional healers practising in that country as there were doctors trained in modern medicine (Kale, 1995). The prevailing justification for their interventions, according to traditional beliefs, is that disease is a supernatural phenomenon. Its manifestations are governed by a hierarchy of vital powers. At the apex of this hierarchy is a deity of greatest power, followed by lesser spiritual entities, ancestral spirits, living persons, animals, plants and then objects (Kale, 1995). These entities interact and, should they become disharmonious, illness could be caused. Harmony can, however, be restored through judicious intervention, provided by a suitably trained person who treats the patient holistically, within the context of their family and their community.

In his article, Professor Zabow emphasises that indigenous healers may be regarded as falling into three broad categories: diviners (the majority of whom are female and selected by their ancestors to this calling); herbalists; and faith or spiritual healers (usually within the Christian tradition). South Africa is trying to regulate the activities of these groups, and to set training standards. Although in the past there had been attempts to ban traditional healing completely, nowadays there is increasingly a collaborative relationship between conventional psychiatric services and those provided by traditional healers.

A very similar situation seems to exist in Nigeria, according to the article from Drs Olugbile, Zachariah and Isichei. The authors arranged a discussion with a group of traditional mental health practitioners. They attempted to derive from that interaction a structure that summarised traditional beliefs regarding the origins and treatment of mental illness. In this report, the authors describe that structure as it pertains to the origins of mental illness. They show that there are clusters of aetiological influences, as perceived by the traditional practitioners, which follow a simple typology of observed behaviour, and link to particular modes of treatment to be employed. The duration of treatment is protracted, up to 6 months, and many such healers claimed they could bring about a complete cure. The authors emphasise the need for a dialogue between health planners, doctors and these traditional practitioners.

Finally, Professor Ndetei discusses the role of such healthcare practices within the context of East Africa. As in South Africa, the prevalence of traditional medicine is very high indeed. He estimates that at least 80% of the healthcare needs of rural inhabitants in East Africa are initially met in this way. The proportion of treatment that is concerned with mental health problems is estimated to be substantial. Traditional approaches may include herbal remedies as well as some form of what Professor Ndetei calls ‘psychotherapy’. The latter, he emphasises, is of considerable sophistication and is taught orally from generation to generation, in the absence of any textbooks. Psychotherapeutic work is done at the individual level, as well as with couples, families and with groups. One of the main objectives of such therapy is to reduce stress. The author emphasises that we in the West have a lot to learn from the way these traditional healers manage their patients and challenges us with the question: ‘Are we willing to learn from them?’