HEIDI HOLLAND

Shrinks versus sangomas

Many in the West view them as charlatans or witches, but their methods may offer more hope of recovery

Sangomas are the psychologists of Africa. Despite being viewed as charlatans by many outsiders, they are the healers who make an often traumatized continent tick. Their methods offer unique glimpses into sub-Saharan Africa’s natural philosophy, yet conventional shrinks – who seldom speak local languages and therefore lack crucial information - believe their own mental health worldview is the valid one.
Time-tested traditional healing skills are easily dismissed as witchcraft by Westerners, partly because isolated murders for the culling of body parts attract a lot of media attention. But the lore of the sangoma includes valuable insights gleaned through dreams or divination to rationalize misfortune, disease and mental illness - which are rare narratives on the way people think, who they are deep down, as well as how they go mad.
For the uninitiated: sangomas explain the relationship between victims and unfortunate events not through the Western concept of chance in the case of accidents or germ theory in the case of illness, but through belief in the supernatural - notably their “living dead” ancestors.
Conventional wisdom historically discarded Africa’s esoteric methods as backward, but generally left the continent to its own devices. Now, however, a growing body of research suggests that the Americanization of mental illness is well underway globally - with pills to suit every diagnosis. According to the New York Times, Americans are spreading their knowledge of madness around the world in the name of science and the belief that their approaches reveal the biological basis of psychic suffering while dispelling the harmful stigma of prescientific myths.
Says Ethan Watters, author of Crazy Like Us:  “There is now good evidence to suggest that in the process of teaching the rest of the world to think like us, we’ve been exporting our Western ‘symptom repertoire’ as well. That is, we’ve been changing not only the treatments but also the expression of mental illness in other cultures. Indeed, a handful of mental-health disorders – depression, post-traumatic stress disorder and anorexia among them – now appear to be spreading across cultures with the speed of contagious diseases.”
This epidemic of US-defined madness results from the world’s leading diagnostic manual being American, most of the field’s premier journals and conferences originating in the States, the dominance of Americans in drug company-funded research and among traumatologists descending on wars and natural disasters to dispense their assumptions of “how the mind becomes broken by horrible events and how it is best healed,” according to Watters.
Not that there aren’t many universal reasons - personal loss, social dislocation and biochemical brain imbalances - to unhinge us, one and all. But regardless of the trigger, we – like those seeking help from sangomas - rely on cultural beliefs and rituals to comprehend the resultant malaise. Whether these stories are of spirit possession or serotonin deficiency, mental illness is a sickness of the mind and “cannot be understood without understanding the ideas, habits and predispositions – the idiosyncratic cultural trappings – of the mind that is its host”, explains Watters.
Modern-day anorexia, for example, is a form of age-old hysteria expressed as disordered eating and false body weight because of our aversion to fat. In centuries past, the hysteria of leg paralysis afflicting thousands of middle-class women was a similar metaphor of psychic distress, though it symbolized female social immobility in the late 19th century.
Fortunately, simply telling such stressed individuals to loosen their knicker elastic went out with the Victorian corset. But the prevalence in middle-class families of Attention Deficit Disorder at a time when Western women are juggling numerous roles beyond child-rearing is part of the worrying modern process of medicalizing ever-larger chunks of human experience – in other words, redefining childhood.
In Africa, kids are free to be hyperactive (if they haven’t been subdued through malnutrition) while the more publicized psychological pathologies reflect the powerlessness of peoples’ lives. Apart from headline-grabbing prophetic movements like Alice Lenshina’s Zambian cult in the Sixties giving mythical expression to hopes and fears where politics had failed, witch burnings in South Africa most often occur at year’s end when men return home from menial city jobs to take up their macho roles in settling accumulated scores.
African “witches” are stigmatized individuals who become scapegoats and, having fallen victim to multiple suspicions, often embrace their roles as denizens of destruction by behaving accordingly. Some psychiatrists believe schizophrenia arises from a similar sequence, based on society’s imposition of a multitude of conflicting roles.
Interestingly, it is in the study of schizophrenia that the limitations of conventional ideas on mental illness have become most evident. After puzzling over the fact that schizophrenics in developing countries fared better in the long run than those in industrialized nations, researchers began to scrutinize Western anti-stigma strategies.
Some severe mental illnesses, it had been assumed, should be treated like brain diseases over which the patient had no control or culpability. “Once people believed that the onset of mental illness did not spring from supernatural forces, character flaws, semen loss or some other prescientific notion, the sufferer would be protected from blame and stigma,” explains Watters. “…Trampling on indigenous prescientific superstitions about the cause of mental illness seemed a small price to pay to relieve some of the social suffering of the mentally ill.”
However, preference for brain disease theory over belief in psychosocial origins - like what happened to the sufferer as a kid - proved more rather than less isolating in a number of studies on schizophrenia, including one by Professor Sheila Mehta in Alabama. The problem, she discovered, was that the approved narrative conveyed the subtle assumption that a brain made ill through biomedical or genetic abnormalities is more comprehensively broken and permanently abnormal than one damaged through life events.
Numerous subsequent studies endorsed Mehta’s finding that public fear of schizophrenics had increased rather than diminished. Like others in her field, she was left wondering if traditional medicine’s recourse to ancestor spirits - who reveal themselves in the dreams of African schizophrenics - offered more hope of recovery by treating each episode of delusion individually rather than issuing a forlorn “brain disease” diagnosis.
Perhaps the ridiculed sangoma is more valuable than conventional shrinks acknowledge.