Perspectives and practices of Xhosa-speaking African traditional healers when managing psychosis
Human Sciences Research Council
Human Science Research Council SA July 1, 2026 Peer reviewed DOI: 10.14749/32860232 via OpenAlex
Summary
Xhosa-speaking traditional healers in Cape Town diagnose psychosis using symptoms consistent with DSM-IV criteria for schizophrenia. They attribute psychosis to supernatural causes such as witchcraft, spirit possession, angered ancestors, and genetic predisposition. Treatment involves cleansing patients and families of evil spirits through washing, steaming, and induced vomiting, followed by group rituals of singing and dancing to evoke evil spirits. The findings highlight possibilities for cooperation between traditional and Western healing systems.
Study at a glance
| Design | qualitative study |
|---|---|
| Sample size | 4 |
| Population | Xhosa-speaking African traditional healers (amagqirha) in Cape Town, South Africa |
| Key finding | Xhosa traditional healers diagnose psychosis with symptoms matching DSM-IV criteria but attribute it to supernatural causes and treat it with cleansing rituals. |
Abstract
The aim of this study was to investigate perspectives and practices of Xhosa-speaking African traditional healers, known as "amagqirha", in managing psychosis. Four traditional healers, three male and one female, were chosen to take part in the study through their association with psychosis patients undergoing treatment at a South African psychiatric hospital in Cape Town. In-depth interviews were used to collect data. The interviews were conducted in Xhosa and were tape-recorded. Following translation, the verbatim transcripts were analysed using thematic content analysis. The main themes that emerged from the analysis were grouped under the following three main issues: diagnosis, aetiology, and treatment. In terms of diagnosis, the African traditional healers identified symptoms of psychosis, which are consistent with the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for schizophrenia. With regards to aetiology, supernatural powers such as witchcraft, spirit possession, angered ancestors, and genetic predisposition were articulated. Regarding treatment of psychosis, cleansing the patient and his or her family of evil spirits through washing, steaming, and induced vomiting were of major importance, followed by a group of traditional healers evocating evil spirits at the patient's home through singing and dancing. Implications of the findings for the continued co-existence and cooperation between traditional and western healing systems are discussed.