In northwest Madagascar, young adolescent schoolgirls in Ambanja commonly experience possession by Njarinintsy spirits, a volatile and dangerous class of spirits that is a relatively recent phenomenon compared to older tromba spirits. These girls are essentially young migrants who have moved alone to town to attend school. Their possession reflects the conflicts and contradictions of shifting from rural to town life and from youth to adulthood, compounded by educational policy issues. Possession offers these girls a way to express the chaos of their fragmented daily lives.
Among the Sakalava of northwest Madagascar, spirit possession and madness are understood as opposite ends of a spectrum, ranging from a good, powerful, and permanent state to a destructive illness. Some mediums seek to end possession due to suffering, while chronic madness often resists cure. Psychiatrists and Protestant exorcists provide last-resort treatments, but efficacy varies greatly. Exorcists are more successful because they accept patients' explanations and redefine madness as normative behavior. Psychiatrists fail when they cannot comprehend patients' experiences, a problem worsened by their reliance on Western cognitive models.