Chasing dön spirits in Tibetan medical encounters: Transcultural affordances and embodied psychiatry in Amdo, Qinghai.

In Tibetan medicine, the category of dön (spirit affliction) offers a framework where physical and mental aspects are inseparable in illness, contrasting with biomedical views that often classify spirit possession as psychiatric. Based on ethnographic fieldwork in eastern Tibet, two case studies illustrate opposite ends of the dön spectrum: one resembling stroke and another similar to schizophrenia. Harmful external influences cause both physiological and psychological symptoms, contributing to a shared pathogenesis. The analysis highlights how cultural affordances and bio-looping shape the presentation of these conditions, and how Tibetan medicine integrates cultural, social, biological, and psychological factors. This challenges biomedical paradigms by providing cultural models for diagnosing and treating chronic inflammatory conditions with mental health components.

Study at a glance

Abstract

Although spirit possession is generally considered a psychiatric illness, the class of conditions designated as dön (Tib. gdon, "afflictive external influences," often glossed as "spirit affliction") in Tibetan medicine represents a distinctive paradigm for an etiology where physical and mental facets inhere in every illness. This study draws upon ethnographic fieldwork in eastern Tibet to examine two conditions that represent illness presentations at both ends of the dön spectrum: one that maps onto a biomedical etiology of stroke and another that presents in a way similar to schizophrenia. The case studies illuminate the forms of harmful external influences that (1) have physiological and psychological impacts that present as symptoms and (2) contribute to a pathogenesis common to both conditions. Our analysis considers the dual role of cultural affordances and bio-looping in the cultural presentation of the two conditions, as well as how the Tibetan medical tradition draws upon cultural, social, biological, and psychological determinants to understand this class of conditions. We also explore the implications the dön illness category has for biomedically oriented paradigms through the way in which it accounts for cultural models for both diagnosis and treatment of several chronic inflammatory conditions that have significant concomitant mental health presentations.