Perspectives and practices of Xhosa-speaking African traditional healers when managing psychosis

Xhosa-speaking traditional healers in Cape Town, South Africa, diagnose psychosis with symptoms matching DSM-IV criteria for schizophrenia. They attribute the illness to supernatural causes: witchcraft, spirit possession, angered ancestors, and genetic predisposition. Treatment focuses on cleansing patients and families of evil spirits through washing, steaming, and induced vomiting, followed by group rituals of singing and dancing to evoke spirits. The findings suggest possibilities for cooperation between traditional and Western healing systems.

Study at a glance

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.