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JPMA ( Journal Of Pakistan Medical Association) Vol 53 ,No.

10,Oct 2003
Review Article
Ethnopsychiatry - a review
A. A. Gadit
Department of Psychiatry, Hamdard University Hospital, Karachi.

The subject of ethnopsychiatry deals with the study of mental ill- But so far, every attempt to define mental health has
nesses in cross-cultural perspective including its definition, classifica- failed since "there exists no psychologically meaningful and
tion, causality and treatment of mentally ill persons in differing contexts. operationally useful description of what is commonly under-
This review paper describes the evolution of ethnopsychiatry, explaining stood to constitute mental health". Attempts were made by
the meanings of normal and abnormal in terms of mental health, the con- researchers using different approaches:
cepts about mental illnesses in various cultures, the socio-cultural influ- One approach simply views mental health as the
ences, treatment issues and shamanism. The emphasis is on understand- absence of mental disorder. This perspective is limited for
ing the cross-cultural issues in order to understand the mental illness in two reasons. First, while most would agree that the absence
its diverse perspective. It also attempts to examine the possibility of col- of psychopathology is a necessary condition for mental
laboration between psychiatrists and shamans in the local context. health, one must still define mental illness in order to under-
Ethnopsychiatry: Background, Definition and Concepts stand, by contrast, mental health. Secondly, this approach
fails to take into account cross-cultural differences in accept-
Ethnopsychiatry is the study of mental illness in a cross- cultural able behaviour.
perspective; including its definitions, classification, causality and treat-
ment of mentally ill persons in different cultural contexts. Other names Another definition of mental health holds that correct
used in psychiatric literature for ethnopsychiatry are cross cultural psy- perception of reality is the key to mental health. In view of
chiatry or transcultural psychiatry. the cross-cultural variations in social norms, this approach
holds little promise. What is "correct" depends on the way in
Concept of Mental illness in the context of ethnopsychiatry which given people perceive the world.
The new transcultural psychiatry demands special consideration Conversely, the view of the uncommon as pathologi-
of indigenous notions of causality and for explanatory models based on cal is even less viable since it logically requires the inclusion
folk beliefs. of the great achievements of individuals and people with
In the context of ethnopsychiatry mental health has not been an high IQs. A third criterion of mental health utilizes the con-
easy task to define as there is a disagreement over the boundaries of nor- cept of adjustment with the environment, which is generally
mal and abnormal behaviour. taken to mean that a person has established a workable
arrangement between personal needs and social relations.
How would one define normal mental health? This question is
The absence of such an arrangement is a definite counter-
apparently very simple but the answer is complex. A diversity of opin-
indication of mental health. After all, a person who is hostile
ions exists across the cultures in the world about the conceptual limita-
towards the everyday social environment cannot enjoy men-
tions. It appears that a mentally normal person in one society or culture
tal stability. In this sense the "adjustment" definition is use-
may not be considered normal in other setups due to existence of a great ful in separating some obviously abnormal people from the
deal of trans-cultural variations across the globe.1 If a person speaks and rest of the population.4
laughs too much, if one is violent or unduly undermined in behaviour,
resorts to deliberate self-harm, disinhibited and odd in expression and Absence of mental disorder, correct perception of
behaviour and/or very unstable in emotional discharge, he can perhaps reality, adjustment to one's environment, and intrapsychic
be labeled as "psychic or mentally disturbed" in one socio-cultural sect equilibrium are theories that most frequently appear in
while not in other.2 Human beings are very complex in nature and for attempts to delineate mental health or normality.
them it is not possible to maintain a particular mood and expression The ultimate concept that emerges as most acceptable
throughout twenty-four hours of the day. This is a very important point by this ongoing debate among a number of experts across the
especially for evaluation of mental health. globe, is the one that say "if a person is able to cope and
function normally in a society, meeting the responsibilities
Scientists are still concerned about the definition of normal men-
and expressing balanced attitudes towards day-to-day chal-
tal health for the simple reason that mental health is the most vital oper-
lenges and problems then he is mentally sound and possess
ational tool when one is talking about the interpersonal communication,
normal mental health".5
professional and social life. All the factors that affect health of the body
as well as the mind must have to be taken under consideration when one The concept of mental health needs further elabora-
is adopting a certain lifestyle and is handling day-to-day situations.3 tion when one incorporates ethnopsychiatric concepts which
embed cross cultural and anthropological factors.

The Bena believe that the attacks are the work of al afflictions. declared criminal. that is frequently the result of possession by a spirit or bhut with little or no warning and for no apparent reason. Speaking is rare during pin the widespread resort to healing centres. The amok run- bhada. Often possessed persons are not others.appearance. aggressive behaviour results. forming part of illness follows a classic four-stage sequence. sidered as respectable members of the community. thus encouraging such as loud noises or fearful objects including snakes. victim is irritable and socially withdrawn. a state of food nausea. The behav- poisonous snakes. sometimes called Arctic hysteria. attempt to walk on ceilings. The onset of the second stage is sudden. also known as the whitiko psy- behaviour occurs affects whether it is adjudged normal or abnormal. . groups in the same society. or even socially acceptable. Possession by bhut may sometimes give rise to trances. They labeled mentally ill.Mystical Accounts of Illness Beyond these differences in acceptable behaviour among Mental illness is explained and understood in a variety of ways. It is frequently triggered by a sudden stimulus shrine is thought to draw out the possessing spirit. abnormal may be accepted and even admired under certain circum. There is occasional loss of consciousness and the Possession in Maharashtra is related to karani which is translated person often experiences considerable embarrassment upon recov- as black magic. They perceive quent. or else will request a become deaf and aggressive towards clansmen. behaviour which is usually considered those around them as fat. forgetfulness. and loss of interest in personal gious leaders who had witches and heretics burned at the stake were con. Among the Bena people of the Eastern Highlands of New means of karani. eat faeces. They run about randomly in circles and with of common beliefs about the spiritual provenance of illness which under- clubs and arrows in threatening gestures. occurs among spiritual afflictions. The seventeenth century reli. and receive psychotherapy. Moreover. collapse.They finally reach a stage of homicidal cannibalism and are usual- stances. men are affected by day-long episodes during which they either ask God to send a bhut upon their enemy. The Muslim shrines or dargahs in Bombay and Puna cater malevolent ghosts who are the objects of intense fear. and stupors sleep or coma. shout are frequently visited by all Hindus in times of trouble and at the major obscenely. of a healing temple. In the final stage. and snails. caterpillars. This in common poverty and illiteracy rather than sect affiliation. lasting for up to Every culture must deal with mental illness to guarantee its sta. be depression.infantile behaviour. In such instances an angered or envious person will Guinea. the victim becomes wildly excited and may tear off Despite doctrinal differences. comparisons between Western and non- An interesting example comes from Maharashtra (India). Apart from similar beliefs. occurs among the Ojibwa Indians of the Northeastern Depending upon the situation. Imu7 is an illness found mainly among the older women of Here the power of the God or saint associated with the temple or the Ainu of Japan. the Mahanubhav temples clothing. Wild. This es. the victim behaves perfectly nor- bility. and periods of semi-stupor. In addition. latah6 is a Malay condition involving compul- aware of the suffering from bhut bhada until they come into the vicinity sive obscenity. or perform other irrational acts Mahanubhav festivals. throw objects. excitement is followed by a third stage characterized by convulsive Cross-Cultural differences and Culture Bound Syndromes seizures. However. handling minor stress which have been reported in Puerto Rico. Maharashtrian popular culture is a set of beliefs regarding illness and a syndrome known as running amok occurs in people who turn wild misfortune. Symptoms involve example. appetizing animals which they wish to eat. The episodes are quickly forgotten and there is no many healing temples specialize in the management and cure of spiritu- social censure. an adolescent who sets fire may seek psychiatric help. including their mantrik (magician) or devrishi (shaman) to do so. trance. regression to honoured by members of certain groups. chosis.mally and has amnesia regarding the experience.twelve hours. however. but today they would There are numerous such syndromes which occupy a large be committed to an institution. Common to western societies demonstrate more striking differences. and be jailed. For possessed by the spirit of the whitiko monster. ly killed since the Ojibwa believe that the craving for human flesh Examples of this are hallucinatory behaviour in a LSD session.are subject to homicidal and/or suicidal thoughts. Victims who suffer from this belief are mental disorder. break furniture. the production of unintelligible speech in a church in which "speaking in There is also a peculiar group of disordered reactions to tongues" is common. In Malaya. in particular. for many thousands a week who present with a wide variety of afflic- tions. It is precipitated by sudden fright. and even suicide are often positively sanctioned and iour includes outbursts of verbal and physical hostility. The temple of the Hindu Mahanubhav pant sect also caters for Piblokto8. or will never leave once it has been fulfilled.the Polar Eskimos of the Thule district of northern Greenland. The same individual become obsessed with the idea of being possessed by the spirit and may have encountered the legal authorities. Such practices as not wearing clothes. nesses are relative because the social context in which a particular The windigo9 psychosis. followed by running away in panic. be labeled a juvenile delin. those which give rise to mental illness. The Mahanubhav sect arose in the thirteenth century. Thus there exists a set wives and children. it is important to recognize that standards of mental ill. It is thought that bhut bhada is usually brought about by ery. the temple users have such as plunging into snowdrifts or jumping off icebergs. In the first stage. the a wider movement of that time which emphasized bhakti or devotion. Throughout Maharashtra these attacks. but more ner usually kills several animals or people before being killed by often it results in ill-health or bad luck. the same behaviour may be considered as United States and Canada.

a "doctor" in the full sense of the word. During the whole period of treatment. A similar account is given by another researcher12 of a . They cultivate. who initiate integrated program of pharmacological. believed to stem from his divinity. with his supernatural powers. the spir- itualist aim to locate the sources of tension in a person's social relationships Apart from using herbs. After the who increasingly human. whether medically to the flour mill. a tuberculous infection of the skin. but these were used on individual sification system. with multiple levels of causation. with modern "After a week some recover. and why. are the logical responses in person. for treatment of men. But he himself performs no therapeutic tic skill being exercised. The healer usually becomes be turned over to a lesser curer. and as monarchs became regarded as alistic. logically require a very different type of discarding the sickness that has been drawn out of the patient. psychological. sive bile to hostility. then I do not let them stay psychiatry. or the task my act of a spirit. the shaman goes into a trance and discovers the cause he is guided by the spirit. In modern sage. can be seen as the direct heirs of the traditional diviner. ied by Dube. treatment for the immediate The spiritualist healer is believed to be an instrument of the healing cause may be administered by the same person. By the end of this period. this practice waned. The carry out these jobs until they are discharged home. a specialist in bowl of water by the healer's side in which he washes his hands after the symptomatic treatment who knows the appropriate herbs. The curandero or the spiritualism we can identify elements common to the traditional healing Ayurvedic specialist is not primarily concerned with the who or techniques described above. And in the Indian villages stud. chiatrically ill clients. On the other hand.10 aware of possession by a tingling sensation in his finger tips. they engage. Hence. Reference has been made to the use of restrictions.They qualified or not. Naturalistic aetiological systems. food spiritual healing of each patient. both of whom are primarily concerned with known as the King's Evil. and direct England and France throughout the fourteenth to seventeenth centuries to contact with the spirit world. among the Nyima of the Kordofan mountains in occurs the healer places his hands on that part of the patient's body to which Sudan. this is the field of other healing experts. ize the Western psychiatry. the Brahmin or a local peer aims at finding out A healing method currently used in the West which has an affinity to what ancestral spirit is angry. attention was paid to the In the context of ethnopsychiatry. He is triumphs of Western psychiatry lie in the field of pharmacology and not in reported as being quite careful in the way he allocates jobs to the area of social management. patients' psychological needs. perhaps a herbalist. and the "witch doctor". including rauwolfia ser- Shamans and Other Curers pentina. and as they recovered they were progressive- tal illnesses. This study demonstrates the eclecticism of some traditional healers. and other forms of treatment such as cupping. poultices. The healer usually strokes the will be referred. to whom the patient healer's hands and penetrating his body. some healers understand the as these might be responsible for the lack of physical well-being. and why have been determined. social treatments. multiple causality. Western psychiatry may benefit from the market unless he was sure the patient was well enough for a closer study of the herbal remedies employed by healers to treat their psy- these tasks. water in traditional exorcism rituals to wash away the evil spirits. and sometimes shakes hands after each stroke. extraction of illness by physical contact with the healer and the use of spirit Traditional Healing possession for diagnosis and healing. In the mental sphere. These disorders need proper placement in the western clas. frequently of a deceased doctor. it is believed that excessive In Mali. Like many traditional healers. and the like. I send them to the market and conventional medicine. The patient feels an intense heat emanating from the act. and why? these techniques. with single patient's body. aetiological systems. which occupy a large chunk of ethnopsychiatric litera. The types of ly involved in increasing amounts of work in and around the healer's com- curers found in a particular society. importance of rehabilitation for psychiatric patients. the people in the tribe want to know why they heat can cause excitement. where they coexist. The practitioners of most of these techniques operate outside idle. patients for no more than two weeks. and nized. fetch water. a traditional healer in Nigeria. The healing power of the king's touch was finding out whom. There is a curer. which was consequently magical powers. more or less peacefully. In particular. there is a diagnostic as well as a therapeu- and cure of the disease. with his treat scrophula. symbolically level of causation. This was used by the kings of The shaman. stem logically from the aetiologies that are recog. which is well understood and practiced by his patients. When this Thus. and he would not send a patient to cultivate or to traditional healers. we note the combination of the why. is the laying on of hands. excessive cold can lead to depression and exces- are ill and not how they got ill". a number of curers were identified. but rather "Who?" and "Why?" the Ayurvedic concepts. their excite- ment was usually controlled by herbal preparations. and they cut grass in the compound". and the curing acts in which pound. However. were restrained by the use of chains. because the primary concern of the patient and his family is not The humoral disease theory of the Greeks may have developed from the immediate cause of illness. mas. Personalistic systems. the psychotherapists. an approach which is widely acknowledged to character- logically require curers with supernatural and/or magical skills. enemas. The The traditional healing techniques applied to psychiatric conditions Kenyan healer interviewed by a researcher11 stated that in most in developing cultures throughout the world have survived in a recognizable cases the patients worked for him: form in the West. He found that acutely excited patients ture.

drum beating and the burning of incense. rushes violently out of client's spirit declares its conditions. that the spirits have departed. Healers who many rituals. a the house. performed by the native healers of the Yoruba in Nigeria. he brushes the sickness from the patient onto the object. and often in Water as a cleansing agent is. The techniques described above exemplify the most concrete form of extraction Possession and Divination of illness. He then stands on the bank of a river and on the concept of a disturbance of normal bodily function. He says to the tional medicine is unsatisfactory. and they are the illness.incomprehensibly. into the body. but speak intelligi- while standing waist-deep in a swiftly flowing river. as in neighboring Sri them will contract the illness. In many traditional cultures. When this duce the illness. and any one touching logue. with sweeping strengthened by the spirit that has entered him or her. The spirit speaking also floats away. or ngaga. An early account of spirit expul- 15 Lanka. indicating away into stillness or silence. telling her that today she has thrown out this bad spirit and asking her not to allow it to return to her. and screeching without cessation. The next step in extraction involves the transfer of an Possession states fulfill a variety of functions in different cultures. Frequently. the patient is dressed in a new white cloth and has his head shaved Ayurveda. the healer's spirit severe tom-toming. and if the healer's spirit is more powerful it orders the other to leave sion in Abyssinia States. "I am giving away this spirit" and the sufferer. which may be an animal sacrifice. The native healer. till the pos- pleads.some religious and some secular. In these cases the illness is ascribed to harmful spir.the role or status of the subject. but has a special place in the transfer of spirits caus. The patient's head is but these are considered to operate on the internal milieu to pro- commonly the focus of activities aimed at extracting the spirit. mate or animate. illness is conceptu- has been achieved. pelted and beaten. such as a log of wood or a saw. Thus. dead mother. standing her next to a sheep or hen in the forest. since rivers never run backwards. foam at the mouth. which may be either inani- ever.14 The Practitioners of the ancient Hindu system of medicine. also use the possession states for diagnosis. both the healer and the client where the Zar quits him. The devil is borne away by the river on the bod- through the healer then engages the spirit possessing the client in a dia- ies of the doves and on the white cloth. causes of the disturbance may include external agents such as The native healer commands or beseeches the spirit causing the excessive intake of alcohol or intolerable psychological pressures. They stride around chanting and working upwards to the top of the head. the object is broken under the control of a greater force than his or her own will. After this. starting from the tips of the toes their bodies convulse in time with the cries.uneven manner. madness to leave the patient and enter into an animal. and he becomes well. The patient takes off his white wrapper. a component of the content of speech which sounds like some strange tongue. the patri goes into a trance.13 The names of spir. After are used as living sponges to wash away the evil from the patient. If the latter has the ascendancy. Thus. Affected people breathe in a rapid and spirits are induced to leave by placing a sticky ball of rice on var. the nganga takes a few grains of each crop that is grown The scientific view of illness of any kind is firmly based and puts them into a black cloth. Their appearance may mark a change in mate object. The diagnostic powers of the possessed healer are presumably object. The healer has the patient lie down near an inanimate sick. speak messages from spirits. Alternative therapies flourish in areas in which conven. A ceremony marking the recovery from psychosis is by to convey the meaning of their utterances to the audience. doubtless distracted with the noise." A river also fea- throw final a fit. manifestation of this is a change in the quality of the voice. A patri acts as the medium for a spirit or bhuta. and pass into unconsciousness. The rice-ball is then thrown away. ritual feast. while rapid cries are seemingly jerked out of them and ious parts of the patient's body. the Gnau of New Guinea recognize its who have to be lured from the sufferer's body. The throws the bundle into the water. Among the Eskimos of Alaska. Possession states are commonly entered into by the traditional heal- insanity and episodic hysteria are usually ascribed to the intrusion er as a technique either to determine the causes of illness or else to heal the of spirits."The favorite remedies are amulets and the body of the client."speak in tongues" in this way usually have a trained interpreter standing ing illness. which show itself and the client breaks into a weird dance. Their its are called out during this procedure and the patient is asked to cries or jerks may reach a crescendo to the point of collapse. or driven off with precautions ensuring that it will not return. then prays to her effects. pos- They are then either drowned or decapitated and their bodies sessed by his master bhuta. or a "house" for its use. In Thailand the a condition known as bengbeng. There is an established hierarchy of spirits. and driven to the nearest brook. invisible illness principle from the subject to an external inani. The spirit possessing the client is then asked to flung downstream. presumably putting an end alized in a concrete way as an external object which has intruded to the spirit. the heal- motions. An additional feature is the use of water to cleanse the patient of evil. asking the other to state its conditions for releasing the client. After this. Three doves bly to the client. A dramatic into pieces. or else fade pray with the healer. er's behaviour changes as he or she becomes possessed and appears to be When the transfer has been accomplished. but to allow it to enter someone Extraction and Exorcism else. costly and associated with side sheep. or utter warnings. Such alien objects do not merely cause the illness. The sessed. of course. the healing procedure consists of sometimes the introduction of flowing water to carry the spirits away for- removal of the offending substance. treats a possessed woman by . and then.17 tures in another exorcism ritual described by Gelfand16 among the Shona. the animal is either killed. from the sufferer's body.

and precipitation of glaucoma. The consultation was determined generalized anxiety disorder. iety and depression but if used for a longer period may lead to depend- . Other unwanted effects have being the major causes of mental distress and usually approach a been reported to include cardiac arrhythmias. healer favored for psychiatric consultation. and epilepsy. but erally prescribed which are useful for short term period in cases of anx- reportedly also hazardous methods are used which include exor. high cost. Disciples mental health care in an Indian village. (1995) and Adnan S. recitations of holy verses and rituals etc. literacy level results due to super sensitivity of dopamine receptors have fatal out- (34%) is very low and the general health scenario is gloomy. ventricular arrhythmias. are actually the people who deal with the major. parkinsonism. ficulty in micturition. and agranulocytosis. Study Three was popu. fine tremor. The Gross National Produce is $430. cine in the background of rising popularity for traditional treatment. and various hypersensitivity reac- is recognized by these therapists if one has displayed odd or aggres. of redressal of problems. constipation. lengthy duration and side respected by its patients. hypothermia. possession. mantrawadis. Usually shamans offer autonomic effects including dry mouth. A large number of people have faith in the heal- ers. but most people consulted both Some adverse Results of Western Treatment traditional and modern healers without regard to the latter's contra- It is important to understand some drawbacks of western medi- dictory conceptual framework. constipation. akathisia. population. shamans is an important category of healer who by definition is a per- son claiming to be in direct contact with the spiritual world and who Folklore psychiatry is practiced by native healers. The following table gives causes. ECG changes. who cured through astrology preparing their dissertations have observed among the attenders of the and charms. the statistics and personal data give some undesirable outcomes of western-oriented Situation in Pakistan treatments. Another form of shaman is a 'sufi' who is generally a disciple and charlatans. Modern doctors were more popular. distress. of a well known saint. seeking cure especially for mental illness. irrespective of educational or ethnic back- ity of psychiatric cases. muscle twitching. apart from and against what the dominant cul. holy water. and simple domestic popular wisdom. headache. Other effects noted include skin rashes. The vast rural population receive mental health treat. and tardive dyskinesia. tions. It is also believed that ignore them. toms had consulted someone. increased sweating. urinary hesitancy and retention. effects of western treatment. 'sufi' saints are effective healers and even after deaths have spiritual Kapur19 conducted three studies to examine the patterns of influence by virtue of which they can cure or provide relief. Research further shows that only 5% of the patients suffering from hypotension. Rarely inhabitated by various ethnic groups with the predominant religion a very serious condition in the form of Neuroleptic Malignant Syndrome being Islam. Thus antidopaminergic effects have been reported to include Pakistan has a population of about 140 millions and is acute dystonia. galactorrhoea. who acted as mediums for spirits and faith heelers. amenor- shaman or a traditional healer for seeking treatment. magic and Jinnic influence as vision. impaired accommodation. The benzodiazepines are lib- ment by spiritual healers with the help of traditional medicines. blurred importance to evil eye. weight gain. (2002) while indigenous medicine. epileptic seizures and mostly in the urban areas of the country which is 28% of the total peripheral neuropathy. Mental illness rhoea. working in hundreds of towns and villages. are flocked by the masses. lack mental illness are referred or seen directly by the psychiatrists of coordination. who practiced an empirical system of Work done by Altaf H. tachycardia. were found to be suffering more from depression. either uneducated or had primary education. Anticholinergic effects may include dry mouth.Folklore Psychiatry Keeping in view the very low number (300)23 of qualified psy- Levine18 argues that folklore psychiatry . chiatrists in Pakistan and the general reluctance towards seeking psychi- beliefs and practices maintained by popular culture and tradition and atric help owing to the stigma. assumes the responsibility of bringing cure thorough this spiritual con- fer distinctly from academic psychiatrists. which have never ing powers of such practitioners and hence shrines and other holy places seen a psychiatrist. The come in one fourth of the cases even with intensive care management. Majority of the patients were more by the severity of illness than by socio-demographic factors. Study One examined the of such saints are well respected and are approached by people in need conceptual frameworks of the various traditional and modern heal. Amongst these the underdeveloped countries. diagnostic criteria and man- lation survey in which every person with one or more symptoms agement of mental illness according to shamans based on a study pub- was asked whether he or she had consulted anyone for the relief of lished in 1998. One study24 has reported that people do bene- ers. dysthymic disorder. Females demons. As Treatment in Ethnopsychiatry evidenced by the prognosis and side effects profile. and patris. tricyclic antidepressant drugs may give rise to various sive behaviour and becomes uninhibited. and it is neither scientific nor practical to neglected by the establishment both in developed and titioners were considered to be worth exploring. Possible antiadrenergic effects include postural hypertension and inhibi- al awareness about existence and causation of mental illness is tion of ejaculation. who dif. cholestatic jaundice. Besides the modern doctors there were three types of tra- ditional healers: vaids. the services offered by these alternate prac- ture accepts .psychiatric ideas. These heal. Similarly. lacking. It was found that 59 per cent of the residents with symp.21 have shown that people give more reduced sweating. incidence of mental illness is continually on the rise and the gener. quacks nection. that 57% were females and 42% were males. Recent studies20. Study Two was an attitude study inquiring about the type of fit from the treatment given by shamans and sufi's. dif- amulet. medicine men.

and various hypersensitivity reac. Lashari26 comments: "Some 'genetic counseling' may be needed 26. Razali sees 14. Bourne EJ. and suggests 15. Modified states of consciousness: their role in ethnopsychiatry. L. 2001. Scope of ethnopsychiatry in Pakistan (ed). recit. depression but if used for a longer period may lead to dependence with disturbing consequences. but much less often for psychotic illnesses. 1992. 12:5-8. and that they should then be helped to adhere to a proper hypotension.. tachycardia.The mental health relevance of traditional medicine and shamanism in refugee camps of Northern Thailand. the faith eral neuropathy. pp. cholestatic healers flourish and have reportedly caused harm in a number of jaundice. (eds). It is an ancient form of health care. WPA. They acquire 6. pp. et al. 25. Simons RC. because the system does not 23. it is the faith of 19.20:23-8. causation and manage- In view of low number of qualified psychiatrists and allied men- ment. Main culture bound syndromes in Phii Pob. Soc Sci people in traditional medicine that makes them seek the help of healers. pp. World Health Forum 1995. 1-19. Other effects noted include skin rashes. Lahore 1995. ethnopsychiatry and alternative therapies. of the psychiatric patients who had not yet consulted a bomoh said they 12. tions have occurred with traditional treatment. rotic disorders. hostility and misunderstanding between the partners'. 17. talismans and incanta. Psychiatrists and folk healers in Malaysia. Muhammad AA. they are powerless against supernatural causes of ill. increased sweating. Gadit AA. Stuttgart. Curr Anthropol 2002. In: Sartorius a marriage possible?" and 18. He recommends that traditional healers should undergo tions. witchcraft. Corporate Printers. 24-26. (ed). ference on cultural psychiatry. Psychosis in a rural west African community.13:39-46. The benzodiazepines are liberally pre. service and research. Prince R. pp. would do so if their current treatment failed. Bristol: Arrow Smith 1998.46:119. that Bomohs should recognise their limitations. Race RP." New York: Oxford University Press. Jilek WG. and agranulocytosis. 189-217 ing special prayers or verses from the Qur'an. cases. Cent Afr J Med should learn more about religious and cultural beliefs. as opposed to only (ed) Ethnopsychiatry. eighteen to twenty-four months before they can join the health culty in micturition. So much time is wasted 24. Psychiatr Clin North Am 1995. muscle twitching. Traditional medicine relevant to psychiatry. pp. Jillek-Aall. State of mental health in Pakistan . Transcult Psychiatr Res Rev 1991. Amok then and now. practitioner. to avoid Forum 1984. 5. Jilek WG. Many patients come to hospital when complica. Shweder RA. 2001. pp. Razali MS. approach them to seek treatment for mental illness. In addition. 2nd ed. Gadit AA. Pfeiffer WM. Culture-bound syndromes. Normal and abnormal behaviour in Chinese culture. The role of traditional healers in mental health care in rural India. Honolulu: 1976. Karachi: 1st ed. 2002. Conclusion Potential for Collaboration This review paper is an attempt to gain insight into different cross-cultural issues in terms of aetiology. Littlewood R. team. Lin T. In: Lebra WP (ed). as part of the culture of many people. who are indigenous Malay medicine 1. Aliens and alienists: normal and abnormal. New York: Marcel Lashari26 reviewed the possibility of collaboration in his paper Dekker 1971. Jilek WG. J Coll Phys Surg Pak 1998. Lashari MS. Spirit possession in rural Thailand. Gaw AC. Washington: WHO/American Psychiatric that when they approach the hospital they are hopelessly ill. gave the following description. He emphasizes that ". act as good counselors. Some Bomohs are thought to be helped by Jinni. It is accessible to people in even the most remote areas. galactorrhoea. Transkulturelle psychiatrie. 1994. the possibility of collaboration between the two systems. examining horoscopes. The treatment methods Dordrecht: Reidel 1992. White GM.23:385-412 Astudy25 shows that 73 per cent of Malayan psychiatric patients 10. constipation. ness. Razali25 in his paper entitled "Psychiatrists and folk healers in References Malaysia" discusses the Bomohs.. Bomohs especially 3.8:198-203. Soc Psychiatr 1973. Treatment approaches by traditional healers: presented in international con- appearance of scientific medicine. Holland: its.13:27-31. headache. 25 per cent who had used general outpatient services. He suggests that . 115-24. Kleinman AM. therefore it is important to monitor their activities with scribed which are useful for short term period in cases of anxiety and appropriate law enforcement. pp. Possession and divination: psychiatry around the globe.. the possibility of collaboration is worth explor- ing. 1997). Thieme. practiced for a long time before the 20. AJ. Cultural conceptions of mental health and therapy. Hollweg MG. bound syndromes. "Culture experience and the startle reflex. J Pak Med Assoc 1996.5:175-7. Albany State University of New York Press. Does the concept of person vary cross-culturally? In: Marsella see those patients who are affected by supernatural agents like evil spir.Treatment of mental disorders. 4. Med 1975. Researchers have observed 13 Suwanlert S. and then the Press. require sophisticated equipment. their treatment skills through years of apprenticeship to an established 7. Khalid N. 22 Gadit AA. 34-42. pp. Traditional and modern medicine: is a marriage possible? World Health to ensure a healthy offspring from a marriage of two systems. Levine RE. ditional medicine go largely unrecorded. Shamanic concept and treatment of mental illness in Pakistan.8:33-5. include record keeping.. Similarly.16:56- 8. Psychiatric disorders as recognized by the Shona. and that psychiatrists 16. 1-42. The drawbacks and side effects of tra. Culture that mild temporary relief is frequently obtained from bomohs for neu. Kapur RL. 2. lack of code of ethics. 10-21. Harding T. Uses and limitations of ethnopsychiatry. Leff J. pp. ventricular arrhythmias. fine tremor. Lipsedge M. pp. entitled traditional and modern medicine . DeGivolamo G. People generally Dordrecht: Riedel 1996. Culture and mental illness. Ethnopsychiatry: the cultural construction of psychiatries. University Press of Hawaii. Curare 1990. Marano L.13:217-24. 9. tions. tricyclic antidepressant drugs may give rise to various training in the basic principles of scientific medicine for at least autonomic effects including dry mouth.28:219-29. and does not 21 Gadit AA. Windigo-psychosis: the anatomy of an emic-etic confusion. ECG changes. Holland: men with important specialization in mental health. 1967. like in any other developing country. impaired accommodation.18:523- 36. Curare 1997. Gaines AD. 1996. In Pakistan. to understand the diverse mental health especially in the tal health practitioners and large number of alternate practitioners who ethnopsychiatric perspective. London: Routledge 1993. Psychiatry Newslett. diffi. (unpublished doctoral thesis use of holy water (sometimes with herbs added). epileptic seizures and periph. 341-90. Transcult physical illnesses. most 11. adopted by these practitioners include communication with spirits. In: Gaines AD in a sample surveyed had consulted a bomoh first. who believes that though modern methods are good for 8. coordination. black magic and divine anger. hypothermia. 101-5. 3-49. Gelfand M. unfavorable outcome leads to the unpopularity of scientific medicine.