A South African Experience: Cultural Determinants of Ukuthwasa

Abstract

The current study investigated ukuthwasa, a South African culture-specific syndrome associated with the calling to become a sangoma, a type of traditional healer. Ukuthwasa has previously been compared to Western mental health constructs, such as depression and schizophrenia due to its accompanying debilitating symptoms. The current study sought to better understand the calling to become a sangoma and define the phenomenology of ukuthwasa. Unstructured interviews were conducted with participants comprised of izangoma (plural of sangoma) who had experienced ukuthwasa and key informants indigenous to South Africa living in and around the Durban metropolitan area (N = 11). The qualitative data were analyzed using grounded theory, which allowed for the categorization of data into themes for further analysis. The results of the study showed that while there were similarities between ukuthwasa and Western constructs of mental health, the course and effectiveness of management differed greatly, suggesting the need to incorporate cultural factors into management decision-making.

Course of psychotic experiences and disorders among apprentice traditional health practitioners in rural South Africa: 3-year follow-up study

“…While there was no significant change in frequency of CAPE psychotic experiences from baseline to follow-up, there was a significant reduction of distress related to these psychotic experiences. These results are congruent with the findings of our qualitative study ( 13 ) and a qualitative study of Bakow and Low ( 16 ), which describe that ukuthwasa seems to be successful in the sense that (apprentice) THPs no longer experience distress, while the hallucinatory experiences may remain as part of the healing (divining) profession. The current study also showed reductions in psychotic symptoms and disorders as measured with the SCAN.…”

“…Later during the process, apprentices assist their trainer while she is seeing patients. They are taught how to convey messages from the ancestors to others, how to conduct rituals and where to find traditional medicines themselves ( 13 , 16 , 18 ). By following the process of ukuthwasa , the hallucinations and other mental disturbances are believed to change from seriously disturbing at the onset, to beneficial and positive at the outcome ( 13 , 16 ).…”

“…They are taught how to convey messages from the ancestors to others, how to conduct rituals and where to find traditional medicines themselves ( 13 , 16 , 18 ). By following the process of ukuthwasa , the hallucinations and other mental disturbances are believed to change from seriously disturbing at the onset, to beneficial and positive at the outcome ( 13 , 16 ). The THPs we interviewed in our ethnographic study ( 13 ) reported to be cured from the distress and dysfunction of their mental disturbances during their ukuthwasa .…”

The experiences and perceptions of mental health service provision at a primary health centre in the Eastern Cape

“…Bakow and Low 17 suggested that the role of culture in mental health is not well understood in spite of the fact that the cultural conception of the self has a powerful influence on the manner in which the disorder is expressed and understood. Similarly, in this study, the majority of participants’ understanding of mental disorder is informed by an indigenous cultural perspective.…”

“…The role of culture produced insightful discussion during the interview regarding issues of worshiping of the ancestors, which is described as the path to healing and viewed as vital for the maintenance of health within traditional African communities. 17 The following participants demonstrate how culture influences the manner in which mental disorder is expressed and understood:…”