Psychopathology among apprentice traditional health practitioners: A quantitative study from rural KwaZulu-Natal, South Africa

Abstract

Sociocultural context seems to influence the epidemiology, phenotype, treatment, and course of psychosis. However, data from low- and middle-income countries is sparse. This research is part of a multidisciplinary and multimethod study on possible mental disturbances, including hallucinations, among (apprentice) traditional health practitioners (THPs) who have experienced the “ancestral calling to become a THP” in rural KwaZulu-Natal, South Africa. The aim of the current article is to examine whether the calling-related experiences can be assessed according to a psychiatric taxonomy. We included individuals who were identified with the calling and who were undergoing training to become a THP ( ukuthwasa). IsiZulu-speaking formal mental health practitioners conducted thorough psychiatric interviews that measured psychological experiences with and without distress using the Community Assessment of Psychic Experiences, and psychiatric symptoms and disorders using the Schedule for Clinical Assessment in Neuropsychiatry. Of the 48 individuals who participated, 92% had psychotic experiences (PE), causing distress in 75%; and 23% met DSM-5 criteria for an unspecified psychotic disorder (15%) or mood disorder (8%). In conclusion, in rural KwaZulu-Natal, the ancestral calling may resemble phenomena that psychiatry would understand in the context of psychosis, ranging from subclinical PE to clinical psychotic disorder. Ukuthwasa might have a beneficial influence on the course of psychotic symptoms in some individuals, potentially because it reduces stigma and promotes recovery. Further multidisciplinary research is needed to investigate the psychopathology of the apprentice THPs and the underlying processes of ukuthwasa.

Ancestral calling, traditional health practitioner training and mental illness: An ethnographic study from rural KwaZulu-Natal, South Africa

“…In a subsequent epidemiological study, we have examined the manifestations of the ancestral calling among a group of apprentice THPs from a psychiatric diagnostic perspective. (Van der Zeijst et al, 2021).…”

Sociocultural contexts of mental illness experience among Africans

“…Although current internationally adopted classifications of mental disorders are used across cultures and contexts globally (Gureje et al, 2019;Gureje, Lewis-Ferna´ndez, et al, 2020), there is an acknowledgement that the definitions of the disorders are mostly based on norms derived from Western Europe and North America (Lucas & Barrett, 1995). An exploration of this situation is provided in this issue by van der Zeijst, Veling, Makhathini, Mtshemla, et al (2021), who report findings from a series of in-depth interviews and a cross-sectional descriptive study of trainee traditional healers. They found that some unusual experiences that would otherwise meet current definitions of psychopathological phenomena were either regarded as normal in the emic view of rural KwaZulu-Natal, South Africa, or even esteemed as evidence of extraordinary ability to communicate with ancestral spirits (Lee, 1969).…”

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

“…In two prior studies, we emically ( 13 ) and etically ( 14 ) examined unusual perceptual experiences and other mental disturbances among a specific group of individuals who visited THPs in Vulindlela, a rural area in KwaZulu-Natal, South Africa. Our first, ethnographic, study ( 13 ) included interviews with 20 THPs, apprentice THPs, patients and relatives who were visiting THPs, patients with a psychotic diagnosis who were visiting a formal health clinic, and biomedical health practitioners.…”

“…They had transformed into well-functioning and respected members of the society with a defined work, role and social status as THPs, and their hallucinatory experiences remained an instrumental part of their healing profession. In our second study ( 14 ), we assessed 48 apprentice THPs who were undergoing ukuthwasa – individuals who are called amathwasa – to see whether and how their calling-related mental disturbances could be interpreted from a Western, psychiatric perspective. Our results showed that psychotic and mood-related experiences, symptoms and disorders were common in this group, confirming suggestions from other studies ( 19 – 23 ) and our own ethnographic study ( 13 ) that there is a relationship between the cultural construct of ancestral calling to become a THP and what Western psychiatry would characterize within the context of psychosis.…”