Traditional and biomedical care pathways for mental well-being in rural Nepal.

BACKGROUND: There is increasing access to mental health services in biomedical settings (e.g., primary care and specialty clinics) in low- and middle-income countries. Traditional healing continues to be widely available and used in these settings as well. Our goal was to explore how the general public, traditional healers, and biomedical clinicians perceive the different types of services and make decisions regarding using one or both types of care. METHODS: We conducted in-depth interviews using a pilot tested semi-structured protocol around the subjects of belief, traditional healers, and seeking care. We conducted 124 interviews comprising 40 traditional healers, 79 general community members, and five physicians. We then performed qualitative analyses according to a grounded theoretical approach. RESULTS: A majority of the participants endorsed belief in both supernatural and medical causes of illness and sought care exclusively from healers, medical practitioners, and/or both. Our findings also revealed several pathways and barriers to care that were contingent upon patient-, traditional healer-, and medical practitioner-specific attitudes. Notably, a subset of community members duplicated care across multiple, equally-qualified medical providers before seeing a traditional healer and vice versa. In view of this, the majority of our participants stressed the importance of an efficient, medically plural society. Though participants desired a more collaborative model, no consistent proposal emerged on how to bridge traditional and biomedical practices. Instead, participants offered suggestions which comprised three broad categories: (1) biomedical training of traditional healers, (2) two-way referrals between traditional and biomedical providers, and (3) open-dialogue to foster mutual understanding among traditional and biomedical providers. CONCLUSION: Participants offered several approaches to collaboration between medical providers and traditional healers, however if we compare it to the history of previous attempts, education and understanding between both fields may be the most viable option in low- and middle-income contexts such as Nepal. Further research should expand and investigate opportunities for collaborative learning and/or care across not only Nepal, but other countries with a history of traditional and complimentary medicine.

Reassessing the Mental Health Treatment Gap: What Happens if We Include the Impact of Traditional Healing on Mental Illness?

In this Fresh Focus, we reassess what the mental health treatment gap may mean if we consider the role of traditional healing. Based on systematic reviews, patients can use traditional healers and qualitatively report improvement from general psychological distress and symptom reduction for common mental disorders. Given these clinical implications, some high-income countries have scaled up research into traditional healing practices, while at the same time in low-and middle-income countries, where the use of traditional healers is nearly ubiquitous, considerably less research funding has studied or capitalized on this phenomena. The World Health Organization 2003-2020 Mental Health Action Plan called for government health programs to include traditional and faith healers as treatment resources to combat the low- and middle-income country treatment gap. Reflection on the work which emerged during the course of this Mental Health Action Plan revealed areas for improvement. As we embark on the next Mental Health Action Plan, we offer lessons-learned for exploring potential relationships and collaborations between traditional healing and biomedicine.

Espiritualidade e brasilidade na clínica etnopsicológica / Spirituality and Brazilianness in ethnopsychological clinic / Espiritualidad y brasilidad en la clínica etnopsicológica

O objetivo deste estudo é discutir de que modo a espiritualidade e a brasilidade podem ser incorporadas na clínica etnopsicológica. Trata-se de um estudo de caso amparado na abordagem qualitativa de pesquisa, a partir do processo psicoterápico realizado com um idoso em um espaço terapêutico construído em um terreiro de umbanda do qual é frequentador. O corpus de análise é formado por transcrições das sessões e por relatos elaborados após os atendimentos, que compuseram duas vinhetas clínicas. Na primeira vinheta, o participante evoca constantemente elementos como retidão de caráter, coragem e respeito à natureza como sendo marcas transmitidas pela sua origem indígena. Na segunda vinheta, a frequente menção a uma profecia espírita desvela a necessidade de ser ouvido e compreendido em termos de seus valores e crenças, notadamente em família. A clínica etnopsicológica, prenhe da brasilidade que atravessa mitos, crenças e aspectos da espiritualidade mestiça que constituem o povo brasileiro, pode ser evocada para compreender o pedido de ajuda e, mais do que isso, acompanhar o participante na travessia de seu processo psicoterápico. Acolher a espiritualidade, portanto, passa pela necessidade de incluir elementos da brasilidade que atravessam práticas, saberes e crenças transmitidos pela coletividade.

The aim of this study is to discuss how spirituality and Brazilianness can be incorporated into ethnopsychological clinic. It is a case study supported in qualitative research from the psychotherapeutic process conducted with an elderly in a therapeutic space built in Umbanda yard which is goer. The analysis corpus consists of transcriptions of meetings and reports prepared after the calls, who composed two clinical vignettes. In the first vignette, the participant constantly evokes elements as uprightness of character, courage and respect for nature as marks transmitted by their indigenous origin. In the second vignette, the frequent mention of a spirit prophecy reveals the need to be heard and understood in terms of their values and beliefs, especially with family. The ethnopsychological clinic, pregnant with Brazilianness running through myths, beliefs and aspects of the mixed spirituality that make up the Brazilian people, may be invoked to understand the request for help and, more than that, accompany the participant in crossing his psychotherapeutic process. Welcome spirituality, therefore, is the need to include Brazilianness elements crossing practices, knowledge and beliefs transmitted by the community.

El objetivo de este estudio es analizar cómo la espiritualidad y la brasilidad se pueden incorporar en la clínica etnopsicológica. Es un estudio de caso apoyado en la investigación cualitativa del proceso psicoterapéutico llevado a cabo con un anciano en un espacio terapéutico construido en un centro de Umbanda. El corpus de análisis consiste en transcripciones de las sesiones y informes elaborados después de las sesiones, que compusieron dos viñetas clínicas. En la primera viñeta, el participante constantemente evoca elementos como rectitud de carácter, valor y respeto por la naturaleza como marcas transmitidas por su origen indígena. En la segunda viñeta, la frecuente mención de una profecía espírita revela la necesidad de ser escuchado y entendido en sus valores y creencias, especialmente con la familia. En la clínica etnopsicológica, la brasilidad a través de mitos, creencias y aspectos de la espiritualidad del pueblo brasileño, pueden ser invocadas para comprender la solicitud de ayuda y, más que eso, acompañar al participante en el proceso psicoterapéutico. Para incorporar la espiritualidad es necesario incluir elementos de la brasilidad en las prácticas, conocimientos y creencias transmitidas por la comunidad.

Com a licença de Oxalá: a ética na pesquisa etnopsicológica em comunidades religiosas / With the licence of Oxalá: the ethics in the ethnopsychological research in religious communities / Con la licencia de Oxalá: la ética en la investigación etnopsicológica en comunidades religiosas

O objetivo deste estudo é discutir as especificidades da pesquisa etnopsicológica em comunidades de terreiro à luz dos dispositivos da minuta de 2016 do Conselho Nacional de Saúde (Resolução 510/2016). A pesquisa em terreiros envolve métodos que preveem a possibilidade de fotografar, realizar vídeos e audiogravação de rituais, consultas mediúnicas e demais atividades que ocorrem em terreiros, bem como observações participantes, entrevistas com consulentes, médiuns em transe de possessão, bem como seus diferentes adeptos. A partir da nova minuta, o processo de esclarecimento do participante não deverá passar, necessariamente, por um termo formal. Essa alternativa contempla a possibilidade de que a autorização para a pesquisa (envolvendo diferentes métodos de coleta) passe pela anuência do responsável pela comunidade não necessariamente pela via escrita, de modo a valorizar a "palavra" do sacerdote, dada como selo de concordância e que possibilita que a comunidade, de fato, abra-se à ação mais direta do pesquisador e suas intervenções. Considerar essas especificidades garante o respeito à dimensão ética do sujeito e sua comunidade de referência.

The aim of this study is to discuss the specificities of ethnopsychological research in the religious communities based on Resolution 510/2016 of the National Health Council. Research in terreiros involves methods that allow the possibility of photographing, making videos and audiotaping of rituals, médiumistic consultations and other activities that take place in terreiros, as well as participant observations, interviews with consultants, mediums in possession trance, as well as their different followers. From the new draft, the process of clarification of participants must not necessarily go through a formal term. This alternative contemplates the possibility that the authorization for the research (involving different methods of data collection) will pass through the consent of the person in charge of the community, not necessarily through the written way, in order to value the priest's "word", given as a seal of agreement and makes it possible for the community, in fact, to open it self to more direct action of the researcher and his interventions. Considering these specificities guarantees respect for the ethical dimension of the subject and his community of reference.

El objetivo de este estudio es discutir las especificidades de la investigación etnopsicológica en comunidades de terreiro a la luz de los dispositivos del borrador de 2016 del Consejo Nacional de Salud (Resolución 510/2016). La investigación en terreros involucra métodos que prevean la posibilidad de fotografiar, realizar videos y audiograbación de rituales, consultas mediúmnicas y demás actividades que ocurren en terreros, así como observaciones participantes, entrevistas con consultores, médiums en trance de posesión, así como sus diferentes adeptos. A partir del nuevo borrador, el proceso de esclarecimiento del participante no deberá pasar, necesariamente, por un término formal. Esta alternativa contempla la posibilidad de que la autorización para la investigación (involucrando diferentes métodos de recolección) pase por la anuencia del responsable de la comunidad no necesariamente por la vía escrita, para valorar la "palabra" del sacerdote, dada como sello de concordancia y que permite que la comunidad, de hecho, se abra a la acción más directa del investigador y sus intervenciones. Considerar estas especificidades garantiza el respeto a la dimensión ética del sujeto y su comunidad de referencia.

Sleep Paralysis in Brazilian Folklore and Other Cultures: A Brief Review.

Sleep paralysis (SP) is a dissociative state that occurs mainly during awakening. SP is characterized by altered motor, perceptual, emotional and cognitive functions, such as inability to perform voluntary movements, visual hallucinations, feelings of chest pressure, delusions about a frightening presence and, in some cases, fear of impending death. Most people experience SP rarely, but typically when sleeping in supine position; however, SP is considered a disease (parasomnia) when recurrent and/or associated to emotional burden. Interestingly, throughout human history, different peoples interpreted SP under a supernatural view. For example, Canadian Eskimos attribute SP to spells of shamans, who hinder the ability to move, and provoke hallucinations of a shapeless presence. In the Japanese tradition, SP is due to a vengeful spirit who suffocates his enemies while sleeping. In Nigerian culture, a female demon attacks during dreaming and provokes paralysis. A modern manifestation of SP is the report of "alien abductions", experienced as inability to move during awakening associated with visual hallucinations of aliens. In all, SP is a significant example of how a specific biological phenomenon can be interpreted and shaped by different cultural contexts. In order to further explore the ethnopsychology of SP, in this review we present the "Pisadeira", a character of Brazilian folklore originated in the country's Southeast, but also found in other regions with variant names. Pisadeira is described as a crone with long fingernails who lurks on roofs at night and tramples on the chest of those who sleep on a full stomach with the belly up. This legend is mentioned in many anthropological accounts; however, we found no comprehensive reference on the Pisadeira from the perspective of sleep science. Here, we aim to fill this gap. We first review the neuropsychological aspects of SP, and then present the folk tale of the Pisadeira. Finally, we summarize the many historical and artistic manifestations of SP in different cultures, emphasizing the similarities and differences with the Pisadeira.

Doença e Morte na Umbanda Branca: A Legião Branca Mestre Jesus / Illness and Death in the White Umbanda: The Master Jesus White Legion

Neste artigo expõem-se e analisam-se as concepções de doença e morte presentes em um renomado centro de cura espiritual, mediante procedimento etnográficos e a consideração dos seus implícitos. Subjacente ao surgimento da Legião Branca Mestre Jesus conta-se a história de uma família de índios cujos fundadores, depois de mortos, se unem no “plano espiritual” para atrair e reunir os seus membros que entretanto se haviam dispersado. Esta narrativa parece ser uma metáfora do encontro edesencontro entre colonizadores e suas vítimas africanas e indígenas. A doença é significada como um sinal de pertencimento a essa família e o fatodos “médicos” serem entendidos como mortos, propõe uma relação defamiliaridade com a morte. A concepção reencarnacionista propicia a composição de laços entre biografias diversas, interligando uma revisão da própria identidade a memórias sociais da escravidão, da subjugação coloniale do etnocídio indígena...

This article sets out and analyzes the concepts of illness and death present in a renowned center for spiritual healing, through ethnographic procedures and consideration of their implicit. Underlying the emergence of the LegiãoBranca Mestre Jesus tells the story of a family of Indians whose founders, when dead, have joined in the "spiritual plane" to attract and bring together its member, however, had dispersed to. This narrative seems to be a metaphor for the agreements and disagreements between settlers and their indigenous and africans victims. The disease is meant as a sign of belonging to this family and the fact that "doctors" are seen as dead, proposes a relationship of familiarity with death. The reincarnation concept enables the formation of bonds between various biographies, linking an examination of his social identity to memories of slavery, colonial oppression and ethnic cleansing of the indigenous...

Doença e morte na umbanda branca: a Legião Branca Mestre Jesus / Illness and death in the white umbanda: the master Jesus White Legion

Neste artigo expõem-se e analisam-se as concepções de doença e morte presentes em um renomado centro de cura espiritual, mediante procedimento etnográficos e a consideração dos seus implícitos. Subjacente ao surgimento da Legião Branca Mestre Jesus conta-se a história de uma família de índios cujos fundadores, depois de mortos, se unem no “plano espiritual” para atrair e reunir os seus membros que entretanto se haviam dispersado. Esta narrativa parece ser uma metáfora do encontro e desencontro entre colonizadores e suas vítimas africanas e indígenas. A doença é significada como um sinal de pertencimento a essa família e o fato dos “médicos” serem entendidos como mortos, propõe uma relação de familiaridade com a morte. A concepção reencarnacionista propicia a composição de laços entre biografias diversas, interligando uma revisão da própria identidade a memórias sociais da escravidão, da subjugação colonial e do etnocídio indígena. (AU)

This article sets out and analyzes the concepts of illness and death present in a renowned center for spiritual healing, through ethnographic procedures and consideration of their implicit. Underlying the emergence of the Legião Branca Mestre Jesus tells the story of a family of Indians whose founders, when dead, have joined in the "spiritual plane" to attract and bring together its member, however, had dispersed to. This narrative seems to be a metaphor for the agreements and disagreements between settlers and their indigenous and africans victims. The disease is meant as a sign of belonging to this family and the fact that "doctors" are seen as dead, proposes a relationship of familiarity with death. The reincarnation concept enables the formation of bonds between various biographies, linking an examination of his social identity to memories of slavery, colonial oppression and ethnic cleansing of the indigenous. (AU)