Examining the Etiology and Treatment of Mental Illness Among Vodou Priests in Northern Haiti.

This study assesses the perspectives and experiences of Vodou priests (ougan) in the treatment of mental illness in northern Haiti. Our goal is to explore the etiology and popular nosologies of mental illness in the context of Haitian Vodou, through understandings of illness and misfortune which are often viewed as a result of sent spirits-or spirits sent supernaturally by others with the intent to cause harm. Using a qualitative approach, this study conducted semi-structured in-depth interviews with 20 ougan living near the city of Cap-Haïtien. Interviews highlight a sample of healers with little formal training who maintain beliefs and practices that differ significantly from current biomedical models. Ougan treat mental illness through a variety of means including prayer and conjuring of spirits, leaves for teas and baths, as well as combinations of perfumes, rum, human remains, and other powdered concoctions that are either imbibed or rubbed on the skin. The primary purpose of these treatments is to expel the spirit causing harm, yet they can often result in additional harm to the patient. Findings suggest that while ougan are willing to collaborate with biomedical practitioners, significant barriers remain preventing cooperation between these two groups.

The Barriers and Facilitators to Decentralised Nurse-Led Mental Health Service Delivery in Sierra Leone.

In 2009, 98.0% of people with mental illness in Sierra Leone were not receiving treatment, partly due to the absence of public psychiatric facilities outside the capital. In response to this situation, the Ministry of Health and Sanitation rolled out nurse-led mental health units (MHUs) to every district. This study evaluates the barriers and facilitators to mental health service delivery in decentralised MHUs in Sierra Leone using key informant interviews and focus group discussions with 13 purposefully sampled clinical staff and senior management personnel. The interviews were audio-recorded, translated from Krio if necessary, transcribed, and analysed using manifest content analysis. The findings suggest that factors affecting nurse-led mental health service delivery include small workforce and high workload, culture and beliefs, risks, lack of safety measures and required resources, outdated policies, poor salaries, lack of funds for medication, distance, power, influence, and stigma. Factors that could facilitate nurse-led mental health services include: increasing motivation, increasing the workforce, knowledge sharing, mentorship, availability of medication, passion and modern psychiatry. The findings contribute towards understanding the challenges and opportunities faced by the recently established nurse-led decentralised mental health services across Sierra Leone, in order to address the large mental health treatment gap. We hope the findings will inform further policy and planning to improve the quality of decentralised mental healthcare.

Behavioral health services in Urban American Indian Health Programs: Results from six site visits.

This study explores behavioral health services for American Indians and Alaska Natives (AIANs) at six Urban Indian Health Programs (UIHPs). Interviews and focus groups with clinicians and staff inquired about behavioral health treatment available, service needs, client population, and financial and staffing challenges. Resulting site profiles were created based on focused coding and integrative memoing of site visit field notes and respondent transcripts. These six UIHPs evidenced diversity across multiple facets of service delivery even as they were united in their missions to provide accessible and effective behavioral health treatment to urban AIAN clients. Primary challenges to service provision included heterogenous client populations, low insurance coverage, limited provider knowledge, lack of resources, and incorporation of traditional healing. Collaborative research with UIHPs harbors the potential to recognize challenges, identify solutions, and share best practices across this crucial network of health care sites for improving urban AIAN well-being.

Perceptions of causes and treatment of mental illness among traditional health practitioners in Johannesburg, South Africa.

Mental disorders are among the most poorly treated illnesses in sub-Saharan Africa. It is estimated that 70%-80% of South Africans consult traditional health practitioners for the treatment of psychological ailments. As traditional health practitioners maintain a strong role in assessing and treating patients with mental illness in this context, this study contributes to the burgeoning research literature on the topic. Semi-structured in-depth interviews were conducted with 18 traditional health practitioners in Johannesburg, South Africa, between January and May 2022. Interviews were transcribed and translated into English. The data were managed using NVivo 12 software and thematically analysed. Traditional health practitioners interviewed generally perceived mental illness to be of supernatural causation, either as a result of bewitchment, a calling for patients to become THPs themselves, due to displeased ancestors, or due to natural causes. Traditional health practitioners identified eight primary treatments that they use for treating mental illness. Among these were throwing of bones (tinhlolo) to start communicating with ancestors, steaming (ukufutha) to start a cleansing process, sneezing (umbhemiso) to forcefully dispel the spirit causing the illness, induced vomiting (phalaza), and the administration of laxatives (mahlabekufeni) to remove the spirits poisoning the body as well as animal sacrifice to purge spirits and communicate with ancestors. This is all followed by cutting (ukucaba), which is the final part of the treatment and ensures that the evil spirit cannot return. Due to the ubiquity of traditional health practitioner usage for mental illness in sub-Saharan Africa, it is essential to understand what conceptions traditional health practitioners have of the aetiology of these disorders as well as their modalities for administering treatment.

American Indian Behavioral Health Treatment Preferences as Perceived by Urban Indian Health Program Providers.

Behavioral health services specifically targeted for ethnoracial clients are typically tailored to the specific needs and preferences of these populations; however, little research has been done with American Indian clients specifically. To better understand how clinicians handle provision of treatment to this population, we interviewed 28 behavioral health staff at six Urban Indian Health Programs in the United States and conducted focus groups with 23 staff at five such programs. Thematic analysis of transcripts from these interviews and focus groups suggests that these staff attempt to blend and tailor empirically supported treatments with American Indian cultural values and practices where possible. Simultaneously, staff try to honor the client's specific preferences and needs and to encourage clients to seek cultural practices and connection outside of the therapy room. In so doing staff members were acutely aware of the limitations of the evidence base and the lack of research with American Indian clients.

Herbal remedies as alternative to conventional therapies for the treatment of pediatric infectious diseases.

Pediatric infections still represent a leading cause of mortality in many developing countries. Since ancient times, traditional healing systems provided some herbal remedies to treat pediatric diseases, only in some cases validated by an evidence-based approach. Therefore, this review covers the herbal remedies in Iranian traditional medicine and aims to assess the potential of phytotherapeutics as safe and effective alternatives to conventional therapies for the treatment of pediatric infectious diseases. Notably, pediatric patients may also benefit from adjuvant therapy, i.e., combined treatment with herbal remedies and conventional therapies, to improve the efficacy of conventional drugs, decrease their adverse effects at the cell-tissue-organ-organism level and reduce the occurrence of microbial strains resistant to antibiotics. Therefore, traditional healing systems still represent an unlimited source of active ingredients to be tested in preclinical assays as well as in humans in terms of efficacy and safety.

Integration of traditional and western treatment approaches in mental health care in Pacific Island Countries.

OBJECTIVE: To explore the extent of integration of traditional and western approaches in mental health care in Pacific Island Countries (PICs). METHOD: Examination of national mental health policies and literature review. RESULTS: Traditional healers were included as resources for mental health in four of the seven policies that we were able to access. While their role in mental health care is widely acknowledged in the literature, there are few empirical studies exploring integration. CONCLUSION: Local research on integrative mental health care is needed to guide mental health policy and service development in PICs. Any research must include the full range of formal and informal service providers as well as patients and families.

Use of traditional and complementary medicine among Norwegian cancer patients in the seventh survey of the Tromsø study.

BACKGROUND: Traditional and complementary medicine (T&CM) is commonly used by cancer patients in Northern Norway, in particular spiritual forms like traditional healing. T&CM is mainly used complementary to conventional cancer treatment and is rarely discussed with conventional health care providers, increasing the risk of negative interaction with conventional cancer care. The aim of this study was to investigate the use of T&CM among cancer patients in Tromsø, and to investigate the differences in T&CM use between people living with cancer, people with cancer previously, and people without a history of cancer. METHOD: Data was drawn from the seventh survey of the Tromsø study conducted in 2015-2016. All inhabitants of Tromsø aged 40 and above were invited to participate (n = 32,591) of whom n = 21,083 accepted the invitation (response rate 65%). Data was collected thorough three self-administered questionnaires and a comprehensive clinical examination. Pearson chi-square tests, Fisher exact tests and one-way ANOVA tests were used to describe differences between the groups while binary logistic regressions were used for adjusted values. RESULTS: Eight percent of the participants (n = 1636) reported to have (n = 404) or have had (n = 1232) cancer. Of the participants with cancer at present 33.4% reported use of T&CM within the last year, 13.6% had consulted a T&CM provider, 17.9% had used herbal medicine/natural remedies and 6.4% had practiced self-help techniques. The participants with cancer at present were more likely to have visited a T&CM provider than participants with cancer previously (13.6% vs. 8.7%, p = 0.020). Among the participants with cancer at present, 6.4% reported to have consulted a TM provider, 5.8% had consulted an acupuncturist, while 4.7% had consulted other CM providers. Women were significantly more likely than men to have used acupuncture and self-help techniques. No significant gender differences were found regarding visits to other CM providers, TM providers nor use of herbal medicine/natural remedies. CONCLUSION: The findings are in line with previous research suggesting that both men and women use TM complementary to other CM modalities outside the official health care system. As herbal medicine might interact with conventional cancer treatment, health care providers need to discuss such use with their patients.

"How Can We Help You": Mental Health Practitioners' Experiences of Service Provision in Northern Namibia.

Although 12-13% of Namibians are reported to struggle with psychological distress, very few practitioners are available to provide mental health services in Namibia. Those practitioners who are available are often trained from Western counseling and psychiatric perspectives that may not readily align to beliefs about illness held constructed in Namibian cultures. Institutional effort is invested in the education and use of mental health practitioners, including counselors, social workers, nurses, psychologists, and psychiatrists. However, little is known about the experiences of these providers. Therefore, this study, a grounded theory ethnography, was undertaken as part of broader ethnographic work to understand how mental health practitioners (N = 7) in Northern Namibia view their work with Aawambo Namibians given that Namibian mental health practitioners are few but embedded in the country's health care system. Four categories were identified in analyses: Provision of Mental Health Services in the North, Practitioners' Conceptualizations of Psychological Distress: Western and Aawambo Influences, Beliefs about Mental Health Services in the North, and Integration of Traditional Treatment and Counseling. Results are discussed with respect to cultural competence in Namibian mental health practice and potential for integrating traditional practices and mental health services.

Huarahi Oranga: an introduction to Maori concepts informing a Maori healing and psychiatry partnership.

OBJECTIVE: The aim of this article is to give an overview of Maori concepts informing a collaboration between a Maori healer (NiaNia) and psychiatrist (Bush). CONCLUSIONS: Wairua (spiritual) problems can resemble psychiatric disorders or symptoms. Knowledge of relevant Maori concepts such as mauri, tapu, mana, matekite and manaakitanga may assist psychiatrists in collaborating with Maori healers and kaumatua (elders) to enable more appropriate cultural and clinical assessment, as well as helping to build rapport and clinical interactions with Maori whanau (individuals and families).

The perceived effectiveness of traditional and faith healing in the treatment of mental illness: a systematic review of qualitative studies.

PURPOSE: This work complements a quantitative review by Nortje et al. (Lancet Psychiatry 3(2):154-170, 2016) by exploring the qualitative literature in regard to the perceived effectiveness of traditional and faith healing of mental disorders. METHOD: Qualitative studies focusing specifically on traditional and/or faith healing practices for mental illness were retrieved from eight databases. Data were extracted  into basic coding sheets to facilitate the assessment of the quality of eligible papers using the COREQ. RESULTS: Sixteen articles met the inclusion criteria. Despite methodological limitations, there was evidence from the papers that stakeholders perceived traditional and/or faith healing to be effective in treating mental illness, especially when used in combination with biomedical treatment. CONCLUSION: Patients will continue to seek treatment from traditional and/or faith healers for mental illness if they perceive it to be effective regardless of alternative biomedical evidence. This provides opportunities for collaboration to address resource scarcity in low to middle income countries.

Use of Traditional Healing Practices in Two Ontario First Nations.

Colonization has negatively impacted Canada's Aboriginal people, with one of the consequences being loss of traditional knowledge, beliefs and practices, including traditional healing practices. In a study of two Ontario First Nations, the objectives of this research were to examine: (1) the extent of use of traditional healing practices, including traditional medicines and healers; (2) factors associated with their use and people's desire to use them; and (3) reasons for not using them among those who want to use them, but currently do not. Registered Band Members and volunteers from two First Nations communities (N = 613) participated in a well-being survey. About 15% of participants used both traditional medicines and healers, 15% used traditional medicines only, 3% used a traditional healer only, and 63% did not use either. Of those who did not use traditional healing practices, 51% reported that they would like to use them. Use was more common among men, older people, and those with more than high school education. Those who used traditional healing practices were found to have a stronger First Nations identity, better self-reported spiritual health, higher scores on historical loss and historical loss symptoms and higher levels of anxiety compared with people who did not use them. Common reasons for not using traditional practices were: not knowing enough about them, not knowing how to access or where to access them. These findings may be useful for promoting the use of traditional healing practices for the purpose of improving the health of First Nations people.

Traditional healing practices in rural Bangladesh: a qualitative investigation.

BACKGROUND: Traditional healing practice is an important and integral part of healthcare systems in almost all countries of the world. Very few studies have addressed the holistic scenario of traditional healing practices in Bangladesh, although these serve around 80% of the ailing people. This study explored distinctive forms of traditional healing practices in rural Bangladesh. METHODS: During July to October 2007, the study team conducted 64 unstructured interviews, and 18 key informant interviews with traditional healers and patients from Bhabanipur and Jobra, two adjacent villages in Chittagong district, Bangladesh. The study also used participatory observations of traditional healing activities in the treatment centers. RESULTS: Majority of the community members, especially people of low socioeconomic status, first approached the traditional healers with their medical problems. Only after failure of such treatment did they move to qualified physicians for modern treatment. Interestingly, if this failed, they returned to the traditional healers. This study identified both religious and non-religious healing practices. The key religious healing practices reportedly included Kalami, Bhandai, and Spiritual Healing, whereas the non-religious healing practices included Sorcery, Kabiraji, and Home Medicine. Both patients and healers practiced self-medication at home with their indigenous knowledge. Kabiraji was widely practiced based on informal use of local medicinal plants in rural areas. Healers in both Kalami and Bhandari practices resorted to religious rituals, and usually used verses of holy books in healing, which required a firm belief of patients for the treatment to be effective. Sorcerers deliberately used their so-called supernatural power not only to treat a patient but also to cause harm to others upon secret request. The spiritual healing reportedly diagnosed and cured the health problems through communication with sacred spirits. Although the fee for diagnosis was small, spiritual healing required different types of treatment instruments, which made the treatment implicitly expensive. CONCLUSIONS: Traditional healing was widely practiced as the means of primary healthcare in rural areas of Bangladesh, especially among the people with low socioeconomic status. The extent of services showed no decline with the advancement of modern medical sciences; rather it has increased with the passage of time.

Antiulcer Agents: From Plant Extracts to Phytochemicals in Healing Promotion.

In this narrative review, we have comprehensively reviewed the plant sources used as antiulcer agents. From traditional uses as herbal remedies, we have moved on to preclinical evidence, critically discussing the in vitro and in vivo studies focusing on plant extracts and even isolated phytochemicals with antiulcerogenic potential. A particular emphasis was also paid to Helicobacter pylori activity, with emphasis on involved mechanisms of action. Lastly, the issue of safety profile of these plant products has also been addressed.

Prevalence and associations for use of a traditional medicine provider in the SAMINOR 1 Survey: a population-based study on Health and Living Conditions in Regions with Sami and Norwegian Populations.

BACKGROUND: In Northern Norway, traditional medicine (TM) is shaped by both Christianity and traditional Sami nature worship. The healing rituals may include prayer and the use of tools such as moss, water, stones, wool and soil. Examples of TM modalities offered is cupping, blood-stemming, laying on of hands, healing prayers, and rituals. The purpose of this study was to investigate the prevalence of the use of TM in areas with predominantly Sami and Norwegian populations, and the influence of ethnicity, geography, gender, age, education, household income, religiosity and self-reported health on such use. METHODS: The study is based on data collected in the first SAMINOR Survey (SAMINOR 1) conducted in 2003/2004, including three self-administered questionnaires, clinical measures, and blood analyses. Data was collected in 24 municipalities in Norway known to have a substantial population of Sami. All residents aged 30 and 36-78/79 years in the predefined regions were invited regardless of ethnic background (N = 27,987). Of these, 16,865 (60.3%) accepted to participate and gave their consent to medical research. RESULTS: Of the 16,544 people responding to the question about TM use, 2276 (13.8%) reported to have used TM once or more during their lifetime. The most outstanding characteristic of the TM users was the affiliation to the Laestadian church, where 34.3% (n = 273) reported such use, followed by an inner Finnmark residence (31.1%, n = 481) and a Sami ethnicity (25.7%, n = 1014). Women were slightly more likely to use TM compared to men (15.9% and 11.5% accordingly, p < 0.001), and the TM users were slightly younger than the non-TM users (mean age 52.3 versus 54.3 years, p < 0.001). The TM users also had lower income (p < 0.001) than the non-TM users. We found no significant differences between the TM users and the non-TM users concerning years of education, and whether the participants were living with a spouse/partner or not. CONCLUSION: Further studies are necessary to examine the development of TM use in Norway over time, and use in areas with mainly Norwegian inhabitants. There is also a lack of studies quantifying TM use among Sami people in Sweden, Finland and Russia.

Biological Activities of Essential Oils: From Plant Chemoecology to Traditional Healing Systems.

Essential oils are complex mixtures of hydrocarbons and their oxygenated derivatives arising from two different isoprenoid pathways. Essential oils are produced by glandular trichomes and other secretory structures, specialized secretory tissues mainly diffused onto the surface of plant organs, particularly flowers and leaves, thus exerting a pivotal ecological role in plant. In addition, essential oils have been used, since ancient times, in many different traditional healing systems all over the world, because of their biological activities. Many preclinical studies have documented antimicrobial, antioxidant, anti-inflammatory and anticancer activities of essential oils in a number of cell and animal models, also elucidating their mechanism of action and pharmacological targets, though the paucity of in human studies limits the potential of essential oils as effective and safe phytotherapeutic agents. More well-designed clinical trials are needed in order to ascertain the real efficacy and safety of these plant products.

Plants of the Genus Zingiber as a Source of Bioactive Phytochemicals: From Tradition to Pharmacy.

Plants of the genus Zingiber (Family Zingiberaceae) are widely used throughout the world as food and medicinal plants. They represent very popular herbal remedies in various traditional healing systems; in particular, rhizome of Zingiber spp. plants has a long history of ethnobotanical uses because of a plethora of curative properties. Antimicrobial activity of rhizome essential oil has been extensively confirmed in vitro and attributed to its chemical components, mainly consisting of monoterpene and sesquiterpene hydrocarbons such as α-zingiberene, ar-curcumene, ß-bisabolene and ß-sesquiphellandrene. In addition, gingerols have been identified as the major active components in the fresh rhizome, whereas shogaols, dehydrated gingerol derivatives, are the predominant pungent constituents in dried rhizome. Zingiber spp. may thus represent a promising and innovative source of natural alternatives to chemical food preservatives. This approach would meet the increasing concern of consumers aware of the potential health risks associated with the conventional antimicrobial agents in food. This narrative review aims at providing a literature overview on Zingiber spp. plants, their cultivation, traditional uses, phytochemical constituents and biological activities.

The role of traditional health practitioners in Rural KwaZulu-Natal, South Africa: generic or mode specific?

BACKGROUND: Traditional health practitioners (THPs) play a vital role in the health care of the majority of the South African population and elsewhere on the African continent. However, many studies have challenged the role of THPs in health care. Concerns raised in the literature include the rationale, safety and effectiveness of traditional health practices and methods, as well as what informs them. This paper explores the processes followed in becoming a traditional healer and how these processes are related to THP roles. METHODS: A qualitative research design was adopted, using four repeat group discussions with nine THPs, as part of a larger qualitative study conducted within the HIV Treatment as Prevention trial in rural South Africa. THPs were sampled through the local THP association and snowballing techniques. Data collection approaches included photo-voice and community walks. The role identity theory and content analysis were used to explore the data following transcription and translation. RESULTS: In the context of rural Northern KwaZulu-Natal, three types of THPs were identified: 1) Isangoma (diviner); 2) Inyanga (one who focuses on traditional medical remedies) and 3) Umthandazi (faith healer). Findings revealed that THPs are called by ancestors to become healers and/or go through an intensive process of learning about traditional medicines including plant, animal or mineral substances to provide health care. Some THPs identified themselves primarily as one type of healer, while most occupied multiple healing categories, that is, they practiced across different healing types. Our study also demonstrates that THPs fulfil roles that are not specific to the type of healer they are, these include services that go beyond the uses of herbs for physical illnesses or divination. CONCLUSIONS: THPs serve roles which include, but are not limited to, being custodians of traditional African religion and customs, educators about culture, counsellors, mediators and spiritual protectors. THPs' mode specific roles are influenced by the processes by which they become healers. However, whichever type of healer they identified as, most THPs used similar, generic methods and practices to focus on the physical, spiritual, cultural, psychological, emotional and social elements of illness.

Alternative Knowledges and the Future of Community Psychology: Provocations from an American Indian Healing Tradition.

In the early years of this globalized century, alternative health knowledges and wellness traditions circulate faster and farther than ever before. To the degree that community psychologists seek collaboration with cultural minority and other marginalized populations in support of their collective wellbeing, such knowledges and traditions are likely to warrant attention, engagement, and support. My purpose in this article is to trace an epistemological quandary that community psychologists are ideally poised to consider at the interface of hegemonic and subjugated knowing with respect to advances in community wellbeing. To this end, I describe an American Indian knowledge tradition, its association with specific indigenous healing practices, its differentiation from therapeutic knowledge within disciplinary psychology, and the broader challenge posed by alternative health knowledges for community psychologists.

Traditional vs. non-traditional healing for minor and major morbidities in India: uses, cost and quality comparisons.

OBJECTIVES: To examine the uses, cost and quality of care of traditional healing for short-term morbidities and major morbidities in India and to compare them with the non-traditional healing. METHODS: We used data from a nationally representative survey, the India Human Development Survey (2004-2005) and descriptive as well as bivariate analyses for the examination. RESULTS: Use of traditional healing is much less common than use of non-traditional healing in both rural and urban areas and across all socio-economic and demographic characteristics; it is slightly more common in rural than urban areas for short-term morbidities. Use of traditional healing is relatively more frequent for cataract (especially in rural areas), leprosy, asthma, polio, paralysis, epilepsy and mental illnesses; its total cost of care and mean waiting time (in the health facility) are substantially lower than for non-traditional healing. Among patients who use both traditional and non-traditional healing, a relatively higher proportion use traditional healing complemented by non-traditional healing for short-term illnesses, but vice versa for major morbidities. CONCLUSION: This is the first study which has investigated at the national level the uses, complementarities, cost and quality aspects of traditional and non-traditional healing in India. Traditional healing is more affordable and pro-poor. Relatively higher use of traditional healing in patients from poorly educated as well as poor households and suffering from diseases, such as, epilepsy and mental illnesses; and higher demand for traditional healing for the above diseases highlight the need for research/policy reorientation in India.