Traditional Healing and Psychosis vs. the Promises of Modern Science

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As noted by Robert Whitaker in his book Anatomy of an Epidemic, the World Health Organization reported that the prognosis for someone experiencing psychosis is far better in developing countries than in industrialized countries.  Mr. Whitaker and others posit that this is  due to the treatment models used in the developing world, as well as to debility and chronicity caused by psychiatric drugs themselves.  I think this is undoubtedly true.

A number of other reasons for the disparity in outcome have been suggested.  Some have put forward the idea that there has been a rush by consumers to apply for this disability money, leading to an increase in apparent chronicity.  While this is quite possible, I doubt that this alone explains the large gap in outcomes. Other researchers have suggested that family and community support networks are often stronger in developing countries and that there is perhaps more tolerance and acceptance of people with psychotic tendencies.

Traditional Perceptions of “Mental Illness”

I think it’s also important to explore traditional tribal and village based models of helping people experiencing psychosis and examine why they may be effective.  Is there something we are missing about how altered and psychotic states have been perceived and treated in indigenous societies?  In traditional societies, psychosis is often seen in a spiritual context.  Instead of defining the experience as due to an underlying flaw or biological illness, psychosis and altered states have often been understood as a spiritual awakening, or as part of a supernatural process.

In the West, we describe psychosis and schizophrenia in terms of positive (auditory and visual hallucinations, delusions, thought distortions) and negative (anhedonia, dysthymia, catatonia) traits.  Scientific explanations have centered around describing brain abnormalities as well as neurotransmitter alterations.  Treatment is primarily centered around taking antipsychotic major tranquilizers such as Risperdal and Zyprexa.

In traditional societies, complex supernatural narratives are often used as explanatory models for psychosis.  In the Hmong culture, psychotic experiences are caused by spiritual entities (dab neeb).  Often those who experience psychosis will go on to be seen as spiritual intermediaries, or shamans who can help heal community members.

Native American tribes such as the Navajo often perceive psychosis as a type of spiritual possession.  Elaborate rituals involving singing, praying, herbs and ritual objects are used to exorcise and combat evil entities.  

In many traditional societies the process of psychosis is often initiated and invited through drumming, chanting, prayer, fasting and meditation.  The Akamba of Kenya can be possessed by the spirits of ancestors, or aimu, in ecstatic rituals.  In Ecuador, the Quichua Indians use plant hallucinogens such as ayahuasca and then invite spirit animals such as jaguars to take over their mind.  In this state they often perform elaborate healing rituals for community members in emotional and physical distress.  And amongst certain Native American tribes, there is a pervasive belief in “Ghost sickness”, a term used to describe symptoms of weakness, dizziness, fainting, anxiety, hallucinations, confusion, and loss of appetite from the action of evil forces.

Explaining these forms of altered states in spiritual terms is often seen as unscientific, and lacking proof.  Modern mental health treatments are seen as based in scientific research and as having been vetted for validity, efficacy, and safety.  Superstitious folk healing is seen as ineffective, or worse, dangerous.

Traditional Healing as Community Based Care

But I return again to the WHO study that shows far worse outcomes for those experiencing schizophrenia in industrialized countries than in societies that don’t use drug medicine, or indeed rely or superstitious folk healing.  Do these traditional societies know something we don’t?

There are two ways I look at it.  One could see the experience of supernatural intercession as the cause of psychosis, literally.  Perhaps there is a complex spiritual cosmology that can lead to dramatic changes in sense and perception.  And perhaps there are certain individuals (healers, shamans) that have a greater capacity for working in that realm, interceding and helping regulate consciousness towards greater harmony and well-being.  This has been accepted practice throughout the world for millennia.  Certainly western science, at least according to the WHO, has not demonstrated a greater template for healing people going through psychosis.

And one could look at it metaphorically.  The elaborate rituals, the use of herbs and sacred objects, the incorporation of the community and tribe; all help in the process of bringing sense and coherence, as well as a deeply felt source of loving support to helping a person navigate the depths of confusion and distress found in psychosis.

At a core level, I think community-level care and support forms the basis for healing.  Folk ceremonies and healing rituals help in the process of reintegration.  They externalize the psychosis as something coming “from without” and not as an intrinsic defect or permanent biological abnormality.  The process of ritual and intercession by a shaman or a healer creates the template for processing and giving meaning to altered states. The community helps to provide a context within which to reintegrate after a “healing”. Whether the experience is literal or metaphorical, the template for managing altered states and psychosis provides a level of care that is often lacking in our modern Western system.

The mental health system in place in the developing world is primarily a white European male construct.  Often people from other cultures and backgrounds feel deeply uncomfortable being labeled with a mental illness, and uncomfortable with the therapy modalities (drugs and psychotherapy) offered.  When we look closely at the modern mental health programs in developed countries, we see that the treatments offered are leading to worsening symptoms and deepening chronicity.

In our desire to look for alternatives that work, we are obliged to examine why prognosis in developing countries is far better.  One easily overlooked aspect is the role of traditional perceptions and treatment of what has come to be known as psychosis.   These forms of “illness” have long been known as a sacred part of the human experience and continue to be in parts of the world that have not been conquered by the false promises of the psychiatric-industrial complex.

29 COMMENTS

  1. Thank You Jonathan,
    You’ve hit a home run here. This type of exploration is what we need much more of on this site. Maybe one day we will even see interviews with practitioners of various healing arts from various cultures as pertains to human wellbeing including mental,emotional,spiritual,psychic,
    psychological,and physical which can each affect each other or others.”First do no harm” can not be left behind.
    Ultimately a human being must become their own healer.
    Fred

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  2. Thanks Fred. I thought it was also timely because a lot of the discussion lately has been about what constitutes “effective” treatment. I have said in other posts that I think relying exclusively on double bind “Science approved” studies have left us with…mainly taking antipsychotics. What went wrong here? Is it the fault of scientific research? The trials themselves? The huge monies invested and a corrupt psychiatric-industrial complex? Eurocentric cultural thinking?

    I think the whole notion of “science-approved” needs to be seriously reexamined.

    And I think we need to allow a great deal more leeway to empirically validated healing processes. We need to trust ourselves again.

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    • Jonathan,

      Chemistry, physics – hard sciences.
      Psychology, sociology – soft sciences, at best.

      People who provide counseling or psychotherapy; those who conduct research in these areas… are these *scientists*?

      Is the process of trying to better understand human thoughts, feelings, and relationships a *scientific process* … one that relies on the *scientific method*?

      Is recovery a *scientific* journey?

      Really?
      Are you kidding me?!!

      I apologize for the redundancy (but I can’t help myself)….

      This is science:

      http://www.nasa.gov/

      This is *not*:

      http://www.psych.org/

      Duane

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      • Most importantly, a person who has a strong desire to fully recover gets to chose *their* method(s) of doing so!

        Please, let’s not replace psychiatry with a one-size-fits-all talk therapy – no matter what the method; no matter what the “scientific” evidence-base.

        The “science” of human behavior?

        Give me a break!!

        Duane

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        • I agree Duane. The term that is bandied around as all powerful is…evidence based. It’s a silencing term for any other forms of care that have not been rigorously double blind studied. Pigeonholing a category of people with vastly complex narratives into singular treatment strategies seems misplaced at best.

          There has to be an allowance for a divergence of healing methods. What works best for one person may not work at all for another.

          Here’s an example. A number of years ago I was having trouble sleeping. I decided to see a therapist who was known as a sleep specialist. When we met we talked about some strategies and sleep hygiene. Then I asked him what he thought about caffeine and diet as it relates to sleep problems. He said he had no idea about that and doubted that it mattered much. I never went back.

          My insomnia was essentially cured by paying close attention to my diet and avoiding caffeine. I probably would have been served better seeing a naturopath.

          People need different skill sets and techniques at different times. Compartmentalization and one size fits all methodologies are part of what’s wrong with modern medicine.

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          • Brett,

            You and I disagree on this subject, obviously. I did not leave the comments to offend you or anyone else, but rather to point to a different view of human suffering, especially emotional suffering.

            It takes a lot of science to land a rover on Mars; psychologists would tend to wonder *why* some human beings are compelled to take on such challenges – looking at rewards, motivational factors etc… quite an art, but not a science. IMO, therein lies the difference.

            Again, we just disagree. That’s all.

            Duane

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          • @Brett

            I find the word “treatment” offensive. Intervention is a better work because what is usually being described is an intervention is someones life. Treatment is something that is done to person…an intervention is something that is done with them.

            Also telling someone you find what they say is offensive without even trying to explain why is also….to me…offensive.

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          • (I am replying to the comments below here, for lack of a better place)

            Duane, you are entitled to disagree with me regarding the value of science in understanding human psychological experience. However, you might consider expressing your positions without dismissing the validity of entire professions and the people in them. As such a person, especially one who MIA’s mission and is actively working to improve matters in my own profession, it is growing tiresome. You may wish to consider that the mission of MIA is enhanced with full participation of individuals who work within the mental health system to make things better, and that routinely characterizing entire mental health professions and their practitioners as frauds and charlatans does not necessarily further MIA’s mission. Or not, feel free to disregard my sentiments if you choose. It does not matter to me either way because I am done being the lone scientist who regularly participates in conversations in the comments section here at MIA (aside from bloggers who comment on their own posts). It is perhaps not a mystery why others like me do not participate on this site in this manner. I will not be responding further to this post, nor will I be participating in discussions at MIA in the near future other than those related to blog entries I post. Goodbye.

            For the record, since it’s apparently unclear to Theinarticulatepoet why I might have taken offense, the relevant comments are quoted below:

            “People who provide counseling or psychotherapy; those who conduct research in these areas… are these *scientists*?”

            “The “science” of human behavior?

            Give me a break!!”

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          • Brett- I’m sorry if I took part in that and I would be sorry to see you stop posting on articles other than your own. While you and I have some disagreements, I have always wanted to hear your point of view. As I have seen from day one coming here- this site is rough. People are direct to the point of being personal at times. There are times I’m not comfortable with the level of vitriol that happens.

            At the same time, I appreciate a good conversation and examining issues that can get heated sometimes. I hate to see conversations become one sided where those who agree just talk amongst themselves. In any event, it would be sad to lose your voice. Thanks for your posts.

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          • Brett,

            You wrote:

            “… routinely characterizing entire mental health professions and their practitioners as frauds and charlatans.”

            In fairness, I’ve done this with the field of *psychiatry*; however I’ve also shown my support for psychiatrists (including those on this site) who have been brave enough to call their own colleagues (those who practice conventional bio-psychiatry) frauds and charlatans.

            I’ve been consistent about my views on counseling, CBT, psychotherapy, by saying I think these certainly have a place. They help many people, who are fortunate enough to find the right person, the right approach.

            When it comes to “mental wellness,” I’m for a multi-dimensional approach (we are complex souls); and this includes modalities that *you* have dismissed as “not evidenced-based.” I have been consistent in saying that I do not think all things that help a person heal need to be “scientific.”

            I appreciate science.
            And religion.
            And an open-minded approach toward healing, especially; healing that involves mental and emotional well-being.

            Music has *ties* to *mathematics* – both use patterns. Repeating choruses or bars have similar patterns and strategies.

            But in my mind, a composer is not a *mathematician*.

            This of course takes away *nothing* from the *genius* of music; the value of it in our lives. So it is with mental health – developing relationships, overcoming trauma, stress, anxiety… Good stuff. And if a person is gifted to help others in these areas, fantastic.

            The best analogy I can think of is music. I love music. In fact, both of my sons are musicians. I consider music a wonderful *art*, but not a science.

            Tchaikovsky was a genius, but IMO, not a *mathematician*:

            http://www.youtube.com/watch?v=37EcV88TRrg

            Duane

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  3. I appreciate this article although I would like it better if it managed its subject matter without the word psychosis, which is really just a code word for schizophrenia….

    I’m not really keen on the idea that some people have “psychotic tendencies” either…its well demonstrated that sensory deprivation leads to altered states of mind anyone who experiences sensory deprivation…

    The idea of psychotic tendencies is to close to the idea of stress vulnerability thinking which in turn leads to the idea that some people are just inherently mentally weaker than others….this hypothesis… I just personally reject.

    I appreciate finding new words is a struggle and its often easier to just try and reuse medical words….that said I think its worth the struggle….to try…

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    • I don’t know- when I think of the word “psychosis”, I think of a temporary state of being. Schizophrenia implies permanence to me. At the same time, I get where you’re coming from with words. Psychosis is a very bland, uninspiring and generic term. There is such an enormous variety of experience placed under the rubric psychosis.

      I also personally don’t have a problem with thinking some people are prone to psychosis. I think one of the concepts in many traditional societies is that some people are more prone to altered states, having visions, hearing voices. But instead of seeing them as weak, they have often been picked out as the seers, the shamans and visionaries.

      At the same time, I don’t want to minimize the extremely confusing and torturous elements that some people go through when they are experiencing “psychosis.” I don’t want to exalt the condition into some rapturous spiritual state. For many who in the depths of severe confusion and emotional distress, the experience is deeply unsettling and scary. But instead of drugs, perhaps we could offer shelter, guidance, some empathy, nourishment and a place to walk through that space of mind with compassion.

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      • @Jonathan

        I understand the points you are making and I can see the merit in what you are saying. However while I agree that psychosis is potentially as you say a generic word it is also redolent of the medical model where its use is very prevalent. So to me it is a question of priorities. When I suggest not using it I am prioritizing using language that puts the maximum amount of distance between what you are saying and what, typically, psychiatrists say.

        When the language changes it changes the way things are thought about. In the final analysis by way of illustration, if psychiatrists used a different language to engage the matters at hand on this site all the papers in their journals, that they currently read, would become unintelligible to them as they would also see them as irrelevant to the matters at hand.

        Knit picking at language is a habit of mine….

        Generally I agree with what you are saying….

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  4. @discover and recover

    Duane…I believe that many of the professionals that visit this site and others are so used to encountering people in the professional context they just fall apart when they meet them “in the wild” so to speak 🙂

    What they want is not so much respect but a sort of reverence….and when they don’t get it….they spit the dummy…toys get thrown out of the pramm…melt down…

    Contrast with the hospital environment where its ok to be as degrading as you like about “patients”… as long as they couch it with what they think are the right words…. they can be as nasty as they like and the “patient” just has to soak it up….quite a contrast…

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    • I was trying to point to the importance of language (see comment above as well)… There is a difference between an “art” and a “science.”

      I as also trying to point out the need to encourage *all kinds* of approaches. I see the value of a good counselor for some people. I just don’t believe that psychotherapy, CBT, etc are the *only* ways people recover.

      Certainly not with anxiety. Meditation, neurofeedback can be helpful. There is almost a 60% *natural* recovery rate for “schizophrenia. I think it’s great that Open Dialogue brings this up to 80-85%, but I think we could see this level of recovery from other options, and combinations of approaches. Some of these would likely not be seen as “scientific” in the mental health field.

      For instance, how do you do a double-blind study on *combinations*?

      One group in the study removes themselves from toxic relationships; combines nutrition, exercise, meditation; enrolls in a college course of their choosing versus the other group who makes none of these life choices?

      Equally important, how do we “scientifically” measure all of this?

      70 percent of one group reports felling “better than ever” while the other group has only a 50% who begin to feel only “slightly better,” based on the “placebo effect” of thinking they were changing their diets, while eating junk food wrapped in Whole Foods packaging?

      Why do we have to have “scientific proof” when it comes to someone finding ways to live a peaceful, more meaningful, happier life. Some of this gets to the point of being ridiculous.

      Duane

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      • I think you make a very good point. The field of psychology doesn’t have to be a science, and really isn’t, because we’re dealing with values and priorities and motivation and emotion, things which don’t lend themselves to measurement. In fact, I think it lends confusion to what is otherwise a much easier subject to understand when we approach it more philosophically. The very fact of choosing to believe that depression or psychosis is a problem that needs solving (for instance) is a value-laden decision that belongs entirely to the field of philosophy. Which is kinda what Jonathan is saying in his article, I think.

        However, I am a scientist by training (a chemist) and find my scientific way of thinking greatly enhances my ability to help people. I treat each interaction with a person as a unique experience (because they are), but I can still hypothesize what might be happening, test out my hypothesis with careful questions, and alter my theory if the facts no longer bear it out. Of course, this is all in the context of helping the person I’m helping achieve his/her goals, rather than my own.

        If all psychiatrists and psychologists approached it this way, the drugs would be minimally used, if at all, because if you really look scientifically at people’s experience with the drugs, on the balance, it’s pretty dismal. I think the biggest problem is that they don’t really think scientifically at all. They have religious faith and pretend it’s science. A more scientific attitude, as well as one more humble and respectful of the person coming to them for help, would actually improve things a whole lot!

        — Steve

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        • Thanks for the comments Steve. I think there is indeed a place for integrating science and the scientific method for helping people in distress. But what is that process? As someone trained in botany and as an herbalist, I am often informed by a scientific understanding of plant chemistry and the active constituents and their biochemical effects on human physiology. This can be important when helping people in emotional distress. But it only informs a part of my understanding of herbal medicine. It is also key for me to understand traditional and empirical uses of plants as well as the unique needs of my clients. That holistic understanding gives me a broader palette to work from.

          The scientific process for helping people in emotional distress has moved towards relying almost entirely on drug “treatment.” And those drugs have been pushed by large and very wealthy companies that have the money to do extensive double blind “studies.” Is this science when many alternate systems of care are ignored because they are not “evidence based”, meaning huge sums of money have not been used to study them?

          When Science becomes bastardized as simply a tool for wealthy corporations to sell a product, then I think we need to completely revamp our notion of what constitutes…good Science.

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          • Thanks for the post JK, and especially your last comment. Some companies have used Science merely as a vehicle to market their products. And when research misconduct is uncovered, then the moral authority of Science is undermined.

            And for patients, it is not just about Science; it is about trust and integrity. Does my doctor provide reliable information that will stand the test of time? In some branches of medicine, I still believe, but not so much in mental health. A hard lesson learned.

            Enjoying your posts.

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