Shaman and Psychiatrist: Alleviating Human Suffering. When I wrote my first blog for MIA, I was surprised so many respondents mentioned shamans and psychiatrists together. Some time ago I had looked into the role of diagnosis and treatment within shamanism and psychiatry. I had explored both their methods of working, and their function maintaining social order. Comparison of their job descriptions to alleviate human suffering was complex. Shamanic practice appeared to be focused on the individual within society, environment, and cosmos. In contrast, early psychiatry was focused on the individual’s body/mind — though recently it considered wider issues. In both cases, the diagnoses which were made by shamans and psychiatrists were linked to their own explanatory models of causation. Although the societal role appeared similar, their practices and treatments were different. To generalize; in order to reduce human suffering: one worked within reductionist medicine, the other within energy medicine. The question: today, do experts by experience find shamanic practices helpful to them, and if so how appropriate is it to open a dialogue with mainstream medicine about its cultural relevance and effectiveness?
A Question of Terminology
The Scottish Anthropologist Ioan Lewis, wrote the book Ecstatic Religion in 1971, in which he suggested a ‘shaman is not less than a psychiatrist, he is more.’ He claimed psychiatry was just one of the functions of the shaman, and he invited comparison between shamans and psychiatrists. The term ‘shaman’ was originally borrowed from the Tungus people of Siberia: a person of either sex who could master spirits and introduce them at will into themselves. Some diagnostic criteria for schizophrenia appeared rather similar to the desired conditions of shamans in an altered state of consciousness. Other terms used (and misused) for therapeutic practitioners included: native or traditional healer, medicine man, witch doctor, soul doctor, sorcerer, magician, spirit medium, exorcist, curer, diviner and diagnostician. As well as ideally doing positive work maintaining social order, shamans may also do mischief (perform as sorcerers or witches).
At first glance the term ‘psychiatrist’ appeared less problematic to define. Google search revealed: a psychiatrist was ‘a medical practitioner specializing in the diagnosis and treatment of mental illness’ while the UK NHS definition was: a physician ‘concerned with the diagnosis, treatment and prevention of mental health conditions’. Then there were those who claimed ‘mental illness’ was a social construct: anomalous episodes were considered spiritual crisis or extreme experience.
It was ‘inappropriate behaviour’ which attracted a psychiatrist’s response. The problem was in the days before cultural competency training became the norm, westerners tended to interpret phenomena and experiences according to their own belief systems. ‘Ethnocentrism’ was the belief that the values of one’s own cultural group were the only correct ones…, for example, earlier psychiatric diagnoses described both Indigenous Americans in reservations or slaves running away from plantations as mentally ill. This did not take account of colonisation and repression.
Diagnoses of Suffering
Both psychiatrists and shamans used a system of diagnosing symptoms and signs to assist in the interpretation of suffering. The psychiatrist’s diagnosis was based on visible and verbal observation and defined according to classifications found in DSM-5. While the shaman’s diagnosis was also based on observation, it included data obtained by divination, intuition and information from overshadowing spirits. In each case, the diagnosis was linked to their explanatory models of causation. Due to differences in their theories of causation, and in problems they may have interpreting a person’s condition, they differed in their selection of the most appropriate methods of treatment to reduce human suffering and maintain social order.
People who consulted a shaman usually did so by choice, according to their own free will. Those who consulted a psychiatrist may have gone by choice, but equally likely, they may have been referred by someone else: a medical officer, social worker, or as a legal requirement. In the first case, the individual perceived something to be amiss and sought help, in the second case, others perceived behaviour to be outside societal norms, and referral or coercion occurred. The problem today is that societal norms change over time and place. They are not constant, and neither is common consensus. Today it seems as if we exist on the cliff edge of healing change: popular versus corporate.
Theories of Causation
Shamanic assessment of illness was based on an assessment of an individual’s life circumstances. The diagnosis was enmeshed with the shaman’s and sufferer’s theories of causation. This might include: interpersonal relationships; inter-group conflicts; ecological, religious or moral misdeeds; improper use of mystical powers; spells cast by sorcerers, witches or the evil eye; and the neglect or displeasure of ancestral or environmental spirits. In some societies illness was believed to occur after inappropriate behaviour, and its acknowledgement was perceived as an effective means of social control.
Problems of Diagnosis
The term ‘culture-bound syndrome’ was used by psychiatrists for people in non-Western countries who experienced dissociative states, multiple selves, or altered states of consciousness (although these were often valued locally as forms of religious experience). Psychiatrist Fernando suggested the most common culture-bound state was spirit possession ‘found in 90% of traditional societies’, the manifestations of which were ‘virtually indistinguishable’ from first rank symptoms of schizophrenia. It was the cultural context which suggested whether or not this was a psychiatric illness. He remarked the perception of possession states as bizarre may be ‘the consequence of our own ethnocentric view and not the hallmarks of psychosis.’
Causality. With regard to ‘causality’ some psychiatrists now take into account the effects of the immediate family situation, the wider society, and the personal traumas which precede mental distress. Some of their diagnostic methods may be more like those of the shaman, but their methods of treatment are different. However, one former British National Health psychiatrist said Multiple Personality Disorder was frequently caused by attached spirits (although his interpretation and treatment strategies were not supported by mainstream psychiatry).
Research by a UK physician suggested it was normal for a bereaved person to have visionary of auditory experiences, or they may simply feel the deceased’s presence: ‘as many as half of all bereaved people experience hallucinations of the dead person for years after the loss’. In UK dialogue is happening: a conference on spirit possession runs in March 2015, integrating research with psychology and psychiatric clinical practice.
The primary tasks of both psychiatrist and shaman are to alleviate distress among clients, and maintain social order. Their methods of diagnosis have similarities today, and though their theories of causation are quite different, the social context of distress concerns both. The main difference here being the shaman’s ability to embody spirits, to see ‘the unseen worlds’ and their effects on the clients. Taking case histories is both a tool of diagnosis and possibly a treatment in its own right. This may be common to both, though they each use different techniques to achieve it.
Other forms of treatment may be quite different: both use pharmacology, but its intended effect is rather different. In India I met one psychiatrist, who preferred to use homoeopathy for treatment. Only the shaman goes into trance or undertakes ritual public performance. The psychiatrist’s performance is essentially in a private session, unless it takes place in a hospital ward. Both are effective with regard to social order: one in reconfirming social norms, the other in maintaining social behaviour.
Neo-shamanism or urban shamanism was embraced by Personal Development movements in the west, where everyone was invited to become their own therapist. Anthropologist Harner’s experiences with the Jivaro peoples changed his assumptions about the nature of reality, and he suggested physicians and shamans could work together. Similarly medical anthropologist Villoldo supported healing based on practices of Amazonian and Andean shamans.
In 2014 a medical centre in Merced California, invited a shaman to perform a ceremony to summon a Hmong patient’s soul. Under a new cultural competencies policy to recognise the role of traditional healers, the hospital invited shamans to perform approved ceremonies. The Joint Commission in USA reported hospitals were increasingly sensitive to their patients’ cultural beliefs. Has anyone got a record of this kind of collaboration being used elsewhere in the field of mental well being? To what extent is it appropriate today, to open a dialogue about the cultural relevance and effectiveness of shamanic practice?