Psychotic experiences: Gift or illness?

Abstract

Cultural and social factors have a significant impact on the clinical presentation, interpretation, and course of psychosis. Data from low- and middle-income countries (LMICs) are scarce. This thesis comprises anthropological and psychiatric research into unusual perceptual experiences among (apprentice) traditional healers in rural KwaZulu-Natal, South Africa. Our findings show that unusual perceptual experiences, such as hearing voices, can be explained from a cultural perspective as the ‘calling of ancestral spirits to become a traditional healer’ in some cases, an interpretation ultimately regarded as a gift. Conversely, the conventional psychiatric perspective classifies the same experiences within the context of psychosis. Ukuthwasa, the process of becoming a traditional healer, is locally considered the only way to recover from calling-related disturbances. Our follow-up study among individuals with the calling who had undergone ukuthwasa, reveals a favourable course of psychosis in most individuals over three years. These findings underscore the effective nature of ukuthwasa as a healing intervention for this specific group of people with psychotic manifestations. The underlying mechanisms of ukuthwasa focus on promoting personal and social recovery, encompassing elements such as sense-making, finding meaning in life and peer support. This thesis emphasises the importance of integrating these elements into the treatment of psychosis, advocating for a person-centred, culturally sensitive, and holistic approach. This is crucial not only in LMICs but also in the multicultural practice in the Netherlands. Furthermore, recognising diverse perspectives and healing practices which go beyond the biomedical paradigm is crucial for bridging the knowledge and treatment gap in psychosis.