'Quichua' Healers Of The Andes Diagnose Mental Illnesses
Traditional healers' practices are widespread around the world, yet their diagnostic skills have rarely been investigated.
This exploratory study was carried out in Otavalo, in the province of Imbabura in the highlands of Ecuador. For over 18 months, 10 yachactaitas from three rural villages drew patients from the surrounding areas.
They identified 50 of these as having a condition known as llaqui. Each was referred to a Quichua-speaking physician trained in western transcultural psychiatry, and underwent the following investigations:
-- A structured interview, using a Quichua questionnaire on the nature of llaqui
-- A medical evaluation, including personal and medical history, and a physical examination
-- Laboratory tests, including blood, faecal and urine analysis, and an X-ray
-- Psychiatric evaluation and diagnosis, using established western diagnostic criteria
-- An adapted Quichua version of a self-rating depression scale
94% of the people studied lived in the rural villages of the Otavalo area. Most were peasant farmers, artisans or homemakers. 56% were illiterate, and an additional 34% had not completed elementary school education. 54% were male, and 65% married.
The Quichuas themselves (and the yachactaitas in particular) identify llaqui as a cluster of four illness sub-categories comprising a symptom (sadness), the name of an illness, life events and a causal factor of illness.
The first two sub-categories are merged into one, which can be translated as 'victim of malignant spirits.' The person is under attack by natural spirits or spirits under human control that will damage the person's body or soul.
The third sub-category ('heart pain or shattered heart') results from life events and sorcery. Among the Quichuas, land disputes, family conflicts and the death of a relative are the most stressful life events. This condition also resembles the symptoms of typical anxiety or depression.
The fourth sub-category ('victim of sorcery') is believed to result from the aggression of malignant spirits under human control (usually a healer), or by a physical or visual contact with materials used in the treatment of sorcery. People can have symptoms from more than one illness sub-category at the same time.
The western clinical diagnoses of the 50 participants with llaqui showed that 82% had a depressive disorder; 44% medically unexplained symptoms (somatoform disorders); and 40% anxiety disorders. Over 80% of them also had infectious or parasitic diseases.
The researchers comment that it is surprising that the Quichua healers, using supernatural and life events notions, seem to identify people who are psychiatrically ill. Since participants were identified as ill by both the yachactaita and by the biomedically trained doctor, a remarkable overlap is apparent in the diagnostic work of both practitioners.
The findings of this study are in line with those of previous studies in different and remote parts of the world. The results highlight the contribution of yachactaitas in the provision of mental healthcare for Quichua people living in the Andes, for whom government-funded psychiatric services are non-existent, say the researchers.
The yachactaitas' diagnostic abilities could be useful in the screening of patients in psychiatric epidemiological and public health research.
"Efficacy of Quichua healers as psychiatric diagnosticians"
Incayawar M (2008)
British Journal of Psychiatry 192, 5, pages 390-391
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