Socio demographic information
Table 1. Socio demographic information of participants of the study
SN
|
Pseudonames
|
Age
|
Gender
|
Educational status
|
Experience
|
1
|
MM
|
40
|
Male
|
Grade 2 education and religious education
|
25
|
2
|
AK
|
45
|
Male
|
High school education and religious education
|
32
|
3
|
AI
|
38
|
Male
|
Religious education
|
25
|
4
|
JM
|
40
|
Male
|
Religious education
|
27
|
5
|
AM
|
38
|
Male
|
Elementary school education and religious education
|
29
|
6
|
MI
|
50
|
Male
|
Religious education
|
36
|
7
|
KM
|
44
|
Male
|
Illiterate
|
28
|
The socio-demographic information of the participants include: pseudo names of participants, age, gender, educational status, experience year. As shown in Table 1, all the traditional healers were males whose work experience ranged from 25 to 36 years. Except one, all the traditional healers have religious education while some of them have lower level of modern education.
Traditional healers understanding about mental illnesses
Most of them have a good understanding about mental illnesses, and they define mental illness by closely observing a person’s behaviors/action, and his/her daily life activities. Besides, their understanding of mental illness was similar,and it seems to be culturally defined.They closely associated their understanding about mental illnesses with their own experience and knowledge. The participants said that mental illness in Berta community is called SulMajinun (madness) or Yeamiro-Ebdet in Amharic and Maraata in Afan Oromo. The traditionalhealers understood mental illness as a deviated and unusual behavior/action that an individual shows in the community. One of the traditional healers expressed his understanding of mental illness as follows:
I understand mentally ill people through his/her action and thought that they show. For example, they always insult people and takes off the clothes in public, play as a child on the road, and in front of some people, eat and drink whatever on the place, move here and there continuously through collecting dirty things, talk none senseless words.” (Participant AM)
In a similarly way, another participant explained his understanding about mental illness as:
I understand mentally ill people through his/her behavior and personal hygiene. That means the behavior/action that mentally ill people show differs from a normal person in society and their hygiene is not good as a normal person. As an example, they do not keep their hygiene, they are easily tempered, unreasonably crying, laughing alone and generally their behavior is not constant especially those who have experienced mental illness for many years. For these reasons the social, psychological well-being of an individual is affected.” (Participant AI)
The above narratives indicatedthat the participants understood mental illnesses through an individual’s behavior/ action. They understood mental illness as a condition that has some behavioral manifestations that are not considered normal within their social context such as insulting community, laughing and crying without any reason, wondering here and there, sleeping everywhere, eating and collecting dirty things, play as a child on the road and in front of the public, drink whatever on the place, speaksenseless words, and change his/her personal hygiene.Therefore, they understood mental illness as the behavior/action of the person different from the social contexts in society.Besides,the traditional healers understood mental illness witha person’s physical and emotional conditions such as they cannot manage their physical in a good way when doing something and go, they do not want to eat and talk with their collagenous, aggressiveness, their hygiene is not good.
Perceived causes of mental illness by traditional healers
Based on their own experience and knowledge, traditional healers who were participated in this study attributed mental illnessesto several factors.They listed different causes of mental illnesses including: curse/ Witchcrafts, harsh social conditions, jealously, hereditary, substance use, and food poising. They described the causes of mental illness as follows :
There are different causes of mental illness. For example, if there is conflict between people, insult, and jealously. Then, they are bewitched you by their ability and bewitched on you by money for this case. These people who are affecting the mental health of individuals in our community are called Arama by the local language of our community. Therefore, if an individual developed such a severe mental illness, we treat them based on our knowledge and experiences, and according to the causes of illness.(Participant AK)
Another participant added:
Some people are harming the mental health of others by using their malicious power gained from evil spirits and religious education or training. These people do these evil practicesfor money or to revenge by their ability to harm the mental health of individuals in society. To treat these mentally ill people as a traditional healer, I use different mechanisms and these are well known to me. In the past times, people who developed severe mental illness were treated only by traditional healers because there was no modern medicine,but traditional healers know its causes of illness.” (Participant AJ)
Participants of the study also believed that mental illness is caused by a supernatural power. They said that individuals can develop severe mental health problems because of punishments of God/Allah if they do wrong acts such as not praying/ Dua. For instance, one participant (AJ) described that when individual violets the religious principles especially one who violates the Allah commandments,a person can develop a mental illness.
Thus, the traditional healers perceived the causes of mental illness related to supernatural powers. That means, supernatural powers can cause misfortunes and illness if an individual commuted wrong acts, and if a person is not praying.
In addition, most of the traditional healers perceived that mental illness canresulted from stressful life events such as family problems/conflict, stressed about general life, bereavement, divorce, and academic failure may cause of mental illness. For instance, two of the participants perceived harsh social conditions as a cause for mental illness in the following way:
Mental illness may cause by the conflict between his/her parents, neighbors, relationships with of HIV/AIDS victims, and divorce. After all,because of factors individual begin to isolate from his/her parents, relationships, think too much, and his/her mental health is disturbed.”(Participant AI)
Unexpected death close relatives, family, loose of loved one, and loose of Gold lead to serious mental illness. For example, if one was too attached to his mother and suddenly the mother passes away, he/she can have difficulty adjusting himself normally whichleads to mental disturbances. I have seen more patients who are come to me to get treatment for these cases after they developed serious mental illness.” (Participant JM)
Participants also believed that mental illness can be caused by heredity factors that pass from one person to another person hereditary. One participant said:
Mental illness can be transmitted through biological descents. Suppose if there is any kind of mental illness case presented among family or back generation, the probabilityto transmit to others is high. As a result, a person can easily develop mental illness in the future. This mental illness is transmitted genetically.”(Participant MM)
Some of the traditional healers perceived poison as a cause that leads to a mental illness. For example, one traditional healer mentioned that mental illness can be caused when peopleintentionally put the poisonous material or substance in the food or drink to harm a person. One participant said that cruel people can put poison in somebody’s food, beer, and around his/her environment to make them ill. You can call the mental illness by poising in society.” (Participant AJ)
Finally, participants of the study also indicated that excessive use of a substance is another cause of the mental illness.
Perceived signs and symptoms of mental illness
Participants described that mentally ill persons showed different signs and symptoms that differ from a normal person in the community. The symptoms may include talking about things that don’t make sense or they tend to talk and laugh alone, taking off the clothes in in public places, collect and carry dirty things, crying and laughing alone, talking nonsense, laughing at inappropriate times, eating dirty food, and being aggressive.
.
Most people who have mental illness are talking about things that do not make sense or they tend to talk and laugh alone, and they become easily tempered.” (Participant MM).
Some of the mentally ill people are always taking off the clothes in community, in the market, collect and carry dirty things. More patients who have severe mental illness have this sign and symptoms.”(Participant AI).
Some mental ill people mostly find them talking about things that don’t make sense or they tend to talk and laugh alone, crying alone.This inconsistent behavior is a symptom among mentally ill persons especially on people who have severe mental illness formanyyears.” (Participant MI).
Most of the time people with mental illness have shown signs and symptoms such as talking by himself and nonsense, laughing at inappropriate times, eating dirty food, and aggression. (Participant AK)
Diagnosis methods of identifying persons with mental illness
Traditional mental illness healers have used several procedures and methods to diagnose persons with mental illness and other illnesses. These methods are physical observation of the patients, asking the patients’ relatives or families, use of religious books (e.g., Kitab), and herbal medicines. The religious books are called (KitabUruk (book of traditional healers), KitabAbumeshar, KitabAlusul, KitabObsubuhan, and KitabAlherar. These books (Kitab) have different purposes in order to diagnose, to identify the causes, and also treat the patient’s problems. The following extracts show how traditional healers identify a mentally ill person:
As a traditional healer, I use different herbal medicines that a person can use in different ways such as mixed with water for washing, cream, mixed with water for washing drinking and eating. In addition to herbal medicinal, sometimes I use KitabAlherar to diagnose, to now and treat the patient’s problem.(Participant AM)
When the patient comes to me, first of all, I look at him/her behavior carefully before diagnosis as a mental illness. At this time, the patient shows signs and symptoms of mental illnesses such as laughing and crying without any reason, smell very bad, he/she cannot manage his/her body, he/she talk alone and sometimes he/she doesn’t know what we talk about and his/her talk. When I see all these signs on the patient, then, I know it is sulmajinun or maarata (madness). Furthermore, I interview the patient’s relatives and parents about the illness, its cause, when, and where the illness was started before concluding on the specific nature of the mental illness. In addition to this, I use traditional and religious books (kitab) specifically kitabAlhusul to clearly diagnose and treat the patient.” (Participant MI)
As a traditional healer, first I ask his/her family to check if the patient is able to talk with me and his/her with his/her relative's. In this case, his/her relative’s or parents speak about patient’s feelings and pains. I also use visually examining of the patient’s appearance and its probable cause to determine the problem. Then, I check it in front of the patient using a book(Kitab) or different techniques in order to determine whether his/her family has mental illness issues or not. Sometimes the information that gathered from patients are not true, and they do not helps to diagnosis his/her illness because sometimes mentally ill patients are talking and give unrelated information. But this kitabcan tell me the real causes and treatment methods of the patient’s problems. Therefore, I observe the patient's behavior and ask the patient’s relatives and family for additional information about the illness before I conclude about the causes of the mental illness (kitab).” (Participant JM)
I ask the family members who brought him to describe the symptoms so that I can rule things out.Then, based on the information, I can determine what is worrying the person, and what are its treatments. Mostly, there will be one or two key symptoms that the patients tell me exactly about what the illness is and about whether or not its causes is by poisoning and ashes. Therefore, if the patient has relatives or parents, I ask them about the patient’s illness. Otherwise, I use traditional herbs and other methods like religious books to diagnose as well as treat the patient’s problems.” (Participant AK)
There are different kinds of diagnostic methods that are used to diagnose patient’s problems such as traditional books (Kitab), dream, and other herbs. Sometimes if Allah tells me in the dream about the patient’s causes of illness and its treatments (herbs), directly I apply that herbs to diagnoses and treat the patient’s problems. Sometimes, I use traditional bones together with the dreams because sometimes the dream will tell me about the person who is sick even before he/she arrived and also the dream can tell me what kind of sickness the person is suffering from.”(Participant MM)
Sometimes I used my knowledge and experience to diagnosis the patient’s problems. Because, I know what kind of illness it is when I observe the patient's behavior, and I also used herbal medicine that is used to now the problem of the patent. Different types of medicinesare used some of which I prepare for the patient to eat depending on the state of the individual. First, I ask the patient’s name and his/her mother’s name to diagnosis his/her illness.”(Participant MI)
Generally, the data obtained from the traditional healersin-depth interview revealed that patient observation especially physical examination of the patient and asking patient’s family to get full description about the current condition and history of the illness. Besides, some traditional healers first ask the patient’s name and his/her mother’s name. Then,the healer determinesif it is related to mental illness.
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Traditional healing practices to treat mental illness
Traditional healers get the patients through either referralfrom modern health institutions or some traditional healers have their own drug shops where they sell herbs and other remedies in Assosacity and around it. One of the traditional methods used to treat patients with mental illness is indigenous herbs. This involves giving different herbal preparations taken from different plants’ root, bark, and leaves.According to participants, most individual with mental illness are treated by traditional ways. Herbsare used with mixed soft porridge and others drinks. The following narratives illustrate how indigenous healers treat mentally ill persons.
Firstly, when the patients who have severe mental illness come to me to get treatment, the patient takes shower, and then I make herbal medicine for drinking by mixing with soft porridge.I also make herbal medicine mixed with water and used for bathing and steaming. However, this treatment is given rarely.Most of the time, I give herbal medicine mixed with soft porridge which should be eaten in the morning, afternoon and evening and I even prepare herbal medicine for use during steaming.” (Participant JM)
“When the patient comes to me to get treatment, the first thing that I do is to give for the patient an order to take a wash and eat. After I gave this wash and eat orders of herbs, then I have to give for the patient some herbs that I have boiled to inhale, and I give a mixture that he/she has to take (orally) again. Following those procedures, I give him some special creams to paint all over his body as well on his/her brain because the mental illness distributed in all body parts are connected to the brain function. For example, I have seen patients who developed severe mental illness beat on their legs. Therefore, as traditional healer, I used and I follow the above steps to treat the patients in our community. However, these steps differed according to the patients' problems and their diagnosis.” (Participant MI)
Sometimes, I give herbal mixtures which the patients will drink and others times which they will use to wash before they eat the medicine. For instance, sometimes, there is a special kind of herbs that we can burn and the personwho have eye evil/Buda will have to breathe the smoke to treat the patient’s illness. However, the herbs that I used to treat the patient's illness depend on the causes and severity of illness. (Participant MM)
Allah also reveals some treatments to me in different ways..Sometimes I will get it as a vision, or sometimes I can immediately fall asleep and then I will dream about the patient’s problem . . . or through other people whom he sends to me. He could use other people to show me what specific treatments to use to treat specific diseases. In addition, burning herbs which is traditionally known in the community is used to treat the patients with mental illness. The patients have to sniff these herbs through his/her nose, then it goes straight to the brain awaking brain sense of the patients and they also used to peace and harmony, purifying and banishments of evil intrusions.”(Participant AI)
Some wild animals are used to treat patient’s problems in a different way in our community. For instance, to treat severely mentally ill people, I use medicine prepared from the brain of hyena because it’s very important to treat mentally ill patients. This can take according to the causes and severity of the patient’s illness with other medicine. During this time, when I treat the patients, I don’t use these things only. In our community, Dua is the most important and common treatment of any illness in our community, especially if the illness is caused by evil spirits.” (Participant AK)
I can use different types of medicines, some of which I prepare for the patient to eat, some I make it for the person to be steamed depending on the individual age, illness, cause of illness symptoms of illness that patients show.” (Participant AM)
In addition to traditional herbs, divination bones which are made from different wild animals such as hyena, snake, leopard, tiger, and hinging dog are used to treat mentally ill persons.