ACADEMIA Letters

Spiritual Sickness: A New Perspective and Approach to

the Treatment of Psychosis
Rebecca M. Rojas

Introduction
Spiritual Sickness
Man’s attempt to understand and classify phenomenological experiences that cross the
boundaries of the general consensus of what constitutes normalcy has produced varying per-
spectives on what these experiences mean and how to work with them. Modern “civilized”
man classifies these experiences as stemming primarily from biological and or psychological
deficiency, while societies that embrace more “archaic” modes of classification interpret these
episodes as being indicative of transformation and utilize the experience as a liminal space for
not only healing but for transfiguration.
Unlike modern psychiatry’s view on psychoticism as a condition with little to no recourse
other than symptom management, societies with shamanistic spiritual beliefs rather equate
a psychotic break to a fever, signaling not illness as an end-all but rather the beginning of a
process, essentially spiritual growing pains. In fact, many cultures do not view this process as
a “sickness” in the Western sense of the word, but rather an unpleasant condition forcing one
to have to face an unsettling truth. “At first he is apparently robust, but in the process of time,
he begins to be delicate, not having any real disease but being really delicate. He dreams of
many things and his body is muddled and he becomes a ‘house of dreams”’ (Calloway, 1868,
p. 260).
Rather than viewing this process as leading to the finality of being lost to the depths of the
unconscious, the shaman recognizes that the psychotic break is a platform for resolving re-

Academia Letters, July 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0

Corresponding Author: Rebecca M. Rojas, [email protected]

Citation: Rojas, R.M. (2021). Spiritual Sickness: A New Perspective and Approach to the Treatment of
Psychosis. Academia Letters, Article 1724. https://doi.org/10.20935/AL1724.

1
pressed or unaddressed issues. Many of these concerns revolve around relational issues with
other family or community members (this can stem from several different areas including
trauma, grief, or guilt revolving around negligence of ancestral rituals). “Becoming a diviner
is not only an entrepreneurial means of earning a living but also a means of resolving interper-
sonal problems in the family” (Hirst, 2005, p. 7). Because of cultural norms and rules, it is not
always acceptable for these complaints to be made openly. In these cases, psychosis provides
a culturally acceptable way of airing out grievances, to those whose voice has otherwise been
muffled.
It is believed with the proper ritual cleansings a person will not only be cured but will come
out of the experience as a shaman themselves. Here rather than pity the patient and outcast
them from the community, the patient is elevated to a venerated figure within the community.
It can be argued along lines similar to Hammond-Tooke who theorized that Nguni diviners
were subject to the ukuthwasa affliction, resulting in their emergence as duly recognized and
empowered psychic sensitives with powers of intuition that are routinely and recursively em-
ployed in divination and healing. (Hirst, 2005, p.7). This transformation of the patient to a
healer is similar to the Jungian idea of the wounded healer. The shaman’s approach is con-
gruent with psychodynamic theory, which asserts that strong feelings and emotions that are
not dealt with consciously are repressed into the unconscious where they return to terrorize
as inner demons.

Symptomatology of Spiritual Sickness VS Psychosis

The key features that define psychotic disorders per the DSM-5 are delusions, hallucinations,
disorganized thinking, grossly disorganized or abnormal motor behavior (including catatonia),
and negative symptoms. These same features can be found in a person undergoing an episode
of spiritual sickness. Much like the medical model’s symptomatology of psychosis, spiritual
sickness shares several of the same characteristics. Common symptoms include visions, vivid
dreams, headaches, and somatic complaints (Kalweit, 1988, 2000, & Turner, 1992).

Precipitating Factors
Trauma appears to be a consistent precipitating event in both spiritual sickness and DSM-5
schizophrenic spectrum disorders and mood disorders featuring psychotic features (Lataster,
Myin-Germeys, Lieb, Wittchen & Van Os, 2011; Steel, Fowler & Holmes, 2005). Events
leading to spiritual emergencies can range from relatively mild experiences such as rejection
from a romantic partner (Hirst, 2005, p. 9) to more extreme events such as witnessing the

Academia Letters, July 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0

Corresponding Author: Rebecca M. Rojas, [email protected]

Citation: Rojas, R.M. (2021). Spiritual Sickness: A New Perspective and Approach to the Treatment of
Psychosis. Academia Letters, Article 1724. https://doi.org/10.20935/AL1724.

2
death of several family members (Hirst, 2005, p. 9). Other instances of emotionally upsetting
events revolve around taboos specific to the culture. These taboo violations often hit hardest
the people who have the least power in the community. For example in the case of “Ms. G”, a
45-year-old married Xhosa woman who developed psychotic symptoms after discovering her
husband was having extramarital affairs (Hirst, Cook & Kahn, 1996, p. 271-272). Another
instance is the case of a Ndembu woman who developed the Ihamba condition (a form of
spiritual sickness where a person believes a human tooth is traveling through their body caus-
ing psychological and somatic pains). The Ihamba ritual covered by Edith Turner in 1985,
describes how the condition develops as a result of pent-up feelings of resentment towards
family members. In fact, an integral stage of the healing process is called mazu, which can be
translated as “words”, or the “coming out with the grudges” (Turner, 1985, p. 66).The latter
two cases present subjects whose protest to their experience would not normally be tolerated
outside of this context of being “mad.”

Utilization of Pathological Defense Mechanisms

Psychiatrist George E. Vaillant created a 4-tier hierarchy of defense mechanisms ranging from
pathological to mature defenses (Vaillant, 1994). From a psychodynamic perspective, a per-
son in the throes of a psychotic episode would be most likely functioning between Level 1
and 2, pathological and immature defense mechanisms respectively. Level 1 (the least adap-
tive of the hierarchy) consists of psychotic denial and delusional projection. Psychotic denial
can be seen in cases of repressed trauma. Often times the person experiencing the onset of a
psychotic episode does not appear to acknowledge the precipitating factor that has to lead to
the psychic upheaval. When a patient comes in to seek treatment for spiritual sickness, rarely
will they report having experienced a recent trauma or upsetting life event. Rather they focus
on reporting the externalizing symptoms, whether they are bodily pains, sleep disturbances,
or hallucinations. This perception of externalizing feelings into physiological symptoms can
be seen as delusional projection. For example, the 45-year-old Xhosa woman mentioned pre-
viously (Hirst et al., 1996, p. 271-272), developed a delusion of having worms in her vagina
after discovering her husband had been unfaithful. When seeking treatment, she did not ini-
tially report the factors leading to this condition, but rather sought medical assistance for a
perceived bodily disturbance. Interestingly enough, the sexual nature of her delusion masked
the true feelings of disgust and shame revolving around her husband’s infidelity. Although
the symptoms themselves are a delusion, they are highly symbolic of the reality she was ex-
periencing.
In addition to reporting the somatic sensation of worms in her vagina, she also reported

Academia Letters, July 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0

Corresponding Author: Rebecca M. Rojas, [email protected]

Citation: Rojas, R.M. (2021). Spiritual Sickness: A New Perspective and Approach to the Treatment of
Psychosis. Academia Letters, Article 1724. https://doi.org/10.20935/AL1724.

3
being visited daily by a demon posing as her husband “commanding her to wash his clothes
and clean the house.” (Hirst et al., 1996, p. 272). The inability to voice her resentment at
having to maintain her marital and domestic obligations to a man who was being unfaithful
to her, lead her unconscious to project these sentiments as a “demon.”

Shamanism‘s Approach to Treatment

The shaman does not view the patient’s state of mind as being detached from reality, but rather
as a reflection of an internal spiritual crisis requiring as much respect and acknowledgment as
physiological illness. “If you bar the way to the Itongo (ancestral spirits that cause the spiritual
sickness), you will be killing him. For he will not be an inyanga (diviner), neither will he be a
man again; he will be delicate and become a fool and he will be unable to understand anything”
(Calloway, 1868, p.261).
Shamanic intervention can be divided into 2 primary stages, including a 3rd optional stage.
The first stage is diagnosis within the socio-cultural context. This first stage resembles a
modern psychological intake. Rather than make a diagnosis using DSM-5 or ICD-10 criteria,
the shaman takes into account family conflicts, recent trauma, or emotional upsets that have
preceded the onset of symptoms. The shaman acts as a safe third party, capable of voicing the
concerns the patient was unable to, due to social class.
It is during the 2nd stage of treatment, that clinicians and shamans diverge on different
paths. Because Western medicine is primarily concerned with empirical treatments that can be
concretely measured, clinicians focus on that which can be physically observed and measured;
the brain. Research suggests that there is a physiological component to psychosis. However,
what research has not been able to prove is whether this physiological deterioration is the result
of psychological breakdown, or whether the physiological condition precedes psychological
symptoms.
Rather than attempt to convince the patient that what he or she is experiencing is not true,
the shaman accepts the patient’s experience and begins to treat them within the context of
their delusions or hallucinations. In the case of Mrs. G., the married Xhosa woman discussed
earlier, rather than focus treatment with the use of antipsychotics, the shaman acknowledges
the woman’s concerns about her husband’s infidelities and agrees with her that she has in-
deed been bewitched. The healer recognizes that the patient’s delusions and hallucinations
are “condensed expressions of her social conflicts” and as “increasingly desperate and unsuc-
cessful attempts to resolve the social conflict of her domestic situation.” (Hirst et al., 1996,
p.273-274).
Treatment begins with the patient being removed from their domicile and isolated from

Academia Letters, July 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0

Corresponding Author: Rebecca M. Rojas, [email protected]

Citation: Rojas, R.M. (2021). Spiritual Sickness: A New Perspective and Approach to the Treatment of
Psychosis. Academia Letters, Article 1724. https://doi.org/10.20935/AL1724.

4
the rest of the community. During this time the patient is washed with several herbs meant
to cleanse the patient externally of any witchcraft. Afterward, the patient begins a special
diet (which excludes heavy foods such as meat, milk alcohol, or tobacco) and begins to ingest
“ubulawu” plants used to increase and clarify dreams. (Hirst, 2005, p.16; Sobiecki, 2012).
From a clinical perspective, this ritualized process is similar to inpatient treatment of psychi-
atric patients; the primary difference is the context in which the patient is being treated. The
use of ubulawu plants, and the subsequent “copious dreaming” (Hirst, 2005), that results from
taking it, leads to bringing forth repressed unconscious content. The shaman acts, much the
same as the psychoanalyst, pulling forth, interpreting, and helping the patient reincorporate
these painful feelings and fragmented components back into the psyche.
A final but not necessary stage in the shaman’s treatment is training the patient in becoming
a healer themself. Having suffered and survived this experience, the patient is now viewed
as a liminal being, which has been on both sides of “madness” essentially. The patient goes
from invalid to an elevated position as a healer within the community. This again is not much
different from the Jungian concept of the wounded healer. Many times those who are drawn
to mental health professions are those who have suffered from their own bouts with mental
health issues. This change in status and act of giving back to the community is healing in
itself.

Transition from Pathological Defenses to Mature Defenses

As discussed earlier, psychotic patients begin by utilizing pathological defense mechanisms
such as repression, somatization, projection, and dissociation. The shaman by means of ritual
works to bring forth repressed content, while at the same time treating the patient’s complaints
of somatic symptoms, by washing the body with “magical” plants said to remove maladies.
Finally, if inducted as a shaman themselves, the patient is provided with a new more mature
defense mechanism “sublimation”. The patient’s predisposition towards “magical thinking”
can be subverted into a culturally acceptable and productive use.

Spirituality as a Means to an End

The cases analyzed throughout this paper have been exclusively from African countries, how-
ever, these techniques can be adapted to any culture. For example, the third stage proposed in
this paper has been documented with Israeli female survivors of trauma. These women were
taught to practice the spiritual practice of “channeling” as means of treating dissociation, with
relatively positive results in regards to the management of their PTSD symptoms. (Stolovy,

Academia Letters, July 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0

Corresponding Author: Rebecca M. Rojas, [email protected]

Citation: Rojas, R.M. (2021). Spiritual Sickness: A New Perspective and Approach to the Treatment of
Psychosis. Academia Letters, Article 1724. https://doi.org/10.20935/AL1724.

5
Lev-Wiesel & Witzutum, 2014). Serious mental illness such as schizophrenia should not be
taken lightly, however, it should be taken into consideration, that the current mode of treatment
being provided to persons suffering from psychosis, is incomplete. Treating these disorders
solely on the basis of biology and with the use of antipsychotics disregards the role of culture
and the social context where these symptoms arise. Rather than viewing spirituality as a hin-
drance to science, it should be viewed as a means to an end. Incorporating the belief system
of the patient, regardless of how bizarre, not only lowers the patient’s defenses against the
clinician but may also provide a fecund environment for healing.

Keywords: shamanism, psychodynamic, spirituality, multiculturalism, African, Jungian,

ethnography, anthropocentrism

References
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Academia Letters, July 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0

Corresponding Author: Rebecca M. Rojas, [email protected]

Citation: Rojas, R.M. (2021). Spiritual Sickness: A New Perspective and Approach to the Treatment of
Psychosis. Academia Letters, Article 1724. https://doi.org/10.20935/AL1724.

6
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Academia Letters, July 2021 ©2021 by the author — Open Access — Distributed under CC BY 4.0

Corresponding Author: Rebecca M. Rojas, [email protected]

Citation: Rojas, R.M. (2021). Spiritual Sickness: A New Perspective and Approach to the Treatment of
Psychosis. Academia Letters, Article 1724. https://doi.org/10.20935/AL1724.