title: Unravelling the spirits' message: a study of help-seeking steps and explanatory models among patients suffering from spirit possession in Uganda.
abstract: As in many cultures, also in Uganda spirit possession is a common idiom of distress associated with traumatic experiences. In the DSM-IV and -5, possession trance disorders can be classified as dissociative disorders. Dissociation in Western countries is associated with complicated, time-consuming and costly therapies. Patients with spirit possession in SW Uganda, however, often report partial or full recovery after treatment by traditional healers. The aim of this study is to explore how the development of symptoms concomitant help-seeking steps, and explanatory models (EM) eventually contributed to healing of patients with spirit possession in SW Uganda. Illness narratives of 119 patients with spirit possession referred by traditional healers were analysed using a mixed-method approach. Treatments of two-thirds of the patients were unsuccessful when first seeking help in the medical sector. Their initially physical symptoms subsequently developed into dissociative possession symptoms. After an average of two help-seeking steps, patients reached a healing place where 99% of them found satisfactory EM and effective healing. During healing sessions, possessing agents were summoned to identify themselves and underlying problems were addressed. Often-mentioned explanations were the following: neglect of rituals and of responsibilities towards relatives and inheritance, the call to become a healer, witchcraft, grief, and land conflicts. The results demonstrate that traditional healing processes of spirit possession can play a role in restoring connections with the supra-, inter-, intra-, and extra-human worlds. It does not always seem necessary to address individual traumatic experiences per se, which is in line with other research in this field. The study leads to additional perspectives on treatment of trauma-related dissociation in Western countries and on developing effective mental health services in low -and middle-income countries.
authors.affiliation: Netherlands Institute for Forensic Psychiatry, The Hague, The Netherlands ; Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: van Duijl
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands ; Centrum '45, Oegstgeest, The Netherlands.
authors.forename: Wim
authors.initials: W
authors.lastname: Kleijn
authors.affiliation: Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands ; Boston University School of Medicine, Boston, USA.
authors.forename: Joop
authors.initials: J
authors.lastname: de Jong
keywords: Dissociative disorders; Explanatory models; Help-seeking; Spirit possession; Traditional healing; Traumatic experiences; Uganda