Zulu Indigenous Practitioners Diagnostic and Treatment Methods - NW Sokhela

INDEXCONTENTS CHAPTER 1: INTRODUCTION PAGE NO(S) I 1.1 1.2 1.3 1.4 1.5 1.6 General conceptual introduction on indigenous practitioners TheQries of illness in underdeveloped societies with particular reference to Zulu Society. -".. Diagnostic and treatment methods with particular reference to Zulu Society Motivation Aim Hypotheses 1 3 9 1i7 • 17 IS CHAPTER 2: METHOD 21 2.1 2.2 2.3 2.4 Subjects Apparatus Procedure Statistical techniques 21 Zl 21 24 CHAPTER 3: RESULTS A ~ D DISCUSSION 26 3.1 3.2 3.3 3.4 3.5 Key Practitioners biographical data Diagnostic methods Treatment methods Inter-practitioner consistency 26 26 31 33 34 CHAPTER 4: CONCLUSION CHAPTER 5: SUMMARY SISt IOGRAPHY APPENDICES 37 39 49 53 11 ACKNOWLEDGEMENTS The author wishes to express his thanks to the following people for their kind and valued assistance in making this research project possible. My Supervisor, Professor S D Edwards, Head of Department of Psychology, University of Zululand for his invaluable suggestions, constructive criticism, and endless patience throughout this study. My Co-Supervisor Miss N V Makunga, senior lecturer in the Department of Psychology, University of Zululand, for her keen interest and consistent encouragement throughout the study. Mr G F Borsten, lecturer, Department of Psychology, University of Zululand whose knowledge of statistics and constructive suggestions made this work a reality. My colleague, Mr K S Mfusi for his interest and support. Mrs T Crous for her patience in typing and re-typing this project. Mr T N who sacrificed his study time to accompany me as a confederate patient when we visited the practitioners. All those who participated as subjects (i.e. practitioners) and without whose co-operation this project would not have been possible. My parents who were always ready to lend a hand (financially and morally) whenever needed. i j i ABSTRACT As indigenous healers are so important lo th" health of many not only in South Africa but also throughout the world, a closer, scientific look at their practices is needed. Again, there is a tendency of the majority of South Africans (especially the Blacks) to consult both western oriented mental health, services and indigenous healers. Various prominent mental health professionals in South Africa have appealed that greater recognition be given to and greater use made of the skills of indigenous healers in the treatment of persons who could benefit from the services. It is for these reasons that this research on indigenous healing was undertaken. The purpose of this research was to investigate diagnostic and treat- ment methods used by a random sample of indigenous healers from the rural Mtunzini district in Kwa-Zulu, and to ascertain whether there is ----- any consistency (inter-practitioner) in their diagnostic and treatment methods. Twelve practitioners were each invited by a researcher and a confederate with a problem requiring treatment. Diagnostic and treatment procedures were tape recorded. Standardized data regarding diagnosis,cause symptomatology, treatment and prognosis, including practitioners' biographical data was collected. In order to ascertain inter-practitioner consistency, practitioners were asked to rank order six diagnosis and six treatment procedures ascertained to be the most frequently occuring among all twelve practitioners. The results emphasized the three distinct basic categories of Zulu indigenous practitioners viz. doctors (izinyanga), diviners and faith healers (abathandazi). Of these categories,the diviner deserve special mention as the results consistently portrayed her as a superior specialist e.g. an elderly, educated, female preserver and provider of traditional Zulu culture. Diagnostic and treatment procedures used by the practitioners were found to be based on dualistic levels viz. natural and supernatural. As suggested by previous studies and also supported in this research, more integration of Western and African oriented mental health subsystems was recommended. v SAMEVATTING Aangesien volksgeneeskundiges so belangrik is vir die gesondheid van mense, nie net in Suid-Afrika nie maar oor die hele wereld, is h nadere, wetenskaplike ondersoek na hulle praktyke nodig. Daar is egter h neiging onder die meeste Suid-Afrikaners (veral Swartmensel om sowel Westersgeorienteerde geestesgesondheidsdienste as volksgenesers te raadpleeg. Verskeie vooraanstaande professionele persone op die terrein van geestesgesondheid in Suid-Afrika het h beroep gedoen' vir groter erkenning aan en groter gebruikmaking van die vaardighede van volksgenesers in die behandeling van persone wat by hul dienste kan baat vind. Dit was om hierdie rede dat die ,navorsing oor volksgeneeskunde onderneem is. Die doel van hierdie navorsing was om ondersoek in te stel na die diagnoserings- en behandelingsmetodes wat gebruik word deur h streekproef volksgenesers van die plattelandse distrik Mtunzini in Kwa-Zulu en om vas te stel of daar enige konsekwensie is (onder verskillende genesersl wat diagnoserings- en behandelingsmetodes betref. Twaalf genesers is afsonderlik uitgenooi deur die navorser en h medewerker met h probleem wat aandag geverg het. Die diagnoserings- en behandelingsmetodes is op band opgeneem. Gestandardiseerde data betreffende diagnose, veroorsakende simptomatologie, behandeling en prognose, asook die geneser se biografiese data is versamel. Ten einde die mate van konsekwensie onder die genesers vas te stel, is die genesers versoek om ses en ses vi behandelingsprosedures wat geblyk het die algemeenste in gebruik te wees onder die twaalf genesers, in voorkeurvolgorde te plaas. Die result ate het die drie duidelik onderskeibare kategorH; van volksgenesers beklemtoon, naamlik doktors (izinyanga), waarseers (izangoma) en geloofsgenesers (abathandazi). Van hierdie drie kategoriee verdien die waarsegster spesiale vermelding aangesien die resultate haar deurgaans uitgebeeld het as n superieure spesialis, byvoorbeeld n bejaarde, kundige, vroulike instandhouer en draer van die tradisionele Zulukultuur. Daar is gevind dat die diagnoserings- en behandelingsprosedures wat deur die genesers . gebruik word gebaseer is op twee vlakke, naamlik die natuurlike en bonatuurlike. Soos deur vorige ondersoeke vermeld en deur hierdie navorsing gestaaf is, is groter integrasie van Westerse met Afrika- georienteerde geestesgesondheid-subsisteem aanbeveel. CHAPTER 1 1 INTRODUCTION 1.1 General Conceptual Introduction on Indigenous Practitioners Despite increasing recognition of highly specialized modern medical science and modern doctors, there are many underdeveloped countries especially in the Third World where indigenous practitioners are the focal point around which the physical, social and religious lives of many people revolve. Such indigenous practitioners have been described by a variety of terms in the literature e.g. Shaman, medicine man, and • folk healer. Such practitioner have been described as follows : "A Shaman is a religious healer, or medicine man found among all primitive people since earliest history". (Universal World Reference Encyclopaedia 1945, p. 4456). " the medicine man is not only the primitive doctor, but he is the diviner, the rainmaker, the prophet, the priest, and in some instances the chief or king" (Landy 1977, 416). "Although folk healers may assume prestigious positions as priests, rulers, or university presidents, many specialize solely in healing. Some healers are sorcerers, but the vast majority work toward .non evil ends. A person may be recruited into a folk-healing role through inheritance from a parent or through a hereditary priesthood; selection by parents, relatives tribal 2 elders. religious sodalities or gods and spirits, self selection by apprenticing oneself to 2 healer. the undergoing of a profound emotional experience involving awe-inspiring symptoms, or receiving a divine call through a dream, a trance or a hallucination; self-dedication to a healing cult, often after having undergone a cult cure; possessing a physical or psychological disability, miraculous self-discovery; and by possessing exceptional personal traits, such as high intelligence, courage, story-telling ability, emotional control, and good judgement". (Kaplan and Sadock 1981, p.89). As is evident in the above definitions, such practitioners have traditionally performed multi-faceted roles e.g. medical, cultural, religious, divinatory, in their respective communities. It is for this reason that the broad term "practitioner" is used in the present study. The term "indigenous", a similar broad conceptual term implies both cultural universality and relativity whereas there may be many common elements to the roles of practitioners operating within different cultural millieus, such practitioners are essentially both preservers and providers of culture, within the particular cultural settings in which they work. One reason for the continuing power of such indigenous practitioners is that many underdeveloped countries throughout the world have broad 3 concepts of illness and health, only some of which are recognized by modern empirically oriented medical science. 1.2 Theories of illness in underdeveloped societies with particular reference to Zulu society Murdock et al (1980) view explanations of illness current among most of the people of the world as having little in common with those recognized by modern medical science and as relating much more closely to the ideology of primitive religion, from which they are derived. These so called "primitive medical systems" have been described by Conco (1972) as follows : , "The concept of "primitive medicine" is derived from anthropological concept of "primitive culture". Generally speaking there is no such thing as primitive mind and primitive man is potentially like modern man (Goldneweiser 1946). Primitive medicine is found in all ages in the Orient as well as in Ancient Greece. Egypt and Mesopotania; in the middle ages as well as in modern industrial society. A system of medicine is produced by every culture. In medicine a department of knowledge and practice dealing with disease and its treatment, man uses language or symbols when he observes, describes or thinks about the world of disease. The . grouping of these observations, descriptions and thoughts leads to certain conceptual orientation. Primitive medical systems vary from culture to culture from epoch to epoch, from group to group and even from individual to individual. But all these systems can be examined and analyzed from a certain interpretive point of view with a standard evaluation, a point of view defined by the canons (p.304) • of reasoning adopted as a framework". Indigenous African views on illness and health in general and mental , illness and health in particular are holistic and cosmological in emphasis (see 1977). Traditional beliefs and practices concerning illness and health are still widely followed particularly in rural areas of South Africa. This is understandable in view of the fact that these beliefs and practices form a coherent system that has maintained individual and social equilibrium for generations. Central to an understanding of these practices is an understanding of traditional African religion, which embodies the essence of all religions with its reverence for elder kinsmen, both living and dead. This African spiritual component of being has been eloquently described by Holdstock (1981, p. 128): "The relationship with the ancestors and through the ancestors with with God permeates all being". Ancestral reverence is the primary factor, then, associated with the continued good health. Sorcery or ubuthakathi, on the other hand refers ultimately to "the manipulation and expression of anger and the desire to destroy" (Berglund 1976, p. 295). It represents all the forces of evil and illness. With the concept of thanatos, freud has similarly given 5 recognition to human destructiveness and violence as the most basic cause of all illness. Traditional African religions and magical theories of illness and health are inextricably interlinked as evident in the popular beliefs that man is most vulnerable to sorcery once for some reason the ancestors are "facing away". (Berglund 1976), and should a man then strengthen himself and his'family by performing appropriate rituals to the ancestors, this will ensure continued good health. The essentually dualistic conception of the basic philosophy of African medicine has been clearly noted by Conco (1972). He quotes a historian of medicine Catiglioni (1947) as follows : "The medicine of the most ancient periods was at first essentially empirical (natural); on this basis magic medicine (supernatural) was developed. This popular medicine stands in close relation to the observation of nature on the one side (natural) and to magical beliefs on the other clear statement of the dualism medical systems ••• ". (p. 304). of " This is a "primitive Weisz (1972), Torrey (1972), Conco (1972), Ngubane (1977) and Murdock et al (1980) have all attempted taxonomies of theories of illness in underdeveloped societies. They all make a distinction between theories of natural and supernatural causation. Murdock et al (1980) in particular have developed a a comprehensive classification' of theories of illness in underdeveloped societies 6 throughout the world. They make a basic distinction between theories of natural and supernatural causation which is 'similar to the umkhuh1ane : ukufa kwabantu distinction made by Ngubane (1977), working among the rural Nyuswa valley in Zulu people near Durban. Umkhuh1ane refers to the explanation of illness by natural causation. This category is recognized by modern medical science with its empirical traditions e.g. as in the case of infection, stress, organic deterioration and accident. (Murdock et a1 1980). Isithuthwane or epilepsy and isifuba somoya or asthma are relevantly classifietl in this category. Ukufa kwabantu on the other hand, attributes illness to supernatural causation. Ukufa kwabantu literally refers to disorder of the African people. To quote Ngubane (1977 p. 24). "The name Js used mainly because the philosophy of causality is based on African culture; this means not that the diseases or rather their symptoms, are seen as associated with African people only, but that their interpretation is bound up with African ways of viewing health and desease". 1.2.1 Theories of Natural Causation This can be seen as any theory, scientific or popular which accounts for the impairment of health as a physiological consequence of some act or experience of the victim in a manner that would not seem unreasonable to modern medical science (Murdock et a1 1980). ,Old age, ingestion of poison, etc. may all be recognized as natural causes of sickness/illness. 1.2.2 Theories of Suoerm,tural Causation These ascribe the illness causatiion to external supernatural forces. Such theories are. particularly used in explaining uncommon or out-of- the-ordinary types of illness. Conco (1972) feels that such theories are made use of at a point where ordinary treatment and explanation have failed. Within the supernatural division of the taxonomy of Murdock , et al (1980), there are three major explanations of supernatural causation, namely animistic, magical and mystical theories. These three categories can best be conceptualized as three differeAt traditionally acceptable attributions made by the afflicted to explain the affliction. The tradition ukufa kwabantu theories can be subsumed within this supernatural division as follows: Animistic theories ascribe the disorder to the behaviour of some personalized supernatural agent such as a spirit or god, for example : abaphansi basifulathele - withdrawal of protection of ancestral shades mostly caused by disharmony within the home. ukuthwasa - a "creative illness" following the calling by the ancestral shades to become a diviner; or a religious conversion experience. Magical theories attribute the disorder to the covert action of a malicious human being who employs magical means to injure his victim, r for example: idliso - pOlsonlng attributed to sorcery - disorder attributed to stepping over harmful concoction of a sorcerer. a Mystical theories explain disorders in terms of an automatic consequence to some act or experience of the afflicted person for example: umnyama umkhondo omubi - experiencing illness or adversity because of contact with places or people immediately associated with the major life events, e.g. birth, death and menstruation. - a dangerous track, or ecological health hazard such as lightning. Edwards et al (1982) view these theories as forming the cornerstone of traditional African cosmological, religious, social and moral world views of good and evil, health and sickness. While the focus of this study is on traditional Zulu speaking people variations of these theories are common to most traditionally oriented African peoples. To explicate the nature of the supernatural theory, and its basic tenets, Conco (1972) has schematically represented this as follows : (1) Person A wants another person 8 to be afflicted by some sickness which would lead to 8's death. (2) A consults traditional doctor D, who agrees or refuses to help A. 9 (3) If doctor D agrees to help A, he consults the supernatural forces or the spirits of destruction or evil. (4) The spirit S shows D the medicine or concoction to use on B. (5) D gives A the medicine with appropriate instructions for use on B. (6) A uses the medicine on B. Various agencies may be used by A e.g. using certain animals - riding on a baboon, sending the "short med' - "Mkhovu", "Tikoloshe", or sending a bird, a snake etc., or lightening and hail storms. Then B becomes sick, or his family, (domesticated) become sick. The sequence may be indicated as below. or his animals A D =Individual Human Being =Anthropomorphic element = Traditional doctor =Mediator in touch with the '''Natural'', and with the S ="Supernatural" which may be (i) Forces of Good, Health, and Prosperity, or (ii) Forces of Evil, Disease and Destruction. I B =The victim. For more detailed discussions on these traditional Zulu views of illness refer to (Coneo 1972, Ngubane 1977, Edwards et al (1982). 1.3 Indigenous practitioners diagnostic and treatment methods with particular reference to Zulu society Diagnostic procedures common among most indigenous healers across the world involve repetitive rituals that involve complex social negotiations and interactions. Some indigenous diagnosticians use astute psychological techniques to gather information from patient and members of their social network. After diagnosis, the indigenous practitioner, then plans a course of treatment. Indigenous practi tioner' s procedures for generally incorporate the patient and his social group as a whole into the treatment program. Kaplan and Sadock (1981) point out that dramatic healing rituals entail the active, public participation of the patient, the members of his social network and the healer. Through the ·use of powerful symbols and impressive, impersonal roles, the healer conducts the healing ritual in a supernatural . context. These rituals are in sharp contrast with Western treatment techniques which often take place in secluded quiet rooms. In Africa particularly, with its essentially third world population, indigenous practitioners are to be found in almost every cultural group. These practitioners are given particular names or labels in accordance with the type of treatment methods they use. There are traditional doctors (-nyanga - Zulu; -gqira - Xhosa, -mganga Swahili; -ngaka - Sotho, ogaissa - Amharic) faith healers, diviners and prophets. Their diagnostic and treatment methods are more or less the same as those discussed above. 1.3.1 Three basic categories of Zulu indigenous practitioners A good case can be made for there being three broad, basic categories of indigenous healers among Zulu speaking society in South Africa today, i.e. the tradition doctor (inyanga), diviner (isangoma) and 11 faith healer (umthandazi). The advent of the umthandazi can be traced to the rise of the African Independent Church movement and it has been argued that many of the traditional roles of the isangoma have been taken over by the umthandazi (Lee 1969, West 1975). 1.3.1.1 Inyanga These traditional doctors are usually male, and typically specialize in the use of herbal medicine and natural treatment methods. "A man who wants to be an inyanga ("doctor") usually gets himself apprenticed to a practising inyanga for a period of not less than a year. At the end of his training he pays his master a cow or its equivalent in money usually not less than R20 00. Sometimes a doctor passes on his skills to one of his sons, who shows an interest in medicine" (Ngubane 1977, p.102). 1.3.1.2 Isangoma The traditional diviner who is usually a.woman, shares a comprehensive knowledge of megicine with the doctor (inyanga), and qualifies after undergoing the ukuthwasa process. "A person does not choose to become a diviner (isangoma), but is chosen by her ancestors, who bestow upon her clairvoyant powers. A neophyte learns about medicine from a qualified diviner to whom she is apprenticed for some time, but in addition some medicines are said to be revealed to 12 her by her ancestors". (Ngubane 1977, p.102). The diviner is however mainly and traditionally a psychodiagnostician and priest who divines within a supernatural context through her culturally accepted mediumship with the accepted shades. 1.3.1.3 This is the general term for a faith healer and literally means "one who prays". Faith healers are professed Christians who may belong to either mission or independent churches and therefore also-typically work within supernatural context. "The power to heal is believed to come from God although in some cases it may be thought to come from God indirectly through the shades and a period of training as a healer mayor may not have been necessary". (West 1975, p.96). 1.3.1.3.1 Specialists and General Practitioners There are various specialists within their three broad categories of practitioners, for example : 1.3.1.3.1.1 inyanga yesisu 1.3.1.3.1.2 inyanga-yomhlabelo 1.3.1.3.1.3 inyanga yez III 11 1.3.1.3.1.4 inyanga yemvllla 1.3.1.3.1.5 inyanga yamakhambi 1.3.1.3.1.6 inyanga yokumisela 1.3.1.3.1. 7 isangoma sekhanda specialist stomach doctor orthopaedic surgeon heaven head rainmaker herbalist specialist in inducing pregnancy head or listening diviner 1.3.1.3.1.8 1.3.1.3.1.9 1.3.1.3.1.10 13 isangoma samathambo i 5 a ~ g o ~ a sesibuko isangoma sabalozi bone throwing diviner mirror diviner ventriloquist/whistling spirit diviner 1.3.1.3.1.11 1.3.1.3.1.12 umthandazi weSiyoni umphrofetbi fai th healer religion prophet of Zionist 1.3.1.3.1.13 umphrofethi wentambo prophet who diagnoses with a rope. Also there is often overlap within these various categories of healers, for example, a general practitioner who will refer to himself as both an inyanga and an umtbandazi. (Krige 1950, Conco 1972, Ngubane 1977, Edwards et al 1982, Hadebe 1982 Thorpe, 1982). 1.3.2 Diagnostic Methods These are mainly supernaturally oriented. Some examples follow: 1.3.2.1 ukubh<lla ngamanzi 1.3.2.2 ukubhula ngamathambo 1.3.2.3 ukubhula ngabalozi 1.3.2.4 ukubhula ngekhanda 1.3.2.5 ukubhula ngesibuko 1.3.2.6 ukubona 1.3.2.7 vumisa technique divination using water (usually in a bottle). divination using bones. divination by ventriloquism/ ancestral shade communication. divination by head through guiding ancestral shades. divination with the aid of a mirror. precognition diviner tells the patient of his illness homing in on the problem areas depending upon the degree of expressed agree- ment by patient and relatives. 1.3.2.8 ukubeka izandla laying on of hands 1.3.2.9 1.3.2.10 1.3.2.11 1.3.2.12 imibono amaphupho ukugida umthandazo 14 symbolic visions revealing the illness. dreams revealing illness. ritualistic dancing and singing divination through prayer. The following diagnostic methods are naturally oriented 1.3.2.13 1.3.2.14 1. 3.2 .15 ukulandisa ukuhlola ukubuza i.e. patient telling the prac- titioner all about his/her illness - case history. actual examining of the patient question and answer method. A practitioner asks the patients various questions pertaining to the illness. 1.3.3 Treatment Methods 1.3.3.1 Natural Methods These can also be used within a supernatural or symbolic context. Some examples follow : 1.3.3.1.1 1.3.3.1.2 ukuphalaza ukugquma induced vomitting through emetic e.g. for idliso. steaming to induce perspiration and reduce fever. 1.3.3.1.3 ukushunqisa fumigating smoke. the house with 1.3.3.1.4 1.3.3.1.5 1.3.3.1.6 ukuhogela ukutshopa inhaling treated smoke. acupuncture, usually porcupine quills. bathing cure. with 1.3.3.1. 7 ukugcaba incissions for the insertion of curative mixtures. 1.3.3.1.8 ukuncinda 15 sucking, for example, medicine from fingertips. hot 1.3.3.1.9 1.3.3.1.10 ukuth:Jl:·a ukuchatha a formenting treatment applied for example, for aching feet. enema, for example for stomach complaints 1.3.3.1.11 ukulumeka blood letting e.g. swollen ankle. for a 1.3.3.1.12 1.3.3.1.13 1.3.3.1.14 ukumoma ukuthwebula ukuqinisa draining e.g. fluid from ear with cow's horn. symbolically extracting illness e.g. through touching the, body with a goats horn, which has been treated with a particular muthi (medicine). general term commonly implying the strengthening or fortifying of the patient e.g. through incissions. 1.3.3.2 Medicinal Compounds A great variety of medicinal compounds are used, which are beyond the scope of the present paper. Refer to Bryant (1970), Ngubane (1977) for detailed expositions. Generally though medicines are divided into two basic categories (Ngubane·1977). 1.3.3.2.1 1.3.3.2.2 amakhambi amakhubalo natural remedies e.g. herbal medicines consisting of green leaves, bark, roots, stem, bulbs, fruits, flowers and seeds, used to cure somatic symptoms. medicines used in ritual symbolic context, which are classified according to colour and administered in strict serial sequence, for example given at night, sunrise or sunset and daytime. In addition such religious and ritual treatment accompany this medical treatment. 16 1.3.3.3 Religious and Ritual Treatment of Supernatural Orientation Such treatment traditionally involves a sacrifice by the head of the home in a family or group context and is directed at ensuring continued ancestral protection and good health. appeasement sacrifice. "scolding" the ancestors for misfortune. sacrifice in thanksgiving to the ancestral shades. to fortify the home against danger e.g. sorcery. the beer" ritual· communication with shades through eating and drinking. 1.3.3.3.1 ukubonga 1.3.3.3.2 ukuthetha 1.3.3.3.3 ukushweleza 1.3.3.3.4 ukubethela 1.3.3.3.5 isidlo 1.3.3.3.6 ukuchela fortifying the homestead through sprinkling and spreading of medicine by the family inyanga 1.3.3.3.7 ukukhwifa spitting at dawn to cast out evil. 1.3.3.3.8 ukuvuma public confession by an accused. 1.3.3.3.9 ukuhlanza vomiting or defecating follow- ing an emetic or purgative. 1.3.3.3.10 ukuguqula amanzi literally reinsure following "turning of water" to ancestral protection lineage sorcery (uzalo) 1.3.3.3.11 ukubuyisa a sacrifice to reintegrate a shade with the members of the homestead. (ukubuyisa idlozi). Besides the individual psychodynamic effect of performing such rituals (e.g. anxiety relief), emphasis has been put on the sociocultural and religious homeostatic effects of such ritual. This point has been eloquently put by Conco (1972, p.31O). 17 "A discussion of psychotherapeutic bases of some Arab rituals (however irrational or illogical) has shown that they pass from generation to generation and further observed that adherence to these rituals acquires some anxiety relieving and anxiety - avoiding properties through the preservation of conformity". 1.4 MOTIVATION Various prominent mental health professionals in South Africa (Le Roux .' 1973, Kruger 1974, Cheetham 1975, Burhmann 1977, Gadner 1978) have appealed that greater recognition be given to and greater use made of the skills of indigenous practitioners in the treatment of persons who could benefit from their services (Holdstock 1979). The Kwa-Dlangezwa, Ongoya area of Natal is an ideal area to investigate indigenous practitioners as this is a semi-rural area where indigenous practitioners are commonly found (Hadebe 1982). Traditional beliefs and practices and traditional practitioners are more commonly 'found in rural areas. (Vilakazi 1962, Ngubane 1977, Edwards et al 1983). 1.5 AIM The aim of the present study is two-fold : (i) To investigate diagnostic and healing methods used by random sample of indigenous practitioners in Ongoye area. the Kwa-Dlangezwa, ~ (ii) 1.6 1.6.0 18 To ascertain whether there is any consistency (intra- practitioner and inter-practitioner) in the indigenous practitioners diagnostic and healing methods. HYPOTHESES It was generally hypothesized that there are three broad basic categories of indigenous Zulu practitioners i.e. the traditional doctor (inyanga), traditional diviner (isangoma) and faith healer /'1.6.1 In view of their traditional roles, it was generally hypothesized that both natural and Zulu indigenous practitioners would supernatural methods of. diagnosis use and treatment. General hypotheses are as follows : 1.6.1.1 Traditional doctors (izinyanga) will make significantly more use of natural methods concerning both diagnosis and treatment. (izangoma) and faith make significantly more and treatment methods 1.6.1.2 Traditional diviners (abathandazi) will both supernatural diagnostic traditional doctors. healers use of than 1.6.1.3 Traditional diviners will be significpntly different from faith healers to the extent to which they use indigenous Zulu supernatural oriented diagnostic and treatment methods as opposed to Christian faith healing methods. These hypotheses can be further reduCed as follows : '0 1.6.1.4 Traditional doctors will make significantly more use of - natural methods than faith healers and traditional diviners in their diagnostic methods. faith healers will make significantly more use of supernatural Christian faith oriented methods than traditional diviners and doctors in their diagnostic methods. 1.6.1.6 Traditional diviners will make significantly more use of indigenous Zulu supernatural diagnostic methods than faith \ healer and traditional doctors. 1.6.1.7 Traditional doctors will make significantly more use of natural treatment methods than faith healers and diviners. 1.6.1.8 faith healers will make significantly more use of supernatural Christian faith oriented treatment methods than traditional doctors and traditional diviners. 1.6.1.9 Traditional diviners will make significantly more use of Zulu , indigenous oriented supernatural treatment methods than 1.6.2 traditional doctors and faith healers. It was further generally hypothesized that all practitioners / would be consistent in their diagnostic and treatment methods. This general hypothesis can be further reduced as follows : 1.6.2.1 There will be a significant degree of agreement among diviners with regard to diagnosis and treatment procedures. 1.6.2.2 There will be a significant of agreement among doctors 20 regarding diagnosis and treatment procedures. ~ 1.6.2.3 There will be a significant degree of agreement among faith healers with regard to diagnosis and treatment procedures. 2.1 Subjects 21 CHAPTER 2 HETHOD Twelve practitioners, 4 traditional diviners (izangoma), 4 traditional doctors Cizinyanga) and 4 Zionist faith healers (abathandazi beziyoni) were selected by means of a random numbers table from a list of these practitioners provided by an informant Hr K.Z. from the Kwa-Dlangezwa, Ongoye area. 2.2 Apparatus 2.2.1 Portable tape recorder; for recording interviews, and 2.2.2 2.2.3 diagnostic and treatment sessions. Writing materials Three questionnaires (See Appendices A, B and C). 2.2.3.1 A patient questionnaire assessing biographical data, diagnostic and treatment procedures. 2.2.3.2 A practitioner questionnaire assessing diagnosis, cause, symptomatology, treatment and prognosis. 2.2.3.3 Inter-practitioner consistancy questionnaire (See Appendix C). 2.3 Procedure 2.3.1 Visit One: Each practitioner was visited by the researcher /' and a confederate with a problem requiring treatment. method of helping people with problems. The researcher then . asked if he would be welcome if he made another visit. Eleven practitioners were affirmative and an appointment was fixed. 2.3.1.6 In order to replace the above practitioner, a further practitioner was randomly chosen from the initial list of practitioners visited and procedure 3.3.1 to 3.3.1.6 repeated. The practitioner was happy about a further visit. 2.3.1.7 The Patient questionnaire was completed by the researcher. \ 2.3.2 Visit Two alone. Each practitioner was invited by the researcher 2.3.2.1 Following further rapport practitioners were informed that the researcher was· a student at University who wanted to learn more about indigenous practitioners in order to write a dissertation for his Masters degree. Diagnostic and treatment sessions were tape recorded. 2.3.2.2 The Practitioner questionnaire was completed by the researcher. 2.3.2.3 Standardized data regarding diagnosis, cause, symptomatology, treatment and prognosis was collected. 2.3.3 Visit Three In order to assess inter-practitioner. consistency as regards diagnostic and treatment methods all practitioners were visited again and the inter-practitioner consistency questionnaire administered. Practitioners were asked to rank order 6 diagnosis and 6 treatment procedures 23 2.3.1.1 Appropriate and initial rapport was established indaba style. 2.3.1.2 The confederate/client requested help for his problem. No further information was given at this stage in keeping with traditional cultural practice which requires all assessment to be initiated by the practitioner concerned. 2.3.1.3 The researcher requested if tape recordings could be made of the session with the rationale this would enable full understanding by the client. 2.3.1.4 Seven of the 12 practitioners were in favour of a tape recorded interview, 5 hesitated (i.e. 2 faith healers, 2 diviners "and 1 doctor), out of which 2 c o n ~ e n t e d (i.e. 1 faith healer and 1 diviner) after R5,OO was offered as additional remuneration to the normal fee. In the case of the 3 practitioners (I diviner, 1 doctor and 1 diviner) who were defineteIy against having the interview recorded, the interview was transcribed manually. 2.3.1.5 After the session between practitioner and client researcher established greater rapport with the practitioner using interview techniques recommended by Kahn and Cannel (1957), Bingham and Moore (1959) Burger (1969), Gordon (1969) and Brammer and Shostrom (1977) in which the interviewer showed warmth and responsiveness, and a genuine interest in, and total acceptance of the subject. The practitioner was informed that the researcher was interested to learn more" about indigenous practitioners 24 which, after visit 2, had been ascertained to be the most frequently occuring among all 12 practitioners (See Appendix C). 2.4 Categorization of data 2.4.1 The data fell into two distinct categories viz. natural and supernatural. The supernatural category was further divided into two viz. supernatural Christian and indigenous Zulu. 2.4.1.1 Natural diagnostic and treatment methods referred to ordinary methods, not necessarily espoused within typical traditional Zulu culture. Diagnostic methods included under this category were (i) question and answer, (ii) actual expmination of the patient, (iii) case history. Treatment methods included were (i) emetics, (ii) steam bathing, (iii) purgatory medicines that is, when all such methods were not used in any traditional/indigenous ritual symbolic context. 2.4.1.2 Supernatural indigenous Zulu methods referred to those methods traditional to Zulu culture and typically occuring within magical and/or religious ritual and symbolic context. Diagnostic methods such as (i)vumisa technique, (ii) bone throwing, (iii) head divination were included under this category. Treatment methods included were (i) ukuthwasa programme, (ii) ukuqinisa (strengthening of the individual, ukuthwebula casting aside of illness. 2.4.1.3 Christian supernatural diagnostic and treatment methods 2.5 2.5.1 25 referred to those methods not traditionally espoused within Zulu culture which reflect acculturation and sociocultural change as evident in African Independent Church movement which is mainly influenced by Western Christian religion. Under this category for example, diagnostic methods included were (i) water divination {ii)ukubona (precognition) (iii) Prayer. Treatment methods included were (i) Holy Water, (ii) Blessed Ash (iii) Baptism. Statistical Techniques Statistical techniques used in this research were, 2.5.1.1 "t"Jests 2.5.1.2 Chi-square tests and 2.5.1.3 K e n d a l l ~ Coefficient of Concordance (W) (refer to Siegel (1951), Downie and Health (1959) and Behr (19B3). 2.5.2 The 95% level of confidence i.e. "p< 0.05 was taken as accepted level of significance for all comparisons 3.1 Key CHAPTER 3 26 RESULTS AND DISCUSSION J K L M refer to the 4 abathandazi A B C D refer to the 4 E F G H refer to the 4 izangoma izinyanga or diviners for short. or doctors for short. or faith healers. 3.2 Biographical data of the practitioners Tables 1 to 6 refer to the biographical data obtained from the twelve practitioners. All practitioners were Zulu, married and resided in the Mtunzini district. Ten practitioners were in full t i ~ e practice, with one faith healer and one doctor in part time practice. TABLE 3.2.1. AGE Diviners Doctors F/Healers Mean Age in years 00 47.75 39.29 46.75 Standard deviation (S) B.IB 9.1 3.40 Table 3.2.1 refers to the mean age and standard deviation of the three categories of practitioners. "t" tests run to investigate differences between means indicated no significant differences between the three categories of practitioners with regard to age. Although the findings indicated no significant differences between the 27 three groups of practitioners with regard to age, it can be observed, however, from the table that diviners tended to be the oldest group,· which is in keeping with the traditional role of the diviner as an old woman who also has the status of a man (Ngubane 1977, Cheetham and Griffiths 1982, Brundley 1983). TABLE 3.2.2 SEX Diviners Doctors F/Healers Male 0 4 2 Female 4 0 2 . Table 3.2.2 refers to the sex of the three categories of practitioners. Chi-square tests indicated no significant differences between doctors and faith healers or diviners and faith healers with regard to sex. However highly significant differences were found between doctors and diviners (X 2 = 8, df = 1, P <0.05). The findings reflect the traditional pattern of doctors as always being male and diviners being female. This is in keeping with the traditional situation in rural, less accultured areas (Ngubane 1977, Hadebe 1982). Farrand (1980) for example, working in urban areas around Johannesburg found this traditional sex role pattern to be breaking down, with male diviners and female doctors becoming more common and accepted. 28 TABLE 3.2.3 RELIGIOUS AFFILIATION I I Diviners Doctors F/Healers I , African Independant Church I 0 3 4 I Traditional 4 1 0 Table 3.2.3 refers to the religious affiliations of the three categories of practitioners. Chi-square tests indicated no significant • differences between doctors and faith healers (X 2 = 1.14, df = 1, p> 0.05). However diviners differed significantly from both doctors and faith healers 2 2 (X = 4.B, df = 1, p< 0.05 and X = B, df = 1, p< 0.05 respectively) in their adherence to traditional religion. The diviners were found to be the only group that solely adhered to the traditional Zulu religion. This emphasized the role of the diviner in traditional Zulu society as an unpolluted (less accultured), sacred being, who is also a preserver of culture (Landy 1977, Ngubane 1977). Faith healers as well as doctors, in their affiliation to African Independent Churches represent a transitional departure from traditional Zulu society owing to the influence of Western Christian religion. TABLE 3.2.4 FORMAL EDUCATION Diviners Doctors F/Healers Formal Education 3 1 1 No Formal Education 1 3 3 29 Table 3.2.4 refers to the education of the practitioners with regard to whether they received formal education or not. Chi-square tests indicated significant differences between diviners and doctors and between diviners and faith healers (X 2 : 4.34, df: 1, p< 0.05 for both comparisons). There was no significant differences between doctors and faith healers (X 2 : 0, df: 1, p> 0.05). The diviners were more educated than both doctors and faith healers. This again emphasized the superior status of the diviner in traditional Zulu society. TABLE 3.2.5 EXPERIENCE Diviners Doctors F/Healers Mean Years (X) lL25 18.5 45 Standard deviation (S) 2.87 6.61 7.18 Table 3.2.5 refers to the mean years (in practice) and standard deviation of the three categories of practitioners."t" tests run to investigate differences between means indicated no statistically significant differences between the three categories of practitioners. Although the tests indicated no statistically significant differences between the means of the three categories of practitioners, it could be observed from the table that faith healers tended to have higher mean years and diviners lower mean years of experience than doctors. This could be due to faith healing apprenticeship starting at a very early age. Diviners on the other hand usually begin practising when 30 they are already old and matured, traditionally after menopause (Ngubane 1977). TABLE 3.2.6 NUMBER OF CLIENTS SEEN OVER PAST WEEK Diviner Doctor F/Healer 0 - 30 4 1 2 30 + 0 3 2 , Table 3.2.6 refers to the number of clients seen over past week by each group of practitioners. Chi-square tests indicated no significant differences between diviners and faith healers, and between doctors and faith healers (X' =1.16, df =1, p> , 0.05 and X=0.54, df =1, p ~ 0.05 respectively). However there was a significant difference between doctors and diviners (X' =4.20, df =1, p< 0.05). It is evident that diviners saw fewer patients than either doctors or faith healers. This may be attributable to the fact that the diviner being the oldest, highest priest in the society is expected to deal with the more important and typically traditional Zulu problems and also owing to the very nature of her work i.e. in depth divination, for example, as in a public divination, umhlahlo. Doctors and faith healers tend to deal with less important, ordinary problems. 3.2.7 Summary of Biographical data This research gives credence and emphasis to the sacred and powerful role of the diviner in traditional Zulu society in that diviners were 31 found to be - (i) the oldest (iil educated (Hi) female and (iv) belonging to traditional religion. 3.3 Diagnostic Methods TABLE 3.3.1 NATURAL AND SUPERNATURAL DIAGNOSTIC METHODS , DIAGNOSTIC METHOD Diviners Doctors F/Healers Natural 4 12 3 . Supernatural 22 12 25 Table 3.3.1 refers to natural and supernatural diagnostic methods used by three categories of practitioners as described under Method, Section 2, Page 24 • Chi-square tests indicated significant differences between diviners and doctors and between doctors and faith healers 2 (X =6.87, df =1, p< 2 0.05 and X =9.37, df =1, p< 0.05 for both comparisons. There was no significant difference between diviners and faith healers (X 2 =0.54, df =1, p ~ 0.05). Although making equal use of natural and supernatural diagnostic methods (12 12) doctors made significantly more use of natural diagnostic methods than either diviners or faith healers which confirmed hypothesis 1.6.1.4. This is in keeping with the traditional role of doctors a people who are commonly consulted for disorders attributed to both natural (umkhuhlane) and supernatural causation 32 (ukufa kwabantul. TABLE 3.3.2 SUPERNATURAL CHRISTIAN AND SUPERNATURAL INDIGENOUS ZULU DIAGNOSTIC METHODS DIAGNOSTIC METHOD Diviner Doctor F/Healer Supernatural Christian 0 6 21 Supernatural Indigenous Zulu 22 6 4 , Table 3.3.2 refers to the supernatural Christian and indigenous Zulu oriented diagnostic methods used by the three categories of practitioners. Chi-square tests indicated significant differences between all comparisons. (Diviner vs Doctor X 2 = 13.39, df = 1, p< 0.05; doctor vs faith healer 2 X =B.83, df = 1, p< 0.05; diviner vs faith healer X 2 = 33.41, df =1, p< 0.05). These findings. confirmed hypothesis 1.6.1.5 and 1.6.1.6 in that faith healers significantly emphasized supernatural Christian oriented diagnostic methods as opposed to both doctors. and diviners who emphasized natural and indigenous Zulu diagnostic methods respectively. Moreover the further finding that diviners emphasized indigenous Zulu oriented diagnostic methods significantly more than either faith healers or doctors again reaffirms the unique traditional role of the diviner as preserver and perpertrator of traditional Zulu culture. 3.4 Treatment Methods TABLE 3.4.1 NATURAL AND SUPERNATURAL TREATMENT METHODS TREATMENT METHOD f Di,iners I Doctors F/Healers I I , . Natural 15 27 14 Supernatural 30 12 ·33 I Table 3.4.1 refers to natural and supernatural treatment methods used by three categories of practitioners. Chi-square tests indicated significant differences between doctors and diviners df = 1, p< 0.05) and between doctors and faith healers (X 2 =10.76, (X' =13.27, df = 1, p< 0.05). No significant difference was found between diviners and faith healers (X 2 ~ 0 . 1 3 , df =1, p ~ 0.01). These findings confirmed hypothesis 1.6.1. 7. Doctors used significantly more natural oriented treatment methods than either diviners or faith healers. TABLE 3.4.2 SUPERNATURAL CHRISTIAN AND INDIGENOUS ZULU TREATMENT METHOOS TREATMENT METHOD Diviner Doctor F/Healer Supernatural Christian 0 2 26 Supernatural Indigenous Zulu 3D ID 7 34 Table 3.4.2 refers to the supernatural christian and supernatural indigenous Zulu oriented treatment methods used by the three categories of practitioners. Chi-square tests indicated significant differences between all comparisons (Doctors vs diviners 2 X = 5.26, df =1, pc 0.05 ; doctors vs faith healers 2 X = 14.46, df = l,pc 0.05 diviners vs faith healers X 2 = 40.23, df = 1, pc 0.05). It was evident that faith healers used supernatural Christian oriented treatment methods more than either diviners or doctors confirming \ hypothesis 1.6.1.8. This finding is in agreement with the type of diagnostic methods the faith healers used (see par. 3.3.2.), all of which is attributable to the affiliation of faith healers to African Independent Churches which are greatly influenced by Western Christian religion. It was also evident that diviners used treatment methods that were typically indigenous Zulu in nature more than either faith healers or doctors. This confirmed hypothesis 1.6.1.9 and is a further testimony to the role of the diviner as a person associated and concerned with maintaining and preserving typical Zulu culture. 3.5 Interpractitioner consistency TABLE 3.5.1 DIAGNOSTIC AND TREATMENT METHODS, WITHIN GROUP COMPARISONS . METHOD Practitioners Diviners Doctors Faith healers (M=12) (M=4) (M=4) (M=4) DIAGNOSIS .15 .66 .60 .62 TREATMENT .008 .61 .80 .82 35 Table 3.5.1 refers to Kendall's coefficients of concordance (W) for all practitioners (M = 12) rankings of the six diagnostic and treatment methods. There was no significant agreement amongst the full group of twelve practitioners regarding diagnostic and treatment method. Significant agreement however was found amongst each category of practitioners separately at the 5% level. The low degree of agreement amongst all twelve practitioners yet significant agreement among the separate group i.e. 4 diviners, 4 doctors, ood 4 faith healers respectively, emphasizes' the exclusiveness of the three different categories of practitioners. TABLE 3.5.2 DIAGNOSTIC AND TREATMENT METHODS, BEtWEEN GROUP COMPARISONS - METHOD Diviner &Doctor Doctor &F/healer Diviner &F/Healer (M=B) (M=B) (M=B) DIAGNOSIS .05 .65 (p< .01) .004 TREATMENT .31 (p< .05) .43 (p< .01) .05 Table 3.5.2 refers to Kendall's coefficients of concordance for between group comparisons, M= B in each case. From the table it is apparent that doctors and faith healers were in significant agreement concerning diagnosis. In this context it seems important to emphasize the religious affiliations of the doctors, three of whom belonged to African Independent Churches. The finding that diviners did not agree with either doctors or faith healers concerning diagnosis again emphasizes the exclusive role of the diviner as an indigenous 36 i.e. medium with supernatural From inspection of appendix D it is is due to diviner's emphasis on religious psychodiagnostician particularly ancestral shades. apparent that this difference indigenous supernatural diagnosis. Concerning treatment, significant agreement was found between diviners and doctors, on one hand and doctors and faith healers on the other with disagreement between diviners and faith healers. This is due to traditional similarity of diviner and doctor's treatment methods and dissimilarity between diviners and faith healers particularly owing to their different religious orientations of their treatment. The finding that the agreement between doctors and faith healers can be attributed to the fact that in this study, three of the doctors belonged to African Independent Churches. 37 CHAPTER 4 : CONCLUSION The main finding of the present research is that there are three broad basic categories of indigenous Zulu practitioners i.e. the traditional doctor (inyanga), traditional diviner (isangoma) and faith healer (umthandazi ), each of which use characteristically different diagnostic and treatment methods. It is recommended that future research among Zulu indigenous practitioners take this finding into account if not as a point of departure. This finding of course does not de-emphasize the commonly found existence of specialists within these three broad categories of practitioners as indicated by among others Conco (1972) and Ngubane (1977). among these three broad categories of diviner deserves special mention by Cheetham and Griffiths (1982) Secondly, traditional emphasized practitioners the as also previously as the results consistently portrayed her as a superior specialist type of practitioner e.g. an elderly, educated, female preserver and provider of traditional Zulu culture, hallowed in the annals of traditional Zulu time. Thirdly, the broad cosmological orientation of all practitioner's diagnostic and treatment methods is re-emphasized, (rarrand 1982, Kruger 1974, Cheetham and Griffiths 1982, Edwards et al 1983). These methods were again found (from a Westernized point of view) to be based on dualistic tenets (Conco 1972) including both natural and supernatural, a pattern which was consistently found among all practitioners. 38 In view of broader social implications as regards the above findings more integration of Western and African oriented -mental health subsystems in particular, in South Africa as suggested by previous studies (Holdstock 1979, Pearce 1981, Rappaport and Rappaport 1981, Edwards et aL 1983) is recommended. Further research on the implications and problems concerning greater integration is needed. Along the lines of therapeutic villages (Lambo, 1972, 1977, Collomb 1973, Rappaport and Rappaport 1981) in a propositional model for integrating tradition and scientific healing have advocated a referral system based on mutual appreciation of expertize e.g. chemotherapy by the modern doctor and concomitant psychocultural counselling by the traditional healer, and or retraining traditional healers to serve as primary health workers, so that the network of hospitals and medical cent er can function more efficiently as secondary and tertiary units. 39 CHAPTER 5 SUMMARY 5.1 INTRODUCTION Various prominent mental health professionals in South Africa (le Roux 1973, Kruger 1974, Cheetham 1975, Burhmann 1977, Garden 1978) have appealed that greater recognition begiven to and greater use made of the skills of indigenous healers in the treatment of persons who could benefit from their services (Holdstock 1979) There are a variety of different types of indigenous healers in South Africa today. Conco (1972) lists six, Ngubane (1977) lists two and West (1975) lists various types. It can be argued that 'there are three broad basic categories of indigenous healers among Zulu speaking people in South Africa today, i.e. the traditional doctor (inyanga), diviner (isangoma) and faith healer (umthandazi). The advent of the umthandazi can be traced to the rise of the African Independent Church movement and it has been argued that many of the traditional roles of isangoma have been taken over by the umthandazi (Lee 1969, West 1975). The traditional doctor specializes in the use methods. (inyanga) is usually of herbal medicine male, and and natural typically treatment The diviner (isangoma) is usually a woman, and shares a comprehensive knowledge of medicine with the doctor (inyanga). She only qualifies as a diviner after undergoing ukuthwasa process. The diviner is however mainly and traditionally a psychodiagnostician and priest who divines within a supernatural oriented context, through her culturally 40 accepted mediumship with the ancestral shades. The faith healer (umthandazi) is generally a professed Christian who may belong to either mission or independent churches and therefore also typically work within a supernatural context. The aim of this present paper were to investigate diagnostic and healing methods used by a random sample of indigenous healers in the Kwa-Dlangezwa, Ongoye area, and to ascertain whether there was any consistency (inter-healer) in these practitioners' diagnostic and treatment procedures. In view of their traditional roles it was generally hypothesized that Zulu indigenous practitioners would use both natural and supernatural methods of diagnosis and treatment. Traditional doctors were expected to make more use of natural methods concerning both diagnosis and treatment. Both diviners and faith healers were expected to make significantly more use of supernatural indigenous Zulu, and supernatural christian oriented diagnostic and treatment methods respectively. ~ I t was also hypothesized that there would be a significant degree of agreement among practitioners (inter- practitioner consistency) concerning diagnoses and treatment procedures for the same patient. 5.2 METHOD 5.2.1 Subjects Twelve practitioners, 4 traditional diviners (izangoma), 4 traditional doctors (izinyanga) and 4 Zionist faith healers (abathandazi beziyoni) were selected by means of a random numbers table from a list of these 41 - practitioners provided by an informant from the Kwa-Dlangezwa, Ongoye area. 5.2.2 Apparatus 5.2.2.1 A patient questionnaire assessing biographical data, diagnostic and treatment methods. 5.2.2.2 A practitioner questionnaire assessing diagnosis, cause, symptomatology, treatment and prognosis. 5.2.2.3 An inter-practitioner consistency questionnaire. 5.2.2.4 A tape recorder for recording interviews, and diagnostic and treatment methods. 5.2.3 Procedure Practitioners were visited on three occasions. On the first visit, the researcher was accompanied by a genuine client/confederate who requested help for his problem. following the session, the patient questionnaire was completed. On the second visit, the researcher established greater rapport with the practitioners and completed the practitioner questionnaire. On the third visit and inter-practitioner consistency questionnaire was administered to practitioners who were asked to rank order six diagnostic and six treatment procedures which had been ascertained to be the most frequently occuring amongst all 12 practitioners. Nine of the 12 practitioners allowed all three sessions to be tape recorded, data being manually recorded in case of the other three practitioners. 5.2.4 Cateqorization of data 42 The data fell into two distinct categories, viz. natural and supernatural. The supernatural category was further divided into two viz. supernatural Christian and indigenous Zulu. Natural diagnostic and treatment methods referred to ordinary methods not necessarily espoused within typical traditional Zulu culture. Supernatural indigenous Zulu methods referred to those methods traditional to Zulu culture and typically occuring within magical and/or religious ritual and symbolic context. Christian supernatural diagnostic and treatment methods referred to those methods not traditionally espoused within Zulu culture which reflect acculturation and sociocultural change as evident in the African Independent Church movement. 5.2.5 Statistical technigues Statistical techniques used in this research were the (i)i;tests (ii) Cri-square tests and (iii) Kendall's co-efficient of concordance (W) (refer to Siegel 1951, Downie and Heath 1959, and Behr 1983). The 95% level of confidence was taken as accepted· level of significance for all comparisons. The main findings are contained in the results which follow. 5.3 RESULTS AND DISCUSSION 5.3.1 Biographical data of the practitioners The central finding concerned diviners, who were found to be female, older, saw fewer patients, adhered solely to traditional religion and had more years in school than either doctors or faith healers. The sacred 43 and powerful role of the diviner as a preserver and perpertrator of traditional Zulu culture in a traditional Zulu setting was consistently emphasized. 5.3.2 Diagnostic Methods Table 5.3.2.1 Natural and Supernatural diagnostic methods Diagnostic Method Natural Supernatural Diviners 4 22 Doctors 12 12 faith healers 3 25 Table 5.3.2.1 refers "to natural and supernatural diagnostic method used by the three - categories of practitioners as described under Method (Section 2.3). tests indicated significant differences between diviners and doctors and between doctors and faith healers l ) (X =6.87, df = 1, p< 0.05 and X" = 9.37, df = 1, p< 0.05 for both I comparisons. There was no significant difference between diviners and faith healers(x" =0.54, df =1, p> 0.05). Although making equal use of natural and supernatural diagnostic methods (12.12) doctors made significantly more use of natural diagnostic methods than either diviners or faith healers as hypothesized. This is in keeping with the traditional role of doctors as people who are commonly consulted for disorders attributed to both natural (umkhuhlane) and supernatural causation kwabantu ). 44 Table 5.3.2.2 Supernatural Christian and Supernatural indigenous Zulu Diagnostic Methods Diagnostic Method Diviners Supernatural Christian 0 Supernatural Indigenous Zulu 22 Doctors 6 6 Faith healers 21 4 Table:5.3.2.2. refers to the supernatural Christian and supernatural indigenous Zulu diagnostic methods used by the three categories of practitioners. Chi-square tests indicated significant differences between all comparisons (Diviner vs doctor X 2 = 13.39, df = 1, p< 0.05 doctor vs faith healer XL = 8.83, df = 1, p< 0.05, diviner vs healer XL =33.41, df =1, p< 0.05). faith These findings are as hypothesized in that faith healers differentially emphasized supernatural Christian oriented diagnostic methods as compared to diviners who emphasized indigenous Zulu diagnostic methods, with doctors making equal use of both orientations. 5.3.3 Treatment Methods Table 5..3.3.1 Natural and Supernatural Treatment Methods Treatment Method Natural Supernatural Diviners 15 30 Doctors 27 12 Faith healers 14 13 45 r Table 5.3.3.1 refers to natural and supernatural treatment methods used by the three categories of practitioners.. Chi-square tests indicated signi ficant l differences between doctors and diviners (X =10.76, df=l, p < 0.05) and between doctors and healers (XL = 13.27, df = 1, p < 0.05). No significant difference was found between diviners and faith healers (X 2 = 0.13, df 1, p> 0.01). Doctors used significantly more natural oriented treatment methods than either diviners or faith healers, as hypothesized. Table 5.3.3.Z Supernatural ChE.!3tian and Indigenous Zulu Treatment Methods Treatment Method Supernatural Christian 0 Supernatural Indigenous Zulu .30 Doctors 2 10 Faith healers 26 7 Table 5.3.3.2. refers· to the sUl:lernatural Christian and supernatural indigenous Zulu oriented methods used by the three categories of practitioners. thi-square tests indicated significant differences between all (Doctors VS diviners XL = L df = 1, p< 0.05; doctors vs faith healersx = 14.46, df=l, P< diviners vs faith healers X" = 40.23, df = 1, p< 0.05). 5.26, 0.05; It was evident that faith as hypothesized, used supernatural Christian oriented treatment methods more than either doctors or diviners, which is in with the type of diagnostic methods the faith healers used. This is attributable to the affiliation of · , faith healers to African Independent Churches which arre greatly influenced by Western Christian religion. It was also evident that diviners used treatment methods that were typically indigenous Zulu in nature more than either faith healers or doctors, as hypothesized. This can be viewed as a further testimony to the diviners' role as a person concerned and associated with maintaining and preserving typical traditional Zulu culture. 5.3.4 Interpractitioner Consistency Table Diagnostic and Treatment Methods, within group Comparisons Method Practitioners(M=12) Diviners(M=4) Doctors(M=4) F/HeaIers M=4) Diagnosis Treatment .15 .008 .66 .61 .60 .80 .62 .82 Table 5.3.4.1. refers to co-efficients of concordance (W) for all practitioners (M=12) rankings of the six diagnostic and treatment methods. There was no significant agreement amongst the full group of twelve practitioners regarding diagnostic and treatment Significant agreement however was found amongst each category of practitioners. The low degree of agreement amongst all twelve practitioners yet significant agreement among the seperate groups i.e. 4 diviners, 4 doctors, and 4 faith healers respectively, emphasized the exclusiveness and homogenous nature of the three different categories 47 , of practitioners concerning diagnostic and treatment procedures. 5.4 CONCLUSION The main finding of the present research is that indigenous . Zulu practitioners; far from being a homogenous group can be clearly categorized into three separate types of practitioners i.e. the traditional doctors (inyanga), traditional diviner (isangoma) and faith healer (umthanaazi), each of which use , characteristically different diagnostic and treatment methods. It is recommended that future research among Zulu indigenous practitioners take this main finding into account if not as a point of departure. This finding of course does not de-emphasize the commonly found existence of specialists within these three broad categories of practitioners as indicated by among others Conco (1972) and Ngubane (1977). Secondly, among these three broad categories of practitioners the traditional diviner deserves 'special mention (as particularly emphasized by Cheetham and Griffiths, 1982) as the results consistently portrayed her as a superior specialist type of practitioner e.g. an elderly, educated, female preserver and provider of traditional Zulu culture, hallowed in the annals of traditional Zulu time. Thirdly, the broad cosmological orientation of all practitioners' diagnostic and healing methods is re-emphasized, (farrand 1982, Kruger, 1974 Cheetham and Griffiths, 1982 Edwards et aI, 1983). 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Paper presented at the Conference on Indigenous Healing, University of the Witwatersrand, Johannesburg. Goldenweiser, 1.(1946) Anthropology: An Introduction to Primitive Culture, cited in Conco, W.Z. (1972) The African Bantu traditional practice of medicine: Some preliminary observations, Journal of Social Science and Medicine, 6, 2B3- 322. Gordon, R.L.(1969)Interviewing:Strategies, "Techniques and Tactics Dorsey Press, Homewood. Hadebe, S.B. (1982) Therapeutic, preventive and promotive magic, among the Dube people of the Ongoye District of Mthunzini, unpublished honours research project, University of Zululand. Holdstock, T.L. (1979) Indigenous healing In South Africa:A neg- lected potential.South African Journal of Psych. 9, 118-124. 27 51 Holdstock, T.L. (1981) Psychology in South Colonial era. . Arrogance or ignorance? of Psychology, 11, 123-129. Africa belongs to the South African Journal 28 Kahn,· R.L. &Conel1, C.F. (1957) Wiley &Sons, New York. The Dynamics of Interviewing, 29 Kaplan, H.I. Sadock, B.J. (1981) Modern Synopsis of Comprehensive Textbook of Psychiatry, Third Edition, Wil1iams and Wilkens, Baltimore. 30 Kiev, A (1964) Magic Faith and Healing, Free Press, USA. 31 Krige, E.J. (1950) The Social System of the Zulus, Shooter, Pietermaritzburg. Shuter and 32 Kruger, D. (1974) Xhosa divining and contemporary psychotherapy - a reciprocal perspective, Fort Hare Papers, 6, 37-47. 33 Lambo, T.A. (1972) Psychotherapy in Africa, Psychotheraphy &Psy- chosomatics, 24, 311-326. 34 Lambo, T A (1977) Psychotherapy in Africa, Human Nature,l, 32-40. 35 Landy, D (ed.) (1977) Culture Desease and Heating: Medical Anthropology, McMillan, New York. studies in 36 Lee, S.G. (1969) Spirit possession among the Zulu, in J. Beattie and J. Middleton (eds.), Spirit Mediumship and Society in Africa, Routledge and Kegan Paul, London. 37 Le Roux, A.C. (1973) Die psiegiatriese betekenis van die toordok- ter in die Bantoekultuur, Proceedings of P I RSA Congress. 38 Malinowski,£. (1948) Magic Science and Religion, The Free Press, New York. 39 Murdock, G.P. Wilson, S.F. &Frederick, V. (1980) World distribu- tion of thepries of illness, Transcultural Psychiatric Research Review, 17, 37-64. ~ 40 Ngubane, H. (1977) Body and Mind in Zulu Medicine, Academic Press London. 41 Pearce, T.O. (1982) Integrating Western orthodox and indigenous medicine, Journal of Social Science and MediCine, 16, 1611- 1617. 42 Rappaport, H &Rappaport, M. (1981) The integration of scientific and traditional healing, American Psychologist, 36, 774-781. 4 ~ 44 45 52 Siegel, S. (1956) Nonparametric Statistics for the Behavioural Sciences, McGraw-Hill, New York. Thatcher, B.S. (1964) Universal World Reference Encyclopedia,Con- solidated Book Publishers, Chicago. Torrey, E.F. (1972) The Mind Game: Witchdoctors and Psychiatrists Emerson Hall, New York. 46 Vilakazi; A. (1962) Zulu Transformations. Press, Pietermaritzburg. University of Natal 47 Weisz, J.R. (1972) East African Medical Attitudes, cited in Conco W.Z. (1977) The African Bantu traditional practice of medicine: Some preliminary observations, Journal of Social Science and Medicine, 6, 283-322. 48 West, M(1975) Bishops and Prophets in a Black City: African Independent Churches in Soweto, Phillip, Johannesburg. 53 APPENDIX A QUESTIONNAIRE I BIOGRAPHICAL DATA : PRACTITIONER • F i 1 NAME : 2 ADDRESS : . 3 DISTRICT : - 4 AGE : - - 5 SEX : 6 MARITAL STATUS : 7 HOME LANGUAGE : 8 RELIG.ION : 9 FORMAL EDUCATION : 10 Could you please categorize yourself as to what type of indigenous practitioner you are? - 11 How many years have you been practising? 12 Are you in full- time or part time practice? 13 How many people come and see you (on average) per week? 54 APPENDIX B QUESTIONNAIRE 11 PATIENT . , I PRACTITIONER NO : 2 CATEGORY OF PRACTITIONER eg.lnyanga: , 3 PATIENT (SPECIFY) : 4 AGE : 5 SEX : 6 HOME LANGUAGE : 7 RELIGION : 8 FORMAL EDUCATION : • 9 MARITAL STATUS : 10 DIAGNOSIS (From most to least important) I I I I • 2 I 3 I I 11 CAUSE (From most to least important) 1 2 3 12 SYMPTOMATOLOGY (From most to least important) I 2 3 13 TREATMENT (From most to least effective) I 2 3 14 PROGNOSIS (Tick appropriately) GOOD FAIR POOR 55 APPENDIX C , INTER-PRACTITIONER CONSISTENCY QUESTiONNAIRE Rank the following diagnosis and treatment procedures from I to 6 with I indicating the most important and 6 the least important for this patient. A DIAGNOSIS I General misfortune (isinyama) 2 Stomach disorder (isisu) 3 Evil spirit possession (imimoya emibi) 4 Calling to become a diviner (ukuthwasa) 5 Bladder problem (isinye) 6 Impotence (ukungazali) B TREATMENT '. I Emetic and purgatory medicines 2 Incissions and general strengthening techniques (ukugcaba, ukuqinisa) 3 Apprenticeship as diviner (ukuthwasa programme) " 4 Fortification of homestead (ukubethela) 5 Blessed Water (isiwasha) 6 Prayer (umthandazo) APPENDIX D PRACTITIONERS DIAGNOSTIC RANKINGS (REFER.APPENDIX "C" ITEM "A") hTEM A B C D . E F G H I J K L 1 1 1 2 1 5 6 5 6 4 4 4 4 2 4 4 3 5 2 1 3 3 1 2 2 1 3 2 3 4 2 6 5 6 5 5 6 5 6 4 3 2 6 3 4 4 4 4 2 5 6 5 '" '" 5 6 6 5 6 1 3 1 1 3 1 3 3 6 5 5 1 4 3 2 2 2 6 3 1 2 * A· B C D REFER TO TRADITIONAL DIVINERS E F G H REFER TO TRADITIONAL DOCTORS I J K L REFER TO FAITH HEALERS APPENDIX E PRACTITIONERS TREATMENT RANKINGS (REFER APPENDIX "C" ITEM "B" ITEM A B C D - E F G H I J K L 1 4 1 4 4 1 1 1 Z 5 3 Z 4 2 3 4 3 3 2 4 Z 1 3 4 4 3 3 1 2 2 1 4 5 6 4 4 6 6 5 ,4 Z 3 1 Z 5 6 5 3 6 5 5 6 ..... '" 5 6 5 6 3 2 4 5 Z 2 1 1 6 6 5 6 5 6 3 3 6 1 1 3 2 * A' B C D REFER TO TRADITIONAL DIVINERS, E F G H REFER TO TRADITIONAL DOCTORS I J K L REFER TO FAITH HEALERS 58 APPENDIX r . , TABLES FOR DIAGNOSTIC AND TREATMENT METHODS USED BY THE PRACTITIONERS TABLE A: DIAGNOSTIC METHODS USED BY THE PRACTITIONERS METHOD DIVINERS DOCTORS r/HEALERS TOTALS Natural 4 12 3 '19 Supernatural Christian 0 6 21 27 Supernatural indigenous Zulu 22 6 • 4 32 TOTALS 26 24 2B 78 TABLE B: ·TREATMENT METHODS USED BY THE PRACTITIONERS METHOD DIVINERS DOCTORS r/HEALERS TOTALS Natural 15 27 14 56 Supernatural Christian 0 2 26 28 Supernatural indigenous Zulu 30 10 7 47 TOTALS 45 39 47 131 59 APPENDIX G r AN INTERVIEW BY ADIVINER PRACTITIONER NO: A PATIENT CONFEDERATE The diviner inhales a powder from the snuffbox. She then sneezes quite frequently. Suddenly she is in a trance, and appears to be listening to some unheard voices, her only response is "yes ,. "no", "Makhosi"as if the amakhosi (ancestors) are asking her questions and also glving her advice about the illness of the patient. She then throws bones on the mat, stares at them for about a minute and then starts talking. , "There is something wrong in your (confederate's) blood. Your feet are painful. This thing goes up the knees through all bones, .you then have difficulty in walking. It then gets in your bladder and you urinate blood, then up to your stomach and makes it filled with wind, your knavel is then painfully drawn inwards. You also have izibhobo (disturbing, throbbing pains at the ribs). Your back is also painful because of this thing. You also suffer from heartburn which is caused by the moving up and down of this thing. Your shoulders become heavy, painful and tired as if you had been carrying a very heavy load, then your arms become week. This thing goes up your neck, and you also feel pain, As though you did not sleep well. It then goes to your head causing headaches. Sometimes 60 you feel "stupid", your brain becomes tired. , The "bones" say that lHhen you are asleep something disturbs you. You feel something pressing you down, but are unable to help yourself. You then become very week and tired. Your dreams are very bad. You dream of animals and deceased people. Some speak to you, some do not. These are evil spirits." The diviner then looks at the patient/confederate for a lHhile and asks \ him "Well do you agree or disagree to lHhat 1 have said so far? Point out what you agree with and leave out that which does not apply to your case". Confederate: "1 agree with almost all you said, and would like to know the cause of all this misery". Practitioner: "The indaba (problem) is at home. Neighbours are jealous of you because of the level of education you are at. They prepared their evil medicine using the soil from a grave, this then became isithunzi (shadow) sent to trouble you. This thing is always with you. It caused tiredness, drolHsiness and makes you lazy to study. You hence do not do lHell in your studies". Confederate: "What is it that presses me at night when I am asleep". Practitioner: "It is the' shadow of a dead person (ghost), sent to you 'by a sorcerer". Confederate: "What is the exact cause of my stomach-ache". 61 Practitioner: "You see my boy, that dead person in you is in a form of r air. It is this person that works upon your blood poisoning it. When your stomach is full of wind, it is the wind of this dead person. He would like to have killed you but your ancestors are by your side, fighting for your health. If it was not for them, you would be dead by now". Confederate: "For a long time, I have been plagued by otokoloshe (familiars). I have since consulted a traditional dbctor who gave medicine for dispelling them. 1 would like to know if they are still with me or have left for good". Practitioner: "If you had tikoloshes, I would have told you. You are being visited by a ghost now, and not tikoloshes. This ghost casts isingama (misfortune) to you. As for the appropriate treatment, the amakhosi advised me that you should (i) steam bath, (ii) drink purgatory medicine and (iii) vomit using emetics. Steam bathing is for cleaning the blood and make you likeable. Purgatory medicines and emetics will take stomach air out, together with isinyama .. You must also be fortified (ukucushwa) , so that the ghost does not trouble you any more". The ukucusbwa process involves- ukugcaba - Incissions made at joints for strengthening the person. (H) ukuncinda - licking hot medicine from sauce- (Hi) pan using fingertips, and washing in the mountains. A P P E ~ D I X H r AN INTERVIEW BY A TRADITIONAL DOCTOR PRACTITIONER NO: G PATIENT CONFEDERATE. Practitioner: "Well, tell me, what have you come here for"? Confederate: "One reason for consulting you is that I suffer from stomach ache". Practitioner: "What type of stomach ache do you have? Does it become windy inside"? Confederate: "Yes, it becomes inflated with air, and then I have difficulty in breathing and sleeping". Practitioner: "This type of stomach ache is usually caused by sleeping with "dirty" women. It may also be caused by the type of food you eat, for example the dumplings and raw mealie meal porridge. If is caused by'food, then, it is only temporary but if caused by "dirty" women, it needs a special treatment". Confederate: "Do you not think it is caused by idliso (food poisoning)"? Practitioner: "It may also be caused by idlisQ,but very rarely. Idliso is usually meant to kill; your stomach ache is not that serious". Confederate: "My feet are also painful. Sometimes they become too cold. What do you think is the cause"? Practi tioner: "It may have been ,caused by umeqo (stepping over a harmful concoction)". 63 Confederate: "A short time ago I have been pestered by the familiars r particularly thetikoloshes. I consulted a traditional doctor who gave me medicine to send them away. For sometime they did not pester me. I then thought they had left but I sometimes see them though not as often as I used to. Is there any possibility that I can be permanently cured"? Practitioner: "1 know how to treat a person with tikoloshes. 1 will give you medicines that will maketikoloshes never come to you again. I have helped so many people with this illness that 1 am very sure you will also be cured. The treatment 1 will administer to you wpl consist of": (i) Purgatory medicines - for treating· a windy stomach (ii) (Hi) Enema - to take air out from your stomach Emetics - for cleaning you inside (the stomach) (iv) Incissions, steam bathing, fumigation for sending the tikoloshes away for good (v) Ukulahlwa process (i.e. you will have to wash yourself far away on the mountains, leave your dirt and some blood in the hole there, so that whatever evil spirits that wants you, will go and seek you there. 64 APPENDIX I . ' AN INTERVIEW BY A FAITH HEALER PRACTITIONER NO: K PATIENT CONFEDERATE The faith healer orders the patient to take off his shoes, and kneel in front of her. She then sings a church song and all members in the room sing along with her. The singing lasts for about five minutes. \ She then hums another song whilst laying her hands and feeling (touching) the body of the patient all over. She has a steel rod (made to resemble the Cross) in her hand, with which she frequently pushes , the patient. The patient remains silent. After some time she stops humming and there is quietness in the room. She takes the bottle filled with water, holds it with both hands and then starts praying. After the big prayer, she puts her hands on the head of the patient, her eyes closed saying - "You are very sick, my boy. There is something in your chest that makes your breathing difficult. There are throbbing, sturbing pains in your ribs (izibhobo). At night you cannot sleep well. You are pestered by izithunzi(shadow of a dead person i.e. ghost). You also have bad dreams, which are caused by these izithunzi. You also suffer from uvalo (related to anxiety). You are always afraid of something. You have frequent headaches; and you heartbeat is irregular, more it is too fast. All these sufferings can be cured. Do you have some questions"? 65 Confederate: "Can you give some more clarification on these izithunzi that pester me at night"? r Practi tioner: "They are the messengers from heaven (izi thunywa) sent to convert you into a Zionist faith healer. God has seen that you have a potential of being a faith healer. You will only be healed once you become a Zionist faith healer because God wishes so". Confederate: "If one does not comply, do these izithunywa cause you misfortunes"? Practi tion: "Of course, yes. Whatever ambitions you have may be thwarted. You just have to comply. If you feel you cannot be a healer at the moment, you must then go to , the river, get baptised, and slaughter a white fowl asking the izi thunywa to wait until you are through with schooling. You should also wear a Zionist robe and blessed ropes to protect you against these izithunywa These ropes will also give you power, courage and fortunes. As for the other ailments you will be given" - (i) Isiwasho - blessed water to drink (H) Ichibi - water, with some herbs to drink (Hi) Ropes - to fasten around your waist and ankles, and (iv) most of all we must pray to God that you get healed. Prayer alone does wonders. 11 ACKNOWLEDGEMENTS The their author kind wishes to express his thanks to the following people and valued assistance in making this research for project possible. My Supervisor, Professor S D Edwards, Head of Department of Psychology, University of Zululand for his invaluable suggestions, constructive criticism, and endless patience throughout this study. My of Co-Supervisor Miss N V Makunga, Psychology, University senior lecturer in the Department for her keen interest and of Zululand, consistent encouragement throughout the study. Mr G F Borsten, lecturer, Department of Psychology, University of Zululand whose knowledge of statistics and constructive suggestions made this work a reality. My colleague, Mr K S Mfusi for his interest and support. Mrs T Crous for her patience in typing and re-typing this project. Mr T N who sacrificed his study time to accompany me as a confederate patient when we visited the practitioners. All those who participated as subjects (i.e. practitioners) and without whose co-operation this project would not have been possible. My parents who were always ready to lend a hand (financially and morally) whenever needed. i j i ABSTRACT As indigenous healers are so important lo th" health of many not only a closer, scientific in South Africa but also throughout the world, look at their practices is needed. majority western Various appealed Again, there is a tendency of the consult both of South Africans (especially the Blacks) to oriented prominent mental health, services and indigenous healers. have mental health professionals in South Africa that greater recognition be given to and greater use made of the skills of indigenous healers in the treatment of persons who could benefit from the services. It is for these reasons that this research on indigenous healing was undertaken. The purpose of this research was to investigate ment diagnostic and treatfrom the methods used by a random sample of indigenous healers rural Mtunzini district in Kwa-Zulu, and to ascertain whether there is any consistency (inter-practitioner) in their diagnostic and treatment methods. ----- Twelve practitioners a were problem each invited by a researcher and a and confederate with treatment requiring treatment. Diagnostic procedures were tape recorded. Standardized data treatment and prognosis, regarding including diagnosis,cause symptomatology, practitioners' biographical data was collected. In order to ascertain inter-practitioner consistency, practitioners were asked to rank order six diagnosis frequently emphasized and six treatment procedures ascertained to be the most occuring the among all twelve practitioners. The results indigenous three distinct basic categories of Zulu g.practitioners viz. health As suggested by previous studies and also supported in this more integration of Western and African oriented mental subsystems was recommended. diviners ("zan1~ma) and faith Of these categories.the diviner deserve special mention as the portrayed her as a superior specialist e. doctors (izinyanga). natural and supernatural. results consistently educated. healers (abathandazi). research. culture. . were female preserver and provider of traditional Zulu and treatment procedures used by the practitioners to be based on dualistic levels viz. Diagnostic found an elderly. v SAMEVATTING Aangesien tall~ volksgeneeskundiges so belangrik is vir die gesondheid van mense. terrein groter Verskeie geestesgesondheidsdienste vooraanstaande as volksgenesers persone op te die professionele van geestesgesondheid in Suid-Afrika het h beroep gedoen' vir erkenning aan en groter gebruikmaking van die vaardighede in Dit die behandeling van persone wat by hul dienste was om hierdie rede dat die .navorsing van kan oor volksgenesers baat vind. Daar is egter h neiging onder die meeste Suid-Afrikaners (veral Swartmensel om sowel Westersgeorienteerde raadpleeg. Die diagnoserings. is h nadere. prognose. asook die geneser se biografiese data is versamel.en behandelingsmetodes genesers is afsonderlik uitgenooi deur die navorser en h medewerker met h probleem wat aandag geverg het. is op band opgeneem. nie net in Suid-Afrika nie maar oor die hele wereld. Ten einde die mate van konsekwensie onder die genesers vas te om ses stel. volksgeneeskunde onderneem is. wetenskaplike ondersoek na hulle praktyke nodig. Gestandardiseerde behandeling data en veroorsakende simptomatologie.en behandelingsmetodes betreffende diagnose. Die doel van hierdie navorsing was om ondersoek in te stel behandelingsmetodes wat gebruik word na deur die h diagnoserings. Twaalf genesersl diagnoserings.en streekproef Kwa-Zulu en volksgenesers om vas van die plattelandse distrik konsekwensie Mtunzini is in te stel of daar enige wat (onder verskillende betref. en is die ses genesers versoek ~dianoseringsprosedures . vi behandelingsprosedures wees wat geblyk het die algemeenste in gebruik in voorkeurvolgorde onderskeibare doktors te plaas. en bonatuurlike. het die drie result ate duidelik naamlik kategorH. Van hierdie drie kategoriee verdien die waarsegster spesiale vermelding aangesien die resultate haar deurgaans uitgebeeld het as superieure spesialis. kundige. volksgenesers beklemtoon. waarseers (izangoma) en geloofsgenesers (abathandazi). navorsing vorige ondersoeke vermeld en hierdie Afrika- gestaaf is. is groter integrasie van Westerse met georienteerde geestesgesondheid-subsisteem aanbeveel. byvoorbeeld n n bejaarde. vroulike instandhouer en draer van die tradisionele Zulukultuur. . te Die van onder die twaalf genesers. Soos deur naamlik die natuurlike deur . Daar is gevind dat die diagnoserings. (izinyanga).en behandelingsprosedures wat deur die genesers gebruik word gebaseer is op twee vlakke. many rulers. 4456). especially focal in the Third World where indigenous practitioners are point around which the physical. the rainmaker. 416).1 INTRODUCTION General Conceptual Introduction on Indigenous Practitioners increasing recognition of highly specialized modern there are many underdeveloped medical countries the Despite science and modern doctors. the priest. Such practitioner have been described as follows : "A Shaman is a religious healer. medicine man. but the vast majority A person role may be recruited inheritance priesthood. social and religious lives of many people revolve. "Although positions presidents.g. specialize solely healers are sorcerers.1 CHAPTER 1 1. and the primitive doctor. priests. prophet. toward . and • folk healer. Some work folk as healers may assume or in prestigious university healing. Shaman.non into a evil ends. p. the the in some instances chief or king" (Landy 1977. found among all primitive people or medicine since man earliest history". relatives tribal . " the medicine man is not only but he is the diviner. folk-healing through hereditary from a parent or through a selection by parents. (Universal World Reference Encyclopaedia 1945. Such indigenous practitioners have been described by a variety of terms in the literature e. and by such disability. emotional control.89). It is for this reason study. religious. The term "indigenous". often after self-dedication having undergone to a healing cult. (Kaplan and Sadock 1981.g.2 elders. As is evident in the above definitions. self-discovery. 2 self selection by apprenticing oneself to the undergoing of a profound emotional awe-inspiring symptoms. possessing as high traits. personal courage. experience a a involving divine or receiving trance or call hallucination. and good judgement". possessing a physical or psychological miraculous exceptional intelligence. cultural. a cult cure. such practitioners are essentially both preservers within the particular cultural settings in and providers of culture. a healer. in their respective communities. religious sodalities or gods and spirits. such practitioners medical. which they work. One is reason for the continuing power of such indigenous practitioners that many underdeveloped countries throughout the world have broad . story-telling ability. p. divinatory. through a dream. a similar broad conceptual term implies both common that the broad term "practitioner" is used in the present cultural universality and relativity whereas there may be many elements to the roles of practitioners operating within different cultural millieus. have traditionally performed multi-faceted roles e. 2 Theories of illness in underdeveloped societies with particular reference to Zulu society Murdock of the et al (1980) view explanations of illness current among most those people of the world as having little in common with recognized by modern medical science and as relating much more closely to the ideology of primitive religion. in the middle society. disease. "The from concept of "primitive medicine" concept of is derived anthropological "primitive culture". Generally speaking there is no such thing as like primitive mind and primitive man is potentially modern man (Goldneweiser 1946). 1. Primitive medicine is found in all ages in the Orient as well as in Ancient Greece. language or symbols or describes thinks about the world observations. grouping of these and thoughts leads descriptions conceptual from orientation. to certain The . from which they are derived. practice man uses ages as well as in modern industrial A system of medicine is produced by every In medicine a department of knowledge and dealing with disease and its when he of treatment. Primitive medical systems vary . Egypt and Mesopotania. culture. only some of which are recognized by modern empirically oriented medical science.3 concepts of illness and health. observes. These so called "primitive medical systems" have been described by Conco (1972) as follows : . With It represents all the forces of evil freud has similarly concept of thanatos. Ancestral reverence is the primary factor. and p. from group to group and even from individual to individual. a point of view defined by the canons (p.304) • of reasoning adopted as a framework". destroy" and given (Berglund 1976. of all religions with its reverence for elder and dead. with all the ancestors and through the ancestors with with God being". Central to an of understanding of these beliefS-a~d practices is an the both understanding essence living traditional African religion. . in cosmological and (see Ng~bane practices illness and health are still widely followed particularly in rural areas of South Africa. But from all these systems can be examined and analyzed a certain interpretive point of view with a standard evaluation. This is understandable in view of the has fact that these beliefs and practices form a coherent system that maintained individual and social equilibrium for generations. illness. Traditional beliefs mental . which embodies kinsmen. the on the other hand refers ultimately to of anger and the desire to "the manipulation expression 295). Indigenous illness emphasis concerning and African views on illness and health in general and health in particular are holistic and 1977). eloquently described by Holdstock (1981. This African spiritual component of being has been p. 128): "The relationship permeates then.culture to culture from epoch to epoch. Sorcery or ubuthakathi. associated with the continued good health. They all make a distinction underdeveloped between theories of natural and supernatural causation. Murdock et al (1980) in particular have developed a a theories of illness in comprehensive societies classification' of underdeveloped . some beliefs the then reason ancestors are "facing away". Traditional African religions and magical theories of illness and health are inextricably interlinked as evident in the popular that man is most vulnerable to sorcery once for (Berglund 1976). Ngubane (1977) and Murdock in (1980) have all attempted taxonomies of theories of illness societies. this will ensure continued good health. and should a man strengthen himself and his'family by performing appropriate rituals to the ancestors. Weisz (1972). et al Torrey (1972). on at this essentially basis magic medicine (supernatural) was This developed. Conco (1972).5 recognition to human destructiveness and violence as the most basic cause of all illness. 304). to popular medicine stands in close relation the observation of nature on the one side (natural) and to magical beliefs on the other clear statement of the dualism of " This is a "primitive medical systems ••• ". historian of medicine Catiglioni (1947) as follows : "The first medicine of the most ancient periods was empirical (natural). (p. The essentually dualistic conception of the basic philosophy He quotes of a African medicine has been clearly noted by Conco (1972). for act the or impairment of health as a physiological consequence of experience of the victim in a manner that would not unreasonable to modern medical science (Murdock et a1 1980).2. 1.Old age. but their interpretation is bound up with African ways of viewing health and desease". "The name Js used mainly because the philosophy of this means causality is based on African culture.1 Theories of Natural Causation scientific or popular which accounts some seem This can be seen as any theory. attributes illness to supernatural causation. are seen that as associated with African people only. Isithuthwane or asthma are relevantly classifietl or in and isifuba somoya this category. Ukufa kwabantu literally refers to disorder of the African people. may all be recognized as natural causes of . with its This category is recognized by modern medical science empirical traditions e. working among the rural Nyuswa valley in Zulu people near Durban. Ukufa kwabantu on the other hand. (Murdock et a1 1980). as in the case of infection. To quote Ngubane (1977 p. etc. Umkhuh1ane refers to the explanation of illness by natural causation. of natural and They make a basic distinction between theories causation distinction which made is 'similar by Ngubane to the supernatural umkhuh1ane : ukufa kwabantu (1977). 24). stress. ingestion of poison. organic deterioration epilepsy and accident. .6 throughout the world. not that the diseases or rather their symptoms.g. or a religious conversion experience. ukuthwasa . .sickness/illness. particularly used in explaining uncommon or the-ordinary are types of illness. These three categories can best be conceptualized as three differeAt traditionally acceptable affliction.2 These Theories of Suoerm. attributions The tradition made by the afflicted to explain be the ukufa kwabantu theories can subsumed within this supernatural division as follows: Animistic theories ascribe the disorder to the behaviour of some personalized supernatural agent such as a spirit or god. for example : abaphansi basifulathele - withdrawal shades of protection of ancestral within mostly caused by disharmony the home.2. 1. magical and mystical theories. namely the supernatural division of the taxonomy of Murdock et . al there are three major explanations of supernatural causation.a "creative illness" following the calling by the ancestral shades to become a diviner.tural Causation ascribe the illness causatiion to external supernatural forces. Within (1980). Magical theories attribute the disorder to the covert action of a malicious human being who employs magical means to injure his victim. Conco (1972) feels that such theories and explanation made use of at a point where ordinary treatment have failed. animistic. out-of- Such theories are. who agrees or refuses to .pOlsonlng attributed to sorcery . To explicate the nature of the supernatural theory. umkhondo omubi .g. and its basic tenets.disorder attributed to stepping over a harmful concoction of a sorcerer. study is health and sickness. Mystical consequence example: umnyama theories to some explain disorders in terms of an automatic person for act or experience of the afflicted . on traditional Zulu speaking people theories are common to most traditionally oriented African peoples. Edwards et al (1982) view these theories as forming the cornerstone of traditional African cosmological. help A.experiencing illness or adversity because of contact with places or people immediately e. death and menstruation. associated with the major life events. (2) A consults traditional doctor D.a dangerous track. social and moral world While the focus of this variations of these views of good and evil.r for example: idliso . birth. religious. or ecological health hazard such as lightning. Conco (1972) has schematically represented this as follows : (1) Person A wants another person 8 to be afflicted by some sickness which would lead to 8's death. or sending a bird. e. Then B becomes sick. he consults the supernatural forces or the spirits of destruction or evil. or his animals (domesticated) become sick. or his family. "Tikoloshe".riding on a baboon. 1. D gives A the medicine with appropriate instructions for use on B. I B For detailed discussions on these traditional Zulu views of illness refer to (Coneo 1972.g.. The sequence may be indicated as below. Ngubane 1977.3 Indigenous practitioners diagnostic and treatment methods with particular reference to Zulu society Diagnostic procedures common among most indigenous healers across the . (4) (5) The spirit S shows D the medicine or concoction to use on B. and with the the S = "Supernatural" = The more victim. which may be (i) Forces of Good. Health. or lightening and hail storms. Edwards et al (1982). A D = Individual Human Being = Anthropomorphic element = Traditional doctor = Mediator in touch with '''Natural''. or (ii) Forces of Evil. sending the med' . (6) A uses the medicine on B. and Prosperity.9 (3) If doctor D agrees to help A."Mkhovu". "short Various agencies may be used by A using certain animals . a snake etc. Disease and Destruction. South Africa today. impersonal roles.world involve and repetitive rituals that involve complex social use negotiations interactions. After diagnosis. In Africa particularly. ogaissa . diviners and prophets. the These which conducts the healing ritual in a supernatural . with the type of treatment methods they (-nyanga .Xhosa. are to be found in almost every cultural in indigenous group. Their diagnostic and treatment methods are more or less the same as those discussed above.3. Through the ·use healer of powerful symbols and impressive. public participation the patient. the members of his social network and the healer. healers among Zulu speaking society the tradition doctor (inyanga). treatment.Sotho. Some indigenous diagnosticians astute psychological techniques to gather information from patient and members of their social network.Amharic) faith healers. practi tioner' s then plans a course of for Indigenous procedures generally incorporate the patient and his social group as a whole into the treatment program.e. practitioners with its essentially third world population. 1. rituals are in sharp contrast with Western treatment techniques often take place in secluded quiet rooms. There -mganga accordance traditional Swahili. context.Zulu. diviner (isangoma) and . -ngaka . -gqira are doctors . Kaplan and Sadock (1981) point out that of dramatic healing rituals entail the active. the indigenous practitioner.1 Three basic categories of Zulu indigenous practitioners basic categories in A good case can be made for there being three broad. These practitioners are given particular names or labels use. of indigenous i. 2 Isangoma The traditional diviner who is usually a. p. "A person does but not choose to become a diviner who and qualifies after (isangoma). The advent of the umthandazi can be traced to the rise of the African Independent Church movement and it has been argued that many of the traditional roles of the isangoma have been taken over by the umthandazi (Lee 1969. who shows an interest in medicine" (Ngubane 1977.1 Inyanga These traditional doctors are usually male. bestow learns whom upon her clairvoyant powers.3. and typically specialize in the use of herbal medicine and natural treatment methods. shares a comprehensive knowledge of megicine with the doctor (inyanga). is chosen by her ancestors.1. undergoing the ukuthwasa process. A neophyte to in to about medicine from a qualified diviner she is apprenticed for some time. of equivalent in money usually not less than R20 Sometimes a doctor passes on his skills to one his sons.3. West 1975). 1. At himself apprenticed to a for a period of not less than a the end of his training he pays his master a cow or its 00.102).1.woman. but addition some medicines are said to be revealed . "A man usually inyanga who gets wants to be an inyanga ("doctor") practising year.11 faith healer (umthandazi). 1. 3.3.1. p.1.5 1.1. 1.1.3 1.3.6 1.3.3.3.1.3 Umtha~jazi This is the general term for a faith healer and literally means Faith healers are professed Christians who may belong or independent churches and therefore "one to who prays".3.1.2 1.102).3. (Ngubane 1977.3. The and diviner is however mainly and traditionally a psychodiagnostician priest who divines within a supernatural context through her culturally accepted mediumship with the accepted shades.1.3.1.3.1.3.3.4 1.1.1. either mission also-typically work within supernatural context.1.1. 1.3.3.1. "The power to heal is believed to come cases it may be thought from to God come although in some from God indirectly through the shades and a period of training as a healer mayor may not have been necessary". p. for example : 1.1.3.1. 7 inyanga-yomhlabelo inyanga yez III 11 inyanga yemvllla inyanga yamakhambi inyanga yokumisela isangoma sekhanda .12 her by her ancestors". (West 1975.1 There Specialists and General Practitioners of are various specialists within their three broad categories practitioners.3.96).1 inyanga yesisu specialist stomach doctor orthopaedic surgeon heaven head rainmaker herbalist specialist in inducing pregnancy head or listening diviner 1. 1.3. Some examples follow: 1.2.6 1.9 1.1.3.1 1.8 1.3.5 1.3.1.3.12 1.8 ukubeka izandla . divination using bones. 1.3.2.3.3.3. Ngubane 1977.3. Conco 1972. divination with the aid of a mirror.3.3.2 1.13 isangoma samathambo i5a~go~a bone throwing diviner mirror diviner ventriloquist/whistling spirit diviner fai th healer religion prophet prophet who diagnoses with a rope.1. a general practitioner who will refer to himself as both an inyanga and an umtbandazi.3.13 1.2. 1982).3 1.11 1.3.1.1.2.3.2.1.1.3.3.3.1. precognition diviner tells the patient of his illness homing in on the problem areas depending upon the degree of expressed agreement by patient and relatives.3.1.3.10 1. for example.1. (Krige 1950. divination by ventriloquism/ ancestral shade communication.1.2. Hadebe 1982 Thorpe.2.2 Diagnostic Methods These are mainly supernaturally oriented.2. various categories of of Zionist sesibuko isangoma sabalozi umthandazi weSiyoni umphrofetbi umphrofethi wentambo Also there is often overlap within these healers.7 ukubh<lla ngamanzi divination using water (usually in a bottle). laying on of hands ukubhula ngamathambo ukubhula ngabalozi ukubhula ngekhanda ukubhula ngesibuko ukubona vumisa technique 1. Edwards et al 1982. divination by head through guiding ancestral shades.4 1.3. steaming to induce perspiration and reduce fever. Some examples follow : 1.3.3. fumigating smoke.3.1 Treatment Methods Natural Methods These can also be used within a supernatural or symbolic context.9 1.3.6 1. 1.3 1.2.4 1.3. acupuncture.3.10 1. A practitioner asks the patients various questions pertaining to the illness.3.2.3. with ukug~~a/ukuhlamba ukugcaba .3.3. actual examining of the patient question and answer method.11 1.2.2.3.3.g.2 1.1 1. usually porcupine quills.1.14 1.3.3.1. for idliso. dreams revealing illness. incissions for the insertion of curative mixtures.3.3.3.3.case history.1. 7 ukuphalaza induced vomitting through emetic e.12 imibono symbolic visions revealing the illness.1.2 .15 ukuhlola ukubuza 1.3.1. the house with ukugquma ukushun qisa ukuhogela ukutshopa inhaling treated smoke.3 1.3.5 1.2.1.e. patient telling the practitioner all about his/her illness . amaphupho ukugida umthandazo The following diagnostic methods are naturally oriented 1.3.1. ritualistic dancing and singing divination through prayer.2.3. 3.14 1.13 ukulandisa i. bathing cure.3. for example given at night.3. which are classified according to colour and administered in strict serial sequence.2.1.3.10 1. herbal medicines consisting of green leaves. scope of the present paper.3. hot ukuth:Jl:·a a formenting treatment applied for example.15 1.3. used to cure somatic symptoms.3.1.1.3. general term commonly implying the strengthening or fortifying of the patient e. stem.9 1.3.1 amakhambi natural remedies e.3. 1.11 1. through incissions. fluid from with cow's horn. medicines used in ritual symbolic context. fruits. through touching the.3. Ngubane (1977) for detailed expositions. Refer to Bryant (1970). which has been treated with a particular muthi (medicine).g.3. In addition such religious and ritual treatment accompany this medical treatment.3.1. sunrise or sunset and daytime.2 amakhubalo .g. for example.3.13 ukuncinda sucking. flowers and seeds.2 Medicinal Compounds which are beyond the A great variety of medicinal compounds are used.3.g.3. 1. for example for stomach complaints blood letting swollen ankle.3. 1. bulbs.1. bark.1.3.1. for a ukuchatha ukulumeka ukumoma draining e. e. Generally though medicines are divided into two basic categories (Ngubane·1977).g.8 1.3.3. enema.g. body with a goats horn. for aching feet.14 ukuqinisa 1. ear ukuthwebula symbolically extracting illness e.12 1.2. roots. medicine from fingertips.3.3. against ritual· communication with the shades through eating and beer" drinking.3.3. anxiety relief).3.3. p.6 ukuchela 1.31O). at dawn to confession cast by out an 1.5 ukubonga ukuthetha ukushweleza ukubethela isidlo sacrifice in thanksgiving the ancestral shades.3.1 1.7 1. .3.3. literally "turning of water" to reinsure ancestral protection following lineage sorcery (uzalo) a sacrifice to reintegrate a shade with the members of the homestead.3.g.3. (ukubuyisa idlozi). emphasis has been put on the sociocultural and homeostatic effects of such ritual.3.3.3.3.3.3.3.3. This point has been religious eloquently put by Conco (1972. 1.3.3.9 1.3.3.3 Such home Religious and Ritual Treatment of Supernatural Orientation the treatment traditionally involves a sacrifice by the head of in a family or group context and is directed at ensuring continued ancestral protection and good health. ancestors to for appeasement sacrifice.3 1.3.3.g.3.2 1.3.3. to fortify the home danger e.3.11 ukubuyisa Besides the individual psychodynamic effect of performing such rituals (e.3.3.3. ukuguqula amanzi 1. sorcery.10 ukukhwifa ukuvuma ukuhlanza vomiting or defecating following an emetic or purgative.16 1.3. "scolding" the misfortune.8 1.4 1.3. fortifying the homestead through sprinkling and spreading of medicine by the family inyanga spitting evil. public accused.3.3.3. . (Vilakazi 1962.' 1973. Kruger 1974. investigate where indigenous practitioners as this is a found semi-rural (Hadebe indigenous practitioners are commonly Traditional more beliefs and practices and traditional practitioners Ngubane commonly 'found in rural areas. The Kwa-Dlangezwa.5 AIM The aim of the present study is two-fold : (i) To investigate diagnostic and healing methods used by sample of indigenous practitioners in the ~ random Kwa-Dlangezwa. Ongoye area. Burhmann 1977. 1. are 1977. Gadner 1978) have of appealed that greater recognition be given to and greater use made the skills of indigenous practitioners in the treatment of persons who could benefit from their services (Holdstock 1979). Cheetham 1975.4 MOTIVATION Various prominent mental health professionals in South Africa (Le Roux .avoiding preservation of conformity". Edwards et al 1983). 1. Ongoya area of Natal is an ideal area to area 1982).17 "A discussion of psychotherapeutic bases of some has Arab rituals (however irrational or illogical) shown and that they pass from generation to generation further observed that adherence to these and the rituals anxiety acquires some anxiety properties relieving through . diagnosis treatment.6 1.1 In view of (~T<thandazi). broad the basic categories of indigenous Zulu practitioners traditional doctor (inyanga).6. General hypotheses are as follows : 1. 1. it was generally use and hypothesized both natural Zulu indigenous practitioners would supernatural methods of.6.0 HYPOTHESES It was generally hypothesized that there are three i.1.3 Traditional diviners will be significpntly different from faith healers to the extent to which they use indigenous Zulu supernatural oriented diagnostic and treatment methods as opposed to Christian faith healing methods. These hypotheses can be further reduCed as follows : .6. traditional diviner (isangoma) their that and traditional roles.6.1. 1.1 Traditional doctors (izinyanga) will make significantly use of natural methods concerning both diagnosis more and treatment.1. and faith healer /'1.2 Traditional (abathandazi) diviners will both (izangoma) and faith more methods healers use of than make and significantly treatment supernatural diagnostic traditional doctors.e.6. 1.18 (ii) To ascertain whether and there is any consistency in the (intraindigenous practitioner inter-practitioner) practitioners diagnostic and healing methods. 2 There will be a significant degr~e of agreement among doctors .6. ~1. 1.6. follows : be consistent This in their diagnostic practitioners and treatment as general hypothesis can be further reduced 1.1.2 / It was further generally hypothesized that all would methods. 1.1. 1.6.6 Traditional indigenous diviners Zulu will make significantly more use \ of supernatural diagnostic methods than faith healer and traditional doctors.1.1.2.7 Traditional doctors will make significantly more use of natural treatment methods than faith healers and diviners.8 faith healers will make significantly more use of supernatural Christian faith oriented treatment methods than traditional doctors and traditional diviners.9 Traditional diviners will make significantly more use of Zulu .6.1. indigenous oriented supernatural treatment methods than traditional doctors and faith healers. 1.6.1~ '0 1. 1.1 There will be a significant degree of agreement among diviners with regard to diagnosis and treatment procedures.6.1.6.6.2.5 faith healers will make significantly faith oriented more use of than supernatural Christian methods traditional diviners and doctors in their diagnostic methods. ~ 1.4 Traditional natural doctors will make significantly more use of methods than faith healers and traditional - diviners in their diagnostic methods.6. 20 regarding diagnosis and treatment procedures.3 There will be a significant degree of agreement among faith healers with regard to diagnosis and treatment procedures.6.2. ~ 1. . 3.3.Z. symptomatology.3 Inter-practitioner consistancy questionnaire (See Appendix C).21 CHAPTER 2 2. .2. B and C).2 A practitioner questionnaire assessing diagnosis.2.2. cause.3 2.2 2. 4 traditional doctors Cizinyanga) and 4 Zionist faith healers (abathandazi beziyoni) were selected by means of a random numbers table from a list of these practitioners provided by an informant Hr K. 2.1 Procedure Visit One: Each practitioner was visited by the researcher /' and a confederate with a problem requiring treatment.1 Apparatus Portable tape recorder.3. 2. 2.1 Writing materials Three questionnaires (See Appendices A. Ongoye area. and diagnostic and treatment sessions. 4 traditional diviners (izangoma). for recording interviews.3 2. A patient questionnaire assessing biographical data. treatment and prognosis.2. from the Kwa-Dlangezwa.2. 2. diagnostic and treatment procedures.2 2. 2.2.1 Subjects HETHOD Twelve practitioners.3. cause.3. 2. 2.3 Visit Three consistency practitioners consistency asked In order to assess inter-practitioner. The practitioner was happy about a further visit.6 repeated.1. inter-practitioner Practitioners were to rank order 6 diagnosis and 6 treatment procedures .3.3.method of helping people with problems.3. 2.1 Following the further rapport practitioners were informed wanted that to Each practitioner was invited by the researcher researcher was· a student at University who learn more about indigenous practitioners in order to write a dissertation for his Masters degree.2.3. 2. \ Visit Two alone.6 further list of practitioner practitioners randomly chosen from the initial and procedure 3.2. symptomatology.3.1.2 The Patient questionnaire was completed by the researcher. treatment and prognosis was collected.2. 2. asked if he would be welcome if he made another visit. .3 Standardized data regarding diagnosis. In order to replace was the above practitioner.2 The Practitioner questionnaire was completed by the researcher. a The researcher then Eleven practitioners were affirmative and an appointment was fixed.7 2.1. all as regards diagnostic and treatment methods were visited again and the questionnaire administered.3.3. Diagnostic and treatment sessions were tape recorded.1 to visited 3. 2.3. 3. The practitioner was to learn informed that the researcher was interested more" about indigenous practitioners . healers.5 After the session between practitioner and client researcher greater rapport with the practitioner using (1957).OO was offered additional remuneration to the normal fee.1 2.1.3.2 Appropriate and initial rapport was established indaba style. and a genuine interest showed in. the interview was transcribed manually. In the case of the 3 practitioners (I diviner.3. 2.1. and established interview Bingham Brammer warmth techniques recommended by Kahn and Cannel and Moore (1959) Burger (1969).3.1. The confederate/client requested help for his problem. 2.1.e. (i. faith healer and 1 con~ented diviner) after R5.3. diviners "and 1 doctor).3 The researcher requested if tape recordings could be made the session with the rationale this would enable of full understanding by the client. 2. Gordon (1969) and Shostrom (1977) in which the interviewer and responsiveness. out of which 2 2 faith of a tape 2 1 as recorded interview.4 Seven of the 12 practitioners were in favour 5 hesitated (i.1. and total acceptance of the subject. No with further information was given at this stage in keeping cultural practice which requires all traditional assessment to be initiated by the practitioner concerned.e. defineteIy against having 1 doctor and 1 diviner) who were the interview recorded.23 2. ukuthwebula methods such as (i)vumisa (iii) technique. 2. 2.4. not necessarily espoused within typical traditional Zulu culture.4 2.2 Supernatural methods indigenous Zulu methods referred typically to those traditional to Zulu culture and occuring within magical and/or religious ritual and symbolic context. after visit 2.1 Categorization of data The data fell into two distinct categories viz. (ii) steam such ritual purgatory medicines that is.1. methods methods (iii) (ii) actual expmination of the included were (i) emetics. supernatural. supernatural diagnostic and treatment methods 2. programme. patient. when all were not used in any traditional/indigenous symbolic context. (iii) case history. (ii) bone this head divination were included methods included were (i) under Treatment ukuthwasa (ii) ukuqinisa (strengthening of the individual.3 Christian . supernatural Christian and indigenous Zulu. Diagnostic methods included under this category were (i) question and answer. casting aside of illness.1 Natural diagnostic and treatment methods referred to ordinary methods. 2. Diagnostic throwing.4.4.1. The natural and supernatural category was further divided into two viz. category.24 which. had been ascertained to be the most frequently occuring among all 12 practitioners (See Appendix C).4. Treatment bathing.1. 2.5.25 referred Zulu change which to those methods not traditionally espoused and within culture which reflect acculturation as is evident in African Independent sociocultural movement religion.5 2. 2.3 Chi-square tests and Kendall~ Coefficient of Concordance (W) (refer to Siegel (1951).1 "t"Jests 2. Downie and Health (1959) and Behr (19B3).1.e. "p< 0. Treatment methods included were (i) Holy Water. were diagnostic methods included (precognition) (i) water divination {ii)ukubona (iii) Prayer.5.1.5.5.5.2 The 95% level of confidence i.1.05 was taken as accepted level of significance for all comparisons . 2.2 2. Church mainly influenced by Western Christian Under this category for example.1 Statistical Techniques Statistical techniques used in this research were. (ii) Blessed Ash (iii) Baptism. TABLE 3.75 3.1. married and resided in the Mtunzini district.2.2 Tables Biographical data of the practitioners 1 to 6 refer to the biographical data obtained from the twelve practitioners.1 refers to the mean age and standard deviation of the three categories between of practitioners. or doctors for short.2. Ten practitioners were in full ti~e practice. All practitioners were Zulu.1 F/Healers 46.40 00 47. with one faith healer and one doctor in part time practice. izinyanga abathandazi K L M refer to the 4 or faith healers.29 9.1 Key A B C D refer to the 4 E F G H refer to the 4 J izangoma or diviners for short. Although the findings indicated no significant differences between the . 3. AGE Diviners Mean Age in years Doctors 39.75 Standard deviation (S) B. "t" tests run to investigate differences three means indicated no significant differences between the categories of practitioners with regard to age.26 CHAPTER 3 RESULTS AND DISCUSSION 3.IB Table 3. 2 Table 3.· which is in keeping with the traditional role of the diviner as an old woman who also has the status of a man (Ngubane 1977. Hadebe around breaking 1982).2 refers to the sex of the three categories of practitioners. Cheetham and Griffiths 1982. However highly significant differences were between doctors and diviners (X 2 = 8. Farrand less accultured areas (Ngubane working in urban (1980) for example. however. from it can be observed. Johannesburg down. P <0. the table that diviners tended to be the oldest group. found this traditional sex role pattern becoming with male diviners and female doctors common and accepted.2. between regard Chi-square tests indicated no significant differences with found doctors and faith healers or diviners and faith healers to sex. TABLE 3. areas to be more and diviners being female. The being findings male reflect the traditional pattern of doctors as This is in keeping always the 1977.27 three groups of practitioners with regard to age.2 SEX Diviners Male Female 0 Doctors F/Healers 4 0 2 4 .2. . Brundley 1983).05). with traditional situation in rural. df = 1. healers as well as doctors. faith between doctors and faith healers (X 2 = 1. This emphasized the role of the diviner in traditional Zulu society as an unpolluted (less accultured).3 refers to the religious affiliations of the three • categories of practitioners. df = 1. Chi-square tests indicated no significant differences p> and p< The 0. departure Zulu society owing to the influence of Western Christian TABLE 3.B.05).28 TABLE 3.05 respectively) in their adherence to traditional religion. Churches represent a in their affiliation transitional to African from Independent traditional religion. doctors However diviners differed significantly from both healers (X 2 2 = 4.05 and X = B. I Diviners 0 4 Doctors 3 F/Healers 4 0 African Independant Church Traditional I I 1 Table 3. p< 0. df = 1.4 FORMAL EDUCATION Diviners Formal Education No Formal Education 3 1 Doctors 1 F/Healers 1 3 3 . 0. Ngubane 1977).2.3 RELIGIOUS AFFILIATION I I .2. sacred being. df = 1.14. Faith who is also a preserver of culture (Landy 1977.2. diviners were found to be the only group that solely adhered to the traditional Zulu religion. 29 Table to 3. The This diviners were more educated than both doctors and faith again emphasized the superior status of the healers. significant Chi-square regard tests and for whether indicated between both differences between diviners and : doctors p< 0. in diviner traditional Zulu society.05 diviners and faith healers (X 2 There was no 4.5 6.18 (X) lL25 2.2.4 refers to the education of the practitioners with they received formal education or not.87 Standard deviation (S) Table 3.05).61 F/Healers 45 7."t" tests run differences between means indicated no statistically significant differences between the three categories of practitioners. df: 1. have observed from the table that faith healers tended to years and diviners lower mean years of experience than could be due to faith healing apprenticeship starting at a age. Diviners on the other hand usually begin practising .34.5 EXPERIENCE Diviners Mean Years Doctors 18. Although the tests indicated no statistically significant between be mean This early differences it could higher doctors. p> 0. very when the means of the three categories of practitioners. comparisons). significant differences between doctors and faith healers (X 2 : 0.5 refers to the mean years (in practice) and standard to deviation investigate of the three categories of practitioners.2.2. df: 1. TABLE 3. traditionally after menopause (Ngubane 1977). in depth divination. p< 0. This may be attributable to the fact that the diviner highest priest in the society is expected to problems deal and the oldest. p> 0. as in a public divination. Doctors and faith healers tend to deal with less important. Chi-square tests indicated no significant differences between diviners and faith healers.2. . df = 1. ordinary problems.6 NUMBER OF CLIENTS SEEN OVER PAST WEEK Diviner 0 30 + Doctor 1 F/Healer 2 2 30 4 0 3 .05 and X = 0. 0.05 respectively).7 This role Summary of Biographical data research gives credence and emphasis to the sacred and powerful of the diviner in traditional Zulu society in that diviners were . However there was a significant difference between doctors and diviners (X' = 4. and between and faith healers (X' p~ = 1. doctors df = 1.20. df = 1. Table 3.e.54. the more important and typically traditional Zulu owing to the very nature of her work i.30 they are already old and matured.6 refers to the number of clients seen over past week by each group of practitioners.2. or It is evident that diviners saw fewer patients than either doctors faith being with also healers.05). for example. umhlahlo. 3. TABLE 3.16.2. There was no significant difference between diviners and faith healers (X Although methods making (12 = 0. role of This is in keeping with the traditional for disorders causation doctors a people who are commonly consulted to both natural (umkhuhlane) and attributed supernatural .1 NATURAL AND SUPERNATURAL DIAGNOSTIC METHODS (iil (Hi) (iv) 3. 0.31 found to be (i) the oldest educated female and belonging to traditional religion.37. Section 2. and = 1.6. 12 25 Table 3. Diagnostic Methods TABLE 3. DIAGNOSTIC METHOD Natural Supernatural Diviners 4 22 Doctors 12 F/Healers 3 .3 . 0.54.1.3.05 and X 2 = 9.87.1 refers to natural and supernatural diagnostic methods used by three categories of practitioners as described under Method. 2 p< 0.05 for both comparisons.05). equal 12) df = 1.4. Page 24 • Chi-square tests indicated significant differences between diviners and doctors and between doctors df and p< faith healers (X 2 = 6.3. df = 1. p~ use of natural supernatural diagnostic of natural which doctors made significantly more use than either diviners or faith diagnostic methods healers confirmed hypothesis 1. 3.83. These healers findings. df 2 X =B.2 refers to the supernatural Christian and indigenous diagnostic methods used by the three categories Zulu of oriented practitioners.2 SUPERNATURAL CHRISTIAN AND SUPERNATURAL INDIGENOUS ZULU DIAGNOSTIC METHODS DIAGNOSTIC METHOD Supernatural Christian Supernatural Indigenous Zulu Diviner 0 22 Doctor 6 6 F/Healer 21 4.05. TABLE 3. all comparisons. 0.05).3.05.32 (ukufa kwabantul. diviner vs = 1. p< p< 0. between Chi-square tests indicated significant 2 differences df = 1. df = 1.6 in that faith significantly methods natural Moreover as emphasized opposed and supernatural to both Christian oriented who diagnostic emphasized doctors. doctor vs faith healer faith healer X = 33. . p< 0.1. confirmed hypothesis 1.39.6.6.41.5 and 1. Table 3.1. indigenous the further finding that diviners Zulu oriented diagnostic methods significantly either faith healers or doctors again reaffirms the unique traditional role of the diviner as preserver and perpertrator of traditional Zulu culture. (Diviner vs Doctor 2 X = 13. and Zulu diviners indigenous diagnostic methods emphasized more than respectively. 1 refers to natural and supernatural treatment methods by three categories of practitioners. Doctors than used either significantly natural oriented treatment methods diviners or faith healers.27.1.01).3. Chi-square tests (X 2 used indicated significant differences between doctors and diviners df = 1.13. 7. p~ 1. p< 0.2 SUPERNATURAL CHRISTIAN AND INDIGENOUS ZULU TREATMENT METHOOS TREATMENT METHOD Supernatural Christian Supernatural Indigenous Zulu Diviner 0 3D Doctor 2 ID F/Healer 26 7 . between = 1.4.05) and between doctors and faith healers df = 10. No significant difference was 0.05).1 NATURAL AND SUPERNATURAL TREATMENT METHODS TREATMENT METHOD Natural Supernatural I f Di. TABLE 3. p< 0. 27 12 F/Healers .4. (X' = 13.4 Treatment Methods TABLE 3.iners 15 30 I Doctors I . df These findings more confirmed hypothesis = 1.6. 14 ·33 I Table 3. found diviners and faith healers (X 2 ~0.76.4. 2.6. It was evident that faith healers used supernatural Christian oriented treatment hypothesis diagnostic which methods 1.05).26.23. 2 differences between all comparisons (Doctors vs diviners df = 1.62 .).1 DIAGNOSTIC AND TREATMENT METHODS. more than either diviners This or doctors confirming \ finding is in agreement with the 3.pc 0.8. type of methods the faith healers used (see par.15 .61 Doctors (M=4) . all of African is attributable to the affiliation of faith healers to Independent Churches which are greatly influenced by Western Christian religion. METHOD Practitioners (M=12) .05 .9 and is a further testimony with the role of the diviner as a person associated and concerned maintaining and preserving typical Zulu culture.66 . 3.46.05 diviners vs faith healers X2 = 40. to This confirmed hypothesis 1.4. It was also evident that diviners used treatment methods that were or typically indigenous Zulu in nature more than either faith healers doctors.5.2 refers Zulu to the supernatural christian treatment methods used and by supernatural the three indigenous categories oriented of practitioners. WITHIN GROUP COMPARISONS .008 Diviners (M=4) . df = l.5 Interpractitioner consistency TABLE 3. doctors vs faith healers 2 X = 14.3. pc 0.1.34 Table 3. pc 0.82 DIAGNOSIS TREATMENT .80 Faith healers (M=4) .1. df = 1.6. Chi-square tests indicated significant X = 5.60 . with either doctors the or The finding that diviners did not agree concerning diviner as diagnosis an again faith healers role of the emphasizes exclusive indigenous . the religious affiliations of the doctors. BEtWEEN GROUP COMPARISONS METHOD Diviner & Doctor (M=B) . African Independent Churches.35 Table all 3. of concordance for is between group comparisons.1 refers to Kendall's coefficients of concordance (W) (M = 12) rankings of the six diagnostic for and practitioners treatment methods. agreement ood 4 among the separate group i. The low degree of agreement amongst all twelve practitioners 4 diviners.01) Table 3.e.05) Doctor & F/healer (M=B) Diviner & F/Healer (M=B) .5. apparent From the table it that doctors and faith healers were in significant agreement In this context it seems important to emphasize three of whom belonged to concerning diagnosis.31 (p< .004 .05 .5.5. healers respectively. faith emphasizes' exclusiveness of the three different categories of practitioners. yet 4 the significant doctors. There was no significant agreement amongst the full group method.43 (p< .05 DIAGNOSIS TREATMENT .01) .65 (p< . of twelve practitioners regarding diagnostic and treatment Significant agreement however was found amongst each category of practitioners separately at the 5% level.2 DIAGNOSTIC AND TREATMENT METHODS. TABLE 3.2 refers to Kendall's coefficients M = B in each case. this difference i. significant agreement was found between diviners and with doctors.e. medium with supernatural is on From inspection of appendix D it is due to diviner's emphasis that indigenous supernatural diagnosis. on one hand and doctors and faith healers on the other disagreement between diviners and faith healers. Concerning treatment. This is due to and traditional similarity of diviner and doctor's treatment methods dissimilarity between diviners and faith healers particularly owing to their different religious orientations of their treatment.36 religious particularly apparent psychodiagnostician ancestral shades. . The finding that the agreement between doctors and faith healers can be attributed to the fact that in this study. three of the doctors belonged to African Independent Churches. ). the traditional doctor (inyanga).g. These to be and all found (from a Westernized point of view) both dualistic tenets (Conco 1972) including a pattern which was natural among supernatural. traditional emphasized consistently among these three broad categories of special mention (1982) as as practitioners also the the diviner by deserves and her previously results type of Cheetham portrayed Griffiths as a superior specialist practitioner e. female preserver and provider Zulu culture. diagnostic Kruger 1974. de-emphasize the commonly found existence of specialists three broad categories of practitioners as indicated by others Conco (1972) and Ngubane (1977). methods based were on the and broad cosmological orientation of all practitioner's (rarrand 1982. Cheetham and Griffiths 1982. practitioners. Secondly. Zulu indigenous practitioners take this finding This finding of course if not as a point of departure.37 CHAPTER 4 : CONCLUSION The main finding of the present research is that there are three broad basic categories of indigenous Zulu practitioners i. treatment methods is re-emphasized. traditional each of which diviner (isangoma) and use faith healer (umthandazi characteristically It is recommended different that future into does within among diagnostic research account not these and among treatment methods. again Edwards et al 1983). Thirdly.e. of traditional an elderly. educated. consistently found . hallowed in the annals of traditional Zulu time. g. primary and or retraining traditional healers to serve as so that the network of hospitals and medical health workers. Rappaport and Rappaport 1981) in a propositional model integrating tradition and scientific healing have advocated a referral system based on mutual appreciation of expertize e. Collomb for Along the lines of therapeutic villages (Lambo. 1977. implications and problems concerning greater integration is needed. 1973. is Rappaport and Rappaport Further research 1983) recommended.38 In view of broader social implications as regards the above integration in of Western and African oriented -mental findings health previous 1981. . center can function more efficiently as secondary and tertiary units. on the more subsystems particular. 1972. Edwards et aL Pearce 1981. the chemotherapy by by the modern doctor and concomitant psychocultural counselling traditional healer. in South Africa as suggested by studies (Holdstock 1979. Cheetham 1975. Garden 1978) have of appealed that greater recognition begiven to and greater use made the skills of indigenous healers in the treatment of persons who could benefit from their services (Holdstock 1979) There Africa are a variety of different types of indigenous healers in South today. It can be argued that 'there are three broad basic categories of indigenous healers i. and shares a comprehensive knowledge of medicine with the doctor (inyanga). among Zulu speaking people in South Africa today.e. The diviner is however divines mainly and traditionally a psychodiagnostician and priest who within a supernatural oriented context. Conco (1972) lists six. The traditional doctor the use (inyanga) is usually male. She only qualifies as a diviner after undergoing ukuthwasa process. Ngubane (1977) lists two and West (1975) lists various types. umthandazi can be traced to the rise of the African Independent Church movement and it has been argued that many of the traditional roles of isangoma have been taken over by the umthandazi (Lee 1969. of herbal medicine natural The diviner (isangoma) is usually a woman. The advent of the (isangoma) and faith healer (umthandazi). Burhmann 1977. and and typically treatment specializes in methods. through her culturally . diviner the traditional doctor (inyanga). West 1975). Kruger 1974.39 CHAPTER 5 5.1 INTRODUCTION SUMMARY Various prominent mental health professionals in South Africa (le Roux 1973. 4 traditional diviners (izangoma).1 METHOD Subjects Twelve practitioners.2. to make more use of natural methods concerning Both diviners use and of treatment. significantly supernatural respectively. faith healers were expected to supernatural diagnostic indigenous and that Zulu. consistency (inter-healer) treatment procedures. significant practitioner more christian ~It oriented also of treatment there would methods be a was hypothesized among degree agreement practitioners and (intertreatment consistency) concerning diagnoses procedures for the same patient. In view of their traditional roles it was generally hypothesized Zulu that indigenous practitioners would use both natural and supernatural Traditional doctors were expected both diagnosis and make and methods of diagnosis and treatment.40 accepted mediumship with the ancestral shades. in and to ascertain whether there was these practitioners' diagnostic Kwa-Dlangezwa.2 5. The may faith healer (umthandazi) is generally a professed Christian belong to either mission or independent churches and who therefore also typically work within a supernatural context. 4 traditional doctors (izinyanga) and 4 Zionist faith healers (abathandazi beziyoni) were selected by means of a random numbers table from a list of these . 5. The aim of this present paper were to investigate diagnostic and the any and healing methods used by a random sample of indigenous healers in Ongoye area. symptomatology.2. 5.2.2 A practitioner questionnaire assessing diagnosis.2 Apparatus A patient questionnaire assessing biographical data. following the session.2. On the second visit. was completed.2. 5. . cause.3 Procedure and diagnostic and Practitioners were visited on three occasions. 5. - Ongoye 5.2.41 practitioners provided by an informant from the Kwa-Dlangezwa.2. On the first visit.4 An inter-practitioner consistency questionnaire.2. the researcher requested was accompanied by a genuine client/confederate the who help for his problem.2.1 diagnostic and treatment methods.2. Nine of the 12 practitioners allowed all three sessions to be tape recorded. treatment and prognosis.2.3 5. consistency On the third visit and inter-practitioner were which questionnaire was administered to practitioners who asked to rank order six diagnostic and six treatment procedures had been ascertained to be the most frequently occuring amongst all 12 practitioners. the patient questionnaire established researcher the greater rapport with the practitioners and completed practitioner questionnaire. 5. A tape recorder for recording interviews. area. data being manually recorded in case of the other three practitioners. treatment methods. 42 5. follow.tests tests and (iii) Kendall's co-efficient of concordance (ii) (W) Statistical Cri-square (refer to Siegel 1951. The central finding concerned diviners. natural and supernatural. methods Zulu referred to those methods not traditionally culture which reflect acculturation and sociocultural change evident in the African Independent Church movement.1 The main findings are contained in the results which RESULTS AND DISCUSSION Biographical data of the practitioners who were found to be female.5 Statistical technigues techniques used in this research were the (i)i. The 95% for confidence was taken as accepted· level of significance all comparisons.3. indigenous Zulu methods referred to those methods traditional to culture and typically occuring within magical and/or religious ritual Christian supernatural diagnostic and treatment espoused within as and symbolic context. and Behr 1983). saw fewer patients. The had more .2. and supernatural category was further divided into two Natural not diagnostic necessarily Supernatural Zulu supernatural Christian and indigenous Zulu.4 The data Cateqorization of data fell into The two distinct categories. level of Downie and Heath 1959.2.3 5. viz. 5. adhered solely to traditional religion and years in school than either doctors or faith healers. viz. treatment methods referred to ordinary methods typical traditional espoused within Zulu culture. 5. older. 43 sacred and powerful role of the diviner as a preserver and perpertrator of traditional Zulu culture in a traditional Zulu setting was consistently emphasized. 5.3.2 Diagnostic Methods Table 5.3.2.1 Natural and Supernatural diagnostic methods Diagnostic Method Diviners Doctors faith healers Natural Supernatural 4 12 3 22 12 25 Table 5.3.2.1 refers "to natural and supernatural diagnostic method used by the three - categories of practitioners as tests indicated described significant and under Method (Section 2.3). Chi~square differences healers for both between diviners and doctors and between doctors faith (X l =6.87, df = 1, p< 0.05 and X" = 9.37, df = 1, p< 0.05 ) comparisons. There was no significant difference between diviners and faith healers(x" I = 0.54, equal doctors df = 1, p> 0.05). and supernatural more or use diagnostic of natural as Although methods making (12.12) use of natural made significantly diviners diagnostic hypothesized. as methods than either faith healers This is in keeping with the traditional role of doctors people who are commonly consulted for disorders attributed to both ~kuta natural (umkhuhlane) and supernatural causation kwabantu ). 44 Table 5.3.2.2 Supernatural Christian and Supernatural indigenous Zulu Diagnostic Methods Diagnostic Method Diviners Doctors Faith healers Supernatural Christian Supernatural Indigenous Zulu 0 22 6 6 21 4 Table:5.3.2.2. refers indigenous Zulu to the supernatural Christian and supernatural categories of diagnostic methods used by the three Chi-square tests indicated practitioners. significant differences between all comparisons (Diviner vs doctor X2 = 13.39, df = 1, p< 0.05 doctor vs faith healer XL = 8.83, df = 1, p< healer XL These 0.05, diviner vs faith = 33.41, df are = 1, as p< 0.05). findings hypothesized in that faith healers differentially methods as emphasized supernatural Christian oriented diagnostic to diviners who doctors emphasized making equal indigenous use of Zulu both compared methods, diagnostic orientations. 5.3.3 with Treatment Methods Table 5..3.3.1 Natural and Supernatural Treatment Methods Treatment Method Natural Supernatural Diviners 15 30 Doctors Faith healers 14 13 27 12 45 Table 5.3.3.1 refers to natural and supernatural treatment methods used by the three categories of practitioners .. Chi-square tests signi ficant indicated r differences between doctors and diviners (X l =10.76, df=l, ~aith p < 0.05) and between doctors and p < 0.05). healers (XL = 13.27, df = 1, and No significant difference was found between diviners ~ faith healers (X 2 = 0.13, df 1, p> 0.01). Doctors used significantly faith more natural oriented treatment methods than either diviners or healers, as hypothesized. Table 5.3.3.Z Supernatural ChE.!3tian and Indigenous Zulu Treatment Methods ~ Treatment Method Diviner~ Doctors Faith healers Supernatural Christian 0 2 26 7 Supernatural Indigenous Zulu .30 10 Table 5.3.3.2. indigenous categories refers· to the sUl:lernatural Christian Zulu oriented tr~atment and by supernatural the three methods used of practitioners. thi-square tests indicated VS significant differences between all compari~ons (Doctors df = 1, p< 0.05; doctors vs faith healersx L diviners XL = 5.26, 0.05; = 14.46, df=l, P< 0.05). diviners vs faith healers X" = 40.23, df = 1, p< It was evident that faith Christian oriented diviners, the which heale~s, as hypothesized, used supernatural either doctors or treatment methods more than is in agreeme~t with the type of diagnostic methods of faith healers used. This is attributable to the affiliation 4. emphasized exclusiveness and homogenous nature of the three different categories . yet 4 the significant doctors.15 .4~ Diagnostic and Treatment Methods.80 .62 Diagnosis Treatment .3. and 4 faith healers respectively.008 . within group Comparisons Method Practitioners(M=12) Diviners(M=4) Doctors(M=4) F/HeaIers M=4) .82 Table 5.3. refers to Kendall~ co-efficients of concordance (W) for all practitioners (M=12) rankings of the six diagnostic and methods.1. arre greatly influenced by Western Christian religion.60 . It was also evident that diviners used treatment methods that were typically indigenous Zulu in nature more than either faith healers or doctors.faith healers to African Independent Churches which · .e. as hypothesized. The low degree of agreement amongst all twelve practitioners 4 diviners.66 .4 Interpractitioner Consistency Table 5. agreement among the seperate groups i.3. twelve treatment There was no significant agreement amongst the full group of practitioners agreement regarding however diagnostic and treatment each method~ Significant was found amongst category of practitioners.61 . This can be viewed as a further testimony to the diviners' role as a person concerned and associated with maintaining and preserving typical traditional Zulu culture. 5. and different future diagnostic and treatment methods. a homogenous group clearly i.4 The main CONCLUSION finding far of the present research is from three being that indigenous . the categorized into traditional faith healer separate types of practitioners doctors (inyanga).g. an elderly. 1982 Edwards et aI. Zulu can be practitioners. 5. female preserver and provider hallowed in the annals of traditional of traditional Zulu culture. of practitioners concerning diagnostic and treatment procedures. traditional emphasized consistently among these three broad categories of deserves 'special and her Griffiths. 1983). educated. It is recommended this research among Zulu indigenous practitioners take finding into account if not as a point of departure. Thirdly. traditional diviner of which use (isangoma) (umthanaazi). Secondly.e. These methods were again found to be based on dualistic tenets (Conco 1972) . as a mention 1982) practitioners (as as the diviner by particularly the results type of Cheetham portrayed superior specialist practitioner e. healing re-emphasized. diagnostic Kruger. each characteristically that main of of as . the and broad cosmological methods orientation of is all practitioners' (farrand 1982. course This finding existence does not de-emphasize the commonly found specialists within these three broad categories of practitioners indicated by among others Conco (1972) and Ngubane (1977). Zulu time.47 . 1974 Cheetham and Griffiths. 48 r including both natural and supernatural. in South Africa as suggested Pearce 1981. . In more view of broader social implications as regards the above integration of Western and African oriented mental by findings health previous sUbsystems studies Edwards in particular. a pattern which was consistently found among all practitioners. of indigenou~ healing as previously Conco 1972. aspects Moreover the psychotherapeutic (Kiev 1964. favour this recommendation. Rappaport and Rappaport 1981. Ngubane 1977) and observed in this research. effectiveness and bited et al 1983) is recommended. (Holdstock 1979. Missouri. 957-958. & Griffiths. Journal of Social Science and Medicine. 283-322. University of Zululand. 12 13 14 . South African Medical Journal. H. Cape Town. Collomb. A. . Cheetham. Hurst and Co.W. Third Edition. C. (1973) Recontre de deux Systems de Soins.(1970) Zulu Medicine and Medicine Men. (1977a) Xhosa Psychotherapeia.T. A.V.G. 31. E. W. R.Z. (1959) How to Interview. Brindley. Harper United. (1959) Basic Statistical Methods.I .A. (1977i The African Bantu traditional practice of Medicine: Some preliminary observations. (1969) Ethnic Live-in: A Guide for Penetrating and Understanding a Cultural Minority. Burhmann. N. M. Journal of Social Science and Medicine 6. (1975) Conflict in a rural African patient treated in an urban setting. W. 7. R. 10 11 Cheetham. (1972) The Afrian Bantu traditional practice of medicine: Some preliminary observations.Z. Downie. Bryant. Butterworths.V.L. R. 30. (1947) A History of Medicine.S. Social Science and Medicine. J. Jersey. & Shostrom. Bingham. (1982) The tradition healer/diviner as psychotherapist.M. Catiglion~ 8 9 diviner as psychotherapists.M. 1567-1568. Ltd. H. New York. Unpublished doctoral thesis.3rd Edition.W. 62. (1976) Zulu Thought Patterns and Symbolism. . Durban. Berglund.623-633 Conco.49 BIBLIOGRAPHY 1 2 3 4 5 6 7 Behr. Prentice-Hall. Medicine. A. Missouri Univ.V. Harper Bros.Publishers.S. & Heath. & Moore.W. ~ited in ConeD. Burger. Ne. Methods for the Human C.' A. (1977) Therapeutic Psychology. Struik. 17-20. 283-322. (19B3) The Role of Old Women in Zulu Culture. London. B. 6. (1983) Empirical Research Sciences. M. W. Brammer. New York. Apropos de therapeutiques des meladies mentales en Afrique. L. Nene.L.(1946) Anthropology: An Introduction to Primitive Culture. Journal of Social Psychology.. G.0.Islam. 8. (1983b) Traditional Zulu theories of illness in psychiatric patients. Sibaya.S...(1969)Interviewing:Strategies. Nene.Kunene S. Farrand.W. cited in Conco.Z. N.T. 1. 23 24 25 ~26 . University of Zululand. EL . 265... T. R. Nene. S. University of Zululand. Makunga. (1982) Therapeutic.T..V. 121. Makunga. 9. L.T.M.M. Grobbelaar. 6. (1972) The Bantu traditional practice of medicine. Some preliminary observations. Grobbelaar. Foster.L.W. Makunga. J.. P... W. cited in Conco W.V. (1983a) Reaction to illness and concepts of mental illness in representative samples of rural urban and university educated Black people. 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University of Natal 44 45 46 47 Weisz. New York. Chicago. 6. (1972) East African Medical Attitudes. 53 APPENDIX A • F QUESTIONNAIRE I BIOGRAPHICAL DATA : PRACTITIONER i 1 2 NAME ADDRESS : : .ION FORMAL EDUCATION Could you please : : : 7 8 9 : : 10 categorize yourself as to what type of indigenous practitioner you are? - 11 12 How many years have you been practising? Are you in full. 3 DISTRICT : : 4 AGE - 5 6 SEX MARITAL STATUS HOME LANGUAGE RELIG.time or part time practice? How many people come and see you (on average) per week? 13 . OF PRACTITIONER eg.lnyanga: PATIENT (SPECIFY) : AGE : SEX : HOME LANGUAGE : RELIGION : FORMAL EDUCATION : • MARITAL STATUS : 10 DIAGNOSIS (From most to least important) I 9 I I I 2 3 11 I I I • CAUSE 1 2 3 (From most to least important) 12 SYMPTOMATOLOGY (From most to least important) I 2 3 13 TREATMENT I 2 (From most to least effective) 3 14 PROGNOSIS GOOD (Tick appropriately) FAIR POOR .. I 2 3 4 5 6 7 8 PRACTITIONER NO : CATEGORY.54 APPENDIX B QUESTIONNAIRE 11 PATIENT . A DIAGNOSIS General misfortune Stomach disorder Evil spirit possession Calling to become a diviner Bladder problem Impotence (isinyama) (isisu) (imimoya emibi) (ukuthwasa) (isinye) (ukungazali) I 2 3 4 5 6 B TREATMENT '. INTER-PRACTITIONER CONSISTENCY QUESTiONNAIRE Rank with the following diagnosis and treatment procedures from I to 6 for I indicating the most important and 6 the least important this patient. I 2 3 4 5 6 Emetic and purgatory medicines Incissions and general strengthening techniques Apprenticeship as diviner (ukugcaba. ukuqinisa) (ukuthwasa programme) (ukubethela) (isiwasha) (umthandazo) " Fortification of homestead Blessed Water Prayer .55 APPENDIX C . E 5 2 F 6 G 5 3 6 4 H 6 3 I 4 J 4 2 K 4 L 4 1 4 3 4 1 5 4 1 2 5 6 3 1 1 6 3 4 2 3 6 3 2 2 3 6 4 6 4 5 4 5 2 6 6 5 1 3 5 3 2 '" '" 5 6 6 5 1 1 3 3 2 1 2 1 2 3 6 5 5 * A· B C D REFER TO TRADITIONAL DIVINERS E F G H REFER TO TRADITIONAL DOCTORS I J K L REFER TO FAITH HEALERS .APPENDIX D PRACTITIONERS DIAGNOSTIC RANKINGS (REFER.APPENDIX "C" ITEM "A") hTEM 1 2 A 1 4 B C 2 D 1 5 . . E F G H REFER TO TRADITIONAL DOCTORS I J K L REFER TO FAITH HEALERS ....APPENDIX E PRACTITIONERS TREATMENT RANKINGS (REFER APPENDIX "C" ITEM "B" ITEM 1 2 A 4 B C 4 D 4 - E 1 2 F 1 4 G 1 Z H Z I J 3 4 K Z L 4 1 4 5 3 3 3 3 1 4 3 3 1 Z 2 3 2 1 6 1 Z 4 5 5 6 6 5 4 3 Z 4 6 6 5 6 5 5 6 '" .4 5 6 6 5 5 3 5 2 6 4 3 5 3 2 1 1 1 1 3 6 6 6 2 * A' B C D REFER TO TRADITIONAL DIVINERS. . TABLES FOR DIAGNOSTIC AND TREATMENT METHODS USED BY THE PRACTITIONERS TABLE A: DIAGNOSTIC METHODS USED BY THE PRACTITIONERS METHOD Natural Supernatural Christian Supernatural indigenous Zulu TOTALS DIVINERS 4 0 22 26 DOCTORS 12 6 6 24 r/HEALERS 3 21 • TOTALS '19 27 32 78 4 2B TABLE B: ·TREATMENT METHODS USED BY THE PRACTITIONERS METHOD Natural Supernatural Christian Supernatural indigenous Zulu TOTALS DIVINERS 15 0 DOCTORS 27 2 10 39 r/HEALERS 14 26 7 47 TOTALS 56 28 47 131 30 45 ..58 APPENDIX r . "There blood. your (confederate's) This thing goes up . also It a very heavy load. "Makhosi"as to some unheard voices.59 APPENDIX G r AN INTERVIEW BY A DIVINER PRACTITIONER NO: A PATIENT CONFEDERATE The diviner inhales a powder from the snuffbox. if her only response is "yes . She then sneezes quite frequently. and appears to be listening "no". thing. drawn inwards. Sometimes . through all bones. As though you did not sleep then goes to your head causing headaches. pain. back also moving throbbing pains at the this ribs). She then throws bones on the mat.you then have knees difficulty in walking. Your shoulders become heavy. the amakhosi (ancestors) are asking her questions and also glving her advice about the illness of the patient. painfully izibhobo (disturbing. It then gets in your bladder and you urinate blood.. the is something wrong in Your feet are painful. stares at them for about a minute and then starts talking. . feel painful and tired as if you had been then your arms become and you well. makes it then up to your stomach and your knavel You also have is then filled with wind. Your You the is also painful because of suffer from heartburn which is caused by up and down of this thing. This thing goes up your neck. carrying week. Suddenly she is in a trance. You feel something pressing you down. then became isithunzi (shadow) sent This thing is always with you. It caused You tiredness.60 you feel "stupid". You dream of animals and deceased people. but are unable to help yourself. . hence do not do lHell in your studies". Confederate: "What is the exact cause of my stomach-ache". drolHsiness and makes you lazy to study. your brain becomes tired. some do not. sent to you Practitioner: "It is the' shadow of a dead person (ghost). Neighbours are jealous of you because of the level of education you are at. 'by a sorcerer". Some speak to you. Practitioner: "The indaba (problem) is at home." The diviner then looks at the patient/confederate for a lHhile and asks \ him "Well do you agree or disagree to lHhat 1 have said so out what you agree with and leave out that which does not far? Point to apply your case". The "bones" say that lHhen you are asleep something disturbs you. a to They prepared their evil medicine using the soil from grave. Confederate: "1 agree with almost all you said. trouble this you. Your dreams are very bad. Confederate: "What is it that presses me at night when I am asleep". You then become very week and tired. . and would like to know the cause of all this misery". These are evil spirits. the amakhosi advised me that you should (i) steam bath. Purgatory medicines and emetics isinyama . ghost and not tikoloshes. It is this person that works upon r your blood it is have poisoning it. If it was not for them.61 Practitioner: "You see my boy. As for casts isingama (misfortune) to you. (H) ukuncinda - licking hot medicine from sauce- pan using fingertips.. with so must also be fortified does not trouble you that the ghost any more". You are This the being visited by a ghost now. you would be dead by now". Confederate: "For a long time. Steam bathing is for cleaning the blood and make you likeable. He would like to of this dead person. I would have told you. the wind When your stomach is full of wind. that dead person in you is in a form of air. will You take stomach air out. I have been plagued by otokoloshe (familiars). I have since consulted a traditional dbctor who gave medicine for dispelling them. Practitioner: "If you had tikoloshes. and (Hi) washing in the mountains. The ukucusbwa process involvesukugcaba - Incissions made at joints for strengthening the person. fighting for your health. appropriate treatment. together (ukucushwa) . 1 would like to know if they are still with me or have left for good". killed you but your ancestors are by your side. . (ii) drink purgatory medicine and (iii) vomit using emetics. Sometimes they become too cold. tell me. for example the dumplings and raw mealie If is caused by'food. Idliso is usually meant to kill. Practitioner: "This type of stomach ache is usually caused by sleeping with "dirty" women.but very rarely. Practitioner: "What type of stomach ache do you have? Does it become windy inside"? Confederate: "Yes. Confederate: "Do you not think it is caused by idliso (food poisoning)"? Practitioner: "It may also be caused by idlisQ.caused by umeqo (stepping over a harmful concoction)". what have you come here for"? Confederate: "One reason for consulting you is that I suffer from stomach ache". . and then I have difficulty in breathing and sleeping". it it is only needs a meal porridge. serious".APPE~DIX H r AN INTERVIEW BY A TRADITIONAL DOCTOR PRACTITIONER NO: G PATIENT CONFEDERATE. it becomes inflated with air. temporary but if caused by "dirty" women. special treatment". Practitioner: "Well. What do you think is the cause"? Practi tioner: "It may have been . then. It may also be caused by the type of food you eat. your stomach ache is not that Confederate: "My feet are also painful. Is there any possibility that I can I be permanently cured"? Practitioner: "1 give to know how to treat a person with tikoloshes. fumigation for sending the tikoloshes away for good (v) Ukulahlwa process (i.for treating· a windy Enema . you will have to wash yourself far away on the mountains. will go .e. 1 will come this you medicines that will maketikoloshes never you again.for cleaning you inside (the (iv) Incissions. and seek you there.63 Confederate: "A short time ago I have been pestered by the familiars thetikoloshes. I have helped so many people with illness that 1 am very sure you will also be cured. For gave me medicine to sometime they did not pester me. I then thought they had left used but I sometimes see them though not as often as to. so that whatever evil spirits that wants you. steam bathing.to take air out from your stomach Emetics stomach) . leave your dirt and some blood in the hole there. The treatment 1 will administer to you wpl consist of": (i) Purgatory stomach (ii) (Hi) medicines . particularly doctor who I consulted a send them r traditional away. After the big prayer. in front of her. You also suffer something. sturbing pains in your ribs (izibhobo). holds it with both hands and then starts praying. After some time she She takes the stops bottle humming there is quietness in the room. Do you more it is have some sufferings can be questions"? . dreams. her eyes closed saying "You are very sick. You are pestered by izithunzi(shadow of a dead person i. At night you cannot sleep well.' CONFEDERATE and kneel the \ faith healer orders the patient to take off his shoes. fast.64 APPENDIX I AN INTERVIEW BY A FAITH HEALER PRACTITIONER NO: K PATIENT The . The patient remains silent.e. then hums another minutes. patient. uvalo (related to anxiety). She has a steel rod (made to the resemble the Cross) in her hand. feeling (touching) the body of the patient all over. There are throbbing. which are ghost). and with which she frequently pushes . All these and you heartbeat is irregular. filled with water. You also have bad from You caused by these izithunzi. There is something in your chest that makes your breathing difficult. room She She then sings a church song and all members in The singing lasts for about five song whilst laying her hands and sing along with her. You are always afraid of have too frequent headaches. she puts her hands on the head of the patient. cured. my boy. If you may feel be you thwarted. just Whatever ambitions you have have to comply. get baptised. you must then go to . cannot the be a healer at the moment. and slaughter a white fowl asking the izi thunywa to wait until you are through with schooling. do these izithunywa cause you misfortunes"? Practi tion: "Of course. You should also wear a Zionist robe and blessed ropes to protect you against these izithunywa These ropes will also give you power. Confederate: "If one does not comply.blessed water to drink . . only be healed once you become a Zionist You faith healer because God wishes so". with some herbs to drink . river. God has seen that will you have a potential of being a faith healer. and around your waist and (H) Ichibi (Hi) Ropes (iv) most of all we must pray to God that you get healed.65 Confederate: "Can you give some more clarification on these izithunzi that pester me at night"? r Practi tioner: "They are the messengers from heaven (izi thunywa) sent to convert you into a Zionist faith healer. As for the other ailments you will be given" (i) Isiwasho .water.to fasten ankles. Prayer alone does wonders. You yes. courage and fortunes. 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