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Religion and traditional medicine: An anthropological case study of a Nigerian treatment of mental illness Uduakobong E. Umoren
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Lecturer in Anthropology at the Institute of Foundation Studies, Rivers State University of Science and Technology, P.M.B. 5080, Port Harcourt, Rivers State, Nigeria Version of record first published: 12 May 2010.
To cite this article: Uduakobong E. Umoren (1990): Religion and traditional medicine: An anthropological case study of a Nigerian treatment of mental illness, Medical Anthropology: Cross-Cultural Studies in Health and Illness, 12:4, 389-400 To link to this article: http://dx.doi.org/10.1080/01459740.1990.9966033
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Religion and Traditional Medicine: An Anthropological Case Study of a Nigerian Treatment of Mental Illness
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Uduakobong E. Umoren Indigenous religions contribute to the development of variant world views thereby impacting on nearly all aspects of native life. This study examines the traditional African religion of the Annang of Cross River State Nigeria, and how it influences their understanding and treatment of illness, and specifically mental illness. Using standard ethnographic techniques data was collected from May to November 1985 as part of a general study of Annang traditional religious culture. Rejecting the structural-functional approach common amongst researchers in this field, the processual symbolic approach advanced by Turner (1964,1967,1977) was adopted, placing the treatment of a psychiatric patient in a pre-liminal, liminal and postliminal processual form. The author contends that traditional Annang theories and/ or explanations of mental illness are related to a world view that is particularly religious and that native medical systems and/or treatments are also related to this religious world view. Findings from the study suggest that native healing consists of a combination of both religio-psychotherapeutic and religio-physiologic elements in a strictly African traditional religious context marked by rituals and symbols.
BACKGROUND TO THE STUDY
A commonality amongst researchers studying variant cultures has been the function they assign symbols in the natives' understanding and treatment of mental illness. The author shares this interest in symbols as a means of studying native theories and treatments of mental illness, but differs from the structural-functional approach best represented by Levi-Strauss (1963). The author has therefore adopted the processual symbolic approach advanced by Turner (1964) in order to explain the native diagnosis and treatment of a case of mental illness amongst the Annang which was marked by religious ". . . symbols operating as dynamic systems of signifiers... in the context of temporal socio-cultural processes" (Turner 1977:143). The religio-medical treatment within the Annang village was seen as processual with three clearly demarcated phases, much like a rite of passage: 1) the pre-liminal UDUAKOBONG E. UMOREN is Lecturer in Anthropology at the Institute of Foundation Studies, Rivers State University of Science and Technology, P.M.B. 5080, Port Harcourt, Rivers State, Nigeria. His research is in the area of religion and national development and religion and traditional medicine in Nigeria. 389
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390 U. E. Umoren phase representing the patient's pre-illness stage; 2) the liminal stage referring to the period of illness and treatment; and 3) the post-liminal phase in which the patient is cured and reincorporated into the society of the mentally well. Mental illness itself is situated in the general context of the sociocultural processes of the people, a context where religious symbols instigate social action and serve as both models of, and models for, reality, including behavior (Geertz 1973; Turner 1967). Symbols are defined for the study as "tangible formulations of notions, abstractions from experience fixed in perceptible forms, concrete embodiments of ideas, attitudes, judgements, longings or beliefs" (Geertz 1973:91). Life is directed by symbols so understood by the Annang (Umoren 1985). The purpose of the study was to investigate the extent to which traditional religion relates to the understanding and treatment of mental illness. Two broad issues were therefore addressed: 1) How does a Nigerian (Annang) community explain mental illness? and 2) How is mental illness treated by the Annang? The thesis proposed was that traditional African theories and/or explanations of mental illness are related to a world view which is particularly religious and that native healing systems similarly reflect this religiosity. Data for the study was collected from May to November 1985 in an Annang village community. The name of the village is withheld for the sake of confidentiality, as the villagers did not feel comfortable with being identified in a paper for public consumption. Standard ethnographic techniques utilized to obtain data included participant observation and interviewing. A brief ethnographic description of the Annang is presented, with descriptions of native healer and patient roles. The case is then examined in pre-liminal, liminal, and post-liminal processual form, with the analysis of the native healer's treatment techniques falling under two categories, religio-psychotherapeutic and religiophysiologic. The author contends the information yielded from the following Annang case analysis will contribute to the knowledge of, and treatment options for, mental illness (Ebigbo and Tydza 1982; Kennedy 1977; Murphy 1976; Edgerton 1966; Wallace 1966; Langness 1965; Lambo 1955,1964; Levi-Strauss 1963; Field 1960; Spiro 1959). THE ANNANG AND THEIR WORLD VIEW
The Annang are one of 250 ethnic groups in Nigeria living in the Cross River State. The Annang area is 350 miles north of the equator and spreads 40 miles north and south and 25 miles east and west. Annangland is bounded to the north by the Isuorgu Ibo, to the south and east by the Ibibio and to the west by the Ndokki and Ngwa Ibo (Messenger 1957). On the basis of the 1973 census, the Annang number one million, scattered throughout the 850 square mile district. The Annang both farm and fish and have a great sense of community life, corporate personality and respect for tradition. Their social organization, as far as kinship is concerned, rises from the nuclear family to the patrilineage, extended family, village, clan and Annang ethnic group. For the Annang, traditional religion is life and life is traditional religion, and in that sense religion permeates every domain of life. For the study, therefore, religion was defined as:
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. . . a system of symbols which acts to establish powerful, pervasive and long lasting moods and motivations in men by formulating conceptions of a general order of existence and clothing these conceptions with such an aura of factuality that the moods and motivations seem uniquely realistic. [Geertz 1973:90]
The Annang religion is a system of symbols, moods, motivations and conceptions, centering around five categories of realities: 1) animate and intelligent (to which beliefs, values and behavior concerning God and ancestors exist); 2) animate but unintelligent (e.g., dogs, and sheep used in sacrifice); 3) inanimate and vegetative (including instruments of religious worship such as knives, fire, trees, water, etc.); 4) place and space (areas such as village squares, certain rivers, lakes and groves; and 5) time (here we refer to worship time as well as the fact that for the Annang, each of the eight days of the week is sacred since each has a patron saint. However, some days are more sacred according to whether the patron deity is placed high or low in the people's estimate). For the Annang, the relationship between the sacred and profane is not expressed in terms of two dichotomized or juxtaposed realities but in terms of co-penetration (Umoren 1981). Religion permeates every domain of life: agriculture, fishing, commerce, child bearing and rearing, recreation, politics, even the legal system. The farming season begins and ends with sacrifice to the deity of agriculture; the legal system has a last court of appeal and swearing an oath to a powerful deity, be it bad or good, ultimately has supernatural explanation. Individuals can harm others through magic and/or sorcery, although charms provide protection. With such concepts of the relationship between religion and life, each Annang village community snares the same religiously colored world view with the rest of traditional black Africa. What Mbiti says of religion and life in Africa generally applies to the Annang: Africans are notoriously religious and each people has its own religious system with a set of beliefs and practices. Religion permeates into all departments of life so fully that it is not easy or possible always to isolate it. [Mbiti 1969]
The Annang world view is a religious one. Religion explains the how and why of things, provides psychological reinforcement in crises, judges and evaluates and finally systematizes as well as orders perceptions into a design. As Keesing and Keesing put it, a people's world view " . . . establishes and validates basic premises about the world and man's place in it and it relates the strivings and emotions of men to them" (1971:303) As a result, for the Annang to live is to live in a religious milieu. It is into this divine African milieu that the traditional healer of the Annang village in this study, known as "the native doctor," was born over sixty years ago. His father, like his grandfather, was a healer of mental illness, so as he says he is carrying on the family's profession. Through the process of enculturation and actual practice, he has accumulated knowledge and skill for his practice. On his own, over a twenty-year period he believes he has healed over 300 patients. Although he cannot say without prolonged calculation how many children he has had by his eight wives, he is gradually initiating five of his sons into being native doctors. These children serve as apprentices and later assistants to him as he did to his own father. The Annang native doctor recognizes a range of religious causes which offer
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explanations for mental illness. Through a description of these causes, there appear to be two main classes of religious explanations for mental illness namely: possession and non-possession (see Table I). In possession, the traditional healer points out that mental illness is caused when a juju, or deity, abandoned or starved of sacrifice and worship by the family, enters one of the family members, signifying the selection of the possessed as religious minister. Second, the spirit or power of a village chief's predecessor may enter an incumbent rendering him more powerful, with the initial impact of such an overdose of power causing mental disorder with socioculturally defined deviant behavior. There exist, however, more non-possession explanations for Annang mental illness. These include: 1. Witchcraft, which may cause a victim to have some degree of mental disorder. 2. An overdose of acquired power. This affects those in search of physical strength to be successful in physical combat, those who want to be successful in attracting and maintaining love from the opposite sex, and those who seek financial success in business or success in exams. All these individuals may pursue their goal by paying for juju they drink or wear. An overdose of such power, or contravening the rules of the acquired power, may cause mental disorder. 3. Poison. Out of jealousy or the desire to settle scores with a foe, one may poison another making him mentally deranged. A girl who refuses the hand of an admirer in marriage, after receiving gifts, is an easy target for such poisoning. A piece of her hair, nail, or dress is placed on the shrine of an appropriate juju, causing her to become mentally ill. 4. An attack by protective juju. One who steals any object placed under the care of protective juju exposes oneself to being punished with mental disorders by the juju. 5. Guilt from perjury. Dispute over ownership, innocence or guilt regarding a crime, e.g., theft, murder, adultery, is often settled by swearing an oath to some powerful juju. A day is agreed upon by disputants before or on which guilt will be established by the juju, causing the guilty person to be mentally ill. The following study is based on this final explanation of mental illness and its treatment by the Annang native doctor.
TABLE I. Native religious explanation of mental illness. Possession explanation 1. Vocational: Family spirit or deity demands service of an individual. 2. A predecessor's power or spirit enters an incumbent.
Non-possession explanation 1. Witchcraft. 2. Overdose of acquired magical power for wealth, physical combat, for attention of the opposite sex, etc. 3. Poison. 4. Guilt established on taking false oath. 5. Punishment for contravening village community laws.
A Nigerian Treatment of Mental Illness 393 THE PROCESSUAL FORM OF TREATMENT OPTION The case of mental illness amongst the Annang is now described in pre-liminal, liminal and post-liminal processual form.
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The Pre-liminal Phase
There was nothing remarkable about Mr. R. before he became mentally ill. In his early forties he was like all men in the village, a farmer. A case of land dispute he had with an old family enemy was tried in the village court and his claim to ownership upheld. His opponent was not satisfied with the verdict which he claimed was manipulated, so he dragged the case to the powerful village juju. According to custom, Mr. R. swore by the juju calling it to punish him with mental illness if guilty of false claim to the ownership of the land.
The Liminal Phase
A few weeks before the first anniversary of the oath-taking, his hair started falling out, his skin turned yellow and then according to family members and friends, he started manifesting bizarre behavior. He tore his clothes, beat up his wife, violently attacked those who tried to restrain him, and stole from other people's homes and farms. When he was not singing, he was screaming at unidentified persons, shouting insults and making embarrassing allegations about others being witches, adulterers, thieves, etc. The only way his relatives were able to restrain him was by chaining his hands and feet. Two months later, after escaping from a psychiatric hospital, he was bundled by the relatives into the native doctor's hospital. The traditional healer charged a non-negotiable N400 fee and akai-kai (local liquor) and then set to work. First, he poured a libation with the akai-kai, inviting the ancestors and especially his deceased father to drink and stand by him in the work about to begin. With his right hand, he poured part of the drink to the ancestors and with the left hand poured the rest to the vagabond spirits to dismiss them. The next step was to find out through divination the cause of the malady. The healer made some incantations in the presence of the patient, relations and friends and called the ancestors to reveal if the cause was from the family. He then threw eight cowries up in the air. If the answer was yes, one of the cowries would fall facing upwards, the other two facing downwards. A "no" answer would be indicated by all facing down. In the case in hand, the answer was no. The malady originated from outside. With some satisfaction that their hands were clean in the malady of their relation, family members waited patiently till the probing indicated the patient's guilt as cause. In stage three, the doctor went into the bush, collected some leaves, squeezed some liquid from them into the eyes, nose, and ears of the patient and then gave him some drink. As the healer administered these drugs he prayed, calling on the ancestors and spirits, then addressed the sick man, telling him he was about to sleep, though he would not actually sleep, but would be sent on an errand into the
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spirit world. He was expected to return with a detailed account of how he came to be ill. The patient began to quiet down and two days later started narrating how he forcefully had stolen another person's land and swore falsely to the oath of the juju and how the juju was punishing him. The patient was then asked in a way that suggested to him the answer, that God, the ancestors and juju needed to be placated with sacrifice and not just any type of sacrifice but that of a dog. This done, the patient was given laxatives once a month and another medicine three times a day, with the particular medicine being changed once every four days. Each medication was accompanied with prayer addressed to God, the ancestors and spirits and then some words addressed to the patient. For example, one evening before the medication was administered, the native healer prayed: Creator of everything, I hear you created this world, water and trees for the use of man. I use the roots from your trees to help man. Let your power help me cure this person. My father [he said turning to the patient], used the same root to cure people who were sick like you. I myself have cured many with it. Medicine, be effective as you always have been effective.
This medication, reference to the supernatural and words to the patient continued daily. By the middle of the third month the patient sang less, stopped shouting and held meaningful conversations with visiting relatives and friends. The owner of the stolen land was contacted and given back the land. By the end of the fourth month, arrangements were made to offer sacrifices to the juju, ancestors and deity. The items for sacrifice were seven white candles, a clay saucer, young palm fronds woven into a ring, liquor and a dog. The place of sacrifice was a shrine in a forest away from the village. Present at the shrine were the healer with two of his associates, two elders of the patrilineage, the patient with his feet in chains, his relatives and friends, the person whose land he had stolen and a dog with its legs in chains. Invisible though present, according to informants, were the deity, ancestors and spirits. The sacrifice began by 5:00 P.M. The traditional healer stood facing the sun, called the Creator then the ancestors, then the deceased elders of the patrilineage and poured them libation with the right hand to welcome them and then poured to the bad spirits with the left hand asking them to depart both from the patient and the place of sacrifice. He then raised the chained dog to the sky and prayed thus: Creator, of our forefathers, you the ancestors, look at this dog, it is captured and chained for you. Having admitted he cared, the patient gives you this dog in exchange. Accept this dog and relieve it of its chains.
As he said this the chains on the dog and patient were made to fall off. All present murmured something approvingly at this time. The dog was immediately struck with an iron rod and then slaughtered in sacrifice. A piece of each part of the sacrificed dog was placed in the shrine for the ancestors and the spirit world to eat. The rest of the dog was shared by all in a sacred meal. The Post-liminal Phase
After the meal Mr. R. returned no more to the secluded room of the mentally ill but lived among the mentally well. He was free to go home any day from then. As he
A Nigerian Treatment of Mental Illness 395 returned he was given some take-home charms, and drugs and was advised to return for more after he had finished his supply. He was also asked to change his residence and live in another compound outside the village for five months. He was to also take part in the seasonal ancestral worship of his people. AN ANALYSIS OF THE TRADITIONAL DOCTOR'S TREATMENT TECHNIQUES
The treatment techniques of the native doctor in this study fall under two classes: 1) religio-psychotherapeutic and 2) religio-physiologic techniques (See Table II).
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Religio-therapeutic Techniques
The religio-therapeutic techniques include: a) restoring harmony and reconciling; b) relaxation and suggestion; c) the giving of meaningful explanation; d) manipulation of the environment; e) offering sacrificial animals with sacramental element; and f) ego strengthening. Restoring harmony and reconciling personal conflict were important goals of the religio-therapeutic process. The mental illness of the man under study was seen by natives as an expression of disorder and disharmony both within him and his village community. Within him, he had gone against his conscience by stealing another person's land and lying about it. Within his sociocultural community, he had deprived another person of his right and property. Within the moral community, with the ancestors as foundation, he had disrupted the smooth flow of regulated behavior by the infraction of rules made sacred by their history, going back to the ancestors and deity. This patient's illness served to announce publicly that some rule had been broken, and therefore harmony must be restored. The announcement kept ringing and gathering momentum as each passing day represented a delay in restoring harmony, and meanwhile the patient was getting worse. The first step towards restoring the disrupted harmony was admission of guilt through confession. When the patient arrived and after the ritual libation, the traditional header administered drugs and suggested the patient sleep, relax and communicate with the spirit world and then return with a description of the cause of his illness—how it all happened. For a day or two, in an atmosphere that
TABLE II. Elements in native treatment of mental illness. Religious psychotherapeutic elements 1. 2. 3. 4. 5.
Furnishing of meaningful explanation. Restoring harmony and reconciliation. Relaxation and suggestion. Manipulation of the environment. Manipulation and exhibition of symbols, offering of sacrificial animal with sacramental element. 6. Ego strengthening.
Physiological elements 1. The medicine for the eyes. 2, The medicine for the nose. 3, The medicine for the ears. 4, The medicine for drinking. 5. Laxative medicine, 6. The chains.
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suggested confidence in the doctor, the patient was hypnotized to tell it all. The patient was not communicating with any spirit world but with his now relaxing memory. The message he brought was not from the spirit world but from his conscience in an exercise of guilt confession. The guilt confession reconciled him first with himself by admitting guilt, then with the ancestors and deity by placating them through sacrifice of reparation and the symbolic sharing of the sacrificial meal with the ancestors and the deity. Reconciliation with relatives and friends was effected as their emotions were manipulated through symbolic actions of sacrifice, words of libation, removal of guilt through confession and the sharing of the sacrificial meal of dog and drinks. Reconciliation with the land owner was effected through restitution and sharing of the sacrificial meat. Relaxation and confidence-inducing techniques used by the native doctor were both religio-physiological and religio-psychotherapeutic. The latter included the removal of guilt through confession. It also created an assurance that the medicine and sacrifice were always effective in the general context of a ritual process. This was achieved by its exhibition and manipulation of symbols, its evocation of awe and of hope, and its creation of a sense of the infallibility of the chief celebrant, the traditional healer, as mediator. This process also created the assurance of supernatural sanction, which heightened the patient's suggestibility. The exhibition and manipulation of the sacrificial dog as a symbol was very important in this context. The characteristics of a dog include being fast, making violent noise by barking, being the only animal in the village community that can be described as being made idat ebua (mad dog), the closest animal to man. These qualities make the dog the most appropriate thing for the symbolic exchange with the mentally ill in the traditional healing process. This association of the dog and the sick was emphasized as the dog brought to be sacrificed was chained, and with that the relationship became one of identification of the dog with the patient. Sacrificed, the dog was substituted for the patient in a symbolic act of "paying off" the offended juju, ancestors and deity. The act of making the chains fall off the dog symbolized the recovery of the patient. Unchained, the dog was not allowed to go. He died for the patient who must be released and let go by the angry but now placated juju, ancestors and deity. The feeding of the deity and ancestors was meant to influence them as one would influence well-entertained guests and obtain favors. Ortner's presentation of the feeding of gods in a Sherpa ritual aids in understanding this feasting of the deity ancestors and angry juju among the people under study: The gods are . . . seated in their toma and the assemblage of alter offerings is served as one serves the food and drink of a party for the sensuous enjoyment of the guests. Thus aroused, pleased and gratified, the gods like one's neighbors will feel happy and kindly disposed towards the worshippers/hosts and any requests they might make. [Ortner 1975:146]
The sacrifice and feeding of the ancestors at this healing ritual established a ThouUs dialogue in a We-situation. This situation designated a point of common interest, namely harmonious life. According to informants, the ancestors are anxious to see the life they handed down in the community preserved. The living members too wanted to protect that life and pass it on. In this feasting the living and
A Nigerian Treatment of Mental Illness 397 the ancestors communed with each other. The life force of the ancestors was expected to flow into the sacrifice and unto the visible community to give the members, especially the patient, good mental health and other gifts of life. Senghor's description of sacrifice in general in Africa applies also to the people under study.
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Le sacrifice est avant tout une entree en relation avec l'Ancestre, le dialogue du toi et du moi. On partage aved lui les aliments dont la force existentielle lui donera le sentiment de la vie et la communion va jusqua'a l'identification en sorte que par un mouvement inverse la force de l'Ancestre flue dans le sacrificateur et la collectivite qu'il incarne. [Senghor 1956:54]
Ego strengthening techniques employed were the ritual, the medicine, suggestions—all of which contribute to strengthening the patient's ego. Of special interest here is the technique used by the doctor as the patient returned home. He was given a charm to go home with and directed to participate in the seasonal ancestral worship of his patrilineage. This was important in making him gain the support and reinforcement of peer devotees. The manipulation of the patient's environment took place first when the patient was not allowed to come for treatment from his home but was forced to transplant himself into a new environment, that of the healer's. Upon his recovery he was again directed to live in a separate compound. Throughout the treatment the patient was given meaningful explanations for his illness and the healing process. This was reassuring and helped establish confidence, thereby facilitating the recovery process. Religio-physiologic Techniques
The second means by which the mental illness was treated by the traditional healer was through the use of religio-physiologic techniques. These included: medicine put in the eyes, nose and ears; medicine for the drinking water; the use of laxatives and charms; and the use of chains which was preceded by prayer. Once the violent, bizarre behavior associated with the mental illness was identified, the patient was chained and remained so throughout most of the period during which other treatments were administered. The chains restrained the patient and made him unable to exert himself and so the powerfully tranquillizing drugs were able to have full effect upon him. The chains later became a symbol of the identification of the sacrificed dog with the patient; their slipping off the dog was a symbol of the healing of the patient. Laxatives, made of warm water treated with special leaves, were used once every month. This treatment had the effect of clearing the patient's system, relaxing his nerves and making him respond more to the other forms of treatment. The medicine for drinking and the one administered for the eyes, nose and ears were expected to relax the patient. The one he drank served many undisclosed ends. Informants were very secretive about the medicine used for the treatment and no names of roots or leaves were disclosed. The administration of the leaves and roots was, however, preceded with prayer in the general context of the ritual process of healing.
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CONCLUSION
This research study set out to examine the relationship between African traditional religion and both the explanation and treatment of one type of mental illness. Through an in-depth analysis of the case study presented, the author contends that such illness explanations and treatments are related to an Annang world view which can best be described as strongly religious. Adopting the processual symbolic approach, the author identified two classes of religious explanations for mental illness amongst the Annang of Nigeria, namely possession and non-possession, in the sociocultural process of the people. One of these explanations, the nonpossessional, was selected in order to describe the treatment in pre-liminal, liminal and post-liminal processual form, which was found to be directly related to the religious explanation for the mental disorder. The traditional healer's treatment was then divided into two treatment modalities, namely the religio-psychotherapeutic and the religio-physiologic. While the one modality includes the use of chains and powerfully tranquillizing medicine, the other includes relaxation, suggestion, and manipulation—all relating to the basic premise established about Annang religion and how it impacts upon their world. One such example was the use of tranquilizers to heal which was predicated on God, who made trees for man's good and was thereby available to assist the traditional healer in his use of trees to heal man's various ailments. On the basis of the preceding discussion it seems logical to conclude that the traditional African theories or explanations for mental illness, and consequently the native medical systems' treatment of such, are both related to a world view that is religious. The native process of healing mental illness consists of a combination of both psychotherapeutic and physiologic elements, both with God at the center. However, these two elements can, upon further analysis, be seen as revealing a peculiar Annang approach to health care delivery, namely the multidimensional, holistic approach. This native process of treatment can thus be analytically set forth as four dimensional, corresponding to the native's four dimensional perception of mental illness contained in this study. These four dimensions include the psychical, the mystico-spiritual, the socio-moral and the physico-biological. The psychical dimension represents the patient's bizarre actions (for example, tearing his clothes to go naked, and screaming at unidentified persons), seen by the Annang as pointing to a disorganization of the mental process. The mystico-spiritual aspect is established by the native's contention that angered spiritual powers effect the mental disorders as a punitive measure against the patient's contravening of moral rules established to uphold social order (the socio-moral aspect). The physicobiological dimension is shown by the patient's hair loss, skin turning yellow and the violent physical attacks on himself and others. This case study shows the Annang treatment of mental illness is accordingly four dimensional. The chains and various drugs relate to the physico-biological dimension; the confession of guilt, the presence of the wronged party and elders of the patrilineage during the sacrifice, as well as the act of restitution, belong to the sociomoral dimension; the libation, prayers and sacrifice speak to the mystico-spiritual aspects; while finally the relaxation, suggestion, the manipulation and exhibition of symbols and the furnishing of meaningful explanations relate to the phychical
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A Nigerian Treatment of Mental Illness 399 dimension of the holistic perception of mental illness. In this holism the traditional religion is the ultimate integrating factor. From this present explication, the author affirms that the Annang holistic approach follows the multidimensional, integrative perception or explanation of mental illness. The elements in this holistic perception and treatment are so interwoven that the Annang believe health cannot be restored if any element is neglected. The author refers to this as the major difference between the Annang perception and treatment of mental illness as compared to those of the Western psychotherapies. The Annang treatment follows their perceptions and is multidimensional and holistic; it aims at helping the patient understand the wholeness of life or its organic structure, the process of integrating the appropriate elements of treatment to achieve holistic health. There seems to be little evidence that Western therapies share this assumption of the wholeness of life and consequently their treatments tend to lack this holistic health care approach. Rather, a unidimensional psychical explanation with emphasis on empirical evidence is basic to the Western scientific option.
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Murphy, J. 1976 Psychiatric Labelling in Cross-cultural Perspectives (Yoruba and Eskimo). Science 191:10191028. Spiro, M. E. 1959 Cultural Heritage, Personal Tension and Mental Illness in a South Sea Culture. In Culture and Mental Healing. M. K. Opler, ed. New York: Free Press. Turner, V. 1964 An Ndembu Doctor in Practice. In Magic, Faith and Healing. A. Kiev, ed. New York: Free Press. 1967 The Forest of Symbols. London: Cornell University Press. 1977 The Ritual Process: Structure and Anti-structure. Ithaca, NY: Cornell University Press. Umoren, U. E. 1981 Give to Africa What is African. Liturgy Among the Annangs. Feeling the Spirit 7(1):13-17. 1985 Religion as a Cultural Factor in Nigerian National Development. Paper presented at the National Conference on "Human Behavior and the Challenge of National Development in Nigeria." University of Ife, Nigeria. April 15-19, 1985. Wallace, A. F. C. 1966 Religion: An Anthropological View. New York: Random House.
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Religion and traditional medicine: An anthropological case study of a Nigerian treatment of mental illness Uduakobong E. Umoren
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Lecturer in Anthropology at the Institute of Foundation Studies, Rivers State University of Science and Technology, P.M.B. 5080, Port Harcourt, Rivers State, Nigeria Version of record first published: 12 May 2010.
To cite this article: Uduakobong E. Umoren (1990): Religion and traditional medicine: An anthropological case study of a Nigerian treatment of mental illness, Medical Anthropology: Cross-Cultural Studies in Health and Illness, 12:4, 389-400 To link to this article: http://dx.doi.org/10.1080/01459740.1990.9966033
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Religion and Traditional Medicine: An Anthropological Case Study of a Nigerian Treatment of Mental Illness
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Uduakobong E. Umoren Indigenous religions contribute to the development of variant world views thereby impacting on nearly all aspects of native life. This study examines the traditional African religion of the Annang of Cross River State Nigeria, and how it influences their understanding and treatment of illness, and specifically mental illness. Using standard ethnographic techniques data was collected from May to November 1985 as part of a general study of Annang traditional religious culture. Rejecting the structural-functional approach common amongst researchers in this field, the processual symbolic approach advanced by Turner (1964,1967,1977) was adopted, placing the treatment of a psychiatric patient in a pre-liminal, liminal and postliminal processual form. The author contends that traditional Annang theories and/ or explanations of mental illness are related to a world view that is particularly religious and that native medical systems and/or treatments are also related to this religious world view. Findings from the study suggest that native healing consists of a combination of both religio-psychotherapeutic and religio-physiologic elements in a strictly African traditional religious context marked by rituals and symbols.
BACKGROUND TO THE STUDY
A commonality amongst researchers studying variant cultures has been the function they assign symbols in the natives' understanding and treatment of mental illness. The author shares this interest in symbols as a means of studying native theories and treatments of mental illness, but differs from the structural-functional approach best represented by Levi-Strauss (1963). The author has therefore adopted the processual symbolic approach advanced by Turner (1964) in order to explain the native diagnosis and treatment of a case of mental illness amongst the Annang which was marked by religious ". . . symbols operating as dynamic systems of signifiers... in the context of temporal socio-cultural processes" (Turner 1977:143). The religio-medical treatment within the Annang village was seen as processual with three clearly demarcated phases, much like a rite of passage: 1) the pre-liminal UDUAKOBONG E. UMOREN is Lecturer in Anthropology at the Institute of Foundation Studies, Rivers State University of Science and Technology, P.M.B. 5080, Port Harcourt, Rivers State, Nigeria. His research is in the area of religion and national development and religion and traditional medicine in Nigeria. 389
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390 U. E. Umoren phase representing the patient's pre-illness stage; 2) the liminal stage referring to the period of illness and treatment; and 3) the post-liminal phase in which the patient is cured and reincorporated into the society of the mentally well. Mental illness itself is situated in the general context of the sociocultural processes of the people, a context where religious symbols instigate social action and serve as both models of, and models for, reality, including behavior (Geertz 1973; Turner 1967). Symbols are defined for the study as "tangible formulations of notions, abstractions from experience fixed in perceptible forms, concrete embodiments of ideas, attitudes, judgements, longings or beliefs" (Geertz 1973:91). Life is directed by symbols so understood by the Annang (Umoren 1985). The purpose of the study was to investigate the extent to which traditional religion relates to the understanding and treatment of mental illness. Two broad issues were therefore addressed: 1) How does a Nigerian (Annang) community explain mental illness? and 2) How is mental illness treated by the Annang? The thesis proposed was that traditional African theories and/or explanations of mental illness are related to a world view which is particularly religious and that native healing systems similarly reflect this religiosity. Data for the study was collected from May to November 1985 in an Annang village community. The name of the village is withheld for the sake of confidentiality, as the villagers did not feel comfortable with being identified in a paper for public consumption. Standard ethnographic techniques utilized to obtain data included participant observation and interviewing. A brief ethnographic description of the Annang is presented, with descriptions of native healer and patient roles. The case is then examined in pre-liminal, liminal, and post-liminal processual form, with the analysis of the native healer's treatment techniques falling under two categories, religio-psychotherapeutic and religiophysiologic. The author contends the information yielded from the following Annang case analysis will contribute to the knowledge of, and treatment options for, mental illness (Ebigbo and Tydza 1982; Kennedy 1977; Murphy 1976; Edgerton 1966; Wallace 1966; Langness 1965; Lambo 1955,1964; Levi-Strauss 1963; Field 1960; Spiro 1959). THE ANNANG AND THEIR WORLD VIEW
The Annang are one of 250 ethnic groups in Nigeria living in the Cross River State. The Annang area is 350 miles north of the equator and spreads 40 miles north and south and 25 miles east and west. Annangland is bounded to the north by the Isuorgu Ibo, to the south and east by the Ibibio and to the west by the Ndokki and Ngwa Ibo (Messenger 1957). On the basis of the 1973 census, the Annang number one million, scattered throughout the 850 square mile district. The Annang both farm and fish and have a great sense of community life, corporate personality and respect for tradition. Their social organization, as far as kinship is concerned, rises from the nuclear family to the patrilineage, extended family, village, clan and Annang ethnic group. For the Annang, traditional religion is life and life is traditional religion, and in that sense religion permeates every domain of life. For the study, therefore, religion was defined as:
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. . . a system of symbols which acts to establish powerful, pervasive and long lasting moods and motivations in men by formulating conceptions of a general order of existence and clothing these conceptions with such an aura of factuality that the moods and motivations seem uniquely realistic. [Geertz 1973:90]
The Annang religion is a system of symbols, moods, motivations and conceptions, centering around five categories of realities: 1) animate and intelligent (to which beliefs, values and behavior concerning God and ancestors exist); 2) animate but unintelligent (e.g., dogs, and sheep used in sacrifice); 3) inanimate and vegetative (including instruments of religious worship such as knives, fire, trees, water, etc.); 4) place and space (areas such as village squares, certain rivers, lakes and groves; and 5) time (here we refer to worship time as well as the fact that for the Annang, each of the eight days of the week is sacred since each has a patron saint. However, some days are more sacred according to whether the patron deity is placed high or low in the people's estimate). For the Annang, the relationship between the sacred and profane is not expressed in terms of two dichotomized or juxtaposed realities but in terms of co-penetration (Umoren 1981). Religion permeates every domain of life: agriculture, fishing, commerce, child bearing and rearing, recreation, politics, even the legal system. The farming season begins and ends with sacrifice to the deity of agriculture; the legal system has a last court of appeal and swearing an oath to a powerful deity, be it bad or good, ultimately has supernatural explanation. Individuals can harm others through magic and/or sorcery, although charms provide protection. With such concepts of the relationship between religion and life, each Annang village community snares the same religiously colored world view with the rest of traditional black Africa. What Mbiti says of religion and life in Africa generally applies to the Annang: Africans are notoriously religious and each people has its own religious system with a set of beliefs and practices. Religion permeates into all departments of life so fully that it is not easy or possible always to isolate it. [Mbiti 1969]
The Annang world view is a religious one. Religion explains the how and why of things, provides psychological reinforcement in crises, judges and evaluates and finally systematizes as well as orders perceptions into a design. As Keesing and Keesing put it, a people's world view " . . . establishes and validates basic premises about the world and man's place in it and it relates the strivings and emotions of men to them" (1971:303) As a result, for the Annang to live is to live in a religious milieu. It is into this divine African milieu that the traditional healer of the Annang village in this study, known as "the native doctor," was born over sixty years ago. His father, like his grandfather, was a healer of mental illness, so as he says he is carrying on the family's profession. Through the process of enculturation and actual practice, he has accumulated knowledge and skill for his practice. On his own, over a twenty-year period he believes he has healed over 300 patients. Although he cannot say without prolonged calculation how many children he has had by his eight wives, he is gradually initiating five of his sons into being native doctors. These children serve as apprentices and later assistants to him as he did to his own father. The Annang native doctor recognizes a range of religious causes which offer
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explanations for mental illness. Through a description of these causes, there appear to be two main classes of religious explanations for mental illness namely: possession and non-possession (see Table I). In possession, the traditional healer points out that mental illness is caused when a juju, or deity, abandoned or starved of sacrifice and worship by the family, enters one of the family members, signifying the selection of the possessed as religious minister. Second, the spirit or power of a village chief's predecessor may enter an incumbent rendering him more powerful, with the initial impact of such an overdose of power causing mental disorder with socioculturally defined deviant behavior. There exist, however, more non-possession explanations for Annang mental illness. These include: 1. Witchcraft, which may cause a victim to have some degree of mental disorder. 2. An overdose of acquired power. This affects those in search of physical strength to be successful in physical combat, those who want to be successful in attracting and maintaining love from the opposite sex, and those who seek financial success in business or success in exams. All these individuals may pursue their goal by paying for juju they drink or wear. An overdose of such power, or contravening the rules of the acquired power, may cause mental disorder. 3. Poison. Out of jealousy or the desire to settle scores with a foe, one may poison another making him mentally deranged. A girl who refuses the hand of an admirer in marriage, after receiving gifts, is an easy target for such poisoning. A piece of her hair, nail, or dress is placed on the shrine of an appropriate juju, causing her to become mentally ill. 4. An attack by protective juju. One who steals any object placed under the care of protective juju exposes oneself to being punished with mental disorders by the juju. 5. Guilt from perjury. Dispute over ownership, innocence or guilt regarding a crime, e.g., theft, murder, adultery, is often settled by swearing an oath to some powerful juju. A day is agreed upon by disputants before or on which guilt will be established by the juju, causing the guilty person to be mentally ill. The following study is based on this final explanation of mental illness and its treatment by the Annang native doctor.
TABLE I. Native religious explanation of mental illness. Possession explanation 1. Vocational: Family spirit or deity demands service of an individual. 2. A predecessor's power or spirit enters an incumbent.
Non-possession explanation 1. Witchcraft. 2. Overdose of acquired magical power for wealth, physical combat, for attention of the opposite sex, etc. 3. Poison. 4. Guilt established on taking false oath. 5. Punishment for contravening village community laws.
A Nigerian Treatment of Mental Illness 393 THE PROCESSUAL FORM OF TREATMENT OPTION The case of mental illness amongst the Annang is now described in pre-liminal, liminal and post-liminal processual form.
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The Pre-liminal Phase
There was nothing remarkable about Mr. R. before he became mentally ill. In his early forties he was like all men in the village, a farmer. A case of land dispute he had with an old family enemy was tried in the village court and his claim to ownership upheld. His opponent was not satisfied with the verdict which he claimed was manipulated, so he dragged the case to the powerful village juju. According to custom, Mr. R. swore by the juju calling it to punish him with mental illness if guilty of false claim to the ownership of the land.
The Liminal Phase
A few weeks before the first anniversary of the oath-taking, his hair started falling out, his skin turned yellow and then according to family members and friends, he started manifesting bizarre behavior. He tore his clothes, beat up his wife, violently attacked those who tried to restrain him, and stole from other people's homes and farms. When he was not singing, he was screaming at unidentified persons, shouting insults and making embarrassing allegations about others being witches, adulterers, thieves, etc. The only way his relatives were able to restrain him was by chaining his hands and feet. Two months later, after escaping from a psychiatric hospital, he was bundled by the relatives into the native doctor's hospital. The traditional healer charged a non-negotiable N400 fee and akai-kai (local liquor) and then set to work. First, he poured a libation with the akai-kai, inviting the ancestors and especially his deceased father to drink and stand by him in the work about to begin. With his right hand, he poured part of the drink to the ancestors and with the left hand poured the rest to the vagabond spirits to dismiss them. The next step was to find out through divination the cause of the malady. The healer made some incantations in the presence of the patient, relations and friends and called the ancestors to reveal if the cause was from the family. He then threw eight cowries up in the air. If the answer was yes, one of the cowries would fall facing upwards, the other two facing downwards. A "no" answer would be indicated by all facing down. In the case in hand, the answer was no. The malady originated from outside. With some satisfaction that their hands were clean in the malady of their relation, family members waited patiently till the probing indicated the patient's guilt as cause. In stage three, the doctor went into the bush, collected some leaves, squeezed some liquid from them into the eyes, nose, and ears of the patient and then gave him some drink. As the healer administered these drugs he prayed, calling on the ancestors and spirits, then addressed the sick man, telling him he was about to sleep, though he would not actually sleep, but would be sent on an errand into the
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spirit world. He was expected to return with a detailed account of how he came to be ill. The patient began to quiet down and two days later started narrating how he forcefully had stolen another person's land and swore falsely to the oath of the juju and how the juju was punishing him. The patient was then asked in a way that suggested to him the answer, that God, the ancestors and juju needed to be placated with sacrifice and not just any type of sacrifice but that of a dog. This done, the patient was given laxatives once a month and another medicine three times a day, with the particular medicine being changed once every four days. Each medication was accompanied with prayer addressed to God, the ancestors and spirits and then some words addressed to the patient. For example, one evening before the medication was administered, the native healer prayed: Creator of everything, I hear you created this world, water and trees for the use of man. I use the roots from your trees to help man. Let your power help me cure this person. My father [he said turning to the patient], used the same root to cure people who were sick like you. I myself have cured many with it. Medicine, be effective as you always have been effective.
This medication, reference to the supernatural and words to the patient continued daily. By the middle of the third month the patient sang less, stopped shouting and held meaningful conversations with visiting relatives and friends. The owner of the stolen land was contacted and given back the land. By the end of the fourth month, arrangements were made to offer sacrifices to the juju, ancestors and deity. The items for sacrifice were seven white candles, a clay saucer, young palm fronds woven into a ring, liquor and a dog. The place of sacrifice was a shrine in a forest away from the village. Present at the shrine were the healer with two of his associates, two elders of the patrilineage, the patient with his feet in chains, his relatives and friends, the person whose land he had stolen and a dog with its legs in chains. Invisible though present, according to informants, were the deity, ancestors and spirits. The sacrifice began by 5:00 P.M. The traditional healer stood facing the sun, called the Creator then the ancestors, then the deceased elders of the patrilineage and poured them libation with the right hand to welcome them and then poured to the bad spirits with the left hand asking them to depart both from the patient and the place of sacrifice. He then raised the chained dog to the sky and prayed thus: Creator, of our forefathers, you the ancestors, look at this dog, it is captured and chained for you. Having admitted he cared, the patient gives you this dog in exchange. Accept this dog and relieve it of its chains.
As he said this the chains on the dog and patient were made to fall off. All present murmured something approvingly at this time. The dog was immediately struck with an iron rod and then slaughtered in sacrifice. A piece of each part of the sacrificed dog was placed in the shrine for the ancestors and the spirit world to eat. The rest of the dog was shared by all in a sacred meal. The Post-liminal Phase
After the meal Mr. R. returned no more to the secluded room of the mentally ill but lived among the mentally well. He was free to go home any day from then. As he
A Nigerian Treatment of Mental Illness 395 returned he was given some take-home charms, and drugs and was advised to return for more after he had finished his supply. He was also asked to change his residence and live in another compound outside the village for five months. He was to also take part in the seasonal ancestral worship of his people. AN ANALYSIS OF THE TRADITIONAL DOCTOR'S TREATMENT TECHNIQUES
The treatment techniques of the native doctor in this study fall under two classes: 1) religio-psychotherapeutic and 2) religio-physiologic techniques (See Table II).
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Religio-therapeutic Techniques
The religio-therapeutic techniques include: a) restoring harmony and reconciling; b) relaxation and suggestion; c) the giving of meaningful explanation; d) manipulation of the environment; e) offering sacrificial animals with sacramental element; and f) ego strengthening. Restoring harmony and reconciling personal conflict were important goals of the religio-therapeutic process. The mental illness of the man under study was seen by natives as an expression of disorder and disharmony both within him and his village community. Within him, he had gone against his conscience by stealing another person's land and lying about it. Within his sociocultural community, he had deprived another person of his right and property. Within the moral community, with the ancestors as foundation, he had disrupted the smooth flow of regulated behavior by the infraction of rules made sacred by their history, going back to the ancestors and deity. This patient's illness served to announce publicly that some rule had been broken, and therefore harmony must be restored. The announcement kept ringing and gathering momentum as each passing day represented a delay in restoring harmony, and meanwhile the patient was getting worse. The first step towards restoring the disrupted harmony was admission of guilt through confession. When the patient arrived and after the ritual libation, the traditional header administered drugs and suggested the patient sleep, relax and communicate with the spirit world and then return with a description of the cause of his illness—how it all happened. For a day or two, in an atmosphere that
TABLE II. Elements in native treatment of mental illness. Religious psychotherapeutic elements 1. 2. 3. 4. 5.
Furnishing of meaningful explanation. Restoring harmony and reconciliation. Relaxation and suggestion. Manipulation of the environment. Manipulation and exhibition of symbols, offering of sacrificial animal with sacramental element. 6. Ego strengthening.
Physiological elements 1. The medicine for the eyes. 2, The medicine for the nose. 3, The medicine for the ears. 4, The medicine for drinking. 5. Laxative medicine, 6. The chains.
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suggested confidence in the doctor, the patient was hypnotized to tell it all. The patient was not communicating with any spirit world but with his now relaxing memory. The message he brought was not from the spirit world but from his conscience in an exercise of guilt confession. The guilt confession reconciled him first with himself by admitting guilt, then with the ancestors and deity by placating them through sacrifice of reparation and the symbolic sharing of the sacrificial meal with the ancestors and the deity. Reconciliation with relatives and friends was effected as their emotions were manipulated through symbolic actions of sacrifice, words of libation, removal of guilt through confession and the sharing of the sacrificial meal of dog and drinks. Reconciliation with the land owner was effected through restitution and sharing of the sacrificial meat. Relaxation and confidence-inducing techniques used by the native doctor were both religio-physiological and religio-psychotherapeutic. The latter included the removal of guilt through confession. It also created an assurance that the medicine and sacrifice were always effective in the general context of a ritual process. This was achieved by its exhibition and manipulation of symbols, its evocation of awe and of hope, and its creation of a sense of the infallibility of the chief celebrant, the traditional healer, as mediator. This process also created the assurance of supernatural sanction, which heightened the patient's suggestibility. The exhibition and manipulation of the sacrificial dog as a symbol was very important in this context. The characteristics of a dog include being fast, making violent noise by barking, being the only animal in the village community that can be described as being made idat ebua (mad dog), the closest animal to man. These qualities make the dog the most appropriate thing for the symbolic exchange with the mentally ill in the traditional healing process. This association of the dog and the sick was emphasized as the dog brought to be sacrificed was chained, and with that the relationship became one of identification of the dog with the patient. Sacrificed, the dog was substituted for the patient in a symbolic act of "paying off" the offended juju, ancestors and deity. The act of making the chains fall off the dog symbolized the recovery of the patient. Unchained, the dog was not allowed to go. He died for the patient who must be released and let go by the angry but now placated juju, ancestors and deity. The feeding of the deity and ancestors was meant to influence them as one would influence well-entertained guests and obtain favors. Ortner's presentation of the feeding of gods in a Sherpa ritual aids in understanding this feasting of the deity ancestors and angry juju among the people under study: The gods are . . . seated in their toma and the assemblage of alter offerings is served as one serves the food and drink of a party for the sensuous enjoyment of the guests. Thus aroused, pleased and gratified, the gods like one's neighbors will feel happy and kindly disposed towards the worshippers/hosts and any requests they might make. [Ortner 1975:146]
The sacrifice and feeding of the ancestors at this healing ritual established a ThouUs dialogue in a We-situation. This situation designated a point of common interest, namely harmonious life. According to informants, the ancestors are anxious to see the life they handed down in the community preserved. The living members too wanted to protect that life and pass it on. In this feasting the living and
A Nigerian Treatment of Mental Illness 397 the ancestors communed with each other. The life force of the ancestors was expected to flow into the sacrifice and unto the visible community to give the members, especially the patient, good mental health and other gifts of life. Senghor's description of sacrifice in general in Africa applies also to the people under study.
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Le sacrifice est avant tout une entree en relation avec l'Ancestre, le dialogue du toi et du moi. On partage aved lui les aliments dont la force existentielle lui donera le sentiment de la vie et la communion va jusqua'a l'identification en sorte que par un mouvement inverse la force de l'Ancestre flue dans le sacrificateur et la collectivite qu'il incarne. [Senghor 1956:54]
Ego strengthening techniques employed were the ritual, the medicine, suggestions—all of which contribute to strengthening the patient's ego. Of special interest here is the technique used by the doctor as the patient returned home. He was given a charm to go home with and directed to participate in the seasonal ancestral worship of his patrilineage. This was important in making him gain the support and reinforcement of peer devotees. The manipulation of the patient's environment took place first when the patient was not allowed to come for treatment from his home but was forced to transplant himself into a new environment, that of the healer's. Upon his recovery he was again directed to live in a separate compound. Throughout the treatment the patient was given meaningful explanations for his illness and the healing process. This was reassuring and helped establish confidence, thereby facilitating the recovery process. Religio-physiologic Techniques
The second means by which the mental illness was treated by the traditional healer was through the use of religio-physiologic techniques. These included: medicine put in the eyes, nose and ears; medicine for the drinking water; the use of laxatives and charms; and the use of chains which was preceded by prayer. Once the violent, bizarre behavior associated with the mental illness was identified, the patient was chained and remained so throughout most of the period during which other treatments were administered. The chains restrained the patient and made him unable to exert himself and so the powerfully tranquillizing drugs were able to have full effect upon him. The chains later became a symbol of the identification of the sacrificed dog with the patient; their slipping off the dog was a symbol of the healing of the patient. Laxatives, made of warm water treated with special leaves, were used once every month. This treatment had the effect of clearing the patient's system, relaxing his nerves and making him respond more to the other forms of treatment. The medicine for drinking and the one administered for the eyes, nose and ears were expected to relax the patient. The one he drank served many undisclosed ends. Informants were very secretive about the medicine used for the treatment and no names of roots or leaves were disclosed. The administration of the leaves and roots was, however, preceded with prayer in the general context of the ritual process of healing.
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CONCLUSION
This research study set out to examine the relationship between African traditional religion and both the explanation and treatment of one type of mental illness. Through an in-depth analysis of the case study presented, the author contends that such illness explanations and treatments are related to an Annang world view which can best be described as strongly religious. Adopting the processual symbolic approach, the author identified two classes of religious explanations for mental illness amongst the Annang of Nigeria, namely possession and non-possession, in the sociocultural process of the people. One of these explanations, the nonpossessional, was selected in order to describe the treatment in pre-liminal, liminal and post-liminal processual form, which was found to be directly related to the religious explanation for the mental disorder. The traditional healer's treatment was then divided into two treatment modalities, namely the religio-psychotherapeutic and the religio-physiologic. While the one modality includes the use of chains and powerfully tranquillizing medicine, the other includes relaxation, suggestion, and manipulation—all relating to the basic premise established about Annang religion and how it impacts upon their world. One such example was the use of tranquilizers to heal which was predicated on God, who made trees for man's good and was thereby available to assist the traditional healer in his use of trees to heal man's various ailments. On the basis of the preceding discussion it seems logical to conclude that the traditional African theories or explanations for mental illness, and consequently the native medical systems' treatment of such, are both related to a world view that is religious. The native process of healing mental illness consists of a combination of both psychotherapeutic and physiologic elements, both with God at the center. However, these two elements can, upon further analysis, be seen as revealing a peculiar Annang approach to health care delivery, namely the multidimensional, holistic approach. This native process of treatment can thus be analytically set forth as four dimensional, corresponding to the native's four dimensional perception of mental illness contained in this study. These four dimensions include the psychical, the mystico-spiritual, the socio-moral and the physico-biological. The psychical dimension represents the patient's bizarre actions (for example, tearing his clothes to go naked, and screaming at unidentified persons), seen by the Annang as pointing to a disorganization of the mental process. The mystico-spiritual aspect is established by the native's contention that angered spiritual powers effect the mental disorders as a punitive measure against the patient's contravening of moral rules established to uphold social order (the socio-moral aspect). The physicobiological dimension is shown by the patient's hair loss, skin turning yellow and the violent physical attacks on himself and others. This case study shows the Annang treatment of mental illness is accordingly four dimensional. The chains and various drugs relate to the physico-biological dimension; the confession of guilt, the presence of the wronged party and elders of the patrilineage during the sacrifice, as well as the act of restitution, belong to the sociomoral dimension; the libation, prayers and sacrifice speak to the mystico-spiritual aspects; while finally the relaxation, suggestion, the manipulation and exhibition of symbols and the furnishing of meaningful explanations relate to the phychical
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A Nigerian Treatment of Mental Illness 399 dimension of the holistic perception of mental illness. In this holism the traditional religion is the ultimate integrating factor. From this present explication, the author affirms that the Annang holistic approach follows the multidimensional, integrative perception or explanation of mental illness. The elements in this holistic perception and treatment are so interwoven that the Annang believe health cannot be restored if any element is neglected. The author refers to this as the major difference between the Annang perception and treatment of mental illness as compared to those of the Western psychotherapies. The Annang treatment follows their perceptions and is multidimensional and holistic; it aims at helping the patient understand the wholeness of life or its organic structure, the process of integrating the appropriate elements of treatment to achieve holistic health. There seems to be little evidence that Western therapies share this assumption of the wholeness of life and consequently their treatments tend to lack this holistic health care approach. Rather, a unidimensional psychical explanation with emphasis on empirical evidence is basic to the Western scientific option.
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