‘Notes on an Exorcism’

Andrew Solomon, author of Noonday Demon: An Atlas of Depression, tells the story of his visit to Senegal, west Africa, where he learned about treatments for depression that depart significantly from dominant Western approaches.  In fact, in Senegal, there is no word for “depression.”  There, depression is not seen as something that happens to individual minds in isolation.  Instead, it is seen as an external force, as spirit possession.  The solution, thus, is a kind of exorcism, a ceremony called an “ndop.”

As a treatment, an “ndop” is communal, dynamic, and physical, almost like a celebration.  This is in stark contrast to the way depression is typically understood and treated in the West.  In Western societies, depression is seen in individualistic terms.  As Thomas Scheff notes, “Western societies are oriented toward individualism and individual achievement rather than toward groups and toward tradition, as in Asian and other traditional societies.”  This orientation can often lead to “blaming the victim” for suffering, and also to stigmatization.  (This relates to Conrad and Schneider’s point about how the “medicalization of madness” is by no means an unequivocal sign of “progress”.)

Research indicates that the “spirit-possession” understanding of mental illness may actually have beneficial social functions.  Ethan Watters, author of Crazy Like Us: The Globalization of the American Psyche, describes these intriguing findings on treatment for schizophrenia in the New York Times Magazine:

“NOWHERE ARE THE limitations of Western ideas and treatments more evident than in the case of schizophrenia. Researchers have long sought to understand what may be the most perplexing finding in the cross-cultural study of mental illness: people with schizophrenia in developing countries appear to fare better over time than those living in industrialized nations.

!!!!! This was the startling result of three large international studies carried out by the World Health Organization over the course of 30 years, starting in the early 1970s. The research showed that patients outside the United States and Europe had significantly lower relapse rates — as much as two-thirds lower in one follow-up study. These findings have been widely discussed and debated in part because of their obvious incongruity: the regions of the world with the most resources to devote to the illness — the best technology, the cutting-edge medicines and the best-financed academic and private-research institutions — had the most troubled and socially marginalized patients.

!!!!! Trying to unravel this mystery, the anthropologist Juli McGruder from the University of Puget Sound spent years in Zanzibar studying families of schizophrenics. Though the population is predominantly Muslim, Swahili spirit-possession beliefs are still prevalent in the archipelago and commonly evoked to explain the actions of anyone violating social norms — from a sister lashing out at her brother to someone beset by psychotic delusions.

!!!!! McGruder found that far from being stigmatizing, these beliefs served certain useful functions. The beliefs prescribed a variety of socially accepted interventions and ministrations that kept the ill person bound to the family and kinship group. ‘Muslim and Swahili spirits are not exorcised in the Christian sense of casting out demons,’ McGruder determined. ‘Rather they are coaxed with food and goods, feted with song and dance. They are placated, settled, reduced in malfeasance.’ McGruder saw this approach in many small acts of kindness. She watched family members use saffron paste to write phrases from the Koran on the rims of drinking bowls so the ill person could literally imbibe the holy words. The spirit-possession beliefs had other unexpected benefits. Critically, the story allowed the person with schizophrenia a cleaner bill of health when the illness went into remission. An ill individual enjoying a time of relative mental health could, at least temporarily, retake his or her responsibilities in the kinship group. Since the illness was seen as the work of outside forces, it was understood as an affliction for the sufferer but not as an identity.” !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Solomon ends the piece by brilliantly flipping the cultural script on mental health treatment.  He describes a Rwandan mental health practitioner’s take on the conventional western treatment for depression:

“We had a lot of trouble with Western mental health workers who came here immediately after the genocide and we had to ask some of them to leave…Their practice did not involve being outside in the sun…which is after all where you begin to feel better.  There was no music or drumming to get your blood flowing again, when you’re depressed and you’re low and you need to have your blood flowing. There was no sense that everyone had taken the day off so that the entire community could come together to try to lift you up and bring you back to joy. There was no acknowledgement of depression as something invasive and external that could actually be cast out of you again. Instead, they would take people one at a time into these dingy little rooms and have them sit around for an hour or so and talk about bad things that had happened to them.  We had to get them to leave the country.”