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Use of indigenous African healing practices as a mental health intervention

ProQuest Dissertations and Theses, 2009
Dissertation
Author: Ifetayo Iyajoke Ojelade
Abstract:
The purpose of this qualitative study was to describe the ways in which Orìsà priests and their clients conceptualize issues and concerns described by Western based approaches as mental health problems. The two research questions guiding this inquiry included: (a) how do Orìsà priests and their clients conceptualize issues and concerns associated with mental health problems in Western psychology and (b) what methods and techniques do Orìsà priests and their clients use to address issues or concerns associated with mental health problems in Western psychology? This study was grounded in African-centered theory by providing a cultural lens to guide the research design, data collection, and analysis. Data were collected during semi-structured individual interviews with four Orìsà priests in a three phase model, for a total of 12 interviews. The study also included three focus groups (six informants per group), who did not participate in the individual interviews. Each group met for two sessions, for a total of six focus groups. Bracketing of assumptions by research team members and use of a reflexive journal was used to ensure credibility and dependability of the data (Creswell, 1998). Data analysis consisted of a recursive process divided into multiple steps, to help strengthen methodological rigor and verification of study procedures. The three part process included codebook development, code application, and data analysis. Three major themes emerged from the data. The first theme, The Conceptualization of Mental Health Problems as Spiritual Matters included one subtheme, Transgenerational Transmission. The second theme, Origins of Mental Health Problems, included three subthemes (Western Socialization, Spiritual Forces, and Ifa as a Healing System). The final theme, Addressing Mental Health Problems, included three subthemes (The Divination Process, Referrals, and Western Therapy). Results of this study indicate that respondents primarily conceptualize mental health problems as spiritual matters and seek to address these problems with the help of an Orìsà priest. In addition, some respondents sought the services of a Western trained therapist for the same issue. Practice and research implications are discussed.

TABLE OF CONTENTS

Page

List of Tables

iii

List of Figures

iv

Chapter

1

USE OF IFA AS A MEANS OF ADDRESSING

MENTAL HEALTH PROBLEMS AMONG AFRICAN DESCENDED CLIENTS

1

Introduction

1

Factors Influencing Selection of Indigenous Healing Modalities

3

Etiology of Mental Health Concerns within Ifa

7

Labeling and Diagnosis

11

Treatment 13

Conclusion

16

References

21

2

USE OF INDIGENOUS AFRICAN HEALING PRACTICES AS A MENTAL HEALTH INTERVENTION

26

Methodology 32

Results

40

Discussion

66

References 78

Appendixes

85

iv

LIST OF TABLES Table

Page

1

Theme/Subtheme Definitions

42

v

LIST OF FIGURES

Figure

Page

1

Themes Interaction

67

1

CHAPTER 1

USE OF IFA AS A MEANS OF ADDRESSING MENTAL HEALTH PROBLEMS AMONG AFRICAN DESCENDED CLIENTS Studies suggest that in the United States, people of African descent experience mental health concerns at the same rate as other Americans (Constantine, Myers, & Kindaichi, 2004). However, this population tends to under utilize available mental health care services (Neighbors, Caldwell, Williams, Nesse, Taylor, Bullard, Torres, & Jackson, 2007). Several studies examine treatment utilization patterns and the causes for poor treatment adherence among African-Americans (Jackson, Neighbors, Torres, Martin, Williams, & Baser, 2007; Sussman, 2004; Williams, Ketring, & Salts, 2005). Authors identify a number of potential barriers to successful mental health treatment for people of African descent including cultural mistrust (Whaley, 2001), stigma regarding mental illness (Satcher, 1999), racism within the therapeutic exchange (Graham, 2005; Parham, 2002), and treatment modalities failing to address the cultural values and worldview of the client (Constantine, et al.; Myers, Obasi, Jefferson, Anderson, Godfrey, & Purnell, 2005). Due in part to the above named barriers; African-Americans often rely on informal networks of support in lieu of seeking mental health care (Helms & Cook, 1999; Parham, 2002; Utsey, Adams, & Bolden, 2000). These networks typically include family and community resources, religious leaders, and indigenous healers (Harley & Dillard,

2

2005; Myers, et al., 2005). Like most Americans, African descended people are likely to seek religious or spiritual experiences rather than admit to mental health problems (Mijares, 2003). Spiritual and mental health problems are often viewed as interconnected; therefore, religious institutions have an extensive history of providing both spiritual guidance and counseling services (Harley & Dillard). Indigenous African spiritual beliefs have also been long recognized as a viable method of addressing mental health concerns through folk magic and faith healing (Harley & Dillard). In fact, African-Americans may rely on indigenous African spirituality as an alternative to Western forms of psychotherapy (Boyd-Franklin, 2003). In order to assist psychologists in increasing their level of cultural competency, this article explores historical factors prompting African-Americans to choose African- based spiritual systems when addressing mental health problems. In addition, an overview of Yoruba-based Ifá is presented. Ifá is the largest indigenous African spiritual system practiced outside of its country of origin (Abimbola, 2006). The spiritual system is utilized by adherents for spiritual uplift and is often employed as a healing modality. Finally, the conceptual, diagnostic, and treatment practices of this healing system are reviewed. Although the counseling psychology professional literature has begun to explore the utility of indigenous healing as a therapeutic intervention, little attention has been given to African-Americans who seek the services of indigenous healers when experiencing mental health problems (Boyd-Franklin, 2006; Constantine, Myers, & Kindaichi, 2004; Moody, 2004). Understanding this information will result in psychologists gaining a broader knowledge base from which to work with this client

3

population. This will enable clinicians to provide intervention strategies consistent with the client’s beliefs regarding the etiology and treatment of mental illness. Providing culturally congruent interventions can result in improved treatment adherence among clients. Factors Influencing Selection of Indigenous African Spirituality as a Healing Modality Sussman suggests that historical and social variables influence the culturally constructed mental health care systems developed by members of a particular society (2004). These healing systems include collectively held knowledge and beliefs regarding the cause, manifestation, and mitigation of mental illness among members of that group. Psychologists who fail to address the underlying assumptions regarding illness etiology, diagnosis, and prognosis, risk misunderstanding perceived resistance toward care among individuals in a particular cultural group. Sussman posits that many Western intervention strategies fail to consider historical factors or the worldview of the client (2004). This approach to care may result in the therapist misinterpreting a client’s low treatment adherence as resistance rather than a culturally constructed means of managing and healing health concerns. Within Western psychology, there is however, a growing trend toward the delivery of culturally competent counseling and psychological services (Constantine, et al., 2004; Mijares, 2003; Moodley, 2005; Myers, et al., 2005; Parham, 2002). This approach includes examining the historical, social, and cultural factors influencing the client’s worldview, to ensure better delivery of mental health services. Historical Interactions within the American Mental Health Care System Historically within the mental-health field, African descended people have been misdiagnosed and improperly treated for psychological concerns (Harley & Dillard,

4

2005; Parham, 2002; Washington, 2006). Studies suggest that African-Americans are disproportionately diagnosed with psychotic disorders (Neighbors, Trierweiler, Ford, & Muroff, 2003) and under-diagnosed and inadequately treated for mood disorders (Simpson, Krishnan, Kunik, & Ruiz, 2007; Trierweiler, Muroff, & Jackson, 2005). Authors further suggest that racial profiling in the therapeutic exchange has historically resulted in African-descended people being characterized as hypersensitive regarding issues of race, unable to meaningfully engage in counseling (Parham, 2002), and excessively paranoid (Whaley, 2001). Such characterizations of African-Americans by mental health professions have resulted in members of this population being apprehensive toward engaging in treatment and may account for lower mental-health utilization rates. Further, these factors provide a context within which to understand treatment seeking patterns among this group (Whaley). Affirmation of an African Identity The efforts of Black Nationalists and cultural anthropologists in the early part of the twentieth century also affected treatment seeking patterns among African descended people. These two movements ignited an interest in those who sought to reclaim their African cultural and spiritual heritage (Clark, 1997; Henderson, 2007; Hucks, 1998). African-based cosmologies brought to America by immigrant practitioners of Santeria, Candomble, and Vodou, redefined religious practices (Appiah & Gates, 1999; Hunt, 1975; Lefever, 2000). Some students of these African cosmologies sought to use African- derived religions as a tool for political organization and social empowerment (Clark, 1997; Henderson, 2007; Hucks, 1998; Umoja, 2002). Adherence to African-based spiritual traditions became an affirmation of Black Nationalist ideology and an African

5

cultural identity (Clark; Henderson; Hucks). This affirmation of political and ethnic identity, coupled with a distrust of the Western mental health system, meant that practitioners of these African-based systems began relying on indigenous healing strategies to address mental health problems. Cultural Congruency of Treatment Approaches In addition to historical patterns of racism in psychology and efforts to reclaim a lost cultural heritage, writers suggest that indigenous healing strategies appeal to the values, beliefs, and worldview of many African-Americans (Graham, 2005; Harley, 2005; Parham, 2002). Indigenous healing methods are defined as those interventions developed and utilized by individuals of a particular group (Constantine, Myers, et al., 2004). Within indigenous African healing concepts, mental, physical, and spiritual wellbeing are integrated. This approach encourages familial and community interconnectedness; key values within the African-American community (Boyd-Franklin, 2003; Myers, 2003; Parham). Mental health concerns are managed via wholistic approaches addressing mind/body/spirit connections, in addition to kinship bonds that extend beyond biological relations (Boyd-Franklin). One of the most common indigenous African healing systems used within the Americas and Caribbean is the Yoruba-based system of Ifá (Abimbola, 2006). Ifá in the African Diaspora While Yoruba more accurately describes the language spoken by people occupying the southwestern region of Nigeria, parts of Benin and Togo, the term has become a moniker representing the group’s indigenous spiritual practices within the United States (Clarke, 2004). A more accurate descriptor is Ifá (Abimbola, 2006). Like

6

many words in the Yoruba language, the term Ifá has multiple meanings. In addition to denoting the spiritual practice, the word is used to identify a spiritual divinity, the divination process (communication with supernatural forces), and the sacred body of knowledge (Ifá Sacred Literary Corpus) utilized by priests of the tradition (Abimbola). During the introductory stages of Ifá in America, African descended people primarily adhered to versions of the spiritual system that syncretized or blended Ifá with Catholicism. These syncretic blends of Ifá and Catholicism include the spiritual systems of Santeria, Lucumi, and Candomble (Hunt, 1975; Clarke, 1997; Lefever, 2000). Later, some devotees (adherents to the spiritual system) adopted a nationalist approach that attempted to remove the African religion from its Catholic shield (Clarke; Curry, 1997; Henderson, 2007; Hucks, 1998). Recently, a new generation of practitioners has emerged (Clarke). This group adheres to orthodox Ifá teachings through initiation and ritual practices as observed by devotees in current day Nigeria. Different manifestations of Ifá existing within the United States are recognized by these devotees, but they look toward southwestern Nigeria for guidance in their spiritual practice. These distinctions among Ifá practitioners still exist within the United States and throughout the Diaspora (Clarke). This is not unusual since regional variations of the tradition are also found throughout Nigeria (Falola & Childs, 2004; Falola & Genova, 2006; Murphy & Sanford, 2001). However, a set of unifying values and beliefs are held by most devotees (Abimbola, 2006). Ifá as a Mental Health Intervention Ifá devotees of African descent often seek the services of an Orìsà priest to address issues and concerns associated with mental health problems in Western

7

psychology (Boyd-Franklin, 2003; Elebuibon, 2000). Like most people, these individuals may utilize a pluralist approach toward healing, which includes seeing both an Orìsà priest and Western-trained therapist for the same issue (Sussman, 2004). Therefore, clinicians who gain a basic understanding of how issues and concerns are defined, interpreted, and managed by Orìsà priests are better able to provide intervention strategies consistent with the beliefs of this population. Also, providing interventions consistent with the client’s beliefs enables psychologists to improve treatment adherence. A full overview of Ifá spiritual practices is beyond the scope of this article. However, the summary outlined in the remainder of this article will assist readers in understanding how the etiology, diagnosis, and treatment of Western defined mental health problems are conceptualized within this spiritual system. Etiology of Mental Health Concerns within the Spiritual System of Ifá Within Ifá, mental health is not typically distinguished from physical or spiritual wellbeing (Abimbola, 2006; Elebuibon, 2000; Oyelade, 1997). A wholistic approach is utilized to address the client’s problems; as is done in most indigenous healing systems (Gielen, Fish, & Draguns, 2004). With this approach, a set of culturally established beliefs and values defining emotional and behavioral normality are applied to recognize an individual as being ill (Sussman, 2004). Through violation of these cultural norms, an individual is may be labeled as “sick” rather than “healthy” (Sussman). Within Ifá, these violations are not labeled as mental health problems, although the emotional and behavioral presentation can be consistent with Western conceptualizations outlined in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR) (American Psychiatric Association, 2000). For the purposes of clarity,

8

violations of cultural norms will be labeled as mental health problems for the remainder of this article. This is not meant to suggest that such a clear distinction exists within Ifá, rather it is to assist the reader in understanding this complex system of culturally shaped beliefs regarding the cause, diagnosis, and management of what, from a Western psychological perspective, would be viewed as mental health problems. Ifá practitioners believe that mental health problems emanate from three sources: (a) supernatural forces (b) natural causes (dietary and substance use), and (c) personal choice (identified as “Ori” and “Iwa Pele”) (Oyelade, 1997). When mental health problems arise in an individual, a priest is consulted to determine the source of the problem and to obtain an appropriate prescriptive remedy (Abimbola, 2006). Supernatural Causes Belief in a supernatural cause of illness is a widespread concept throughout the world (Sussman, 2004). Among priests in Ifá, anxious, depressive, and more severe psychotic symptoms are perceived to be supernatural in origin (Oyelade, 1997). Resulting symptoms include alterations in behavior, speech, affect, and perceptions of reality. Social relationships can also be adversely impacted. Humans are believed to initiate many of these negative supernatural occurrences (Sussman). In fact, humans are viewed as the primary source of psychosomatic illnesses and psychological complaints (Oyelade; Elebuibon, 2000). For instance, people may create supernatural problems by wishing bad experiences upon another individual, gossip, or active engagement in negative magic designed to hurt others (Falola & Genova, 2006). Failure to propitiate or offenses against one’s ancestors, or other divinities can also trigger consequences resulting in mental health problems (Abimbola, 2006; Prince,

9

2004). When an individual’s emotional or behavioral patterns indicate a need for care, divination (communication with supernatural forces who know about the client’s problem) is sought to determine what is needed to appease the harmful spirit and remove the symptoms (Prince). When multiple therapeutic interventions fail, the cause of the illness may be attributed to predestination (Oyelade, 1997). In such cases, continuous sacrifice (the giving up of something to improve one’s circumstances) is performed to improve one’s life experience, but not to alter the individual’s destiny (Badejo, 1996). Natural Causes of Mental Health Concerns According to Odejide’s seminal work, Yorubas perceive two natural causes of mental health problems; use of mind altering substances and/or eating certain foods identified as restricted or taboo (1979). Consumption of these forbidden items results in mental health problems (Elebuibon, 2000). These prohibitions are identified during a spiritual ceremony or after problems arise within the individual (Elebuibon). In Ifá, substance use is recognized as causing mental health problems paralleling those outlined in the DSM-IV-TR (American Psychiatric Association, 2000; Odejide). Noncompliance with dietary prohibitions is also believed to result in mental health problems. When problems arise, consultation with a priest is done to identify needed changes in order for the client to regain or sustain optimum health (Elebuibon). Recommendations for nutritional and behavioral changes may include the addition or elimination of certain foods, prayer, and ongoing refrain from the prohibited act (Elebuibon). Personal Choice Resulting in Mental Health Problems The Yoruba worldview emphasizes the notion of personal responsibility for one’s own choices (Abimbola, 2006). Although mental health problems are generally perceived

10

as emanating from sources outside the individual, personal choice is also believed to impact an individual’s wellbeing (Prince, 2004). The concepts of Ori and Iwa pele as discussed below, illustrate this point. Ori refers to the individual’s spiritual head or guardian spirit. Ifá devotees believe that each person chooses their guardian spirit prior to being born. Iwa Pele refers to the concept of good character. Each person is believed to have the ability to maintain good character, if one so chooses. Priests use the concepts of Ori and Iwa Pele to explain the reason for a client’s problems or as proverbs used for imparting advice. Ori Like many other terms in the Yoruba language, Ori is a concept with multiple meanings. It can refer to the physical head and also a spiritual entity (Abimbola, 2006). When the term is used to represent the spiritual entity of Ori, it can be loosely compared to a guardian spirit that influences human behavior (Elebuibon, 2000). Each person has their own spiritual head which is chosen by the individual prior to being born. The quality of the spiritual head chosen affects the number of difficulties a person must overcome in life (Abimbola). This choice also suggests that individuals facing ongoing challenges may have made a poor choice of a spiritual head (Badejo, 1996). Overall, devotees believe that an individual’s choice impacts the quality of their lives and suggests that each person is responsible for their own successes and failures. Through the process of divination, an Orìsà priest is able to identify whether a mental health problem is the result of an individual’s poor choice or failure to adequately care for one’s spiritual head (Elebuibon). This is done when the priest interprets the messages obtained through

11

divination. Caring for one’s spiritual head is also utilized as a preventive measure against mental health problems (Badejo). Iwa Pele Maintaining Iwa Pele or good character is also considered an important tool in the maintenance or restoration of mental health. Considered a cornerstone value, Ifá devotees believe that individuals who choose to forgo good character risk developing mental health problems (Abimbola, 2006). Iwa is roughly translated as character or the essence of being. Pele is translated to mean gentle or good (Badejo). The term Iwa Pele is therefore translated in English to mean good character. In Yoruba theology, sacrifice must be coupled with good character in order for a devotee’s life problems to be resolved (Abimbola). Therefore, clients who seek the services of a priest for mental health problems may be counseled through divination to improve their character (Elebuibon, 2000). This suggests that the responsibility remains with the individual to alter their character in order to improve their life circumstances. For example, parents who seek guidance from a priest regarding a child’s behavioral problems may be advised that the source of the problem is their own character that needs to be improved. In fact, verses within the Ifá Sacred Literary Corpus advise parents to teach their children by example, noting that offspring emulate the behavior of their parents (Elebuibon). This suggests that some problems can be resolved by making character improvements rather than necessitating spiritual intervention. Labeling and Diagnosis Indigenous healers tend to address the gamut of human dysfunction from a wholistic orientation (Gielen, Fish, & Draguns, 2004). Priests are consulted for a variety

12

of issues without specifically separating out mental health problems. This wholistic approach generally eliminates the need for mental health labeling categories. The introduction of Western psychological methods into Nigeria brought about the practice of distinguishing and labeling mental health problems as separate from other conditions. At least one author makes limited labeling categorizations for acute psychotic disorders in the Yoruba language (Odejide, 1979). Were, disease of the mind, is similar to a diagnosis of schizophrenia in the DSM-IV-TR (American Psychiatric Association, 2000; Odejide). Symptoms include poor appearance and hygiene, disorganized speech patterns, and auditory and visual hallucinations (Odejide). Were Agba, occurs only in women and parallels a diagnosis of post-partum depression in Western Psychology (Odejide). Although these labels exist, in general, priests place emphasis on the cause of the problem rather than classification of the symptoms (Gielen et al., 2004). Diagnosis of mental health problems begins with a perceived violation of emotional and behavioral norms, resulting in impairment of social relationships (Sussman, 2004). These violations are indicators of problems emanating from either a natural, personal, or supernatural source (Oyelade, 1997). Once the problem is identified, a priest is sought out to determine the source of the problem and a prescriptive remedy. The priest employs the spiritual system of Ifá as a diagnostic tool through the process of divination (Abimbola, 2006; Badejo, 1996; Prince; 2004). Divination is a method of connecting with spiritual forces to obtain information regarding the cause and treatment of the client’s problems (Abimbola; Boyd-Franklin, 2003; Falola & Genova, 2006; Oyelade; Prince). There are three types of divination within Ifá (Kola nut, Merindilogun, and Dafa), each of which requires a different skill and knowledge level to be utilized

13

(Idowu, 1995). The divination tools include cowrie shells or various types of seeds (kola nuts and ikin) (Boyd-Franklin; Idowu, 1995). A more thorough explanation of divination is provided later in this chapter. The client seeking divination does not initially reveal the problem to the priest. This helps to ensure that the information resulting from divination is not influenced by the subjective opinion of the diviner (Abimbola, 2006). The client is provided an object upon which to pray quietly, returning it when finished (Gielen et al., 2004). A series of invocations are performed opening the lines of communication between the priest and the spirit world (Prince, 2004). The priest casts the divining tools (shells or seeds) until a set of four binary symbols are obtained. These symbols relate to specific chapters of the Ifá Sacred Literary Corpus (Abimbola; Elebuibon, 2000; Falola & Genova; Prince). The priest explains the message in the chapter by relating relevant stories and proverbs to the client (Abimbola). In the process, the source of the problem is ascertained, the client’s questions are answered, and the appropriate intervention is prescribed. Treatment When mental health problems arise, Ifá devotees use interventions prescribed through divination to alleviate the issue (Abimbola, 2006; Elebuibon, 2000). Priests treat clients through a variety of methods including spiritual baths, talismans (healing symbols), Ifá medicine, chanting verses of the Ifá Sacred Literary Corpus, and sacrifice, (Oyelade, 1997). Use of these intervention strategies is a method of healing the symptoms while also addressing the underlying spiritual problem (Abimbola; Oyelade). Family members of the client often participate in therapeutic healing ceremonies, assist

Full document contains 100 pages
Abstract: The purpose of this qualitative study was to describe the ways in which Orìsà priests and their clients conceptualize issues and concerns described by Western based approaches as mental health problems. The two research questions guiding this inquiry included: (a) how do Orìsà priests and their clients conceptualize issues and concerns associated with mental health problems in Western psychology and (b) what methods and techniques do Orìsà priests and their clients use to address issues or concerns associated with mental health problems in Western psychology? This study was grounded in African-centered theory by providing a cultural lens to guide the research design, data collection, and analysis. Data were collected during semi-structured individual interviews with four Orìsà priests in a three phase model, for a total of 12 interviews. The study also included three focus groups (six informants per group), who did not participate in the individual interviews. Each group met for two sessions, for a total of six focus groups. Bracketing of assumptions by research team members and use of a reflexive journal was used to ensure credibility and dependability of the data (Creswell, 1998). Data analysis consisted of a recursive process divided into multiple steps, to help strengthen methodological rigor and verification of study procedures. The three part process included codebook development, code application, and data analysis. Three major themes emerged from the data. The first theme, The Conceptualization of Mental Health Problems as Spiritual Matters included one subtheme, Transgenerational Transmission. The second theme, Origins of Mental Health Problems, included three subthemes (Western Socialization, Spiritual Forces, and Ifa as a Healing System). The final theme, Addressing Mental Health Problems, included three subthemes (The Divination Process, Referrals, and Western Therapy). Results of this study indicate that respondents primarily conceptualize mental health problems as spiritual matters and seek to address these problems with the help of an Orìsà priest. In addition, some respondents sought the services of a Western trained therapist for the same issue. Practice and research implications are discussed.