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A Village Possessed by “Witches”: A Mixed-Methods Case–Control Study of Possession and Common Mental Disorders in Rural Nepal

Abstract

In Nepal, spirit possession is a common phenomenon occurring both in individuals and in groups. To identify the cultural contexts and psychosocial correlates of spirit possession, we conducted a mixed-method study in a village in central Nepal experiencing a cluster of spirit possession events. The study was carried out in three stages: (1) a pilot study consisting of informal interviews with possessed individuals, observations of the possession spells, and video recording of possession events; (2) a case–control study comparing the prevalence of symptoms of common mental disorders in women who had and had not experienced possession; and (3) a follow-up study with focus group discussions and in-depth interviews with possessed and non-possessed men and women, and key informants. Quantitative results indicated that possessed women reported higher rates of traumatic events and higher levels of symptoms of mental disorder compared to non-possessed women (Anxiety 68 vs. 18 %, Depression 41 vs. 19 %, and PTSD 27 vs. 0 %). However, qualitative interviews with possessed individuals, family members, and traditional healers indicated that they did not associate possession states with mental illness. Spirit possession was viewed as an affliction that provided a unique mode of communication between humans and spirits. As such, it functioned as an idiom of distress that allowed individuals to express suffering related to mental illness, socio-political violence, traumatic events, and the oppression of women. The study results clearly indicate that spirit possession is a multi-dimensional phenomenon that cannot be mapped onto any single psychiatric or psychological diagnostic category or construct. Clinical and public health efforts to address spirit possession must take the socio-cultural context and systemic dynamics into account to avoid creating iatrogenic illness, undermining coping strategies, and exacerbating underlying social problems.

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Notes

  1. 1.

    Bir gādne involves making dolls of cloth, inside which mantras are placed along with a personal item of the person about to be harmed (i.e., their hair, fingernails, or a piece of cloth used by women to control blood during menstruation). The dolls are then pierced with pins and, finally, buried in the ground (in Nepali this process is also known as bir khelne).

  2. 2.

    At the end of each focus group discussion, we presented the results of the quantitative study. We then explained to the participants that people could experience extreme distress (pidā) and suffering (dukha) due to work-related issues, having to live without a husband or other male family members, financial problems, disputes in the family, etc. These difficulties could, in turn, lead to “heart-mind problems” (maan ko pida/samasya huna sakchha), which could be relieved through a supportive social environment and meaningful interactions with others. However, in the absence of such a supportive context, people may rely on other strategies to relieve or come to terms with their distress (mānchhe le maan ko pidā kam garna anek upāye garchhan) or, as previous studies have shown, experience chhopne. We then went on to clarify that chhopne is not necessarily a mental illness or sign of “hysteria” as health workers who had visited the village previously had suggested, but, rather a reaction to distressing life situations.

  3. 3.

    Nowadays, the English term “tension” is used more commonly than the Nepali equivalent “tanāb.”

  4. 4.

    The general meaning of the word guru is teacher. Today, the term is used in Nepal specifically to address a religious leader (dharma guru), or a cult leader, priest (pujari), astrologer, etc. At the case study site, for instance, villagers used the term guru to address the tantric healer and his teacher, guru Gorakhnath.

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Acknowledgments

We would like to thank Dr. Bhogendra Sharma and Phanindra Adhikari of CVICT, Nepal and Madhav Nepali, Jeet Raj Giri, Badri Raj Giri, Dr. Suraj Sharma and his colleague from Bir Hospital and Prasansa Subba for their support during intervention and data collection.

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Correspondence to Ram P. Sapkota.

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Sapkota, R.P., Gurung, D., Neupane, D. et al. A Village Possessed by “Witches”: A Mixed-Methods Case–Control Study of Possession and Common Mental Disorders in Rural Nepal. Cult Med Psychiatry 38, 642–668 (2014). https://doi.org/10.1007/s11013-014-9393-8

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Keywords

  • Spirit possession
  • Conversion disorder
  • Social contagion
  • Idioms of distress
  • Nepal