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Culture, Medicine, and Psychiatry

, Volume 38, Issue 4, pp 642–668 | Cite as

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

  • Ram P. SapkotaEmail author
  • Dristy Gurung
  • Deepa Neupane
  • Santosh K. Shah
  • Hanna Kienzler
  • Laurence J. Kirmayer
Original Paper

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.

Keywords

Spirit possession Conversion disorder Social contagion Idioms of distress Nepal 

Notes

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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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Ram P. Sapkota
    • 1
    Email author
  • Dristy Gurung
    • 2
  • Deepa Neupane
    • 2
  • Santosh K. Shah
    • 3
  • Hanna Kienzler
    • 4
  • Laurence J. Kirmayer
    • 5
  1. 1.Division of Social and Transcultural Psychiatry, Department of PsychiatryMcGill UniversityMontrealCanada
  2. 2.PGD Psychological Counseling, Tri-Chandra CollegeTribhuvan UniversityKirtipurNepal
  3. 3.Central Department of StatisticsTribhuvan UniversityKirtipurNepal
  4. 4.Department of Social Science, Health and MedicineKing’s College LondonLondonUK
  5. 5.Division of Social and Transcultural PsychiatryMcGill UniversityMontrealCanada

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