Child witchcraft confessions as an idiom of distress in Sierra Leone; results of a rapid qualitative inquiry and recommendations for mental health interventions

Background Reports about child witchcraft are not uncommon in sub-Saharan Africa. In this study we approach child witchcraft as an idiom of distress. In an environment that may prohibit children from openly expressing distress, the shared imagery of witchcraft can provide a cultural idiom to communicate about psychosocial suffering. We used an ecological approach to study how some children in distressing circumstances come to a witchcraft confession, with the aim to set out pathways for mental health interventions. Methods We employed rapid qualitative inquiry methodology, with an inductive and iterative approach, combining emic and etic perspectives. We conducted 37 interviews and 12 focus group discussions with a total of 127 participants in Freetown, Sierra Leone. Inductive analysis was used to identify risk and protective factors related to witchcraft accusations and confessions. Results We identified risk and protective factors related to the individual child, the family, peer relations, teachers and other professionals in a child’s life, traditional healers, pastors and the wider society. We found that in the context of a macrosystem that supports witchcraft, suspicions of witchcraft are formed at the mesosystem level, where actors from the microsystem interact with each other and the child. The involvement of a traditional healer or pastor often forms a tipping point that leads to a confession of witchcraft. Conclusions Child witchcraft is an idiom of distress, not so much owned by the individual child as well as by the systems around the child. Mental health interventions should be systemic and multi-sectoral, to prevent accusations and confessions, and address the suffering of both the child and the systems surrounding the child. Interventions should be contextually relevant and service providers should be helped to address conscious and subconscious fears related to witchcraft. Beyond mental health interventions, advocacy, peacebuilding and legislation is needed to address the deeper systemic issues of poverty, conflict and abuse.

Walking Corpse Syndrome: A trauma-related idiom of distress amongst Sri Lankan Tamils

This article introduces Walking Corpse Syndrome, a common idiom of distress in Tamil Sri Lanka that is characterized by a variety of cognitive difficulties, feelings that an individual is functioning reflexively or impulsively, and acute attacks of dissociation that are accompanied with the sensation of empty-headedness. Walking Corpse Syndrome demonstrates some overlap with Western nosology, although it appears to be its own unique illness category, most likely of Ayurvedic provenance. The article comprises two studies. One is a secondary interview analysis of community members that aimed to identify the key symptoms of Walking Corpse Syndrome, allowing us to determine the local ethnopsychology of the syndrome and to elicit illustrative vignettes. The other study is a survey of Sri Lankan Tamil psychiatrists that aimed to investigate their understanding and experience of the disorder. This article outlines how, in certain cultural contexts, such syndromes emphasise the loss of attentional capacity and forgetfulness; it highlights the importance of “thinking a lot” as an idiom across cultures; and it details the many ways that Walking Corpse Syndrome is a key idiom of distress, in order to assess to give adequate mental healthcare to Sri Lankan Tamil populations.

Child witchcraft confessions as an idiom of distress in Sierra Leone; results of a rapid qualitative inquiry and recommendations for mental health interventions.

Background Reports about child witchcraft are not uncommon in sub-Saharan Africa. In this study we approach child witchcraft as an idiom of distress. In an environment that may prohibit children from openly expressing distress, the shared imagery of witchcraft can provide a cultural idiom to communicate about psychosocial suffering. We used an ecological approach to study how some children in distressing circumstances come to a witchcraft confession, with the aim to set out pathways for mental health interventions.Methods We employed rapid qualitative inquiry methodology, with an inductive and iterative approach, combining emic and etic perspectives. We conducted 37 interviews and 12 focus group discussions with a total of 127 participants in Freetown, Sierra Leone. Inductive analysis was used to identify risk and protective factors related to witchcraft accusations and confessions.Results We identified risk and protective factors related to the individual child, the family, peer relations, teachers and other professionals in a child’s life, traditional healers, pastors and the wider society. We found that in the context of a macrosystem that supports witchcraft, suspicions of witchcraft are formed at the mesosystem level, where actors from the microsystem interact with each other and the child. The involvement of a traditional healer or pastor often forms a tipping point that leads to a confession of witchcraft. Conclusions Child witchcraft is an idiom of distress, not so much owned by the individual child as well as by the systems around the child. Mental health interventions should be systemic and multi-sectoral, to prevent accusations and confessions, and address the suffering of both the child and the systems surrounding the child. Interventions should be contextually relevant and service providers should be helped to address conscious and subconscious fears related to witchcraft. Beyond mental health interventions, advocacy, peacebuilding and legislation is needed to address the deeper systemic issues of poverty, conflict and abuse.

Child Witchcraft Confessions as an Idiom of Distress in Sierra Leone; Results of a Rapid Qualitative Inquiry and Recommendations for Mental Health Interventions.

BackgroundReports about child witchcraft are not uncommon in sub-Saharan Africa. In this study we approach child witchcraft as an idiom of distress. In an environment that may prohibit children from openly expressing distress, belief in witchcraft can provide a shared language to communicate about psychosocial suffering. We used an ecological approach to study how some children in distressing circumstances come to a witchcraft confession, with the aim to set out pathways for mental health interventions. MethodsWe employed rapid qualitative inquiry methodology, with an inductive and iterative approach, combining emic and etic perspectives. We conducted 37 interviews and 12 focus group discussions with a total of 127 respondents in Freetown, Sierra Leone. Inductive analysis was used to identify risk and protective factors related to witchcraft accusations and confessions. ResultsWe identified risk and protective factors related to the individual child, the family, peer relations, teachers and other professionals in a child’s life, traditional healers, pastors and the wider society. We found that in the context of a macrosystem that supports witchcraft, suspicions of witchcraft are formed at the mesosystem level, where actors from the microsystem interact with each other and the child. The involvement of a traditional healer or pastor often forms a tipping point that leads to a confession of witchcraft. ConclusionsChild witchcraft is an idiom of distress, not so much owned by the individual child as well as by the systems around the child. Mental health interventions should be systemic and multi-sectoral, to prevent accusations and confessions, and address the suffering of both the child and the systems surrounding the child. Interventions should be contextually relevant and service providers should be helped to address conscious and subconscious fears related to witchcraft. Beyond mental health interventions, advocacy, peacebuilding and legislation is needed to address the deeper systemic issues of poverty, conflict and abuse.

Neighborhood characteristics and ataque de nervios: the role of neighborhood violence

Ataque de nervios is a Latina/o idiom of distress that may occur as a culturally sanctioned response to acute stressful experiences, particularly relating to grief, threat, family conflict, and a breakdown in social networks. The contextual factors associated with ataque de nervios have received little attention in research. This study examined the association between neighborhood factors and the experience of ataque de nervios among a sample of Latinas/os participating in the Latino Health and Well-Being Project in the northeastern United States. We examined the association between neighborhood cohesion, safety, trust, and violence and ataque de nervios. In multivariate logistic regression models, neighborhood violence was associated with ataque de nervios ( p = .02), with each unit increase in the neighborhood violence scale being associated with 1.36 times greater odds of experiencing ataque de nervios. None of the other neighborhood variables were significantly associated with ataque de nervios. The positive association between neighborhood violence and the experience of ataque de nervios makes a further case for policy efforts and other investments to reduce neighborhood violence.

Keeping it together: Idioms of resilience and distress in Thai Buddhist mindlessness

Mindfulness is increasingly lauded as a mark of well-being around the world, but less often is its opposite, mindlessness, articulated in discussions of mental health. In Thailand, where people follow the kinds of Theravāda forms of Buddhism that have inspired today's global mindfulness movement, “mindlessness” is understood as a culturally salient mark of distress. In this article I address what mindlessness looks like for people in and around the Northern Thai city of Chiang Mai, where mindlessness can be thought of as ephemeral and passing as a fleeting forgetfulness that necessitates re-reading a page in a book, or as long lasting and powerful as a destabilizing condition to be treated in the in-patient ward of a psychiatric hospital. I emphasize local meanings and contexts of mindlessness, and their entanglement with broader discourses in the mindfulness movement, in order to point to mindlessness as a type of local and potentially international idiom of distress. I do this to argue for both the continued importance of cultural concepts of distress in our psychiatric nosology, and for further study into the slippages that can occur when local idioms like mindfulness go global.

Jerusalem Syndrome and Paris Syndrome

The affinity of people to a specific and meaningful geographical area is a well-known human behavioral phenomenon. Some scholars labeled this complex mental relationship with a significant space as “psychogeography.” In “Jerusalem syndrome” pilgrims and tourists may consider themselves to be biblical or messianic figures, act accordingly and utilize the Holy city as the arena where they act out their “mission.” “Paris syndrome” is a form of culture-shock observed primarily in Japanese tourists visiting Paris for the first time. Both are relatively rare phenomena. This chapter briefly describes the historical background and the cultural context underlying the narratives of the afflicted individuals. Research reveals that the vast majority of afflicted pilgrims suffered from severe mental problems prior to their arrival in the Holy City, and that the syndrome reflects their particular idiom of distress.