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Quichua healers and the identification of mental illness
- Ruth V Reed (8 August 2008)
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Ruth V Reed, Specialty Registrar in Psychiatry MRCPCH
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ruthvreed{at}gmail.com Ruth V Reed
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Incayawar’s research appears to indicate that traditional Quichua healers have a perhaps surprisingly successful ability to identify those with psychiatric and physical illness in their rural communities. Incayawar states that none of the sample of llaqui cases were fully healthy from a Western medical or psychiatric perspective, as 82% fulfilled DSM-III-R criteria for depressive disorders, and 80% had parasitic and infectious diseases. I undertook my medical elective in a similar rural highland Quichua area in neighbouring Peru in 2002, and would like to make several observations on his findings. One must consider that there are several factors which deliver to the traditional healer a pre-selected group of ‘patients’ who have a very high chance of being genuinely unwell in Western terms, irrespective of the healer’s own skill in identifying them as ill. I found that infection with parasites in the jungle highlands was essentially universal and all healthcare staff and affluent patients would regularly test and treat themselves, invariably becoming reinfected and symptomatic within a couple of months - thus, it is not surprising that all of the identified ‘cases’ had at least one diagnosable condition. Life in such areas of the Andes is very physically challenging, and journeys from village to village can be a matter of days. The cases in the sample, male or female, would all have had to work hard for the survival of their families, and taking time out from these responsibilities to seek treatment would not be undertaken lightly, particularly as other family members would probably need to be involved. The degree of illness and its effects on the person’s fulfilment of duties would therefore be quite significant and of concern to more than the individual themselves before outside help was sought. The individual, family and community are therefore acting as a moderately effective screening tool in themselves. The supernatural beliefs and different categories of llaqui are an explanatory cultural framework that proves confusing to the Western- trained practitioner, but in its essence Llaqui as a concept involves self -identified sadness and the co-existence of adverse life events such as the death of a relative. It is not, then, so surprising that healers using these criteria should be able to select out individuals with sadness that we would identify as a depressive illness. Dr Ruth V Reed Specialty Registrar in Psychiatry, Berkshire Adolescent Unit, Wokingham Hospital, Barkham Road, Wokingham, Berkshire, RG41 2RE. Declaration of Interest: No conflict of interest to declare. |
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