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Cultural explanatory models and consideration for local systemic interventions can benefit the treatment of patients with dissociative symptoms attributed to possession by spirits. This is one of the conclusions of the research conducted by Marjolein van Duijl into the relationship between possession by spirits, dissociative symptoms and traumatising experiences in Uganda. Van Duijl will receive her doctorate from the University of Amsterdam (UvA) on Wednesday, 22 October 2014.

Traditional Healing Session
Artwork: Tusiime Albert (Photo: Marjolein van Duijl)

Van Duijl seeks to understand possession by spirits as an outlet used by people in Uganda to express their problems. ‘In my research I wish to bridge the gap between Western psychiatry and local phenomena and explanations,’ Van Duijl says. ‘In the Western world, possession by spirits is often seen as something that falls outside the scope of conventional psychiatry and which has little relevance to the discipline. However, the belief in spirits and symptoms caused by spirit possession features strongly in around three-quarters of the world's cultures. In these cultures, people express their problems through spirits rather than identify them directly. Failure to understand this can result in incorrect diagnoses.’ 

From indeterminate to active symptoms 

In a study of 120 patients with signs of possession and a control group of 70 non-possessed patients, Van Duijl demonstrates that possession by spirits is linked to traumatic experiences. Based on the stories of the patients, she learned that possession occurs in stages. ‘It begins with unexplained physiological symptoms, such as dizziness, headaches and nausea. As these symptoms point to a medical problem, the patient seeks medical assistance. Yet the symptoms baffle the doctors. The patient then experiences what we refer to as passive influential symptoms: dreams, hearing voices and the feeling of being restrained and not being able to move. These are symptoms that are often confused in conventional psychiatry with psychosis or schizophrenia. In the final phase, the patient experiences active symptoms such as the involuntary shaking of the body and speaking with a voice that the patient attributes to a ghost,’ according to Van Duijl.

The majority of Ugandan patients received satisfactory explanations for their symptoms from traditional healers, resulting in the alleviation of the symptoms. Spirits were invited to manifest and express themselves, and this occurred without any reference to the actual traumatic experiences. The possession was usually explained as being caused by the neglect of spiritual rituals or responsibilities towards next of kin and inheritance. The patients' problems proved to be caused in part by conflicting interests between culture and the individual, as in the case of forced marriages, but also by feelings of guilt, fear and so on. Van Duijl: ‘It helps to keep asking questions in these areas and to be mindful of what the patient experiences as important. Talking already brings relief and it offers an opening to other solutions. In this way, traumas are dealt with symbolically rather than by applying the therapy to the traumatic experiences directly, as is usual in Western psychology.’

Wider relevance

In Uganda, one of the poorest countries in the world, there is a wide gap between the need for and availability of adequate psychiatric care: the mental health gap. Van Duijl argues that as psychiatric care provided through official channels is unable to meet demand, there should be more cooperation with local healers. This could lead to improvements in mental health care, improve communication and offer handles for diagnostics and treatment. Van Duijl's findings are also relevant for the psychiatric care provided to migrants and refugees in Western countries. ‘The Netherlands is home to many groups with spiritual traditions, such as the Surinam community with Winti or the Moroccan with djinns. By taking a transcultural approach and comparing the various explanatory models with one  another, we can acquire a broader set of tools for developing solutions and patients can get back on their feet – for the time being.’


E.M. van Duijl: Spirits, Devils and Trauma: Dissociation in Uganda. Supervisor: Prof. J.T.V.M. de Jong.

Time and location

The doctoral thesis defence ceremony will take place on Wednesday, 22 October, at 15:00.

Location: Aula of the UvA, Single 411, Amsterdam.