By Gerald D. Klee, MD
[Winter 2007; Vol. 33, No. 2; Pg 5, 11]
The
audience was captivated by Tigani El Mahi, MD when he addressed a scientific
meeting of the MPS in 1958.
Dr.
El Mahi, a citizen of the Sudan, represented the World Health Association (WHO)
for North Africa. His talk was on psychiatry in Africa, a subject about which we
knew very little.
A
native of Sudan, Dr. El Mahi was a deeply learned man and a profound scholar in
the Islamic faith. His extensive psychiatric training took place in major
European centers followed by a stint at Johns Hopkins under Adolf Meyer. After
completing his training he returned to Khartoum, Sudan and hung out his shingle.
Psychiatric
disorders tend to be fundamentally similar in all parts of the world, but their
expression can vary widely due to cultural differences. El Mahi was disappointed
to find that despite his use of the best methods known to Western science many
of his African patients didn’t do so well. He wondered why.
He
discovered that patients from traditional African communities were far more
satisfied under the care of traditional healers. In the best scientific
tradition, he made extensive observations of the methods used by traditional
healers to see what accounted for their success.
He
found that traditional healers were also practitioners of indigenous African
religions. Their methods included exorcising evil spirits and combating spells
cast by witches. The patient’s ancestors were called upon to exert spiritual
influence. These treatments were performed in the village with the patient’s
family participating. There was dancing, singing and prayers to ancestors.
Sometimes the whole village participated. Even among patients who had converted
to Christianity or to Islam, traditional religious practices were usually
employed.
“How
can these superstitious approaches be more successful than the scientific
methods of Europe and the US?” Dr. El Mahi wondered.
As
he continued his observations, El Mahi developed increasing respect for native
healers. It dawned on him that his prized Western methods were utterly foreign
to African patients from traditional cultures. He realized that could account
for his ineffectiveness. In contrast to his western, “scientific” approach,
the methods of traditional healers were deeply meaningful to such patients and
their families and consequently yielded greater satisfaction.
In
a simple sentence, El Mahi explained why the traditional healers got better
results than he did. “When the patient and the doctor agree, the patient gets
well”, he said. That sounded like good common sense. He then added that he
heard it years ago from Adolf Meyer at Johns Hopkins.
But
what does it mean? El Mahi explained that the patient needs to feel that the
doctor/healer understands him. If the patient believes that the root of his
illness is due to witchcraft or evil spirits, it doesn’t help to tell him
he’s wrong.
A
great deal of mutual respect developed between El Mahi and traditional healers
as they worked together in treating the same patients. The results were good.
Instead of seeing conflict between theories and disciplines, they saw good
therapeutic outcomes.
As
Dr. El Mahi’s approach to understanding and treating mental patients became
widespread in Africa he became known as the father of African psychiatry.
Even
today, most of Africa suffers severe shortages of
doctors and other trained health care workers. Traditional healers help
to fill the gaps.
Strange as it may seem to Americans, the Tigani El Mahi story has relevance in the US and elsewhere. Americans also have various belief systems and folkways that influence their ideas about illness and health. Our most advanced scientific methods will be less effective if we ignore Doctor Tigani El Mahi’s African wisdom. American psychiatrists don’t need to team up with traditional healers, but we must take the time and effort to learn what is important to patients and to take it into consideration.