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If sufferers accept the call and go through the process of training, they emerge as shamanic healers (Xhosa = amagqira; Zulu = isangoma). If they do not, the illness is unlikely to be cured. They may even die. Among the Xhosa and Zulu, this illness is called intwaso (having the illness is called ukuthwasa kwegqira: to emerge as a healer).
It is believed to have been sent by ancestors who have chosen the person to undergo initiation as a healer. The initiation involves training in work with altered states of consciousness. These abilities will help them to diagnose and treat illnesses and generally help their community. Four features of this training illustrate the transpersonal aspects of the process and the importance of altered states of consciousness:
- Importance of dreams: Images which indicate contact with the spirit world, for example, of ancestors are regarded as very significant.
- Performance of rituals: As a means of honouring and communicating with the ancestors. Many rituals involve going to the river and leaving offerings to the river people (Buhrmann, 1986). The river people are not literally in the river of ordinary reality, but in a river in the non-ordinary world that can be visited in dreams and other altered states. Rituals provide a way of working on the boundary between the two realities.
- Entering altered states of consciousness: Assisted by a group of people who are clapping, chanting and drumming. In this state they may hear voices guiding them or giving them advice. These voices are attributed to the river people. They may also see images or feel sensations in their bodies which give them information about what is wrong in the patient’s body (Thorpe, 1982). They may also enter a possession trance and utter a stream of words, often very quickly, as if beyond conscious control, which provide information about the problem.
- Extra-sensory perception is used to obtain information about what is wrong with the patient and how it can be cured. This is facilitated by the altered state.
African traditional healers do not attribute all psychotic symptoms to intwaso. Some are attributed to spirit possession illnesses such as amafufunyana and others to madness (phambana). Like shamans worldwide, however, they believe that in cases of intwaso it is possible to create a safe place where the person can experience these altered states under guidance. The person will then emerge stronger, healthier and able to offer wisdom and healing to the community.
Although intwaso is considered a culture-bound syndrome, shamanic initiatory illnesses are found all over the world, for example in Siberia and among Native Americans. They are not even confined to traditional rural and pre-industrial societies. Even though, in Europe, the shamanic tradition was suppressed centuries ago, some Westerners who develop psychotic illnesses may themselves be undergoing a shamanic initiatory illness. This is best treated in the way African traditional healers work with people with intwaso.
Grof & Grof write, ‘We have seen instances where modern Americans, Europeans, Australians and Asians have experienced episodes that bore a close resemblance to shamanic crises’. They call the process spiritual emergence. Although not writing from an African perspective, this is virtually a direct translation of intwaso. The DSM system has been criticised (Lukoff, 1985; Lukoff, Lu and Turner, 1992) because it does not provide any account of this type of process.
Extract from Psychology: An Introduction for Students in Southern Africa by Louw, DA and Edwards, DJA (1997) Heinemann: Johannesburg
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