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Culture-bound syndromes
Amafufunyana
Amafufunyana is a serious disorder described among Zulus and Xhosas. African traditional healers believe that people have been invaded and possessed by evil spirits as a result of witchcraft.

The person who performs the bewitchment takes ants that have been feeding on a dead body in a grave. These ants are made into a poisonous idliso which is given secretly to the affected person. One symptom is that people hear voices coming from their own stomach area. These voices speak a different language to their own. Xhosa speakers in the Eastern Cape, for example, claim that the voices speak Zulu.

 
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One woman’s symptoms began with a feeling of tiredness, loss of appetite, uncontrolled angry outbursts, sleep difficulties and disturbing dreams. She began to hear voices in her stomach. At first the voices sounded far away but later seemed to come nearer and nearer. They told her she would be unable to have children. It was true that she had been unable to conceive a child.

On one occasion they told her they had come to kill her because someone else wanted to marry her husband. On another occasion they threatened to cause epileptic seizures. Whenever she became angry she blamed the amafufunyana spirits (Schweitzer, 1977).

People may go into states of extreme agitation and run about and break things. In one case it was said that it took five men to hold down a 13-year-old sufferer (FS Edwards, 1984). Some patients attempt suicide. One girl drank a bottle of paraffin. Another kept trying to throw herself in front of cars, claiming that the spirits were telling her to do this - this is called a command hallucination (Freeman, Pretzer, Fleming & Simon, 1990).

The person may fall down exhausted and begin to speak in a strange voice which sounds like that of another person. For example, a woman may speak in a deep man’s voice. The voices are believed to be those of the possessing spirits. Onlookers may question the voices and be told the names of the amafufunyana and who sent them.

Mass phenomenon
Amafufunyana can occur as a mass phenomenon. From 1981 to 1983, over 400 children at a junior secondary school in Transkei were affected (FS Edwards, 1984). It was reported that a few children had swollen and painful stomachs. The local clinic was unable to relieve the symptoms. Later the stomach problems were attributed to witchcraft.

At school, children ran about out of control, rolling their eyes and hitting out wildly or kicking chairs and desks. One teacher reported that, if the children’s stomachs were squeezed, voices in Zulu could be heard saying they had been sent to possess the children.

Three local women were accused of having bewitched the children. Two of them fled the area. The third refused to leave and was attacked by an angry crowd of children who wanted to kill her. Later several children were charged with assault and taken to court. There, they became noisy and violent and the court had to be adjourned on five occasions.

Outbreaks of intense and uncontrolled emotion used to be called "hysteria". Such mass outbreaks were called mass hysteria. However, the term hysteria has been used in many different ways. Because of this the ICD-10 (International Classification of Diseases) recommends that the term should not be used. It is not used in the DSM-IV either. In terms of the DSM, amafufunyana includes symptoms characteristic of psychotic, dissociative, somatoform and impulse control disorders.

Extract from Psychology: An Introduction for Students in Southern Africa by Louw, DA and Edwards, DJA (1997) Heinemann: Johannesburg

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