Zinzi

Zinzi, The Sangoma in Zwelathemba, South Africa

Photograph taken by Valerie Halls, April 13, 2006.

During my junior year of college, I had the opportunity to study healthcare in India, China, and South Africa. The experience taught me more than I can put into words, but one story has shaped and continues to inform my perspective on medicine.

I met Zinzi on a hot afternoon. We walked to her house through what appeared to be an empty township called Zwelathema, 120 km northeast of Cape Town. It was not empty however. The residents hid indoors out of reach from the unbearable sun.

            The sunlight followed us into Zinzi’s shack through uneven slits in the corrugated iron walls. It cut through the dusty shadows and illuminated the strands of thick white beads that hung around her neck. A faded floral curtain separated the room in which we sat from a slightly larger space that served as her bedroom and her kitchen. The smell reflected the piles of small trinkets, animal hides, twigs, roots, fruits, empty cans, and strings of beads on the walls and in corners.

Zinzi shifted her large body as she scattered and arranged objects on the sheet that covered part of her dirt floor. Her beads clinked as she moved and she grunted as she sat back on a short stool and crossed her legs. She looked us over, 32 American students and four professors, and began to tell her story through a translator about how she became a Sangoma, a traditional Southern African healer.

Zinzi speaks to IHP group, Miriam translates

Aleha Aziz, Belinda Dobson, Derique, Emily Wheelis.

Photograph taken by Valerie Halls, April 13, 2006.

Zinzi was a churchgoer. She fell ill with sores all over her body, and the sickness kept her from going to church. Soon thereafter, her ancestors began to speak to her in her dreams, telling her that her body will heal once she becomes a Sangoma.  At first, she did not listen to them. She did not want to believe that they were real.  One night, she fell asleep in her bed and woke up by a bush far from her home; her ancestors had brought her there. They told her to find a hare on the other side of the mountain, to slaughter it, and to make it into an offering.  She went to the other side of the mountain and was not afraid because she knew that her ancestors would protect her. She knew which hare to capture. She slaughtered it, and she made an offering. 

In a short while, the dreams returned and a few nights later she woke up in a shallow river. Once again, she followed the orders of her ancestors and made an offering to them.

 Then for a third time, her ancestors called on her in her sleep, and she woke up in a cave. After performing the rituals that they called upon, she knew that she had to accept her calling as a Sangoma lest the ancestors become angry.  

She kept a bone and the skin of the first hare that she slaughtered, and she uses them as charms.  She says that these items helped her body to heal, and they help her to heal others. 

Zinzi now heals others.  She does not charge money for her service unless the ailment is healed.  If “the patient” does not get better, she either continues to work with him or she sends him to the “white doctor.”  The medicines that she prescribes come in the form of potions, herbs, recommended foods, and through the performance of healing rituals.  The combination of specific healing methods that she uses depends on the complaint of the individual and on his ancestral background.  In her rituals, Zinzi hears her ancestors with the help of her African beer, and sees the signs that they send in other ceremonial items. She quenches the thirst of her ancestors by making offerings of homemade Brandy.

She performs a form of fortune telling called bone throwing.  Her client takes a pile of her special collected charms in their hands, blows on them, and drops them.  She reads the arrangement into which they fall as insight into the seeker’s past, present, and future.

The Voices of the Ancestors

Zinzi

Photograph taken by Daniel Seeman, April 13, 2006

We sat and listened to Zinzi’s story. We may have interpreted the voices of her ancestors’ as auditory hallucinations, her night adventures as sleepwalking, and the disappearance of her brandy as evaporation, but we understood the importance of her role in her community. She listened to people’s ailments, she gave them faith amidst their troubles, and she served as a liaison between her community and the “white doctor,” who many of her patients would not trust or go see on their own.[1]

I cannot help but think that if she were in another context, Zinzi would be considered mentally ill. Had she disclosed the same story to a psychiatrist, he may have diagnosed her constellation of symptoms as Schizophrenia. [2]

In 1956, Ethnologist and Psychoanalyst George Devereux wrote about a case similar to that of Zinzi’s in his article entitled "Normal and Abnormal: The Key Problem in Psychiatric Anthropology."  He commented on how the behavior of a shaman may appear dissociated and could be interpreted as a sign of schizophrenia.  He asked, “Was the shaman normal or was he instead ‘really’ schizophrenic but merely labeled differently?”[3]  Devereux and another researcher, Julian Silverman, assumed that the experience of a shaman is schizophrenia, but expressed through different cultural symbols and interpreted as normal by the shaman’s community. [4] 

This interpretation did not sit well with my understanding of Zinzi. One of the reasons for diagnosing a mental illness is to treat it. What would be the purpose of diagnosing Zinzi as mentally ill if she were functional in her community? If her “symptoms” bring more purpose than suffering, do we call them a disease?

At a time when the cracks in mental health care in the US are seeping into the public eye, Zinzi’s story reminds us that the way we define and treat mental illness is entrenched in our own history, and that to fix it may mean to take a step back and redefine it.

In a series of longitudinal studies, the World Health Organization found a higher prevalence of schizophrenia and negative symptoms such as social withdrawal and apathy in urban areas of more developed societies.[5] What could we learn from Zinzi’s culture that could help us better accommodate people in our society with similar symptoms?

History reveals that definitions of disease change over time. Cervical carcinoma in situ becomes high grade dysplasia. Homosexuality ceases to be an illness. As science dives deeper into understanding the biological mechanisms behind mental illness, we must not forget to consider the role of the culture that surrounds it.

Trinkets line the Floor
Photograph taken by Valerie Halls, April 13, 2006.

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   Adapted from senior thesis on global perspectives of mental illness, published in May 2007. This version was originally published in USF MCOM Wellness Bulletin, Vol. 4, No. 2, April 2013. http://health.usf.edu/NR/rdonlyres/B43E3CE8-EECC-4550-BC82-06785DBCE502/0/Bulletinv4n2_Web.pdf

Notes and References:
[1] Apartheid in South Africa fostered an environment of distrust between traditional healers and medical doctors.  The conflict increased in intensity and publicity with the country’s growing epidemic of HIV/AIDS.  Recently, activists and practitioners on both sides have aimed to bridge the gap of trust and understanding.  One Sangoma was quoted in Nature magazine saying, “Both play vital roles in healing the majority of AIDS-afflicted South Africans…ARVs (antiretroviral) are the only medical intervention available to alleviate the physical effects of AIDS. The traditional healer, in addition to using herbs, also works on the spiritual level, which is an essential part of the African healing process that Western medicine does not address.” Zinzi shared this belief.  Under her beads, she wore a white shirt with a red ribbon. She has attended conferences that address the divide between doctors and Sangomas, where she learned the signs to look for in a person with AIDS.

[2]According to the DSM-IV-TR: “Schizophrenia is a disorder that lasts for at least 6 months and includes at least 1 month of active-phase symptoms (i.e., two [or more] of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms).”

Allen Frances, M.D., chairperson.  Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association. (2000), p. 298.

[3] Horacio Fabrega, Jr., “Conceptions of Human Behavioral Breakdowns,” in in What is Schizophrenia?, ed. William F. Flack, Jr., Daniel R. Miller, and Morton Wiener. (New York, NY: Springer-Verlag New York Inc., 1991), 128.

[4] Julian Silverman, “Shamans and Acute Schizophrenia.” American Anthropologist, New Series, Vol. 69, No. 1. (Feb., 1967), pp. 21-31. (Accessed March 16^th, 2007).

 [5] Hopper, Kim. “Interrogating the Meaning of ‘Culture’ in the WHO International Studies of Schizophrenia,” in Schizophrenia, Culture, and Subjectivity: The Edge of Experience, ed Jenkins, Janice Hunter, and Robert John Barrett. Cambridge, UK: Cambridge University Press, 2004.