Yachactaitas (the Quichua healers of the Andes) may be
identifying general psychiatric disorders in their communities,
according to a study published in the May 2008 issue of the British
Journal of Psychiatry.
Traditional healers’ practices are widespread around the world,
yet their diagnostic skills have rarely been investigated.
This exploratory study was carried out in Otavalo, in the
province of Imbabura in the highlands of Ecuador. For over 18
months, 10 yachactaitas from three rural villages drew patients
from the surrounding areas.
They identified 50 of these as having a condition known as
llaqui. Each was referred to a Quichua-speaking physician trained
in western transcultural psychiatry, and underwent the following
investigations:
• A structured interview, using a Quichua questionnaire on the
nature of llaqui
• A medical evaluation, including personal and medical history,
and a physical examination
• Laboratory tests, including blood, faecal and urine analysis,
and an X-ray
• Psychiatric evaluation and diagnosis, using established
western diagnostic criteria
• An adapted Quichua version of a self-rating depression
scale.
94% of the people studied lived in the rural villages of the
Otavalo area. Most were peasant farmers, artisans or homemakers.
56% were illiterate, and an additional 34% had not completed
elementary school education. 54% were male, and 65% married.
The Quichuas themselves (and the yachactaitas in particular)
identify llaqui as a cluster of four illness sub-categories
comprising a symptom (sadness), the name of an illness, life events
and a causal factor of illness.
The first two sub-categories are merged into one, which can be
translated as ‘victim of malignant spirits.’ The person is under
attack by natural spirits or spirits under human control that will
damage the person’s body or soul.
The third sub-category (‘heart pain or shattered heart’) results
from life events and sorcery. Among the Quichuas, land disputes,
family conflicts and the death of a relative are the most stressful
life events. This condition also resembles the symptoms of typical
anxiety or depression.
The fourth sub-category (‘victim of sorcery’) is believed to
result from the aggression of malignant spirits under human control
(usually a healer), or by a physical or visual contact with
materials used in the treatment of sorcery. People can have
symptoms from more than one illness sub-category at the same
time.
The western clinical diagnoses of the 50 participants with
llaqui showed that 82% had a depressive disorder; 44% medically
unexplained symptoms (somatoform disorders); and 40% anxiety
disorders. Over 80% of them also had infectious or parasitic
diseases.
The researchers comment that it is surprising that the Quichua
healers, using supernatural and life events notions, seem to
identify people who are psychiatrically ill. Since participants
were identified as ill by both the yachactaita and by the
biomedically trained doctor, a remarkable overlap is apparent in
the diagnostic work of both practitioners.
The findings of this study are in line with those of previous
studies in different and remote parts of the world. The results
highlight the contribution of yachactaitas in the provision of
mental healthcare for Quichua people living in the Andes, for whom
government-funded psychiatric services are non-existent, say the
researchers.
The yachactaitas’ diagnostic abilities could be useful in the
screening of patients in psychiatric epidemiological and public
health research.