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Mental Illness Among Bhutanese Shamans in Nepal

Mark van Ommeren, PhD,* Ivan Komproe, PhD,* Etzel Carden˜a, PhD,†

Suraj B. Thapa, MBBS, MPhil,‡ Dinesh Prasain, MA,‡ Joop T. V. M. de Jong, MD, PhD,* and  Bhogendra Sharma, MBBS, MSc

 

Abstract: Despite efforts to promote traditional medicine, allopathic practitioners often look with distrust at traditional practices. Shamans in particular are often regarded with ambivalence and have been considered mentally ill people. We tested the hypothesis that shamanism is an expression of psychopathology. In the Bhutanese refugee community in Nepal, a community with a high number of shamans, we surveyed a representative community sample of 810

adults and assessed ICD-10 mental disorders through structured diagnostic interviews. Approximately 7% of male refugees and 0.5% of female refugees reported being shamans. After controlling for demographic differences, the shamans did not differ from the comparison group in terms of 12-month and lifetime ICD-10 severe depressive episode, specific phobia, persistent somatoform pain, posttraumatic stress, generalized anxiety, or dissociative disorders.

 

This first-ever, community-based, psychiatric epidemiological survey among shamans indicated no evidence that shamanism is an expression of psychopathology. The study’s finding may assist in rectifying shamans’ reputation, which has been tainted by past speculation of psychopathology. (J Nerv Ment Dis 2004;192: 313–317)

Ashaman is a traditional, animistic healer who receives community recognition for having expertise in entering altered states of consciousness to experience contact with the spirit world on behalf of community members (Heinze, 1991; Reinhard, 1976). Shamanic healing is widely used in a broad range of societies throughout the globe (Winkelman, 1992; World Health Organization, 2002). Shamans are able to provide meaning to communities by explaining causes for suffering and misfortune. Even though their therapeutic efficacy is not established, shamans tend to succeed in inspiring hope and instilling subjective improvement of well-being (Frank and Frank, 1991). Despite serious ongoing efforts to promote traditional medicine by the World Health Organization, allopathic practitioners still often look with distrust at traditional practices (World Health Organization, 2002). Shamans in particular are often regarded with ambivalence (Krippner,

2002), and their mental health status has been debated (Devereux, 1961; Katz, 1982; Walsh, 1990; Watson, 1994). Early transcultural studies described shamans as severely neurotic (Devereux, 1961) or as psychotic (Silverman, 1967), and shamans have been called wounded healers (Halifax, 1982). Assessments with projective tests in the American continent have concluded that shamans are relatively healthy (Boyer, 1967; Fabrega and Silver, 1973). Yet the validity of projective tests is debatable (Wood et al., 2000), and discourse on the mental health status of shamans continues (Walsh, 1990; Watson, 1994). A pathologized view of shamanism is harmful to efforts to promote appreciation for traditional medicine among allopathic practitioners. We conducted a community-based epidemiological study of mental disorders among shamans and tested the hypothesis that shamans are at elevated risk.