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The Distress of Makutu: Some Cultural-Clinical Considerations of Maori Witchcraft

Ingo Lambrecht

I clearly recall the first day I met ‘D’ in my therapy room at Manawanui, the Maori mental health service in Auckland, New Zealand. As a Maori man in his middle years, D sat opposite me, talking with generous arm gestures, speaking in his rich language of symbols and strange associations. It took all my cognitive skills and some leaps of faith to follow him, to stay with his story. His story was filled with numerous cultural references and anomalous experiences. It was hard to get a grasp on what was going on. He was clearly intelligent, yet difficult to follow in the tangential flow of consciousness he produced, replete with visions, Maori cultural practices, experiences of paranormal phenomena, and tales of terrifying witchcraft, called makutu in Maori.

In this chapter, the complex cultural-clinical interface in Global Mental Health will be explored through the lens of psychotherapy with a tangata whai i te ora (client) in a New Zealand Maori mental health service. Cultural mental health discourse acknowledges the cultural-political context (Kirmayer et al. 2003). In New Zealand, an academic postmodern sensitivity to cultural factors in the mental health domain is not uncommon (Lambrecht and Taitimu 2012). In the name of postmodern disclosure, the therapist is of German descent, has had the honour of being whangaid (adopted or brought into a [1]

Maori family), and is currently a clinical advisor, integrating various Maori mental health services for He Kamaka Oranga, Maori Health Service at the Auckland District Health Board. Talking therapies have been reviewed for Maori by Maori as being welcomed, effective, and healing, as long as they are culturally sensitively practised (Te Pou o Te Whakaaro Nui 2010). However, how does the cultural-clinical integration in Global Mental Health actually occur on the ground directly in the space between the client and the therapist? The therapy room itself will be contextualized in terms of some political-cultural factors determining Maori mental health services. This is followed by sections on the integrative Maori mental health model, the cultural-clinical entanglements, makutu or witchcraft, and finally a brief sketch of D’s therapy. The reflections in this chapter have therefore been personalized to capture some of the experiences and thoughts of the therapist, to avoid the notion of the objective, distant, truthful author, sufficiently critiqued in postmodern literature. Through the therapeutic work within a Maori-specific mental health service, the complexity of Global Mental Health for indigenous people all over the world is highlighted.

Coming back to the first session, when I was seeking to understand and formulate, I realized that from a Western psychiatric perspective according to the DSM-5 (APA 2013), the obvious diagnosis of schizophrenia, psychosis, or maybe a manic state with some paranoid ideation and psychotic features would seem to be appropriate. I then was struck by how witchcraft could be considered by Western psychiatric discourse as a form of psychosis, a paranoid schizophrenia. Yet amongst many indigenous people, witchcraft and curses are very real. The question was how to work with this, allowing D to experience his cultural reality. The so-called culture-bound syndromes and the cultural formulation as per DSM-5 (APA 2013, p. 749) are attempts to acknowledge common cultural signs of distress of certain regions or countries. Many countries face the challenge of developing integrative approaches to clinical and traditional health, and mental health specifically. Equally, globalization continues to widen the cultural context in which clinicians have to perform their duties of healing. An increasing number of reviews document racial, ethnic and cultural disparities in mental health care and in continuity of care (Snowden and Yamada 2005). Many explanations focus on cultural factors: trust and treatment receptiveness, stigma, culturally distinctive beliefs about mental illness and mental health, culturally sanctioned ways of expressing mental health-related suffering and coping styles, and client preferences for alternative interventions and treatment-seeking pathways, as well as unresponsive programmes and providers.

A meta-analytic review of culturally adapted mental health interventions finds that many studies advocate for traditional mental health treatments being modified to better match clients’ cultural contexts (Griner and Smith 2006). This review finds that across 76 studies evaluating culturally adapted interventions, they have found a moderately strong benefit. Interventions targeted to a specific cultural group were four times more effective than interventions provided to groups consisting of clients from a variety of cultural backgrounds. Interventions conducted in clients’ native language (if other than English) were twice as effective as interventions conducted in English. Recommendations suggest mental health interventions be adapted to the cultural context of the client. In the therapy sessions with D, this became the aim, namely using his culture and constructs to establish effective healing.

  • [1] Lambrecht (*) Manawanui, Maori Mental Health Services, Auckland, New Zealand© The Author(s) 2017 R.G. White et al. (eds.), The Palgrave Handbook of Sociocultural Perspectiveson Global Mental Health, DOI 10.1057/978-1-137-39510-8_26
 
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