A Note About Cultural Beliefs

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Many people believe that mental illness is caused by supernatural powers or witchcraft. According to the traditional medicine system in Malawi, some of the causes of mental illness are:

• An Angry God punishes wrongdoers for violating taboos (Chauta, Chiuta, Mulungu).
• Ancestors and other spirits; who feel they have been forgotten, not recognised or not purified by sacrifice (nsembe).
• Witches working for individuals or village communities for personal benefit.
• Spirit possession (mizimu, majini, vimbuza) or intrusion of an object (living or inanimate) into the body.
• Loss of basic body equilibrium usually by the entry of excessive heat or cold (mphepo ndi madzi oipa).
• The ‘evil eye’ (tsoka) – aggression or punishment is directed against a person as a result of the will and power of another human being supernatural agent or being.

It is important that mental healthcare professionals are sensitive, respectful and empathic in their assessment and treatment of people with mental illness. It is important to understand the beliefs of the person and family, even if you don’t agree with them.

It may help to network with other treatment providers (e.g. traditional healers) for consensus and compromise on some treatment areas.

However, it is also important that health workers protect patients from harmful aspects of traditional healing such as chaining, beatings or the use of traditional medicines that may make a patient more unwell. 

You may hold strong religious beliefs or believe that witchcraft occurs in Malawi. That is ok. However, if somebody has a mental illness that could be helped using the approach described in this guide, you must help them to get the best treatment possible.