Regression therapy is entering the psychiatric field in Suriname
While I was in Suriname in February this year I had the honour to be present at the promotion of dr. Kamla Nannan Panday-Jhingoeri. This psychiatrist became a ‘doctor of medical science’ because of her study of working with ‘Transpersonal regression therapy’ with psychiatric patients. In her dissertation she describes 20 cases of patients with whom she successfully worked with Transpersonal regression therapy.
Patients felt helped by a treatment that was open to ideas that in their cultural backgrounds are common, like reincarnation,
influences from ancestors, spirit possession and ‘helping entities’. While dr. Kamla Nannan Panday-Jhingoeri explained at her promotion these things can be seen as metaphors, she emphasizes the importance of using a pluralistic approach in the treatment of psychiatric problems in Suriname.
Dr. Kamla Nannan Panday-Jhingoeri was trained by the Dutch past life therapists Rob Bontenbal and Ronald van der Maesen in Suriname. Ronald van der Maesen was present at the promotion asnwell.
The study will probably be published in Dutch soon and hopefully in English later. For now we are thankful to Dr. Nannan-Panday she has agreed to share the summary of her study with us, available to you through this link.
Janine Booij.
Pluralism in the treatment of psychiatric problems in Suriname
Summary of the dissertation of dr Kamla Nannan-Panday Jhingoeri
“Pluralism in the treatment of psychiatric problems in Suriname”, refers to multiple treatment options for psychological problems that can co-exist and that can be combined with each other. The pluralism in this study is the addition of transpersonal regression therapy to the biopsychosocial model by one and the same therapist.
The main objective of this study is to examine how therapist and patient can combine cultural explanations for psychological problems in the treatment with the biopsychosocial model. Despite the development of increasingly advanced treatment methods in the biopsychosocial model, it appears that patients also seek help in complementary and alternative medicine. One reason may be that they do not want to use psychotropic drugs because of the side effects such as weight gain, increased risk of diabetes, heart problems, metabolic syndrome, neurological disorders and an increased risk of suicide.
In Suriname, people from different ethnic groups often explain psychological problems in culturally anchored beliefs that lie in the supernatural or transpersonal realm. Due to these beliefs people seek – sometimes prior to, sometimes simultaneously with the doctor’s visit – help from traditional healers. This traditional healing can entail risks, such as side effects of the herbs administered and even abuse of the patient.
This study uses the framework of the integrative psychiatry, that combines the transpersonal regressiontherapy as a complementary and alternative medicine (CAM) with the biopsychosocial model. The biopsychosocial model is based on the assumption that psychiatric diseases arise from a complex interaction of biological, psychological and social factors. One of the limitations of this model is that during diagnosis and treatment it hardly provides (space) room for the cultural and religious perception of the patient. With this framework of the integrative psychiatry, the physical, emotional, mental and spiritual and cultural dimensions are involved in the treatment.
Research question
The title of this research, “Pluralism in the treatment of psychiatric problems in Suriname”, refers to multiple treatment options for psychological problems that can co-exist and that can be combined with each other. The pluralism in this study is the addition of transpersonal regression therapy to the biopsychosocial model by one and the same therapist.
The research question of this study is: How can therapist and patient optimize the treatment of psychological problems within the integrative psychiatry by involving the patient’s perception on cultural aspects and explanations?
In addressing the research question, this study examines first of the impact of biopsychosocial model on the treatment of the patient. It also analyzes how culture, spirituality, and religion influence psychological problems. And finally, the study assesses the possibilities of the transpersonal regression therapy as a complementary tool to the biopsychosocial model.
Methodology
The selection of the cases was based on homogeneous sampling, a form of purposive sampling. The justification for purposive sampling is that patients could be selected, whose cases made it possible to answer the research questions from a theoretical point of view. The methodological principle of saturation is followed, which means that data collection was ceased when no longer new insights could be obtained. After 21 cases the saturation point was achieved. Data were analyzed based on themes that are theoretically relevant and crosscut cultural explanations for psychological problems by ethnic groups in Suriname. Main cultural themes were reincarnation, influences from ancestors, possession and the helping entity.
Research results
The biopsychosocial model does not include culture and religion in the diagnosis and treatment of the patient. However, culture strongly influences the way patients expresses their illness. If a therapist is not aware of these perceptions and experiences and ignores them, it can result in a wrong diagnosis and treatment. Religion and spirituality can influence mental health both negatively and positively. They can have negative effects, when they are a source of guilt, shame, fear and a rigid way of thinking. They can manifest as symptoms of psychopathology, for example religious delusions. Positive effects of spirituality and religion are their protective and resilience-enhancing factors for mental disorders: better coping strategies for stress, less depression, suicide, anxiety and substance abuse.
In addition to biopsychosocial causes, international studies show that there are transpersonal and supernatural explanations for psychological problems. Our research provides empirical evidence for such explanations in Suriname. The main transpersonal and supernatural explanations mentioned by the patients were perinatal events, reincarnation, influences of ancestors, spirit possession, and black magic.
Patients’ transpersonal and supernatural explanations for psychological problems were derived from experiences in the form of narratives, which often fit in their world of culture and religion. As a therapist, I accepted their explanations, which might seem bizarre to the Western trained therapist, in an open and empathic way without judgments.In the study of twenty-one cases, the emphasis was on the themes of reincarnation, ancestral influences, possession, and the ‘helping entity’. These have been further examined based on theoretical views and empirical cases.
In the case of reincarnation, patients have experiences which they associate with previous lives. These past life events show similarities with today’s problems, for which the patient had seeked help. Their current disorders by and large overlap with the past life experiences, sometimes in great detail at both physical and mental level. Notable is that in the three cases related to reincarnation, two patients practiced Christianity.
Records of patients showing ancestral influences, deal with evoking the souls of deceased ancestors to harm the own offspring. Patients also report negative consequences of neglecting rituals of their ancestors. There are cases confirming curses of or by ancestors that continue for generations. According to the winti religion such cases involve kunu, which can only be broken by a descendant who is strong enough.
Some cases illustrate the influence of spirit possession, that is being possessed by an entity. There are two forms: the first one with an overall takeover and with loss of consciousness. In the second form there is no overall takeover or loss of consciousness, but psychosocial and somatic disorders. Complaints such as suicidality, psychosis and migraine were attributed to spirit possession. None of the patients – Hindus, Christians, and atheists – had ever expected to find explanations involving with possession.
In various interviews a ‘helping entity’ was identified who was not experienced as pathological. Rather, it contributed to solutions for life problems and gave advice without being compulsive.
The re-experience, reinterpretation and restructuring of situations and the reintegration of dissociated parts of the patients contributed to reducing their physical and mental problems. As a therapist, I acted as a catalyst for the self-healing capabilities of the patient. By reinterpreting life-events and -experiences using a broader view on life, patients were able to cope with past events. After the therapy, twenty out of the twenty-one cases reported an improvement of the disorders for which help had been sought. Furthermore, the intake of their medicines could be reduced or gradually stopped. There was one patient with auditory hallucinations who could even stop the use of antipsychotics.
Added value and limitations
An advantage of this study is that it is carried out by a therapist who, as a psychiatrist, has years of experience with various cultures, who speaks the languages and has confidence of the patients whose stories are being investigated. As a result, the meaning and value that patients give to these stories, which are also grafted on culture, can be traced and a solution can be created together with the patient.
A limitation is that the researcher participated as a therapist in the cases, which required extra attention for balancing proximity and distance towards the patient. All efforts are undertaken to reduce the therapist’s bias through systematic reflection and discussion of the raw data, coding, the analytical framework and interpretations of the findings with the promotor and the co-promoters. At the same time attempts are made to explicit the role of the therapist and researcher as much as possible.
Another limitation is that this study does not allow the generalization of the findings to the larger psychiatric patient population of the Psychiatric Center Suriname. After all, the selected patients, who gave uncommon explanations for psychological disorders, are not representative of the general population of patients seeking help at the Psychiatric Center Suriname. Furthermore, they are not representative, as generally treatment of psychological problems occurs according to the biopsychosocial model.
Recommendations
Religion and spirituality can have positive influences on health. Hence it is recommended to identify how to incorporate them in the curriculum of institutions that train physicians, psychiatrists, psychologists, psychotherapists, psychosocial therapists and nurses. More specifically these people need to be educated in communication techniques concerning religion and spirituality.
Patients will continue to seek help from traditional healers, including all the risks. Therefore, physicians are advised to regularly inquire about their complementary and alternative treatments. This can enable therapists to identify whether the patient is consulting in the traditional sector at an early stage, and thus detect undesirable effects sooner.
The help-seeking behavior of the traditional healer must be mapped, so that the content and strategy of this treatment can be identified. As a result, the eventual undesirable effects of this treatment method can be reduced.
An alternative to treatment by the traditional healer is that medics, psychologists and psychotherapists and other psychosocial therapists are trained and integrate complementary and alternative treatments in their practice. Alternative therapists with an acceptable educational level can also be appointed to provide complementary and alternative therapy in consultation with the physician.
The treatment of psychological disorders in the practice of the psychiatrist can be optimized by incorporating cultural and religious aspects of such problems from the patients’ perceptions. This requires an interdisciplinary approach that utilizes insights from five academic disciplines in the integrated psychiatry: medical anthropology, psychology, sociology, religion and transpersonal psychology.
