في الذكرى الأربعين لرحيل التجاني الماحي

Wisdom from the Father of African Psychiatry
By Gerald D. Klee, MD
[Winter 2007; Vol. 33, No. 2; Pg 5, 11]

The audience was captivated by Tigani El Mahi, MD when he addressed a scientific meeting of the MPS in 1958.
Dr. El Mahi, a citizen of the Sudan, represented the World Health Association (WHO) for North Africa. His talk was on psychiatry in Africa, a subject about which we knew very little.
A native of Sudan, Dr. El Mahi was a deeply learned man and a profound scholar in the Islamic faith. His extensive psychiatric training took place in major European centers followed by a stint at Johns Hopkins under Adolf Meyer. After completing his training he returned to Khartoum, Sudan and hung out his shingle.
Psychiatric disorders tend to be fundamentally similar in all parts of the world, but their expression can vary widely due to cultural differences. El Mahi was disappointed to find that despite his use of the best methods known to Western science many of his African patients didn’t do so well. He wondered why.

He discovered that patients from traditional African communities were far more satisfied under the care of traditional healers. In the best scientific tradition, he made extensive observations of the methods used by traditional healers to see what accounted for their success.

He found that traditional healers were also practitioners of indigenous African religions. Their methods included exorcising evil spirits and combating spells cast by witches. The patient’s ancestors were called upon to exert spiritual influence. These treatments were performed in the village with the patient’s family participating. There was dancing, singing and prayers to ancestors. Sometimes the whole village participated. Even among patients who had converted to Christianity or to Islam, traditional religious practices were usually employed.

“How can these superstitious approaches be more successful than the scientific methods of Europe and the US?” Dr. El Mahi wondered.

As he continued his observations, El Mahi developed increasing respect for native healers. It dawned on him that his prized Western methods were utterly foreign to African patients from traditional cultures. He realized that could account for his ineffectiveness. In contrast to his western, “scientific” approach, the methods of traditional healers were deeply meaningful to such patients and their families and consequently yielded greater satisfaction.
In a simple sentence, El Mahi explained why the traditional healers got better results than he did. “When the patient and the doctor agree, the patient gets well”, he said. That sounded like good common sense. He then added that he heard it years ago from Adolf Meyer at Johns Hopkins.
But what does it mean? El Mahi explained that the patient needs to feel that the doctor/healer understands him. If the patient believes that the root of his illness is due to witchcraft or evil spirits, it doesn’t help to tell him he’s wrong.

A great deal of mutual respect developed between El Mahi and traditional healers as they worked together in treating the same patients. The results were good. Instead of seeing conflict between theories and disciplines, they saw good therapeutic outcomes.
As Dr. El Mahi’s approach to understanding and treating mental patients became widespread in Africa he became known as the father of African psychiatry.

Even today, most of Africa suffers severe shortages of doctors and other trained health care workers. Traditional healers help to fill the gaps.

Strange as it may seem to Americans, the Tigani El Mahi story has relevance in the US and elsewhere. Americans also have various belief systems and folkways that influence their ideas about illness and health. Our most advanced scientific methods will be less effective if we ignore Doctor Tigani El Mahi’s African wisdom. American psychiatrists don’t need to team up with traditional healers, but we must take the time and effort to learn what is important to patients and to take it into consideration.