Academic journal article European Journal of Psychotraumatology

Global Mental Health and Trauma Exposure: The Current Evidence for the Relationship between Traumatic Experiences and Spirit Possession

Academic journal article European Journal of Psychotraumatology

Global Mental Health and Trauma Exposure: The Current Evidence for the Relationship between Traumatic Experiences and Spirit Possession

Article excerpt

Responsible Editor: Marianna Purgato, Johns Hopkins Bloomberg School of Public, USA.

Copyright: © 2015 Tobias Hecker et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License, allowing third parties to copy and redistribute the material in any medium or format, and to remix, transform, and build upon the material, for any purpose, even commercially, under the condition that appropriate credit is given, that a link to the license is provided, and that you indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.

Received: 13 July 2015; Revised: 14 September 2015; Accepted: 15 September 2015; Published: 19 November 2015

Competing interests and funding: The authors declare that they have no conflict of interest and funding.

*Correspondence to: Tobias Hecker, Department of Psychology, University of Zurich, Binzmuehlestr. 14/17, CH-8050 Zurich, Switzerland, Email:

This paper is part of the Special Issue: Global mental health and trauma . More papers from this issue can be found at

For the abstract or full text in other languages, please see Supplementary files under 'Article Tools'

Global mental health is an emerging field of knowledge highlighting the gaps in mental health services worldwide (Collins, Insel, Chockalingam, Daar, & Maddox, 2013). More than 80% of the global population lives in low- and middle-income countries (LMICs), although these countries possess only less than 20% of the resources needed to treat mental disorders. The consequence is that more than 75% of people with mental health disorders in these countries do not receive any official health care at all. A growing amount of research has highlighted this substantial gap between the burden caused by mental disorders and the resources devoted to prevent and treat them (Collins et al., 2013). To bridge these gaps, there is an urgent need for research and action focused on mental health in LMICs.

The World Health Organization (WHO) Mental Health Gap Action Program (mhGAP) provides a strategy, especially for LMICs, for scaling up services for mental, neurological, and substance use disorders (Mathers, Fat, & Boerma, 2008). The vision of the WHO Mental Health Action Plan 2013-2020 (WHO, 2013) is to provide access to culturally appropriate health and social care for all persons suffering from mental disorders. The WHO's plan also fits with the Inter-Agency Standing Committee's (IASC) recommendations to consider local idioms of distress and to collaborate with local, indigenous, and traditional healing systems (IASC Reference Group for Mental Health and Psychosocial Support in Emergency Settings, 2010). Although experiences of spirit possession occur worldwide in many societies (Bourguignon, 1973), and universally used classification systems for mental disorders include criteria to classify dissociative and possessive trance states (American Psychiatric Association, 2000, 2013; WHO, 1992), specific attention on spirit possession and dissociative and possessive trance disorders is still largely lacking in the mhGAP approach and training program. This is even more surprising as anthropologists have already described various forms of pathological possession as an idiom of distress, and there is a now a growing body of research suggesting a relationship between traumatic experiences and pathological forms of spirit possession (Van Duijl, Nijenhuis, Komproe, Gernaat, & De Jong, 2010).

Pathological forms of spirit possession

The belief that spiritual forces or entities may have an impact on the well-being and personality of individuals is one that is present in cultures around the globe (Bourguignon, 1973). Spirit possession is commonly defined as an altered state of consciousness that involves experiences of being under the control of a powerful entity, such as a god, a demon, a devil, or a spirit (Boddy, 1994). …

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