Background
Methods
Design and setting
Participants and sampling
Data collection
Data analysis
Trustworthiness
Ethical considerations
Results
Descriptive findings
Qualitative findings
# | Participants | Age (Y*) | Gender | Educational level | Employment | The duration of the disease (Y) |
---|---|---|---|---|---|---|
1 | Sister | 39 | Female | Elementary | Unemployed | 8 |
2 | Spouse | 40 | Male | Elementary | Paid employment | 22 |
3 | Sister | 30 | Female | Diploma | Paid employment | 5 |
4 | Brother | 33 | Male | Elementary | Paid employment | 9 |
5 | Mother | 45 | Male | Elementary | Unemployed | 5 |
6 | Spouse | 31 | Male | Elementary | Paid employment | 9 |
7 | Mother | 65 | Male | Elementary | Unemployed | 8 |
8 | Spouse | 43 | Male | BScυ | Full time employment | 10 |
9 | Child | 32 | Male | MSC† | Full time employment | 18 |
10 | Spouse | 50 | Female | Elementary | Paid employment | 15 |
11 | Father | 51 | Male | BSc | Paid employment | 5 |
12 | Child | 26 | Female | BSc | Unemployed | 20 |
13 | Child | 27 | Female | Diploma | Unemployed | 15 |
14 | Father | 55 | Male | Elementary | Paid employment | 5 |
15 | Mother | 48 | Female | Elementary | Unemployed | 4 |
16 | Uncle | 35 | Male | BSc | Full time employment | 6 |
17 | Brother | 40 | Male | Elementary | Paid employment | 8 |
18 | Prayer writer | 46 | Male | Diploma | Prayer writer | |
19 | Recovered patient | 46 | Female | Elementary | Unemployed | |
20 | Psychologist | 38 | Female | PhD | Full time employment | |
21 | Normal person in the community | 30 | Female | MSc | Full time employment |
Theme | Categories | Sub-categories |
---|---|---|
Immersion in the cultural beliefs | Belief in the superstitious and supernatural nature of the psychological disease | Possessed by jinn |
Delusion, the manifestation of bewitchment | ||
Mental illness, conspiracy of those around | ||
Sinking into the superstitions | ||
Cultural erroneous believability | ||
Superstitious beliefs, an attempt to free the patient | Prayer writers as local experts | |
Spell breakers, earthly saviors of patients | ||
Superstitions, a way to escape stigma | ||
Conflict between cultural beliefs and science | Adherence to the treatment, the victim of superstition | |
Religious beliefs parallel with scientific therapy |
Theme: immersion in the cultural beliefs
Category 1: belief in the supernatural nature of the psychological disease
Sub-category 1: possessed by jinn
“He saw the jinn and he smelled the jinn, he also told us that it smelled bad, and sometimes he pulled the blanket over his head to keep the smell out. Sometimes he talks to himself under the blanket. At times we thought he was having a physical fight with someone and it was as if he was talking to a group and said, “Leave me alone, and don’t beat me” (p2).
“He saw a jinn and we saw him talking to someone. He said that, the jinn appeared to me in the form of a strong man. I think he told us the truth and he saw it, but we didn’t see it (p10).
Sub-category 2: delusion, the manifestation of bewitchment
“She was bewitched, she didn’t eat anything, she said there was poison in her food that would kill her, she was very upset, she didn’t even drink water and she went to drink water from the tap in the yard, which was hot and salty” (p3).
“My son is a marine engineer. He did a training course on a ship that travelled all over the world. He went to Europe, Africa and America. He was in a bad mood when he was doing the training course. He called and told us that, we have a marine engineer who is black and from Kenya. He has performed black magic on me and now I’m not well” (p7).
Sub-category 3: sinking into the superstitions
“They told his brother that, you should bring a sheep and sacrifice it to give blood to the jinn. His poor brother gave a lot of money to prayer writers in the hope that she would be cured. But it had no effect, it made his even worse. Finally, the prayer writer said because the jinn married him and won’t let him go, he won’t get better” (p10).
Sub-category 4: mental illness, conspiracy of those around
“My husband’s financial situation was very good. When he got sick, we thought that someone around him wanted to hurt him financially and put a spell on him. We had a tenant who said that he was clearly being cursed” (p8).
“Because my father had a lot of land, my first thought was that my relatives and cousins had bewitched him for the land so that he would be possessed and the land would remain for them, and now the land is left for them and they have reached their goal” (p1).“
Sub-category 5: cultural erroneous believability
“My husband came back from Yazd (a city in Iran) and said that, your brothers sent someone to kill me. My father and brothers were very upset about this. They said that if something bad happens to him, his family and your children will think that your brother committed the crime. So they informed his family of this matter, and asked why he was slandering them, and sent a message to his brother that we should negotiate” (p4).
“When he was discharged from hospital, he was much better; that’s why we thought he must be telling the truth, and black magic must have made him sick “(p6).
Category 2: superstitious beliefs, an attempt to free the patient
Sub-category 1: prayer writers as local experts
“We took her to different prayer-writers several times, they said that she was bewitched, and they gave amulets and prayers to get rid of her symptoms” (p.15).
“Without exaggeration, when I asked all the families of our patients, they definitely mentioned that before they went to a psychiatrist, they went to a prayer writer at least once. It is really a disaster (P.20).
“First, I pray on their heads and blow on their faces, for a period of 7 to 10 days, I give them amulets to hang on the patient’s neck or arm. In addition, sometimes I give them some herbal medicine; Herbs such as gilli flowers and roses are recommended for calming. There are always people who believe in us and spend big bucks, even though we know these things are ineffective and a form of brainwashing for patients and their loved ones” (p18).
Sub-category 2: spell breakers, earthly saviors of patients
One of the participants said:“The spell breaker said that to break the spell, you should bring a white hen to kill it in the evening and its blood will break the spell. We paid a lot and he told me to come tomorrow and get the spell breaker. There were many crooked lines written on folded papers and he said to put one in a fish’s mouth and sew up the fish’s mouth with thread and throw it into the river”.
Sub-category 3: superstitions, a way to escape stigma
People call them crazy, some call them psychopaths (mad), but when they realize that they’ve become jinn or they are bewitched, they know that it’s not their fault and they feel sorry for them” (p17).
Category 3: conflict between cultural beliefs and science
Sub-category 1: adherence to the treatment, the victim of superstition
“We have a patient to whom the jinn appeared, he saw the jinn; when he saw the jinn twice, it affected his nerves and heart, and he has had to go to a psychiatrist and to a mullah (a prayer writer) to cure its effects. Some people are so strongly affected by magic that no medical treatment can help them” (p21).
“After hospitalization, my sister’s symptoms improved, but at home, they didn’t always give her medication regularly. When the symptoms returned, everyone told us that hospitalizing her will only damage the reputation of the family, and the neighbors will say that they have a mentally ill daughter. These drugs only damage her brain and have no effect” (P.1).
Sub-category 2: religious beliefs parallel with scientific therapy
“Yes, we took him to Maulavi…; when we took him, he said take him to a hospital. These are from his mind, and for this problem, I cannot do anything for him, and it will not be cured with amulets“(p13).
“My family believes that by reading the Quran and praying every daily, evil spirits can be kept away from the house, and by sacrificing sheep and sharing among the poor, God will help the sick to recover sooner” (P.4).