On December 10th, 2020 DER and the Society for Visual Anthropology teamed up for a virtual Talanoa, bringing together filmmakers and scholars from around the world to discuss Mike Poltorak’s The Healer and the Psychiatrist. Poltorak’s film is the culmination of over 20 years of research and collaboration with the Vava’uan spirit healer Emeline Lolohea and the Tongan Psychiatrist, Dr. Mapa Puloka, and presents two parallel systems of mental health care in Tonga.
Panelists included Tongan native and medical anthropologist Patricia Fifita, cultural and medical anthropologist Jessica Hardin, and the filmmaker himself, Mike Poltorak. The panel was moderated by visual and psychological anthropologist Robert Lemelson. This post summarizes the discussion about the film’s exploration of the distinctly cultural ways in which mental health issues are experienced and treated.
A video recording of the full panel discussion can be found below.
The panelists began by acknowledging the ways in which health care in Tonga is rooted in the local culture. The Vava’uan spirit healer Emeline comments early in the film that healing “is a work of love.” Fifita explained this love reflects the interconnectedness and relatedness that’s felt in Tongan communities. “As a Tongan,” she continued, “your identity is embedded in the land, so it’s this cyclical and interrelated concept that binds you together. It’s a responsibility but also a privilege to care for one another.”
Poltorak added that, “one of the wonderful things about health services in Tonga is most health practitioners are actually Tongans,” which allows for both traditional healers and doctors to relate to patients through shared cultural values and beliefs. “Across both biomedical and non-biomedical spaces there’s an underlying understanding that the disease experience is deeply connected to who folks are as Tongans. The healers do a wonderful job at helping to manage these Tongan identities,” Fifita says.
Mental health issues carry stigma in Tonga as elsewhere. By approaching these diseases in terms of Tongan cultural beliefs, Poltorak explained, healers are able to circumvent stigma attached to certain mental illnesses like bipolar disorder or schizophrenia. “Healers define illness in ways that are powerfully meaningful to people. It could be an intervention from an ancestral spirit who has come back to visit or someone who has died in dramatic circumstances on the island. The healer defines the condition in relation to something non-stigmatizing,” he says. “The stigma gets diffused because healers can help the patient acknowledge that what they’re experiencing is a Tongan experience, as opposed to a pathological condition that isolates them from everyone else. They are still very much a part of the collective,” Fifita adds.
The panelists noted the ineffective communication that presents a barrier to successful treatment. Poltorak explained that there isn’t much communication across the boundaries of traditional and biomedical spheres of healing. “There are perceptions on both sides that underlie a lack of understanding and blame. Surgeons will often blame healers for a delay in treatment when in actual fact, my research reveals that it’s the lack of persuasive, caring communication from some doctors that leads to patients thinking that the hospital can’t heal them.” This becomes an issue, Lemelson reflected from his own research, that “traditional healers were really good at reducing symptoms in a psychiatric sense but for neuropsychiatric disorders, their efficacy was almost zero.”
The panel discussion closed with a consideration of the challenges and wisdom of integrating these different systems of care. Towards this end, Hardin posed the question, “in what ways do [traditional healers’] efficacy and value come from the fact that they are a distinct and separate entity?” and in response, recalled Dr. Puloka’s comment in the film, “The more you build sophisticated infrastructure, the more you move away from the reality of the patient.”
Watch the full panel event:
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