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A. M. P.
SEMINARI 1998 - '99
Jaak Le Roy, M.D.

Disruption and reconstruction of identities and families in
Kinshasa (Congo): the therapeutic function of faith healing groups

The paper will consist of three parts.
First I will introduce you into the general landscape of this research on the psycho-and sociotherapeutic work in faith-healing (or 'spiritual healing groups') groups in Kinshasa, capital of Kongo. In the second part healing procedures and rituals of two different groups will be shown on a video-tape. In the third part I will make comments on this material and try to present you how we may understand these phenomena . Some hypotheses from a group-analytic perspective with conceptual tools of Bion, Foulkes and Rouchy will be developed. In the last part we can discuss and exchange on this material .

1. Illness and therapy in Kongo
This study is part of a medical-antropological and clinical research in the pluri-cultural context of Kinshasa. Through long-term participant observation and interviews with patients , healers and doctors in these contexts, we aimed at a deeper understanding of how illness is conceptualized and healed in the three different forms of health care, the biomedical care, the traditional care and the faith-healing care. These practices have to be related to the culturally shaped experience and ideas regarding the body, the symptoms, illness and therapy. We take into account the rapid cultural transitions and the severe socio-economic crisis which have an impact on the relational, emotional and mental world of the individual man and woman.
Actually in Kinshasa one can find a variety of these 3 practices. The medical health centres and hospitals working with bio-medical concepts. Then the traditional healers who followed the migration from the village to the city and adapted their methods to this new context. Finally the creation and rapid expansion of faith healing provided in autonomous 'churches', centered around a profet-healer.
When somebody feels sick, unable, powerless, impotent, depressive, crazy, unhappy in his relational network, with or without severe somatic disorders, he will try to be cured of his symptom in one or more of this 3 types of care. When symptoms are not cured by medication or herbal treatment , the family wants to know and understand why their family member became ill. In this search of meaning they go to the traditional healer or the faith-healer. In traditional medecine, curing the symptoms and the disease has always been based on a diagnosis of the meaningful origin. Generally the patient is considered as the carrier of a dysfunction , a disorder or disharmony in the social structure , the extended family or the social groups, to which he belongs. Or something in the actual familygroup or in earlier family-generations has been done which was a transgression or a non-realisation of a social code . According to this etiology, a ritual treatment is conducted by the healer aiming at a new dynamic and harmonious equilibrium of the patient and his group. One is used to say that such healing of the individual is always also healing of the socialgroup and aims at a dynamic restauration and restrenthening of the cultural codes.
Faith healing is practised by therapists and the communities who call themselves profets and healing churches. These autonomous churches are more or less organised communities around a man or a woman, who is called a prophet. They see themselves as part of a mouvement outside the catholic, protestant or official kimbanguist church .The Wholy Spirit is their central reference. Their goal is to help and to cure all the people coming to them with a whole variety of symtoms and complaints from severe mental, somatic and psychosomatic illness to problems in relationships, unemployment and bad luck. After a sort of diagnostic moment, called a 'revelation' during a consultation with the prophet, the patient will be integrated in the community life or will be asked to come back regularly to attend the ritual group sessions. Sometimes he will be prescribed to go to the hospital first for a biomedical or surgical treatment.
In the 'revelation' during a trans-like state in which he touches the patient's body but without any anamnestic interview the prophet declares 1. What is happening with the patient, for example what part of him or of his body is ill; 2. Why this is happening to him, for example a disturbance in the relationships between family-members, with colleagues in the workplace, or because he behaved in a certain way in his actual life; 3. What he has to do, for example participate in the ritual, rest, pray, go to the hospital, do something in the family.
This 'revelation' can be given also, repeated or developed further by the assistent-therapists (called 'mbikudi'), who share this same 'revealing' capacity with the prophet. In fact the prophet is surrounded by a group of co-therapists with different tasks in the treatment and in the organisation of the therapeutic community. The patient can be cured in some sessions, or stay in the community several months . Some patients become later co-therapists, members of the therapeutic team. The ritual sessions take place during specific moments in the day and during large ritual meetings, called masses. The masses on Sunday go on for 5 to 6 hours and you will see parts of these in the videotape.
During such a therapeutic session ,the whole group and collectivity is participating at a structured program with speaches, praying, bible reading and religious songs , intertwined with a more spontaneous, associative activities like rythmic dances, transe-states ,body movements and specific ritual acts. In the last part of the session, persons or families come to the fore-ground and receive from the profet or his cotherapists in trance personal therapeutic advice . In the video we will see two different faith healing groups.

2. Therapeutic setting and processes
These faith healing groups have positive therapeutic results on the level of symptom changes and on the level of the psychological functioning of the family and patients, in particular with psychosomatic and mental disturbances. The setting, theory and techniques used are different than the ones practised in group-psychotherapymodels , like group analysis or psychodrama. They are founded in culture-specific (etio)logics on health, illness, individual and group-identity, and therapy.
My thesis is that in these therapeutic groups and communities offer culturally-sensitive solutions for individual illness and family problems by a specific use of grouptherapeutic processes.
I have tried to understand these with the help of concepts from groupdynamic and groupanalytic theory (Bion, Foulkes, Rouchy, Winnicot). The study of these therapies can also enhance our knowledge on therapeutic factors and processes in groups in general. I will focus this presentation on four therapeutic functions and mechanisms.

2.1 The group as a containing frame
The prophet and his group of revealers and helpers have created a groupstructure with a stable containing capacity. Geographically and symbolically the boundaries between the inner and the outer space are clearly defined. When you enter the therapeutic space , this is signified by a number of rules and codes of behaviour . The internal cohesion of the group is created by the adhesion to these common rules and life-style and by the identification as member (brothers, sisters) of a therapeutic group. The organisation of the daily life in the community and of the ritual sessions offer a clear supportive framework . Everyone , patients and healers, has to take up specific roles and tasks, and time and space are clearly organised. As member of such a group one's personal social identity ( class, profession, family, personal history) becomes less relevant by the identification to this new group.
There is also a common goal and expectation which unites all the participants, related to a common spiritual belief and reference, the Holy Spirit. In groupdynamic terms the group is organised around the belief that they will receive care and guidance from the Spirit through the profet-therapist, his channel and representative. The good Spirit will expulse the bad destructive forces which are considered as causes of the illness or the family disorder. The therapy is imagined as a common fight against these forces. This is symbolised in the importance of the boundaries between the inside and the outside of the groupspace as shields and barriers of the good inside against the bad outside. These group processes to which all the participants identify during the sessions are therapeutically used forms of the basic-assumption group functioning as described by Bion (dependency, fight-flight).
As we know from studies of the organisational and groupdynamics, such containing structures reduce anxieties and offer support . In Kinshasa , patients searching help in faith healing groups are mostly extremely puzzled in their sense of identity and overwhelmed by social problems (poverty, unemployment) and family tensions (conflicts, sorcery) .They feel powerless , unsecure and unprotected for external and internal forces. Arriving in a state of generalized anxiety and a sense of being in pieces, the containing group gives patients and families a secure basis and a coherent and protective shield. Archaic anxieties and feelings of loss are experienced , channeled and warded off in the containing structure and the active archaic group processes.

2.2 The group as transitional space
The group also functions as a space of play and re-discovery through emotional and bodily experiences . Winnicot described how in art, therapy and culture , a transitional space exists in which objects and experiences are 'me' and 'not-me' at the same time. Boundaries between internal and external reality are loosened and the internal psychic world rearranged.
In the faith healing groups this space is continuously created during the rituals. Danses and songs are performed with excitement and have rytmic patters in which all the members resonate and participate. They allow the expression of a variety of feelings collectively or individually. Persons in trance or overwhelmed by fantasies, images or feelings are allowed to circulate in the therapeutic space without being repressed.
Between the ritual sessions, members of the community (patients, their family members, assitents and co-therapists ) often sit together and exchange stories about their life, clan or village, myths, illness beliefs, dreams. The therapeutic community creates a containing structure and a space in which bodily sensations, feelings, pre-verbal and verbal elements circulate between participants . This enables them to experience with and through others parts of themselves which were lost or disconnected.

2.3 Re-creation of identity and re-structuring of family networks
Most of the patients have been part or key-figures of a traumatic configuration in the primary family unit . This old or actual experiences and positions in the traumatising primary group, are reactivated in the group context, which is family-like but differs also from the original context. In this shift, everything which has structured the internal world of the patient is transferred and rearticulated. In the dreams and stories , the experiences and patterns concerning generations and family-life, position in the desire of the parents and family, relation to ancestral laws, and transgressions are evoked.
In the 'revelations' of the profet, the meaning of the illness is given in terms of disturbances and conflicts in the family or personal network of the patient, personal behaviour and moral attitudes. They are often repeated and reworked out in ritual and informal meetings between patients themselves, and patients and the therapeutic team together. The illness is attibuted to a mixture of causes from different belief-systems - traditional , medical, spiritual and social - and a global sense is offered to the patient.
With the majority of the patients , in the last phase of the treatment, the most important persons of the family network of the patient are invited by the profet to attend a therapeutic meeting and family ritual. In the presence of the patient, a clear meaning is given by the profet and the concerned family members are pressed to accept the 'interpretation' concerning their ill-provoking conflicts and actions. Using his symbolic and imaginary power and knowledge, the profet-therapist indicates how a conflict should be resolved and how responsabilities should be taken up and by who . This intervention re-unites the family, decentralises the patient from his pathogenic nodal position and rearranges the order in the family.
In traditional medecine the origin of the symtoms, the conflicts and the internal tensions were projected and located outside the patient and between family members or family and ancestors. In the community of the prophet, the patient and the family members are faced more directly with their own responsability or part in the disfunctioning of patient and family. From a symbolic paternal position , the profet re-establishes a paternal law and indicates who is supposed to carry this paternal role in the family in the future . When asked about the timing of this intervention , the profet explains that first the patient has to be remoulded to a whole person and healed, and only then the family network restructured . The fact that the patient has recovered has given the profet the authority to intervene in the often very disturbed and resistant family network .

2.4 Position of the therapist
The capacity of the prophets to "reveal" and to conduct these healing groups is directly linked with their own family transgenerational history. They are very close to their somatic sensations, through which elements on the archaic psychic level in the patient are perceived. The profet's capacity to use and metabolize these sensations and his capacity to give them meaning to the patient depend on his own internal mental organisation. All the prophets have discovered their therapeutic skills early in their youth or these capacities were 'revealed' to them during an illness . In the organisation of the therapeutic setting and in their interpretations about the illness, one can find more or less conscious parts of their own personal history .The quality of the community as a containing and transitional group for patients will depend on how the own traumatic history of the prophet has been worked through and on how much he still depends or not on the community for his personal stability.

3. Summary
In this paper I have tried to describe briefly some essential dynamics of the therapeutic process in congolese faith-healing groups. I distinguished four dimensions , which according to the group-analytic understanding, can explain therapeutic improvement of ,often severe chronic, individual illness.
The faith-healing group is an intermediary group, offering a protective containment, enabling the individual and the family to resource in a transitional space and to reorganise their internal relationships. The function that the group has in the personal history and mental life of the profet-therapist will determine the setting and outcome of the therapy.

J. Le Roy is psychiatrist, group- and psychoanalyst.
Adress : Regional Institute for Mental Health Care (Riagg), Department of Psychotherapy,
Parallelweg,45 6221BD Maastricht (Netherlands)

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