Specific Cultural Syndromes In Maori

Mate Mäori and other Specific Mäori Concepts relating to Mental Health   Note that while it is useful for psychiatrists and registrars working with Mäori patients and whänau to have some idea that mate Mäori and other specific conditions exist and to have heard the terms, it is very important that non-Mäori mental health clinicians do not assume that they in fact understand these conditions or have any expertise in them. This is the area of expertise of local tohunga and kaumätua assisted by Maori cultural workers, and if such concepts arise in work with Mäori patients and whänau, it is vital to seek expert cultural assistance.

In Mauri Ora, (Published Oxford University Press 2001), Mason Durie writes:

"While many disorders are recognised the world over, even if they do present in different ways, there are some mental and behavioural states that cannot be accommodated in Western classifications… Although culture-bound syndromes are not frequently recognised among Mäori, explanations for poor health can be quite different from Western beliefs…  Mate Mäori, for example, leads to an affliction said to be related to spiritual causes, and requires the intervention of a traditional healer, a tohunga. In Rapuora, the 1984 study of the health of Mäori women, one in every five women respondents said they would go to a Mäori traditional healer if they had a mate Mäori though not all knew who might be an appropriate healer, nor could one in five women say what was meant by mate Mäori.¹  The term refers essentially to a cause of ill health or uncharacteristic behaviour which stems from an infringement of tapu (a tribal law) or the infliction of an indirect punishment by an outsider (a mäkutu).²  The prevalence of mate Mäori has never been recorded although there are published accounts of isolated cases of the condition and its management.³ It may take several forms, physical and mental, and various illnesses not necessarily atypical in presentation may be ascribed to it. 

While mate Mäori applies to physical as well as mental illnesses, increasingly it has become a focus to explain emotional, behavioural and psychiatric disorders, presumably because many physical illnesses are now seen as having a more specific cause. Thus there is no single clinical presentation and clinicians need to be alert to the possibility that relatives may have considered the possibility of mate Mäori. Most families will be reluctant to discuss mate Mäori in a hospital or clinic setting, fearing ridicule or pressure to choose between psychiatric and Mäori approaches. In fact, one approach need not exclude the other; cooperation between traditional Mäori healers and health professionals is now becoming acceptable to both groups. Mate Mäori does not mean there cannot be a coexisting mental disorder. At best, the term is a comment on perceived causes of abnormality rather than on the symptoms or behaviour which might emerge. Yet it remains a serious concept within modern Mäori society, and to many people, mate Mäori sounds more convincing than explanations that hinge on a biochemical imbalance or a defect in cerebral neurotransmission.

Other situational responses may present as if they were mental disorders. Whakamaa for example, a mental and behavioural response that arises when there is a sense of disadvantage or a loss of standing, can be manifest as a marked slowness of movement and a lack of responsiveness to questioning, as well as avoidance of any engagement with the questioner.⁴  A pained, worried look can add to a picture that is suggestive of depression or even a catatonic state. But the history is different and the onset is usually rapid - unlike those other conditions where a more gradual development occurs. Sometimes, because Mäori will often report seeing deceased relatives or hearing them speak, a diagnosis of schizophrenia or some other psychosis may be made. However, if visions or hearing voices are the only symptoms there is never a firm basis for diagnosing a serious mental disorder."

Footnotes:

1. E. Murchie, Raupora: Health and Maori Women, Maori Womens Welfare league, Wellington (1984)
   
2. Elsdon Best, Mäori Religion and Mythology, Dominion Museum Bulletin No. 11, Wellington, p.108 (1982)
   
3. G. Blake Palmer, Tohungaism and Mäkutu, Journal of the Polynesian Society, vol 63, no. 2, pp 147-163 (1954)
   
4. Joan Metge, Whakamaa, Mana and Mäori Self-Image, in Philip Culbertson (ed.), Counselling Issues and South Pacific Communities, Accent Publications, Auckland, pp 46-47 (1997)