International Journal of Emergency Mental Health and Human Resilience
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Zar cult, Dissociative disorders, Culture-bound syndromes

Definitions: Zar (a.k.a Zahar or Saar) is an ancient healing practice cult, based on a folk belief in possession by alien spirits as a cause of disease, and in the possibility of curing such a disease by ceremonial placation of the possessing spirits (Lewis, 1986) (Boddy, 1989) (Abdel Rahim et al, 1999).

• It is a term used to describe a cluster of symptoms including generalized and persistent depression, apathy, headaches, chronic pain, crying and infertility. (El Nagar 1987, (Kennedy, 1967) (Modaressi et al, 1986).

• “Zar” itself is variably used to, denote a type of spirit, the illness that such a spirit can cause by possessing humans and the rituals necessary for pacification of these spirits.(Okasha, 1966) (Opler, 1959)

• It is also the name given to the ceremony required to pacify spirits known interchangeably as Zar, Dustur and alriha alahmar (Lewis, 1971)

• These possessive entities enslave the afflicted who obeys their orders and wishes, giving rise to the symptoms and behaviors and may last for life.

• Etymology of the word is assumed to originate from the word Ziyara or visit in Arabic (Zenkovsky, 1950). It also means, became visible when Zahar is the name (WHO 1993).

• The names of this spirit possession suggests that many of the cults are historically related although evidence has not directly addressed this claim. This is interesting when we consider the existence of the cult in a range spanning from Iran, Kuwait in the Arabian gulf in the east all the way to Nigeria in the west. This has led to suggestions that the origins of the cult could be from either end of the range (WHO 2021).

• Studies show that Zar clients are predominantly females of middle age. The exception is the Amhara tribe of Ethiopia and Iran where males predominate (Williams et al 2013).

• The word is also believed to be the name of the Supreme divinity of the Pagan Kushites of Ethiopia, called adjar.

• Zar prototypes include symptoms of blindness, paralysis, deafness, seizures and many other dissociative or conversion symptoms.

The two main diagnostic systems used by psychiatrists worldwide, the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric association & the International Classification of diseases (ICD) of the World Health Association have had a complicated relationship with Zar Diagnosis. Each of them dealt with possession and trance phenomena differently. Below is a summary of that complexity: In the DSM-IV-TR, Zar was included as a culture-bound syndrome (CBS).

• A culture-bound syndrome was defined as a recurrent, locality-specific patterns of aberrant behavior and troubling experience that may or may not be linked to a particular DSM-IV diagnostic category. (DSM-IV, 1994, DSM-IV-TR 1999, DSM-5, 2013).

• In DSM-5, Zar is not mentioned but culturally shaped syndromes or truly culture-bound syndromes are seen as forms of Cultural Concepts of Distress (such as cultural syndromes, cultural idioms of distress and/or cultural explanations). These are not pathological in the local cultures. As such, cultural groups experience, understand and communicate suffering, behavioral problems, or troubling thoughts and emotions through these means.

• It is worth noting that DSM IV opted for dissociative trance disorder instead of possession disorder.

• Coded under F 44.3 of ICD10 of the WHO are trance and possession disorders. The possessed individual “may act as if “taken over by another personality, deity, spirit or force.

• A distinguishing feature between pathological and nonpathological possession states is whether these states are voluntary or involuntary.

• Neither the DSM-5 not the ICD 11 mention Zar specifically.

Zar is known in many African countries e.g., Sudan, Egypt, Morocco, Algeria, Nigeria, Ethiopia, Kenya, Somalia, Tanzania and Zambia. It is also known in Asia e.g., Iran, Israel and in parts of Arabia and Yemen. The concept of culture-bound syndromes can be traced back to the 8th edition of Kraepelin’s Textbook of psychiatry (Kraeplin, 1913), where Latah, Koro and amok were described for the first time. The terms later became part of the concept of culture- bound syndromes. The term changed later to exotic; culture related then culture reactive (an example of the latter is Anorexia nervosa). Yap introduced the term culturespecific in the 1950s and 60s. (Yap, 1967). Other terms used were culture concepts of distress (CCDs) and idioms of distress. The term has been rejected by many scholars calling it a remnant of colonial psychiatry. The list of culture-bound syndromes reached 168 according to Hughes glossary (1985), whereas DSM glossary had only 25 and the ICD just12, leaving an unresolved and unsatisfactory term and situation. The late Taha Baashar states that “two systems of health care are in operation: allopathic or modern medicine, which is under state control and traditional medicine which community owned and self-developed. He places the “ancient Zar cult” with the psychotherapeutic devices, according Baashar maybe simple or complex group interaction and abreactive measures. Zar according to him is a psychodramatic technique based on musical therapy and group activity (Bannerman et al, 1983).

Relationship to Dissociative & Conversion Disorders: The Zar spirit possession is associated with dissociative episodes such as sudden changes in consciousness or identity that may include periods of shouting, banging of the head against the wall, laughing, singing, or crying. Possessed people may become apathetic or withdrawn, or may not be able to accomplish their usual responsibilities (American Psychiatric Association (1980). To understand the syndrome, one must appreciate its relationship to dissociation and conversion phenomena. Let’s first consider dissociation. There are 5 core components of dissociation namely (dissociative amnesia, depersonalization, derealization, identity confusion, identity diffusion. (Mind, 2023). When dissociation is continuous and repeated it is then called a dissociative disorder. The types of dissociative disorders according to DSM-5 are:

• Dissociative identity disorder. (DID).

• Dissociative amnesia including dissociative fugue

• Depersonalization, derealization disorder.

• Dissociative disorder specified or not otherwise specified.

The ICD 11: (BlockL1-6B6) Dissociative disorders are characterized by involuntary disruption or discontinuity in the normal integration of one or more of the following: identity, sensations, perceptions, affects, thoughts, memories, control over bodily movements, or behavior. Disruption or discontinuity may be complete, but is more commonly partial, and can vary from day to day or even from hour to hour. The symptoms of dissociative disorders are not due the direct effects of a medication or substance, including withdrawal effects, is not better explained

by another Mental, behavioral, or neurodevelopmental disorder, a Sleep-wake disorder, a disease of the nervous system or other health condition, and are not part of an accepted cultural, religious, or spiritual practice. Dissociative symptoms in dissociative disorders are sufficiently severe to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning. The ICD11 classifies them differently into:

Dissociative neurological symptom disorder

• Dissociative amnesia

• Trance disorder

• Possession trance disorder

• Dissociative identity disorder

• Depersonalization-Derealization disorder.

Conversion disorders, on the other hand, are conditions in which the person experiences physical and sensory symptoms like paralysis, blindness, deafness or seizures without apparent underlying neurological causation.

It is useful to remind ourselves that possession phenomena are universal and are not confined toone part of the globe. Zar is probably the best-known spirit possession phenomena in East & North Africa and the Middle East. It is a remarkable coping strategy for people struggling with psychosocial complexities, especially women in these parts of the world (predominance among women is well documented). Zar has apparently been modified over many centuries to fit with the changing times, religious beliefs, historical and cultural transformations. Sudanese Zar is thought to have originated in Ethiopia, Egypt or Nigeria. It could have spread eastwards with pilgrims to Mecca and the Arabian Gulf and as far as Iran but the direction of its spread is not settled. It is interesting to note that when Mohamed Ali Pasha’s army invaded Sudan in 1821, the returning army may have taken Zar along with the women taken as slaves and harem back to Egypt. (Brenda Seligman, 1965) There are two types of Zar, Tambura and Zar Bori in Sudan (Akasha & Umama, 1994). Zar Bori may be practiced at the Shaikha’s (the leader) house or at the house of the possessed and the spirit is considered masculine. Tambura can only be performed at the Shaikha/ Tambura’s house and the spirit is regarded as feminine (American Psychiatric Association, 1994).

The ceremony itself consists of rituals that are fascinating to analyze. One can see remnants of pagan or religious practices. Some are forbidden and taboo in the culture (e.g., drinking alcohol or blood, sacrificing animals etc. Ceremony has distinct parts of preparation, the event itself and the follow up. The ceremonies and rituals practiced based on the concept that the possessing spirit can be negotiated with, pacified or convinced to leave the afflicted, it is no different to the expectations from Shamans and medicine men. Zar routines follow a regular pattern with a preparation phase, initiation and induction after assessment, opening the box to determine which spirit is possessing the client and finally the ceremony starts. Once induced the client is expected to be a fellow or follower of the cult for life and may need boosters every now and then, depending on their need.

Preparation Phase: Usually the possessed or boosters approaches the Zar leader or someone does so on their behalf. demands material favours such as jewellery, new clothes, or expensive food, which the leader is expected to provide. supernatural causes, like sorcery (amal) or the evil eye (ain harra). The candidate is then isolated sometimes the symptoms may be attributed to separated from others till an assessment is made to be incorporated.

Assessment, Initiation and Induction: The person approaches the leader of the cult and must be accompanied by a relative or friend. The entry into the house of the leader has an etiquette and obligations of respect such as entering bare footed, kissing the leader’s forehead, shoulders, hands & feet. The leader (male or female Shaikh or shaikha or Umiya or mama) makes an assessment. The leader then makes as assessment and makes an initial.

Opening the Box: The person seeking help is now alone with the leader. A box “diagnosis” a containing 4 colored pots is opened and incense is put in each pot and burned. The red pot supposedly corresponds with Ethiopian spirits (Loolia or Loola). The white pot is for Muslim and the black for Christian spirits. The last is multicolored for the other spirits. The leader patiently keeps an eye on the client to observe their emotions and if there is an indication or a response to a specific box like sweating or fear or crying, then he makes the recommendation and the diagnosis of possession is made. The ritual date is set and all the process is started. The leader can use other means to identify possession like taking a piece of clothing and keep it under his pillow waiting for a guiding dream or plays some songs and observes the response of the possessing spirit.

One, Three or Seven-Day Ceremonies: Depending on the financial ability of the client the ceremony is prescribed either a one day (Yawmia, meaning day), 3-day (Taspeera, meaning patience) or 7- day full ceremony. The day before the event the client applies Henna to both hands and feet and on the limbs of the animal to be sacrificed. Henna application has strong connotations as it is only sanctioned for women as part of the marriage ceremony and then it is only applied by married women, a kind of a social passport used to show off at social gatherings. Usually, men only apply henna twice in their life, when circumcised or when they get married. The client is given the status and name of Aroos or bride for a lady and Arees or groom for the man. Both can ask for an attendant of their choice a wazyr or wazyra (means minister) of the corresponding gender. The client is isolated and there are rules on who communicates with them and how. At mid- day the animal is slaughtered. The client may be asked to step over the sacrificed animal or may be dabbed with the blood of that animal. Then a procession led by the leader starts and involves going around a central point, usually a table, where the demands of the spirits are placed. The attendants all sing along throughout this stage and eventually form a line waiting for the leader to deliver a sermon calling on deities, prophets, spirits setting the stage for the client to enter a circle formed by all attendants and start dancing. This goes on until the client is exhausted and reaches a climax of a trance. The leader then takes the demands of the spirits which are articulated through the client. These demands are later passed on to the client who, supposedly, are unaware that they have uttered the itinerary

Table 1 The classic 7 boats or Zar spirits that commonly possess people. As shown in table 1, there are 7 common spirits and they are expected to inhabit the box. However, there are slight variations which could be regional or historical and are called Khait or thread and are given a fictitious character’s name, examples of these threads are:

Table 1. Zar spirits in Sudan

Ahmed Al Bashir Alhadandawi (referring to the Hadandawa tribe of eastern Sudan). During the ceremony those afflicted with this spirit wear the classic Hadandawa tribe clothes and carry their sword (Table 2).

Table 2. Examples of possession phenomena in African Folklore

• Ahmed Al Bashir Alhadandawi (referring to the Hadandawa tribe of eastern Sudan). During the ceremony those afflicted with this spirit wear the classic Hadandawa tribe clothes and carry their sword.

• Nimr alkindo (desert leopard/tiger). During the ceremony a leopard skin is worn and the leopard or tiger term is used interchangeably as there are no tigers in Sudan. Children are prohibited from attending this character as the “tiger” will consume raw meat.

• Aljayashi (army soldier) wearing of course full army balaclava.

• Bashir Lumi, (this one is interesting as he is known to drink Araq the local liquor excessively and the spirits need the client to drink it for Mr. Lumi. This is not the only taboo to be broken as the Khawajat also may need alcohol especially whisky and cigarettes.

• loola or loolia alhabashya (the Abyssinian or Ethiopian lady). This character is full of sexual and fertility symbolism as the dress is the one the only a bride can wear for their wedding party and honeymoon. The gown is called “Garmasees” a colorful silky and Lucious dress that is irresistible to men. This comes with the complete works like henna, the special perfume mixes famous in Sudan (sandalwood oil, musk and other special ingredients from spices and perfumes. This was once jokingly described by a zoology professor as a pheromone. No review would be complete without referring to Boddy’s influential work in this field. She dissects society and describes the women’s life from childhood when they endured circumcision to late adolescence and early adult life when she is groomed for marriage only for that institute to be perilous as many marriages fail. (Boddy, 1989). It’s worth noting that all the characters speak the language expected from them (English, Ethiopian, hadandawa). This can be mind boggling with echoes from the similar phenomenon in multiple personality disorder (now dissociative identity disorder).

The Zar cult served its purpose for hundreds of years if not more, as therapeutic tool for mild to moderate psychosocial and some medical difficulties. Its presence in a wide geographical range is testament for its usefulness to these societies. It showed a remarkable ability to absorb and accommodate cultural, religious and ethnic diversities and stood the test of time. This is coming to an end and it is vanishing quickly under pressures in modern times as it is under pressure from the medical model of dis-ease and legislations banning it in many countries and other factors pertaining to dynamics in societies from urbanization and our modern ways of life. The wealth it is leaving behind should be studied and documented. It has helped mankind to heal and leaves legacies in folklore, psychodrama, music and songs that continue to inspire and even utilized by some societies as entertainment.

The author does not have any existing conflict of Interest

The author received no financial support for the research, authorship, and/or publication of this article.

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