Sangoma

The term and its roots

The origin of the word isangoma is not settled. In a 2023 article in the Journal for the Study of Religion, Agnieszka Podolecka reports that her informants explained it as meaning a person of the drum, from ngoma, drum music, and she cites an earlier ethnographer, Berglund, who recorded diviners linking the word to the ancestral shades from whom they obtain the ability to divine. She notes that comparable diviners are called igqirha in isiXhosa and lethuela in seSotho, and that English speakers across the region use the term sangoma for convenience.

What the written record covers

The sources reviewed for this page do not give a dated account of how diviner practice arose among Nguni-speaking peoples, so no founding date is stated. Podolecka's article rests on fieldwork in Gauteng, KwaZulu-Natal and the Western Cape in 2013, 2018 and 2019, on written testimonies from practitioners and on earlier scholarship, and it treats the existence of ancestral spirits as a matter of faith that no academic method can verify.

A 2020 ethnographic study from Vulindlela, a rural area of KwaZulu-Natal, describes the setting of healing there as shaped by several sociopolitical changes, which the authors present as background to their interviews with apprentice and established practitioners, patients and clinic staff.

The twentieth century and after 1994

Podolecka reports that the first records of people of European origin being called to ubungoma date from the early twentieth century, that colonial and then apartheid conditions made their training impossible in her account, and that a growing number of white izangoma became visible after 1994. She records hostile reactions toward some of them and a division among practitioners: some teachers regard them as fully qualified if they have had the calling and completed the same training, while others take a purist position. No count of white izangoma exists, according to the article.

Isangoma, sangoma and ubungoma

Isangoma is the singular and izangoma the plural in Zulu and related Nguni languages, and sangoma is the anglicized form used in English. Ubungoma is the abstract noun, meaning the state and duties of an isangoma, and amadlozi is the Zulu word for ancestors. Podolecka describes izangoma as diviner-healers whose distinguishing feature, in the view of practitioners and their clients, is communication with ancestral spirits.

Isangoma, inyanga and umthandazi

A qualitative study of nine traditional healers in the Hlabisa sub-district of rural northern KwaZulu-Natal described three types: the isangoma, a diviner called by ancestors who uses bones and medicines; the inyanga, a herbalist trained through apprenticeship in plant remedies; and the umthandazi, a faith healer called by spiritual messengers and ancestors who uses prayer, holy water, ash and salt. Six of the nine participants occupied more than one category, so the labels describe emphases more than separate professions.

Sources differ on how the inyanga relates to ancestors. Podolecka states that izinyanga do not involve spirits in their healing, while the Hlabisa study reports that an inyanga requires an ancestral connection to activate healing abilities. A survey of 118 Xhosa-speaking healers in the Western and Eastern Cape found that the term a healer used for himself or herself was associated with the mode of diagnosis, the mode of treatment and the conditions treated, and the authors asked for clearer operational definitions in future research.

Ukuthwasa and related terms

In a three-year follow-up study in KwaZulu-Natal, ukuthwasa is the process of becoming a traditional healer, usually a diviner, and participants used the word for the training rather than the calling itself. The authors write that the ancestral calling applies mainly to the isangoma, whereas inyanga and umthandazi usually have not received a calling. Podolecka notes that the term is also spelled itwasa and ithwasa, with an apprentice called itwasa.

Xhosa healers also use the term amafufunyana, which a psychiatric study describes as a culture-bound syndrome with negative connotations, in contrast to ukuthwasa, which it describes as a culture-specific event with positive connotations. The study used both labels as explanatory models for symptoms in people with schizophrenia.

Calling and apprenticeship at overview level

Practitioners describe the calling as an illness of body and mind marked by visions and overwhelming weakness, widely held within the tradition to be resolved only through training under a fully qualified isangoma. In the Hlabisa study, isangoma and umthandazi described the calling as involuntary. The apprenticeship is said to take years, and the details of initiation are not described here because the sources treat much of it as restricted to the tradition.

Podolecka reports, from informants including a university researcher who began training himself, that about 80 percent of people who start training either do not complete it or stop working, and adds that there is no way to establish the figure. Some practitioners attribute stopping to feeling better after the calling sickness has passed, and others say the spirits abandoned them.

Consultation and divination at overview level

Podolecka writes that clients often do not state their problem at the outset, because they expect the isangoma to enter a trance or to throw bones and thereby identify the problem and its meaning. Among Zulu practitioners the bones include animal bones, shells and small objects. One white isangoma trained in the Xhosa tradition told her that Xhosa diviners usually go into trance rather than throw bones, though traditions are sometimes mixed. Recommendations may involve herbal remedies called muti, advice, and rituals addressed to ancestors.

In the Hlabisa study, healers of all three types reported providing counseling, protection, mediation with ancestors and referrals, so the consultation is not limited to divination. The study had nine participants, recruited by purposive and snowball sampling, and does not represent healers across the region.

Information and consent

An interview study of eight healers in KwaZulu-Natal, four inyanga and four sangoma, examined whether the elements of informed consent appear in practice. The healers reported disclosing diagnosis, risks, benefits and treatment options to patients. These are self-reports from a small interview sample and were not checked against observed consultations.

Problems brought to practitioners

Practitioners and researchers describe consultations as addressing physical, spiritual, cultural and psychological concerns together. Podolecka reports that izangoma look for the causes of illness in mind, body and spirit and may also act as advisors, including to business clients. The Xhosa-speaking healer survey found that spiritualists and male healers were more likely to treat mental disorders, so the conditions brought to a practitioner vary with the type of healer.

Conditions as described by healers

Xhosa-speaking healers in a Cape Town township told researchers that epilepsy could be caused by amafufunyana, described as evil spirits, and that biomedical doctors could not treat supernatural causes, while also holding that both Western and traditional medicines could help with seizures. These are healers' explanatory models and do not show that a given remedy affects seizures.

In a mixed-methods study of traditional healers in rural South Africa, 133 completed a survey. Few (7.5 percent) believed they could treat tuberculosis (TB), whereas 72.9 percent believed they could successfully treat the illnesses tindzhaka and mafularha, which are reported to arise from breaking social rules around death and sex. A focus group of 12 sangomas in Johannesburg showed limited knowledge of human papillomavirus and the HPV vaccine but interest in sharing prevention information about cervical cancer.

What has been studied

Searches of PubMed for sangoma, for ukuthwasa and for traditional healers combined with HIV, TB and South Africa returned qualitative studies, surveys, small observational studies and reviews. No randomized or other controlled trial of sangoma consultation, divination or ritual practice was found. Statements about whether those practices change health outcomes therefore rest on belief and on indirect findings, and the studies below should not be read as tests of the practice.

Apprentices and psychotic experiences

A study of 48 people in rural KwaZulu-Natal who had received the ancestral calling and were in training found that 92 percent reported psychotic experiences, causing distress in 75 percent, and that 23 percent met criteria for an unspecified psychotic disorder (15 percent) or a mood disorder (8 percent). The authors concluded that the calling may resemble phenomena that psychiatry understands in the context of psychosis. An ethnographic study of the same area found that some interviewees considered ukuthwasa the only effective response.

At three-year follow-up of 42 of the 46 surviving participants, psychotic experiences were less distressing and the number with a psychotic disorder fell from seven (17 percent) to four (10 percent), while 98 percent reported that training had positively influenced their symptoms. The study had no comparison group, a small sample and isiZulu instruments that were not fully validated, so it cannot show that training caused the change and does not apply to people outside this setting.

Work with biomedical services

A systematic review of traditional healers' and biomedical practitioners' views on collaborative mental health care included 14 papers from seven countries, 13 of them from Africa and seven from South Africa. It found a willingness to work together on both sides, variable study quality, concerns about patient safety and human rights in some traditional methods, and skepticism among some healers about psychiatric medication.

In a single-arm pilot, 17 traditional health practitioners entered a recognized HIV testing training program in rural South Africa, 16 completed it, and the healers' clients accepted 418 tests, with 20 (4.8 percent) positive. Only about 60 percent of those who tested positive enrolled in treatment. The pilot had no comparator, and the participants were traditional health practitioners generally, not diviners specifically.

Delayed biomedical care

The authors of the TB study state that they have no definitive data, but that healers who diagnose TB as tindzhaka or mafularha may be contributing to delays in diagnosis and treatment of active TB. A qualitative study of healers during an HIV treatment-as-prevention trial in rural KwaZulu-Natal found that stigma and fear of disclosure made linkage to HIV clinics difficult for many clients and that some healers struggled to refer suspected cases.

Herbal remedies and interactions

The sources reviewed do not characterize the full range of remedies used by sangomas, and findings about one plant should not be extended to others. A 2005 review of Hypoxis and Sutherlandia, two African herbals used in HIV care, found no efficacy trials at that time and low-level evidence of harm indicating a potential for interaction with antiretroviral drugs.

A later randomized placebo-controlled trial of Sutherlandia frutescens in 107 HIV-positive adults over 24 weeks found no change in viral load and similar CD4 counts, but more days of infection-related events in the herb arm, attributed to two TB cases among participants taking isoniazid preventive therapy. The authors called for evaluation of a possible interaction and found no other safety issues in that cohort.

Care boundaries and unverified claims

Podolecka writes that not everyone who claims to be an isangoma has completed training, that clients often cannot check this, and that frauds exist. The sources reviewed do not describe a national register or training standard, and none was verified. Ongoing or serious medical and mental health conditions need assessment by qualified health professionals, and the sources reviewed do not support delaying or replacing that care with divination or ritual.