Atlas›Domain XI · Traditional medicine & indigenous healing›Guide 036
Guide XI-036

Tuvan shamanic revival and shaman clinics

Mongush Kenin-Lopsan, Dugar-Syuryun Oorzhak1993Kyzyl, Tuva
A 36 · L 54 · M 1019 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the post-Soviet institutional form of Tuvan shamanism in Kyzyl (registered shamanic societies, beginning with Dungur in 1993), as described by Pimenova (2013), Kharitonova (2015, 2018), Vyatkina (2018), Stelmaszyk (2022) and reporting by FOBOS and The Moscow Times. The therapist's own procedures follow the DSM-5-TR Cultural Formulation Interview (CFI) and Kleinman's explanatory-model questions.

What it is. This is a living religious and healing tradition with its own practitioners and its own sources of authority. It is not a psychotherapy, and a psychotherapist does not practise it. Tuva's 1995 law on freedom of conscience named shamanism, alongside Buddhism and Orthodoxy, as one of the republic's traditional confessions [source: Pimenova 2013]. The first post-Soviet shamanic organisation, Dungur ("Drum"), was founded in Kyzyl in 1993 [source: Pimenova 2013]. The Moscow Times reports that the shaman Dugar-Syuryun Oorzhak filed its founding paperwork and calls it the first post-Soviet shamanist association in Russia [source: Kupfer and Jardine 2016]. The ethnographer and writer Mongush Borakhovich Kenin-Lopsan was among its founders. He became the "lifetime president" of Tuvan shamans, without being a shaman himself or directing any one organisation [source: Pimenova 2013; Kuzhuget 2020]. The Foundation for Shamanic Studies (a US organisation) reports that he died on 10 February 2022 [source: FSS 2022]. FOBOS describes him as president of the "Society of Tuvan Shamans" and as the person who "oversees the certification of shamans in Tuva" [source: FOBOS, Shamans' Clinic]. Whether FOBOS's "Society of Tuvan Shamans" is Dungur under an English name or a separate umbrella body over the societies is [uncertain]. A 2004 FOBOS programme page, which FOBOS itself marks as no longer accurate, calls Tos Deer the "Centralized Religious Organisation of Shamans in the Republic of Tyva" and names Kenin-Lopsan as its founder and honorary chairman, while treating Dungur ("Shaman's Drum") as a separate clinic [source: FOBOS, Shaman School page]. The English name may therefore point to Tos Deer rather than Dungur, but no source states this directly [uncertain]. In practice, when a client mentions "the society", ask which organisation they mean rather than assuming.

Shaman clinics. FOBOS describes a "Shamans' Clinic" at 41 Lenin Street, Kyzyl, directed by Dugar-Syuryun Oorzhak. It reports short consultations involving pulse-taking, incense and drumming, a registration book for clients, and the director's statement that "most of our clients have medical or psychological problems" [source: FOBOS, Shamans' Clinic]. The page is undated. Its fees are in pre-1998 roubles, which suggests the mid-1990s [uncertain: not verified]. This guide names these practices only as reported and does not describe how they are done.

How change happens (as attributed). Practitioners and scholars describe healing as restoring a person's relations with spirits, ancestors and kin, and as removing curses and misfortune. Kharitonova describes shamanic healing as aimed at restoring the "spiritual and psycho-physiological integrity" of community members, and argues that a shaman "does not treat" (не лечит) but creates conditions for healing [source: Kharitonova 2015; Kharitonova 2018]. These are the tradition's and its scholars' accounts. They are stated neither as fact nor dismissed. The therapist's own theory of change is different: understanding the client's explanatory model and help-seeking makes a shared, culturally safe plan possible, with parallel or collaborative care when the client wants it [synthesis; source: APA CFI].

2. Framework

The tradition's institutional framework (as sources describe it).

  • Legal form. Societies are registered as local religious organisations, first under the 1990s republican law and later under the federal law of 1997 [source: Pimenova 2013; Kharitonova 2018; Vyatkina 2018]. Kharitonova argues that former healers accepted religious status largely "in exchange for tax exemption" (в обмен на освобождение от налогов) [source: Kharitonova 2018]. She also states that under the federal health law spiritual healing is not medicine and needs no licence, and that healing within a religious organisation is "de jure" illegal [source: Kharitonova 2015]. No state licence or registration attests to a shaman's competence as a healer.
  • Number of organisations. Several more societies appeared between 1998 and 2001, and by 2009 there were eight [source: Pimenova 2013]. Radio Svoboda reported in March 2006 that six shamanic religious organisations were officially registered in Tuva and that more than 300 shamans practised legally [source: Radio Svoboda 2006]. Stelmaszyk reports that three remain: Dungur (the oldest, in central Kyzyl), Tos Deer and Adyg-Eeren [source: Stelmaszyk 2022]. Kharitonova also names Tos Deer (headed by Ai-Churek Oyun), Adyg Eeren and a shamanic clinic at the Ai-Churek centre [source: Kharitonova 2018]. The current list is [uncertain: not verified].
  • Hierarchy. Pimenova describes three levels: ordinary member shamans; society chairs, who handle administration and relations with officials; and Kenin-Lopsan at the top, with symbolic status. Members may hand over up to 50% of their income in exchange for access to clients and foreign contacts [source: Pimenova 2013]. Who has held the presidency since 2022 is [uncertain: not verified].
  • Membership and certification. Dungur introduced membership identity cards to mark its members as legitimate in contrast to independent shamans [source: Pimenova 2013]. FOBOS reports a card in a red case, 34 registered shamans and more than 100 in training at that time [source: FOBOS]. Stelmaszyk reports that applicants once had lengthy training and a practical healing exam, but that membership now rests on verbal confirmation of skills [source: Stelmaszyk 2022]. Kharitonova states that a certificate from Kenin-Lopsan's research centre "still does not mean shaman status", which practitioners say must be felt and confirmed through ability [source: Kharitonova 2018]. The sources conflict, so a membership card is not evidence of training standards [uncertain].
  • Setting and fees. Stelmaszyk describes a society in a small wooden house with a waiting room, a price list, a cash box and several shamans working in shared rooms with little privacy. Societies keep fixed price lists for each ritual, while independent shamans avoid fixed prices [source: Stelmaszyk 2022]. Oorzhak criticises shamans who set fixed prices and says shamanism "has become a business" [source: Kupfer and Jardine 2016].
  • Other sources of authority. Independent shamans work outside the societies. Buddhist lamas take part in cooperation networks with doctors and shamans in Kyzyl [source: Stelmaszyk 2022]. Some Tuvans dispute whether shamanism is a religion, and some criticise the societies' corporate organisation as a break with tradition [source: Pimenova 2013]. Authority is therefore plural. A society's membership does not settle who a particular family regards as a legitimate shaman [synthesis].
  • Links with health care. A 2017 Tuva Ministry of Healthcare order on traditional medicine, and a centre of folk medicine opened on 28 June 2017 within the republic's Research Institute of Medical and Social Problems and Administration, are described by Kharitonova. The order is Tuva Ministry of Health Order No. 19 of 13 January 2017 on the procedure for practising folk medicine; it bars folk-medicine practitioners from using folk methods inside health-care organisations that hold a medical-activity licence, and it moves the regulation of folk medicine from the republic's religion law to Article 50 of the federal health law. The centre's stated aims are prevention, health preservation, treatment, rehabilitation and research; the officially permitted practitioners she lists are a Tibetan-medicine doctor, a manual therapist and two homeopaths. She reports that the centre does not seek active contact with registered shamanic organisations or practising shamans, so it is not a route to shamanic care [source: Kharitonova 2018, Folk and traditional medicine]. Physicians report that some Tuvan doctors pass on healers' contacts to patients and that shamans are sometimes called to rural patients [source: Vyatkina 2018].

The psychotherapist's framework (the therapist's own work; phases are [synthesis] built on the CFI).

  • Phase 0, preparation (before contact). Goal: examine your own assumptions, whether romantic ("ancient wisdom") or dismissive ("superstition"), and learn the local institutional picture above. Move on once you can state what you do not know and whom you could ask.
  • Phase 1, cultural assessment (sessions 1–2). Goal: the core CFI with the client, an informant version with family if the client agrees, and the relevant supplementary modules. APA states the modules can be used at the first evaluation, later in care, or repeatedly [source: APA CFI Supplementary Modules]. Move on once you know the client's name for the problem, its perceived cause (for example a curse, ancestors or spirits), the help already sought (shaman, lama, physician) and what the client wants from you.
  • Phase 2, formulation and differential (sessions 2–3). Goal: a cultural formulation that separates culturally normative experience from disorder and identifies medical red flags. Move on once risk is assessed and any urgent medical or psychiatric need is routed.
  • Phase 3, shared plan (session 3 onward). Goal: agree the therapeutic focus, and whether and how parallel care with a shaman, lama or physician fits, with explicit consent about information sharing. Move on once the client has endorsed the plan in their own terms.
  • Phase 4, ongoing work and integration. Goal: standard evidence-based therapy for the presenting problem, adapted to the explanatory model, with integration of any shamanic consultations the client chooses. Revisit CFI modules when the problem, the help-seeking or the family situation changes.
  • Format. Individual sessions, with family sessions when the client wishes. Use an interpreter for Tuvan where needed. Session count follows the presenting problem, not the tradition [synthesis].

3. Guiding principles

  • Alongside, never instead of the tradition. You do not perform, imitate or prescribe shamanic healing, pulse-taking, drumming, incense or divination. Practical meaning: your role ends where the shaman's begins; refer to the community, never re-enact [synthesis].
  • Authority sits with the community and its institutions. Practical meaning: when a question is about what is legitimate in Tuvan shamanism, ask the client and the client's family, and where relevant a society chair, independent shaman or lama the family trusts. Do not decide it yourself [source: Pimenova 2013; Stelmaszyk 2022].
  • Authority is plural and contested. Practical meaning: do not treat society membership as a guarantee, or independence as a red flag. Ask whom the client and family trust and why [source: Pimenova 2013; Stelmaszyk 2022; Kharitonova 2018].
  • Attribute, do not adjudicate. Practical meaning: speak of "what you understand as a curse" or "what the shaman said about your ancestors". Neither confirm nor dispute the spiritual reality [synthesis].
  • The client defines the problem first. Practical meaning: begin with CFI Domain 1 in the client's own words before using diagnostic language [source: APA CFI].
  • Cultural information supports diagnosis; it does not replace it. Practical meaning: the CFI is not meant to be the only basis for a diagnosis, so combine it with standard assessment [source: APA CFI].
  • Normative is not pathological, and illness can still be present. Practical meaning: rule out disorder before calling an experience shamanic illness, and rule out cultural normativity before calling it psychosis. Use DSM-5-TR and ICD-11 cultural exclusions, and consult cultural brokers [source: PMC9199574; ICD-11 6B62 and 6B63].
  • No delay to medical care. Practical meaning: doctors in the region report patients ignoring prescribed treatment or returning only after healers fail. Ask about physical symptoms and medicines, and route medical questions to the physician or prescriber [source: Vyatkina 2018].
  • Never advise on medicines, herbs or substances. Practical meaning: do not comment on starting, stopping or combining anything. Refer to the prescriber [synthesis].
  • Watch commerce without disparaging the faith. Practical meaning: fixed prices, high fees and local suspicion of invented curses are reported, so ask about money and pressure as you would about any helping relationship. Do not use this as a reason to dismiss the tradition [source: Stelmaszyk 2022; Kupfer and Jardine 2016].
  • Consent and confidentiality for any collaboration. Practical meaning: share nothing with a shaman, society or family member without the client's explicit, specific consent. Remember that consultation rooms may be shared and offer little privacy [source: Stelmaszyk 2022; synthesis].
  • Touch only with consent and never sexual. Practical meaning: you do not touch clients. If a client describes a consultation that involved touch, ask whether they agreed and could stop, and screen gently for unwanted or sexual touch [synthesis].
  • History matters. Practical meaning: shamanism was suppressed under the Soviet state [source: Kupfer and Jardine 2016; FSS 2022]. Expect wariness of state institutions, including mental-health services, and name it [synthesis].
  • Avoid exoticism and tourist framings. Practical meaning: Kyzyl is called a "shamanic Mecca" with festivals and tours [source: Vyatkina 2018; Kharitonova 2018]. Your Tuvan client is not a cultural exhibit, and your non-Tuvan client's workshop experience is not the same as community membership [synthesis].

4. Intervention inventory

Everything below is the psychotherapist's own work. None of it is shamanic practice. Example language is illustrative throughout.

4.1 Cultural humility and self-examination

  • Purpose: to stop your own romantic or dismissive views of shamanism from shaping the assessment. Use before the first session and whenever you feel certain about what the client "really" means [synthesis].
  • Steps: (1) Write down your assumptions about Siberian shamanism, including any from popular neo-shamanism or tourism. (2) Note what the sources show: authority is contested between societies, independent shamans and lamas, and both commercialisation and deep local trust are reported [source: Pimenova 2013; Stelmaszyk 2022; Vyatkina 2018]. (3) Identify a cultural consultant you could ask, such as a Tuvan colleague, interpreter or community member, with the client's consent. (4) Revisit the list after each session.
  • Example language (illustrative): "I know a little about Tuvan traditions from reading, but you are the expert on your own life and family. Please correct me when I get things wrong."
  • Watch for: curiosity that turns into interrogation about ritual details. Only ask what matters for the client's care. It is working when the client corrects you and adds information unprompted.

4.2 Core Cultural Formulation Interview (DSM-5-TR)

  • Purpose: to clarify the problem from the client's and their social network's perspective: what it means, possible sources of help, and what they expect from services. Use at intake for every client [source: APA CFI].
  • Steps: (1) Introduce the interview as a way to understand the problem in the client's terms. (2) Domain 1, cultural definition of the problem (Q1–3): the client's words for it and what troubles them most. (3) Domain 2, cultural perceptions of cause, context and support (Q4–10): causes, including spiritual ones such as curses or ancestors; stressors and supports; and the role of cultural identity. (4) Domain 3, self-coping and past help seeking (Q11–13), including shamans, lamas, physicians, herbalists, and any barriers. (5) Domain 4, current help seeking (Q14–16): preferences, and the clinician-client relationship, including language and experiences of discrimination. (6) Summarise back to the client and check. APA permits clinicians to reproduce the form for use with their own patients. Modifying or translating it requires APA permission [source: APA CFI]. Allow enough time [uncertain: APA forms give no duration].
  • Example language (illustrative): "Sometimes people describe a problem very differently from how a doctor might. How would you describe what is happening, in your own words, or in Tuvan if you prefer?"
  • Watch for: the client offering only a biomedical account because they expect disapproval. Return to causes later, once trust is greater. It is working when the client tells you about past help seeking, such as a visit to a society in Kyzyl, without apologising for it.

4.3 CFI Informant Version with family

  • Purpose: to bring in the family's view, which often decides help seeking and whether a curse is suspected. Use when family members are involved and the client consents [source: APA CFI Informant Version; Stelmaszyk 2022].
  • Steps: (1) Get the client's consent to speak with a named relative. (2) Use the informant version: the informant's relationship with the client first, then the same four domains [source: APA CFI Informant Version]. (3) Note where the family and the client disagree about cause or help. (4) Do not reveal the client's private disclosures to the family.
  • Example language (illustrative): "Your son has agreed that I can ask you how the family understands what is happening. What do you think caused it?"
  • Watch for: family pressure on the client to see a particular shaman, or blame of a relative as the source of a curse. That second possibility is also a safeguarding cue (4.14). It is working when the family's model and the client's model are both visible and can be discussed.

4.4 Supplementary modules: Spirituality, Religion and Moral Traditions; Cultural Identity

  • Purpose: an in-depth look at the client's religious affiliation and practice, which may be shamanist, Buddhist, Orthodox or several at once, and at their Tuvan, Russian or mixed identity. Use when spiritual causes or identity themes come up [source: APA CFI Supplementary Modules; Pimenova 2013].
  • Steps: (1) Choose the relevant modules. They can be used as add-ons to the core CFI or on their own, at any point in care [source: APA CFI Supplementary Modules]. (2) Ask about practice and meaning, not procedure: which traditions, which practitioners, what each means to the client. (3) Ask about identity conflicts, for example a Tuvan client working in Russian-speaking institutions. (4) Record the answers in the client's own terms.
  • Example language (illustrative): "Some families in Tuva go to both a shaman and a lama, and to the polyclinic too. How does that work in your family?"
  • Watch for: your questions straying into how a ritual is done. That is not needed and is not yours to collect. It is working when you understand which practitioner the client trusts for what.

4.5 Supplementary modules: Explanatory Model, and Coping and Help-Seeking (with Kleinman's questions)

  • Purpose: to map the client's explanatory model, including curse, evil eye, ancestral or spirit explanations reported in Tuvan practice, and the help they expect. Use whenever the cause the client attributes differs from your working formulation [source: APA CFI Supplementary Modules; Kharitonova 2018; Stelmaszyk 2022].
  • Steps: (1) Ask Kleinman's questions in your own words: what the client calls the problem; what caused it; why it started when it did; what it does and how it works; how severe it is and how long it will last; what treatment it needs; what problems it has caused; and what they fear most [source: Tanenbaum handout, after Kleinman, Eisenberg and Good 1978]. (2) Use the Explanatory Model and Coping and Help-Seeking modules for depth [source: APA CFI Supplementary Modules]. (3) Write the client's model and your clinical model side by side. (4) Look for overlap you can work in, for example sleep, worry and conflict in the family.
  • Example language (illustrative): "You said the shaman told you a curse may be involved. What do you think it is doing to you, and what are you most afraid it will lead to?"
  • Watch for: fear of a curse that keeps escalating, especially if new curses keep being identified, and how much the client has spent. Kharitonova reports that some clients arrive with diagnosed illnesses expecting treatment, while shamans typically offer ancestral contact or cleansing [source: Kharitonova 2018]. Check what the client expects. It is working when the client can hold both models and choose which problems to bring to you.

4.6 Cultural concepts of distress as DSM-5-TR uses them

  • Purpose: to use DSM-5-TR's category of cultural concepts of distress, which covers idioms, explanations or perceived causes, and syndromes, as the manual describes [source: APA DSM-5-TR Section III]. Use when a client frames distress as a curse, evil eye, spirit trouble or shamanic illness.
  • Steps: (1) Classify what you hear: an idiom of distress, a perceived cause such as a curse, or a syndrome. (2) None of the DSM-5-TR glossary entries listed in the sources available here is specific to Tuva [source: UNMC DSM-5-TR slides]. Do not force a listed concept onto the client. (3) Record the client's own term and meaning in the cultural formulation. (4) Then complete the standard diagnostic assessment separately.
  • Example language (illustrative): "So in your family, what's happening is understood as a curse after the quarrel with your neighbour. I'll write that down in your words."
  • Watch for: treating the client's explanation as a diagnosis, or ignoring it. It is working when the cultural explanation and any diagnosis sit together in your formulation.

4.7 Distinguishing culturally normative experience from disorder

  • Purpose: to avoid both pathologising a culturally recognised experience (for example being called to shamanise, contact with ancestors, or trance in a recognised context) and missing a psychotic, mood, dissociative or medical disorder. Use whenever such experiences are reported [source: PMC9199574; Kharitonova 2015; Kharitonova 2018].
  • Steps: (1) Learn how the experience is understood. Shamanic illness is a theme practitioners discuss at seminars, including how they overcame it. Kharitonova notes that many new practitioners (in Russia generally) experienced depression or psychosomatic illness and interpreted it as shamanic illness [source: Kharitonova 2018; Kharitonova 2015]. (2) Ask whether the family and the client's own community, not only the client, recognise the experience as normative. (3) Apply the diagnostic exclusions. DSM-5 dissociative identity disorder (possession form) excludes disturbance that is "a normal part of a broadly accepted cultural or religious practice", and dissociative trance excludes trance in accepted collective practice; DSM-5-TR keeps these exclusions in substance [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299], but whether it keeps this exact wording is [uncertain] [source: PMC9199574]. ICD-11 6B62 trance disorder and 6B63 possession trance disorder require the state to be involuntary and unwanted and outside accepted cultural or religious practice, with significant distress or impairment [source: findacode ICD-11 6B62; PMC9199574]. (4) Assess function, distress, sleep, substance use, mood, risk, and course over time. (5) With consent, consult a cultural broker or someone the family trusts within the tradition. (6) Arrange a medical and psychiatric review whenever there are red flags.
  • Example language (illustrative): "Some people in your tradition describe a hard illness before becoming a shaman. Others in the family might see what's happening to you differently. What do your parents and the people you trust make of it?"
  • Watch for: red flags whatever the frame: loss of function, not eating or sleeping, risk to self or others, disorganisation, new neurological signs, heavy alcohol use, or the client's own community regarding the experience as abnormal. It is working when the formulation is shared and the client can accept medical review without feeling their tradition has been dismissed.

4.8 Asking about shamanic and other consultations without judgement

  • Purpose: to learn about all the care the client is using, since parallel care is common and often unspoken. Use at intake and at review points [source: Vyatkina 2018; Kharitonova 2018].
  • Steps: (1) Normalise the question. Physicians in the region report that visiting healers is ordinary and that some doctors visit healers themselves [source: Vyatkina 2018]. (2) Ask which practitioner: a member of a society (which one), an independent shaman, a lama, an herbalist, a psychic, an online service. (3) Ask what the client was told and how they felt afterwards. (4) Ask about cost and any follow-up visits they were asked to make. (5) Ask whether anything they were told conflicts with medical advice. Do not ask how rituals were done.
  • Example language (illustrative): "Many people here see a shaman or a lama as well as coming to see me. Have you seen anyone like that about this problem? What did they say?"
  • Watch for: shame or fear that you will report them. Some clients may not see a shaman visit as "treatment" at all, so ask about "anyone you went to for help". It is working when the client brings up later consultations themselves.

4.9 Collaboration and referral with community-sanctioned practitioners (when the client wishes)

  • Purpose: to support the client's wish for parallel care while keeping clinical responsibility clear. Use only when the client asks for it or is already engaged [source: Vyatkina 2018; Stelmaszyk 2022; synthesis].
  • Steps: (1) Find out whom the client and family trust. There is no state register of shamans' competence. Society membership confirms affiliation only, and certification standards are reported inconsistently [source: Pimenova 2013; Stelmaszyk 2022; Kharitonova 2018]. (2) Do not recommend a particular shaman or society yourself, and do not refer to tourist festivals or shows as care [synthesis]. (3) If the client wants you to be in contact with the practitioner, get specific written consent covering what may be shared and for what purpose. (4) Keep contact to coordination: safety, medical care and timing. Do not discuss ritual content. (5) Some shamans are reported to refer HIV-related cases to doctors [source: Stelmaszyk 2022], so ask a practitioner the client trusts how they handle medical problems. (6) In Tuva, the folk medicine centre within the Research Institute of Medical and Social Problems may be a formal contact point [uncertain: its role was not verified]. (7) No randomised evidence specific to collaboration with Tuvan shamans was found. Collaborative-care trials with traditional and faith healers have been run elsewhere. The COSIMPO cluster randomised trial in Nigeria and Ghana (Gureje et al., The Lancet 2020) found that collaborative care between traditional or faith healers and primary health care workers reduced psychotic symptoms (PANSS) and harmful practices more than usual care [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306] [source: https://centreforglobalmentalhealth.org/node/839].
  • Example language (illustrative): "It's your choice whether you see the shaman as well. If you'd like me to coordinate with them on anything, for example making sure your doctor's treatment carries on, we can agree exactly what I may and may not say."
  • Watch for: the client feeling they must choose between you and the shaman, or a practitioner advising them to stop medical treatment. It is working when both kinds of care continue without conflict and the client feels free to tell you about both.

4.10 Protecting medical care and medicines

  • Purpose: to prevent delay to medical diagnosis or treatment, a harm doctors in the region report. Use whenever there are physical complaints, prescribed medicines, or a serious medical diagnosis [source: Vyatkina 2018].
  • Steps: (1) Ask about physical symptoms, diagnoses and medicines at intake. (2) Ask whether any practitioner has advised changing treatment. (3) Never advise starting, stopping or changing a medicine, herb or remedy. Route the client to the prescriber or physician [synthesis]. (4) If the client is ignoring a serious diagnosis, explore their fears and their explanatory model (4.5) and support a medical appointment. (5) Document what you did and, with consent, inform the physician.
  • Example language (illustrative): "I'm not the right person to advise about medicines. Your doctor is. Would you be willing to tell your doctor what the shaman suggested, so they can advise you?"
  • Watch for: a pattern of returning to medicine only after other help has failed, which doctors report [source: Vyatkina 2018]. Shamanic healing is not a treatment for cancer or other physical disease. It is working when the client keeps up medical care and does not hide it from either side.

4.11 Exploring money, pressure and possible exploitation

  • Purpose: to protect the client from financial or emotional exploitation without discrediting the tradition. Use when fees, repeat visits or escalating fear come up [source: Stelmaszyk 2022; Kupfer and Jardine 2016; Kharitonova 2015].
  • Steps: (1) Ask neutrally how much the client has spent and whether that is affordable. (2) Ask whether they were told something terrible would happen if they did not return or pay. (3) Bear in mind the reported concerns: Stelmaszyk's interlocutors suspect some shamans of staging shows and inventing curses to keep clients, and Oorzhak criticises fixed pricing and commercialisation [source: Stelmaszyk 2022; Kupfer and Jardine 2016]. Kharitonova describes forged credentials among healers in Russia more generally [source: Kharitonova 2015]. These are reported perceptions, not verified findings about any individual. (4) Help the client weigh it up in their own terms, perhaps by consulting a relative or another practitioner they trust. (5) If there is clear fraud or coercion, support the client to use consumer or police routes as they wish.
  • Example language (illustrative): "Some people say that real help shouldn't leave you more frightened or in debt. How do you feel about what you've paid and been told so far?"
  • Watch for: your own scepticism leaking out as contempt, which ends disclosure. Watch also for a client whose fear grows with each visit. It is working when the client makes a choice they feel is their own.

4.12 Interpreters and cultural brokers

  • Purpose: to make sure language does not distort the client's account. Tuvan, Russian or both may be needed. Use whenever the client is more comfortable in Tuvan or uses Tuvan terms for the problem [synthesis; source: APA CFI Domain 4].
  • Steps: (1) Offer an interpreter, preferably not a family member. (2) Brief the interpreter on confidentiality and on translating spiritual terms without commenting on them. (3) Check that the interpreter has no conflict, for example ties to a particular shaman society in a small community. (4) With consent, consult a cultural broker on the meaning of terms, without identifying details.
  • Example language (illustrative): "If some things are easier to say in Tuvan, we can work with an interpreter. Would you like that, and is there anyone you'd rather it wasn't?"
  • Watch for: an interpreter who softens or explains away spiritual content. It is working when the client's own terms appear in your notes.

4.13 Integrating experiences from a shamanic consultation

  • Purpose: to help the client make sense of what they experienced or were told, in a way that supports their goals. Use after a consultation the client wants to talk about [synthesis].
  • Steps: (1) Invite the client to describe whatever they wish to share. Do not probe for ritual detail. (2) Explore what they were told and what they made of it emotionally. (3) Link any guidance they found helpful, for example on family reconciliation or remembering ancestors, to the therapy goals they chose. (4) Process anything distressing, such as being told of a curse or of a death in the family, with standard emotional processing and grounding. (5) If the consultation involved touch, check that it was consented to and that the client could stop.
  • Example language (illustrative): "What stayed with you most from the visit? Is there anything from it you'd like to build on here, or anything that left you uneasy?"
  • Watch for: new fear, guilt or blame directed at a relative, or intrusive imagery after the visit. It is working when the client uses what helped and has a place to bring what did not.

4.14 Safeguarding

  • Purpose: to protect clients and children from harm, whether the harm is done in the name of tradition or hidden behind it. Use whenever there are signs of coercion, violence, unwanted touch, neglect of urgent medical care, or a child accused of carrying misfortune [synthesis].
  • Steps: (1) Screen for unwanted or sexual touch, threats, confinement, or withholding of food or medical care in any helping relationship. (2) For children, ask about consent and assent, and about any accusation or blame directed at the child. Do not name minors in any communication outside statutory routes. (3) Follow your jurisdiction's reporting duties. (4) Separate the tradition from the individual: a harmful act is assessed as such, not as a judgement on Tuvan shamanism. (5) Consult a supervisor and, where useful, a trusted cultural consultant.
  • Example language (illustrative): "Whoever we go to for help, nobody should touch us in ways we didn't agree to or frighten us into paying. Has anything like that happened to you?"
  • Watch for: both errors, misreading an ordinary family practice as abuse and accepting abuse because it is labelled tradition. Whether any Tuva-specific safeguarding guidance exists is [uncertain]; follow the safeguarding law and procedures of your own jurisdiction. It is working when the risk is named, managed and documented while the client's faith is respected.

4.15 Working with families and with curse accusations in community conflict

  • Purpose: to work with how families understand misfortune, since curses are a central explanatory frame in Kyzyl and are tied to social conflict. Use when the client, or the family, attributes the problem to someone's curse [source: Stelmaszyk 2022; Kharitonova 2018].
  • Steps: (1) Map the relationships involved: who is said to have cursed whom, and why. (2) Explore the conflict itself, its losses and grievances, alongside the spiritual explanation. (3) Offer family sessions, if all parties consent, focused on safety and communication. (4) Assess the risk of retaliation or harassment against the person accused. (5) Respect the client's choice to seek a shaman's help with the curse, while working on the interpersonal problems in therapy.
  • Example language (illustrative): "Whatever the curse is doing, the quarrel with your sister is clearly painful too. Would it help to look at that part here?"
  • Watch for: escalation toward hostility or violence against the accused person, or the client becoming isolated. It is working when the family conflict can be discussed and nobody is harmed.

4.16 Historical suppression, intergenerational trauma and racism in services

  • Purpose: to name the legacy of Soviet suppression of shamanism and possible experiences of discrimination in Russian-language institutions, so that the therapeutic relationship can survive them. Use early on, and whenever mistrust appears [source: Kupfer and Jardine 2016; FSS 2022; APA CFI Domain 4].
  • Steps: (1) Ask CFI Q16-type questions about the client-clinician relationship, including language barriers and perceived discrimination [source: APA CFI]. (2) Acknowledge the history that practices were suppressed and kept alive by families and scholars [source: Kupfer and Jardine 2016; FSS 2022]. (3) Ask about family stories of repression, if the client wishes to share them. (4) Adapt how you present services so they do not repeat that history.
  • Example language (illustrative): "For a long time these traditions were forbidden, and doctors and officials weren't always respectful. If anything I do feels like that, I'd like you to tell me."
  • Watch for: the client agreeing politely and then disengaging. It is working when the client voices disagreement with you directly.

4.17 Alcohol and other substance use within a cultural frame

  • Purpose: to assess and treat alcohol problems, which Stelmaszyk reports shamans address and some Tuvans call a "curse of civilisation". Use whenever alcohol is mentioned or suspected [source: Stelmaszyk 2022].
  • Steps: (1) Screen for alcohol use with a standard instrument. (2) Explore the client's model, for example alcohol understood as a curse, a social ill, or both. (3) Offer evidence-based treatment, and refer for medical withdrawal management where needed; do not give medication advice yourself. (4) Respect any parallel shamanic help the client seeks. Kharitonova notes that a society could expel members for alcohol use, which shows norms within the community [source: Kharitonova 2018].
  • Example language (illustrative): "Some people see drinking as a kind of curse that came with modern life. However you see it, what would you most like to change?"
  • Watch for: withdrawal risk, co-occurring depression and suicide risk. It is working when drinking-related goals are set in the client's own terms.

4.18 Non-Tuvan clients after Tuvan-styled workshops or tours

  • Purpose: to support clients outside Tuva who attended seminars, festivals or tours led by Tuvan shamans and now report distress. Use when a client presents after such an experience [source: Kharitonova 2018; Kupfer and Jardine 2016].
  • Steps: (1) Ask what happened and what they were told, without asking for ritual detail. (2) Assess for spiritual emergency versus psychosis, mania, dissociation or trauma (4.7), with medical review if needed. (3) Note that Kharitonova describes seminars and "shamanic illness" presentations abroad, and states that healing services offered in Europe and the US are provided illegally [source: Kharitonova 2018]. Oorzhak describes outsiders who attend a few sessions and then open their own clinics [source: Kupfer and Jardine 2016]. (4) Help the client distinguish a workshop experience from belonging to a community. Do not encourage them to seek further ceremonies outside legitimate community pathways [synthesis]. (5) Ground and stabilise first; integrate later.
  • Example language (illustrative): "It sounds as though the workshop stirred up a lot. Let's first make sure you are sleeping and feeling safe, then we can try to understand what it meant to you."
  • Watch for: sleep loss, grandiosity, or the conviction of having been called to become a shaman. It is working when the client stabilises and can reflect on the experience.

4.19 Tuvan clients living away from Tuva (Immigrants and Refugees module adapted)

  • Purpose: to understand Tuvans living in Moscow, Novosibirsk or abroad, who may have lost access to trusted practitioners and to their kin. Use when the client has moved away [source: APA CFI Supplementary Modules; synthesis].
  • Steps: (1) Use relevant items from the Immigrants and Refugees and Social Network modules. The Immigrants and Refugees module is designed for migrants; using it with internal migrants is an adaptation [synthesis]. (2) Ask how the client keeps in touch with family and traditions, and whether they consult practitioners remotely. (3) Ask about discrimination and isolation. (4) Support the connections the client wants.
  • Example language (illustrative): "Being far from home can make it harder to get the kind of help your family would usually turn to. What has that been like for you?"
  • Watch for: isolation, or remote services that charge large fees (4.11). It is working when the client has meaningful support networks.

5. Handling problems

All of the following is [synthesis] unless a source is given.

  • The client won't discuss shamanic help. Do not push. Normalise parallel care (4.8) and come back to it later. Explain that you ask because it helps you coordinate, not to judge. Mistrust may reflect history (4.16).
  • The client wants you to confirm or deny a curse. Decline either way, warmly: "I can't say whether it's a curse; that isn't my area. I can help with the fear and with the problems in your family." Then work on what you share (4.5, 4.15).
  • The client asks you to recommend a shaman or society. Do not. Explain that authority over who is legitimate lies with the community and the client's family, and help the client consult those they trust [source: Pimenova 2013; Stelmaszyk 2022].
  • Escalating fees or fear ("one more curse"). Explore it gently (4.11). Help the client involve a trusted relative. If there is coercion or fraud, safeguarding and consumer routes apply.
  • Medical treatment stopped or delayed. Prioritise safety. Encourage contact with the physician, do not advise on medicines, document what you did, and with consent inform the doctor (4.10) [source: Vyatkina 2018].
  • Unclear: calling or crisis. Assess risk and function first. Arrange medical and psychiatric review, consult people the family trusts, and avoid labelling either way until assessment is complete (4.7). Treat acute risk as you would any crisis.
  • The client feels caught between the family's model and their own. Make the conflict explicit and use the informant version (4.3). Support the client's autonomy, and consider family sessions.
  • Rupture over perceived disrespect. Acknowledge it, take responsibility for your part, and ask what respect would look like. Repair openly; do not defend.
  • Overwhelm after a consultation or workshop. Stabilise first with grounding, sleep and safety planning. Postpone meaning-making (4.13, 4.18).
  • Non-adherence to the therapy plan. Check that the plan matches the client's explanatory model. Revise the goals in the client's terms, and consider whether parallel care is filling a need your plan has missed.
  • Your own scepticism or enthusiasm interferes. Take it to supervision and revisit 4.1. Neither commercial concerns nor romantic views of the tradition should guide clinical decisions.
  • Confidentiality in a small community. Expect overlap between interpreters, practitioners and family. Agree with the client in advance what is shared with whom, and check for conflicts (4.12).
  • No local guidance or programme. Kharitonova reports that a 1990s attempt in Tuva to coordinate official medical institutions with shamanic organisations was not sustained, and that today some clinicians and shamans refer patients to each other through personal contacts, without publicity [source: Kharitonova 2018, Folk and traditional medicine]. No formal referral programme is described. Proceed case by case with consent, and document.

Sources

← Previous · XI-035Evenki clan shamansNext · XI-037 →Sakha Aiyy Faith and Yhyakh