Atlas›Domain XI · Traditional medicine & indigenous healing›Guide 037
Guide XI-037

Sakha Aiyy Faith and Yhyakh

Lazar Afanasyev1993Sakha Republic (Yakutia), Russia
A 39 · L 50 · M 1117 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 Aiyy (Aar Aiyy) religion as its registered organisations and Russian and Sakha scholarship describe it (Kut-Siur, 1993; Religion of Aar Aiyy, registered by the Russian Ministry of Justice in 2014); Yhyakh as the Sakha Republic state holiday proclaimed in 1992. The therapist's procedures follow the DSM-5-TR Cultural Formulation Interview (CFI) and its supplementary modules, Kleinman's explanatory-model questions and ICD-11. [source: Wikipedia, Aiyy Faith; Ushnitsky 2016; EastRussia 2014; University of Aberdeen Ysyakh project; APA CFI]

What it is. This is not a psychotherapy. It is a living religious and cultural revival among the Sakha (Yakut) people of the Republic of Sakha (Yakutia), in the Russian Federation. It has two parts:

  • The Aiyy faith. Followers call it a revival of the Sakha people's ancestral religion: the bright Aiyy deities of the Upper World, an emphasis on kinship with nature, and the moral codes called siyer-tuom. Scholars present it as a post-Soviet systematisation, largely the work of the philologist Lazar Afanasyev (Teris, 1952–2017), whose book Teachings of Aiyy (1993) set out the doctrine. Russian scholars describe it as Yakut "Tengrism" or Tangarism. [source: Wikipedia, Aiyy Faith; Ushnitsky 2016; EastRussia 2014]
  • Yhyakh (Ysyakh). The main Sakha calendar festival, held at midsummer around 21 June. The Russian Museum of Ethnography describes it as a "New Year in the middle of summer" and a day of renewal, with communal feasting, horse races, wrestling and the osuokhai circle dance. Under Soviet rule it was kept but secularised. Its revival in the late 1980s was tied to the Sakha cultural and autonomy movement, and in 1992 the first government of the Republic proclaimed it a state holiday. [source: Russian Museum of Ethnography 2024; University of Aberdeen Ysyakh project]

Core idea of change, as the tradition holds it. Sakha ideas of health, as ethnographers report them, centre on kut, a soul or life force with three parts (often given as mother-soul, air-soul and earth-soul), and on sür, the human spirit. A person is described as well only when all three parts of kut are present. Illness may be understood as the loss of a part, for example after a severe fright, or as theft of kut by harmful spirits (abaasy). Restoring it is the work of the tradition's own specialists, not the therapist. [source: Mekkyusyarova 2022; Ushnitsky 2016] These concepts are described here as the tradition holds them, neither as fact nor as error.

The therapist's role. You work alongside the tradition, never inside it. Your change model is your own: a culturally responsive therapy in which a client's Sakha identity, faith, festival life and ties to alaas (home settlement), kin and land can be explored as meaning and resource, and in which the client's explanatory model shapes the shared treatment plan. [synthesis]

2. Framework

There is no therapy protocol to follow. The framework below organises the psychotherapist's own work with a Sakha client for whom Aiyy faith, shamanic or healer traditions, or Yhyakh matter. Session counts are planning guides. [synthesis]

Phase 0. Preparation (before contact). Goal: know enough of the context to ask good questions and to avoid harm. Learn the basic history: the 17th-century arrival of Russian Orthodoxy, Soviet suppression of religion, and the 1980s–90s revival. Know that there are rival Aiyy organisations, as well as Orthodox, neo-shamanic and secular Sakha. Know that coercive psychiatry is a live concern in the region (see 4.16). Exit criterion: you can name your own assumptions about religion, "shamanism" and psychosis. [source: EastRussia 2014; Ushnitsky 2016; Amnesty International 2021; synthesis]

Phase 1. Engagement and cultural assessment (sessions 1–3). Goal: understand the problem in the client's terms. Use the core CFI (16 questions in four domains; with a relative or friend, the 17-question Informant Version). Add the supplementary modules that fit, typically Spirituality, Religion and Moral Traditions; Cultural Identity; Explanatory Model; and Coping and Help-Seeking. The modules can be used at intake, later in care, or repeated. No APA form gives a duration, so how long the CFI takes is [uncertain]. Exit criterion: you can state the client's name for the problem, its believed cause, the help already sought, and what the client expects from you. [source: APA CFI; APA CFI Supplementary Modules]

Phase 2. Formulation (sessions 2–4). Goal: a shared cultural formulation. Decide what is culturally normative and what is distress or disorder, working with cultural brokers where needed. Write a formulation that sets the client's model beside the clinical one. Exit criterion: the client recognises the formulation as theirs, and diagnostic decisions have been checked against DSM-5-TR culture criteria and ICD-11 exclusions. [source: APA DSM-5-TR Section III; ICD-11 6B62/6B63; synthesis]

Phase 3. Plan, collaboration and referral (from session 3 onward). Goal: agree which helpers do what. This can include a community-recognised algyschyt or healer, the client's congregation or family, medical services, and you. Collaboration happens only if the client wishes it, with written consent. Exit criterion: roles, information-sharing limits and medical safety have been agreed. [source: COSIMPO trial (Gureje et al. 2020); synthesis]

Phase 4. Therapy and integration (typically 8–20 sessions, depending on the presenting problem). Goal: treat the presenting problem with your usual evidence-based method, adapted to the client's model. Integrate the client's festival, faith or healing experiences into the therapy. Exit criterion: agreed goals are met, measured by the client's own markers as well as yours. [synthesis]

Throughout: safeguarding and risk. Assess suicide risk, medical delay, coercion and harm to children at every phase, and move to safety steps at once if any appears. [synthesis]

Format. Individual sessions in the client's preferred language (Sakha or Russian, or English in diaspora), with a professional interpreter where needed. Family or informant sessions only with consent. [source: APA CFI Informant Version; synthesis]

3. Guiding principles

  1. Alongside, not inside. You never perform, simulate or advise on Aiyy rites, algys blessings, purification, shamanic healing or divination. Meaning: if a client asks you to bless, cleanse or "read" them, decline warmly and ask who in their community they would trust for that. [synthesis]
  2. Authority belongs to the community. Religious authority rests with the registered Aiyy organisations and their leaders, with algyschyts recognised by their communities, and, for shamanic healing, with practitioners whom local people recognise. There is no single body for all of these. Meaning: never assume one organisation speaks for every Sakha believer, and ask the client whose authority they accept. [source: Ushnitsky 2016; Mekkyusyarova 2022; EastRussia 2014]
  3. Plurality is normal. Sakha people may be Aiyy believers, Orthodox, Buddhist-influenced, secular, or several of these at once. Aiyy groups disagree with one another, and with neo-shamanic and Tengrist currents. Meaning: ask, don't infer, from ethnicity. [source: Ushnitsky 2016; Wikipedia, Aiyy Faith]
  4. Attribute, don't adjudicate. Describe kut, abaasy, deities and spirits as the client and the tradition hold them. Meaning: use the client's words ("your kut"), and neither endorse them nor correct them. [synthesis]
  5. Neither pathologise nor miss illness. A culturally sanctioned experience is not a symptom. A genuine mental disorder still needs treatment. Meaning: test every unusual experience against the cultural-exclusion criteria and against the person's own community norms before you diagnose. [source: ICD-11 6B62/6B63; Lewis 2023 study guide citing DSM-5-TR]
  6. Historical suppression is clinical context. Religion was persecuted and festivals were secularised under Soviet rule. Some followers once hid the name of Aar Aiyy Toyon. Meaning: expect caution about disclosure, and earn trust before probing belief. [source: University of Aberdeen Ysyakh project; Ushnitsky 2016]
  7. Psychiatry carries a political shadow. In 2021, Amnesty International called the court-ordered, indefinite psychiatric confinement of the Sakha shaman Aleksandr Gabyshev "punitive psychiatry". Meaning: be transparent about your role, about confidentiality and about what a diagnosis does, and never use diagnosis to settle disputes over belief or politics. [source: Amnesty International 2021]
  8. Client-led collaboration. Contact with healers or algyschyts happens only at the client's wish and with written consent. Meaning: the client decides whether, who and what is shared. [synthesis; source: COSIMPO trial]
  9. Healer certificates are not regulation. The regional Ministry of Health has no regulatory framework for folk medicine, and officials have said certificates from a Moscow-based association have no legal force. Meaning: legitimacy comes from community recognition, not paperwork, and you cannot "verify" a healer for the client. [source: Mekkyusyarova 2022]
  10. Medical safety first. Some healers and clients avoid surgery or biomedical care. Meaning: whenever a client describes delaying urgent care, ask about it and route them to medical services. Never advise on medicines or herbs, and route all such questions to the prescriber. [source: Mekkyusyarova 2022; synthesis]
  11. No reproduction of sacred material. Do not ask clients to teach you, record or perform algys, festival rites or prayers, and do not repeat them in notes. Meaning: record only the meaning the experience held for the client. [synthesis]
  12. Language is identity. Sakha concepts often lack exact Russian or English equivalents. Meaning: keep the client's terms in your notes, with their own gloss. [synthesis]

4. Intervention inventory

These are the psychotherapist's own interventions. Nothing here describes or substitutes for Aiyy rites, Yhyakh ceremonies, algys blessings or shamanic healing, which belong to the tradition's own specialists. [source: APA CFI; synthesis]

4.1 Cultural humility and self-examination

  • Purpose / when: Use before and throughout the work, especially if you are not Sakha, or if you come from the Russian Orthodox or the secular Soviet-educated majority. [synthesis]
  • Steps: (1) Write down what you associate with "shaman", "pagan" and "Yakut". (2) Note any reflex to read spirit talk as a psychotic symptom, or as quaint folklore. (3) Read about the Soviet secularisation of Yhyakh and the suppression of religion. (4) In supervision, examine the power you hold: diagnosis, notes, and the link to compulsory treatment. (5) Repeat after any session where you felt dismissive or fascinated. [source: University of Aberdeen Ysyakh project; Amnesty International 2021; synthesis]
  • Example language (illustrative): "I am not Sakha, and I will get things wrong. Please correct me. You are the expert on your own tradition."
  • Watch for: exoticising (asking to see rites, "collecting" stories), using "pagan" as a put-down, and assuming a client is a believer. It is working when the client corrects you freely and brings up spiritual material without being asked.

4.2 Core Cultural Formulation Interview

  • Purpose / when: Use at intake with every client for whom culture may shape the problem. It clarifies the problem as the client and their network see it, its meaning, the sources of help, and what the client expects from services. It supports clinical judgement but is not the sole basis for diagnosis. [source: APA CFI]
  • Steps: (1) Explain that you ask everyone about their background and views. (2) Work through the four domains in your own order: how the client defines the problem; what they think causes it, what stresses and supports them, and the role of cultural identity; how they have coped and sought help, and what got in the way; and their current preferences, including their relationship with you. (3) Record their words verbatim where you can (e.g. "my kut is weak"). (4) Note which supplementary modules to add. (5) Clinicians may reproduce the APA form for use with their own patients, but translating or modifying it needs APA permission. [source: APA CFI]
  • Example language (illustrative): "People from different backgrounds understand problems like this differently. How would you describe what is happening to you, in your own words or in Sakha?" "Is there anything about who you are, as a Sakha person or in your faith, that makes this harder or easier?"
  • Watch for: answers that are guarded or that defer to you ("whatever the doctor says"), which may reflect wariness of psychiatry. It is working when the client offers their own name for the problem and their own idea of its cause.

4.3 Supplementary module: Spirituality, Religion and Moral Traditions

  • Purpose / when: Use when the client mentions Aiyy faith, deities, kut, Yhyakh, an algyschyt, shamans or Orthodoxy, or when moral codes (siyer) shape their distress. [source: APA CFI Supplementary Modules; Ushnitsky 2016]
  • Steps: (1) Ask which tradition or traditions they identify with; some combine Aiyy, Orthodox and other practice. (2) Ask what role the faith plays in daily life, and in this problem. (3) Ask whether a spiritual or moral rule is relevant (a sense of breach, impurity or duty). (4) Ask what support the community gives, and what tensions it creates. (5) Do not ask for the content of rites or blessings. [synthesis]
  • Example language (illustrative): "Some people find strength in the Aiyy teachings or in Yhyakh. Others feel pulled between traditions. What is it like for you?"
  • Watch for: guilt over a perceived breach of tradition, family conflict between Orthodox and Aiyy members, and spiritual struggle. It is working when you can name the client's spiritual resources and stressors separately.

4.4 Supplementary module: Cultural Identity

  • Purpose / when: Use for urban and rural, bilingual, mixed-heritage or diaspora Sakha clients, and where language loss or Russification is part of the story. [source: APA CFI Supplementary Modules; synthesis]
  • Steps: (1) Map language use (Sakha, Russian, other). (2) Map belonging: alaas or home village, kin, ulus (district). (3) Ask what Yhyakh or other community events mean to them now, and meant in childhood. (4) Ask about any discrimination they have experienced. (5) Ask how their identity relates to the problem. [synthesis]
  • Example language (illustrative): "Which language do you feel closest to when you talk about feelings?" "What does going home to your village for Yhyakh mean to you?"
  • Watch for: grief over lost language or land, shame about "not being Sakha enough", or over-identification as a defence. It is working when identity becomes a resource in the formulation rather than a backdrop.

4.5 Explanatory model (Kleinman) and the Explanatory Model module

  • Purpose / when: Use when the client holds a spiritual or traditional cause (e.g. loss of part of kut after a fright, harm from abaasy, the unsettled dead, or a disturbed place), or whenever their expectations of treatment differ from yours. [source: Kleinman et al. 1978, as cited by Dinos et al. 2017; Mekkyusyarova 2022; Ushnitsky 2016]
  • Steps: Ask Kleinman's questions in your own words: (1) what they call the problem; (2) what caused it; (3) why it began when it did; (4) what it does to them and how it works; (5) how severe it is and how long it will last; (6) what treatment they think they should get; (7) the main problems it has caused; (8) what they fear most. Then (9) summarise their model back to them and (10) set it beside your own, looking for overlap. [source: Kleinman 1978 questions via Tanenbaum handout]
  • Example language (illustrative): "You said this began after the fright on the river. What do you think happened to you then?" "What do you think would help, from me and from others?"
  • Watch for: a hidden fear (e.g. of death, a curse or inherited misfortune) and a mismatch in expectations ("I need my kut restored, not talk"). It is working when the client feels their model is respected and you can agree on a plan that honours both models.

4.6 Asking about past and current help-seeking

  • Purpose / when: Use at intake and at review. Sakha clients may consult an algyschyt, shamanic practitioners, folk healers (including bone-setters, herbalists and moxibustion practitioners), Buddhist practitioners, Orthodox clergy and doctors, sometimes all at once. [source: Mekkyusyarova 2022; APA CFI]
  • Steps: (1) Normalise the question ("many people see several helpers"). (2) List the helpers: who, when, what was understood, and how it helped. (3) Ask about any advice to avoid or stop medical treatment. (4) Ask about payments and any pressure. (5) Note any herbs or remedies only so you can tell the prescriber, and never comment on doses or use. [source: Mekkyusyarova 2022; synthesis]
  • Example language (illustrative): "Have you talked with anyone in the community, an algyschyt, a healer or an elder, about this? What did they say it was?"
  • Watch for: concealment (expecting you to disapprove), escalating fees, or advice to refuse surgery or medication. It is working when the client discloses openly and you can coordinate.

4.7 Working with cultural concepts of distress

  • Purpose / when: Use when the client expresses distress in Sakha idioms or cites a traditional cause. DSM-5-TR treats cultural concepts of distress as idioms, explanations or perceived causes, and syndromes, and its examples were revised to avoid stigmatising or generalising language. None of the DSM-5-TR examples is Sakha. The DSM-5-TR list, as given in secondary teaching slides, is (ataque de nervios, dhat, hikikomori, khyâl cap, kufungisisa, maladi dyab, nervios, shenjing shuairuo, susto, taijin kyofusho) [uncertain]. [source: APA DSM-5-TR Section III; UNMC slides]
  • Relevant Sakha material (attributed): Ethnography describes illness from loss of a part of kut after a strong fright, and from abaasy taking kut (Mekkyusyarova 2022). It also describes fear of the untimely or violently dead and of "abnormal places" (Ushnitsky 2016). Historical literature describes menerik (also called emiryachenie), mainly among women, which was read in the past as a channel for spirits or as a sign of shamanic calling (Sodnompilova 2021, abstract). Older DSM editions placed "Arctic hysteria" phenomena among culture-bound syndromes, and DSM-5 moved several such entries into the dissociative disorders [source: Teodoro & Afonso 2020]. Whether any contemporary Sakha clinical idiom corresponds to menerik today is [uncertain: not verified].
  • Steps: (1) Treat the idiom as a cause or explanation, not a diagnosis. (2) Explore what it means for this person, and how common it is in their family and community. (3) Assess separately for depression, anxiety, PTSD, dissociation or psychosis. (4) Formulate using both languages (e.g. "a frightened kut" and "post-traumatic hyperarousal"). (5) Agree on how the two can be addressed together. [synthesis]
  • Example language (illustrative): "When you say part of your kut left after the accident, what changed in you? What would it be like if it came back?"
  • Watch for: using the idiom as a stand-in label that hides a treatable disorder, or the opposite, reducing the idiom to a symptom. It is working when the client experiences the dual formulation as accurate.

4.8 Distinguishing culturally normative experience from disorder

  • Purpose / when: Use when a client reports spirit contact, dreams of ancestors, a sense of shamanic calling, trance-like states, or experiences tied to Yhyakh or other rites. [synthesis]
  • Criteria to apply: ICD-11 6B62 Trance disorder and 6B63 Possession trance disorder require the state to be involuntary and unwanted, to cause significant distress or impairment, and not to be part of an accepted collective cultural or religious practice. DSM-5(-TR) dissociative identity disorder notes that identity disruption may be described as possession in some cultures, and excludes disturbances that are a normal part of a broadly accepted cultural or religious practice (a study guide citing DSM-5-TR paraphrases both points, so DSM-5-TR keeps them in substance; the exact wording is [uncertain]). Dissociative trance falls under other specified dissociative disorder. A DSM-5-TR note that culturally sanctioned beliefs should not count as psychotic symptoms is [uncertain]. [source: ICD-11 via findacode and PMC9199574; DSM-5 via PMC9199574; DSM-5-TR via Lewis 2023 study guide]
  • Steps: (1) Ask whether the experience is chosen, expected or welcomed, and whether it occurs within a recognised community setting. (2) Ask how the client's own community or algyschyt views it, with consent if you are to ask them directly. (3) Assess the wider picture: functioning, sleep, mood, disorganisation, risk, substance use and medical causes. (4) If you are unsure, consult a cultural broker or a Sakha-speaking colleague before you diagnose. (5) Document your reasoning, including the cultural exclusions you considered. [source: ICD-11; synthesis]
  • Example language (illustrative): "In your family, how would people understand what you experienced? Would they see it as something good, something worrying, or both?"
  • Watch for: the client's own community seeing the experience as abnormal (a key signal), declining function, unwanted and repeated episodes, and danger. It is working when the community view, the client's view and the clinical picture line up, or when the differences are named and documented.

4.9 Interpreters and cultural brokers

  • Purpose / when: Use when the client prefers Sakha, when concepts resist translation, or when you need community context. [synthesis]
  • Steps: (1) Use professional interpreters, not family members, for clinical content. (2) Check the interpreter for conflicts of interest, such as a small community or a rival religious affiliation. (3) Brief them on confidentiality. (4) Ask them to keep Sakha terms as they are and gloss them. (5) Consult cultural brokers (e.g. Sakha clinicians or scholars) with the client's consent, or on an anonymised basis. [synthesis]
  • Example language (illustrative): "Would you like to speak in Sakha? We can have an interpreter who is not from your village."
  • Watch for: interpreter editorialising, and the client holding back because the community is small. It is working when the client uses their own terms freely.

4.10 Collaboration and referral with community-recognised figures (only when the client wishes)

  • Purpose / when: Use when the client wants their algyschyt, a healer or community elder involved alongside therapy. In Nigeria and Ghana, a cluster randomised trial of collaborative shared care between traditional and faith healers and primary care for psychosis (COSIMPO) found greater symptom reduction, and a fall in harmful practices from 57% to 9%. In Ghana, adding psychiatric medication to prayer-camp care reduced symptoms but did not significantly reduce days in chains. A comparable collaborative programme in the Sakha Republic is [uncertain: not verified]. [source: COSIMPO via PubAnnotation; Ofori-Atta et al. via APHRC repository]
  • Who holds authority: Registered Aiyy organisations, including Kut-Siur (registered 1993), the Religion of Aar Aiyy (registered 2014, then led by Avgustina Yakovleva) and Aar Aiyy Itegele (associated with Vladimir Kondakov), each recognise their own clergy and teachers. Many contemporary algyschyts trained under A. S. Fedorov, and their roles increasingly combine priesthood, healing and spiritual mentoring. Ethnographers also describe neo-shamanic practitioners and commercial healers' associations whose standing is contested. [source: Ushnitsky 2016; EastRussia 2014; Mekkyusyarova 2022] Wikipedia gives the Aiyy Faith organisation as "registered since 2015"; the 2014 versus 2015 date is [uncertain].
  • Steps: (1) Ask whether the client wants any collaboration at all, and with whom. (2) Get written, specific consent: who, what may be shared, and for how long. (3) Agree with the client what you will and will not discuss with the other person. (4) If you make contact, introduce yourself, ask how they understand the situation, and agree on separate roles; never ask about rites or their content. (5) Agree on safety non-negotiables (urgent medical care, medication continuity, no coercion, child safety). (6) Review the collaboration with the client regularly. [source: COSIMPO model; synthesis]
  • Example language (illustrative): "You've said your algyschyt matters to you. Would you like me to be in touch with them, or would you prefer to keep these separate?"
  • Watch for: practitioners who advise stopping medication or surgery, charge escalating fees, or exert pressure; rivalry between organisations drawing in the client; and confidentiality leaks in small communities. It is working when the client feels supported from both sides and safety agreements hold.

4.11 Community belonging and festival life as resource

  • Purpose / when: Use when isolation, displacement (urban migration, diaspora), grief or depression has cut the client off from kin and community events such as Yhyakh. [synthesis]
  • Steps: (1) Ask what participation in community life, including Yhyakh, has meant to them. (2) Explore whether reconnection fits their goals. (3) Plan steps the client chooses, such as contacting kin, joining a community association, or attending public events. (4) Use these steps within your usual method (e.g. behavioural activation, grief work), framed in the client's terms. (5) Never prescribe participation in religious rites, and leave such choices to the client and their community. [synthesis]
  • Example language (illustrative): "You said summer at home, with family at Yhyakh, used to give you strength for the year. What would it mean to reconnect with that, in a way that fits your life now?"
  • Watch for: pressure to participate (from you or from family), conflict for clients of other faiths, and alcohol at gatherings for clients in recovery. It is working when the client reports more connection and meaning, by their own markers.

4.12 Integrating ceremonial, festival or healing experiences

  • Purpose / when: Use after a client has attended Yhyakh, received an algys blessing or purification, or seen a healer, and wants to make sense of it in therapy. [synthesis]
  • Steps: (1) Invite the client to share only what they wish, with no detail of the rite needed. (2) Explore its meaning, the emotions it brought up, and any changes since. (3) Link it to their therapy goals. (4) Note any distress it caused, such as unexpected memories, fear, or conflict with family. (5) Record meaning, not ritual content. [synthesis]
  • Example language (illustrative): "You don't need to tell me what happened there. What did it mean to you, and what has felt different since?"
  • Watch for: retraumatisation, sudden fear of spiritual harm, or a sense of failure if the expected change did not come. It is working when the experience becomes part of the client's own story of recovery.

4.13 Perceived spiritual calling or spiritual emergency

  • Purpose / when: Use when a client believes they are being called to a spiritual role, or is overwhelmed by spiritual experiences. Ethnographic literature on Inner Asian peoples describes mental conditions that were read as signs of being chosen as a shaman, or as punishment by spirits (Sodnompilova 2021, abstract). Whether, and how, contemporary Sakha communities recognise a calling is a matter for those communities [uncertain]. [source: Sodnompilova 2021]
  • Steps: (1) Do not confirm or deny the calling. (2) Stabilise: sleep, safety, grounding, and support from trusted people. (3) Assess for mood disorder, psychosis, substance use and medical causes, using 4.8. (4) Ask whom in the community the client would trust to advise on the spiritual question, and leave that question with them. (5) Keep therapy focused on coping, meaning and functioning. [synthesis]
  • Example language (illustrative): "Whether this is a calling is something for you and the people you trust in your tradition. My part is to help you get through it safely and sleep again."
  • Watch for: a rapid decline, risk to self or others, exploitation by anyone offering "initiation" for payment, and family pressure in either direction. It is working when the client is stable and can approach the spiritual question at their own pace.

4.14 Medical safety and coordination

  • Purpose / when: Use when a client is combining healer care with medical care, or describes avoiding biomedical care. Ethnography reports Sakha healers' clients who avoided surgery, and rural use of bone-setting, herbal treatment and moxibustion. [source: Mekkyusyarova 2022]
  • Steps: (1) Ask neutrally about all remedies and treatments. (2) Never advise starting, stopping or changing a medicine or herb. Pass the information to the prescriber or GP, with the client's consent. (3) If a client is delaying urgent medical care, say so plainly, and help them reach care while respecting their faith. (4) For any physical practice, the client's own medical clinician advises on safety. [source: Mekkyusyarova 2022; synthesis]
  • Example language (illustrative): "I'm glad the healer's help means a lot to you. Could we also make sure your doctor knows, so nothing interacts or gets missed?"
  • Watch for: stopped psychiatric medication, an untreated physical illness, and burns or injuries. It is working when all helpers know about one another and medical care continues.

4.15 Safeguarding

  • Purpose / when: Use whenever a practice harms or threatens harm, such as restraint, beating, starvation, sexual abuse, the exploitation of distressed people, or the delay of urgent care, and always where children are involved. [synthesis]
  • Steps: (1) Separate the harm from the tradition: harm by an individual practitioner is not the faith itself. (2) Follow your jurisdiction's safeguarding and reporting law. (3) Consult your safeguarding lead. (4) Where safe, involve legitimate community authorities who reject the harm. (5) Do not report legitimate religious practice as abuse, or abuse as tradition. [synthesis]
  • Example language (illustrative): "I respect your faith. What you've described, being hurt and kept from eating, is something I have to act on to keep you safe."
  • Watch for: fear of community retaliation and minimisation. It is working when the client is safe and their trust in you is preserved where possible.

4.16 Rights-informed practice and the shadow of coercive psychiatry

  • Purpose / when: Use with any client from the region, and especially with those whose spiritual identity overlaps with political or social protest. In 2021, a Yakutsk court ordered the shaman Aleksandr Gabyshev into a psychiatric institution for an indefinite period with forcible treatment. The Sakha Supreme Court upheld the order, and Amnesty International called it "punitive psychiatry". [source: Amnesty International 2021]
  • Steps: (1) Explain your role, confidentiality and its limits, and what you will record. (2) Base any diagnosis on functional impairment and clinical criteria, never on belief or dissent. (3) Use least-restrictive options and the client's informed consent. (4) Share your formulation with the client. (5) Consult on any involuntary step, documenting your cultural reasoning. [source: Amnesty International 2021; synthesis]
  • Example language (illustrative): "What you believe about the spirits is not something I diagnose. I'm asking about sleep, safety and how you're coping."
  • Watch for: fear of being "put away", which leads to silence about experiences. It is working when the client talks openly about spiritual material.

4.17 Family, community and historical trauma

  • Purpose / when: Use where distress links to the suppression of faith under Soviet rule, family splits over religion, loss of language, or migration. Under Soviet rule, religious institutions nearly vanished and Yhyakh was turned into secular state performance, and some followers hid the name of Aar Aiyy Toyon. [source: University of Aberdeen Ysyakh project; Ushnitsky 2016]
  • Steps: (1) Build a genogram that includes religious affiliation and its history. (2) Explore stories passed down about the suppression and the revival. (3) Hold family sessions, with consent, to address faith conflict. (4) Frame the revival as one possible resource, not an obligation. (5) Use the CFI Informant Version for relatives. [source: APA CFI Informant Version; synthesis]
  • Example language (illustrative): "Your grandmother kept some things hidden, and your mother chose the church. Where does that leave you?"
  • Watch for: idealising or rejecting the revival, and loyalty conflicts. It is working when the client holds the family's different paths with less distress.

5. Handling problems

The sources do not address therapy problems directly. All of the guidance below is [synthesis] unless a source is given.

  • The client is guarded about belief. This may reflect historical persecution, or fear of psychiatry (see 4.16). Respond by explaining confidentiality, saying you don't diagnose beliefs, and moving to safer topics first. Example (illustrative): "You don't have to tell me anything about your faith. I'll only ask if it helps you."
  • The client wants you to perform or endorse a rite ("Can you cleanse me?", "Tell me my kut is back"). Decline warmly, ask who in their community could help, and offer what you can do. Example (illustrative): "That isn't mine to do. Who would you trust for it? Meanwhile, we can work on the sleep and the fear."
  • Stuck on "only a healer can fix this". Validate the model and look for overlap (e.g. fright, sleep, safety). Offer a joint plan in which the healer handles the spiritual side and therapy handles coping. Review progress by the client's own markers.
  • Rival authorities. The client is caught between Aiyy organisations, a neo-shamanic practitioner and the Orthodox church, or between relatives with different affiliations [source: Ushnitsky 2016 on inter-group disagreements]. Don't take sides. Help the client clarify their own values and choices.
  • Non-adherence to medical treatment on a healer's advice. Address it as a safety issue, not a question of belief. Seek consent to involve the prescriber, and where the client agrees, seek to collaborate with the healer on continuing the medication (cf. COSIMPO [source: COSIMPO]).
  • Exploitation. Watch for escalating fees, promises of cure, or pressure toward "initiation". The regional health ministry does not regulate folk medicine, and healer certificates have no legal force [source: Mekkyusyarova 2022]. Help the client weigh the risks and talk to trusted community members, and use safeguarding (4.15) if harm occurs.
  • Overwhelm after a festival, rite or spiritual experience. Stabilise first, then assess (4.8 and 4.13), then integrate (4.12). Don't push the client to explore spiritual content during acute distress.
  • Rupture: the client feels you dismissed or exoticised them. Name it, apologise specifically, ask what they needed, and repair. Example (illustrative): "I think I treated what you told me as a curiosity. I'm sorry. How did that land for you?"
  • Over-identification by the therapist. If you start wanting to attend, learn or adopt the practices, take it to supervision. Keep your role boundary.
  • Diagnostic pressure from a service. If a referrer frames a spiritual identity as a symptom, offer a cultural formulation (CFI-based) with documented exclusions, and advocate for least-restrictive care [source: Amnesty International 2021; APA CFI].
  • Alcohol at festivals for clients in recovery. Plan with the client in advance (supports, exit plans, alcohol-free company), without discouraging cultural participation.
  • Suicide risk. Use standard risk assessment and safety planning. Explore protective factors the client names, which may include faith, kin and land, and involve family or community supports only with consent.
  • Diaspora clients far from Sakha. Help them find Sakha community associations and online cultural groups, and treat isolation in your usual way. Spiritual matters stay with authorities the client recognises.

Sources

Web sources:

Books and articles cited by bibliographic detail (as listed in the sources above):

  • Afanasyev, L. A. (Teris) (1993). Aiyy üörehe (Teachings of Aiyy). [uncertain: not verified]
  • Balzer, M. M. (2005). Whose Steeple is Higher? Religious Competition in Siberia. Religion, State & Society 33(1): 57–69.
  • Gureje, O., Appiah-Poku, J., et al. (2020). Effect of collaborative care between traditional and faith healers and primary health-care workers on psychosis outcomes in Nigeria and Ghana (COSIMPO). The Lancet.
  • Kleinman, A., Eisenberg, L., & Good, B. (1978). Culture, illness, and care. Annals of Internal Medicine 88: 251–258.
  • Ofori-Atta, A., et al. (2018). Joining psychiatric care and faith healing in a prayer camp in Ghana: randomised trial. British Journal of Psychiatry 212(1). [uncertain: year]
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