Atlas›Domain XI · Traditional medicine & indigenous healing›Guide 114
Guide XI-114

Mapuche machi

Chile and Argentina
A 40 · L 49 · M 1116 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: Mapuche healing as described by Mapuche-run and state intercultural health services in Chile (the Programa Especial de Salud y Pueblos Indígenas, PESPI; Ley 20.584 Article 7 and its regulation; the community-run Makewe hospital) and in Neuquén, Argentina (the Raguiñ Kien intercultural health centre at Ruca Choroi), with Ana Mariella Bacigalupo's ethnography as attributed outsider context; the psychotherapist's own work follows the DSM-5-TR Cultural Formulation Interview (CFI).

What it is. The machi is a Mapuche healer and ritual specialist in Chile and Argentina. This is a living spiritual and healing tradition, not a psychotherapy, and a psychotherapist does not practise it. In one Chilean nursing-journal overview, the machi is described as the only person authorised to communicate directly with creator and protective spirits (ngen); machi may be women or men and hold ritual, spiritual and social roles as well as healing ones. The same overview names other Mapuche health agents: the lawenche or lawentuchefe (herbal knowledge), ngütamchefe (bone-setting) and püñeñelchefe (childbirth). [source: https://revistas.udec.cl/index.php/cienciayenfermeria/article/download/13204/11398/34246]

Core idea of illness and healing (as attributed). In that account, illness (kutran) follows a break in the balance of relationships among people, nature and spirits, for example through social discord, disrespect for sacred places or harm to nature. A weakened person is more open to harmful energy (wekufe), which may be sent from a distance or arise from envy or anger. Herbal and other agents treat many illnesses, while possession, loss of one's spirit and other causes held to be supernatural are treated only by a machi, whose work addresses the cause rather than only the symptoms. Trance and negotiation with spirits are described as central to machi healing. [source: https://revistas.udec.cl/index.php/cienciayenfermeria/article/download/13204/11398/34246] The authors note that part of their Mapuche-specific material comes from non-peer-reviewed web sources, so treat it as one account among several. The trance state is named küymin in some literature, and the healing and community ceremonies are commonly named machitun and ngillatun [uncertain: not verified]. In an urban Chilean programme, a machi is reported as saying that "mental health" is not a category he recognises. [source: https://intervencion.uahurtado.cl/index.php/intervencion/article/download/176/237]

Scholarly context. Bacigalupo's Shamans of the Foye Tree: Gender, Power, and Healing among Chilean Mapuche (University of Texas Press, 2007) draws on about fifteen years of fieldwork. It follows how machi perform gender across ritual, social, sexual and political settings, and it states that the Chilean state has stigmatised machi as witches and sexual deviants. This is an outsider's ethnography. [source: https://utpress.utexas.edu/9780292782846/] [source: https://mapuche.info/archivo/fakta/bacigalupo061222.html]

Where the psychotherapist fits. The therapist's work is culturally responsive assessment and therapy alongside the tradition: understanding the client's own account of their suffering, respecting their choice to consult a machi, distinguishing culturally normative experience from disorder, collaborating through legitimate intercultural channels when the client wishes, and safeguarding. [synthesis]

2. Framework

This is a tradition and a set of health-system arrangements, not a phased therapy. The framework below has two parts: who holds authority and how services are organised, and the therapist's own sequence of work.

Who holds authority.

  • Machi and Mapuche communities. Recognition of a machi comes from within Mapuche communities, not from any state licence. How a person becomes a machi is not described here; it is a matter for the tradition. In a Santiago programme, a machi is quoted as saying that preserving the Mapuche world is "responsabilidad de nosotros ... no de ellos" (the responsibility of Mapuche people, not of outsiders). [source: https://intervencion.uahurtado.cl/index.php/intervencion/article/download/176/237]
  • Community health organisations. The Makewe hospital in Padre Las Casas, La Araucanía, passed in 1999 to a Mapuche community association (named in coverage as the Asociación Mapuche para la Salud Makewe-Pelale) and is described as the first hospital in Chile administered entirely by its beneficiary community. It serves more than 120 mainly Mapuche communities, and a new 24-bed building opened in 2023. [source: https://www.elciudadano.com/?p=1002844] An earlier overview describes the Maquehue-Pelale model as incorporating Mapuche disease categories and causes alongside scientific medicine. [source: https://revistas.udec.cl/index.php/cienciayenfermeria/article/download/13204/11398/34246]
  • Chilean state framework. PESPI, run by the Ministry of Health since 2000, rests on ILO Convention 169, the Ley Indígena 19.253, Ley 20.584 Article 7 (public providers in areas with a high Indigenous population must ensure culturally relevant care), the 2006 Política de Salud y Pueblos Indígenas and the 2006 general norm on interculturality in health services. Its components include Indigenous participation, intercultural facilitators (who must speak the language, know the Indigenous health system and belong to an Indigenous people), "Indigenous health provision" delivered by agentes de medicina indígena such as machi and lawentuchefe, and referral and counter-referral protocols between Indigenous and biomedical medicine. [source: https://www.dipres.gob.cl/597/articles-212527_doc_pdf1.pdf] A 2024 regulation of Article 7 (Decreto 21) adds duties on a validated intercultural model, intercultural facilitators, bilingual signage and the right to culturally appropriate religious assistance at the end of life. [source: https://revistamedicadechile.cl/index.php/rmedica/article/download/10833/37936/133801]
  • Neuquén, Argentina. The Raguiñ Kien intercultural health centre at Ruca Choroi opened in November 2021. In 2022 the province appointed 13 Mapuche agents to permanent posts, including a head of centre (wichafe), intermediaries between hospital and patients, link workers between healers and patients, people who gather and prepare medicines, and intercultural facilitators. The healers themselves (kimche: machi, lawentuchefe, bone-setters, pregnancy support and spiritual guidance) are selected by the centre's community body and are deliberately not public employees. [source: https://www.rionegro.com.ar/politica/designan-a-13-agentes-mapuche-para-el-hospital-intercultural-de-ruca-choroi-2421051/?amp=1] In Río Negro, a 2026 pilot in Bariloche and El Bolsón trains health workers with Mapuche participants but does not yet offer Mapuche medicine as a public service. [source: https://www.noticiasnqn.com.ar/noticias/2026/08/21/348997-salud-rio-negro-busca-acercar-la-medicina-a-los-saberes-mapuches]
  • Contested ground. Mapuche views of state "intercultural" health differ. A machi in an urban programme is quoted: "Ese hospital que se llama intercultural en el sur no es Mapuche." [source: https://intervencion.uahurtado.cl/index.php/intervencion/article/download/176/237] Interviews in Cañete and Tirúa found biomedical dominance, vague definitions of interculturality, little staff training and work resting on volunteer effort. [source: https://scielosp.org/pdf/rpsp/2016.v39n2/122-127]

The therapist's sequence of work [synthesis, built on the CFI's structure; source: https://www.psychiatry.org/File Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]

  1. Preparation (before or at first contact). Goals: check your own assumptions; learn whether the service has an intercultural facilitator or PESPI contact; arrange an interpreter if the client prefers Mapudungun. Move on when the client is engaged and language is settled.
  2. Cultural assessment (sessions 1–3). Goals: core CFI (16 questions, four domains), plus the Explanatory Model, Spirituality/Religion/Moral Traditions, Cultural Identity and Coping and Help-Seeking modules as needed; ask about machi or other Mapuche agents. Move on when you can state the problem in the client's terms and know what help they are already using or want.
  3. Differential and safety formulation (overlapping). Goals: separate culturally normative experience from disorder, using DSM-5-TR and ICD-11 cultural exclusions, family and cultural informants; screen risk. Move on when risk is managed and the formulation is shared with the client.
  4. Collaborative plan. Goals: agree what the therapist will do, what the client may seek from a machi or community, and whether, with consent, the two will be connected. Revisit whenever help-seeking changes.
  5. Ongoing therapy and integration. Goals: usual evidence-based work adapted to the formulation; space to integrate healing experiences; regular review of explanatory model and help-seeking (the CFI modules can be repeated during care). [source: https://psychiatry.org/File Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
  6. Ending. Goals: plan for continuity with community and biomedical supports.

Session count and format follow the therapy you are already delivering; none of the cited sources sets a number. [uncertain: not verified]

3. Guiding principles

  • The tradition belongs to Mapuche communities. Do not perform, imitate, describe or teach machi practice; refer only through community-sanctioned or official channels. [source: https://intervencion.uahurtado.cl/index.php/intervencion/article/download/176/237] [synthesis]
  • Attribute, do not adjudicate. Describe spirits, harmful energy and spirit loss as the client and tradition hold them; neither affirm them as fact nor dismiss them. In practice: "you understand this as..." rather than "this is" or "this is only a belief". [synthesis] The urban study warns against calling Indigenous knowledge "belief" while treating biomedicine as neutral. [source: https://intervencion.uahurtado.cl/index.php/intervencion/article/download/176/237]
  • Look beyond the symptom. Mapuche accounts link illness to relationships with people, land and spirits; ask about those. [source: https://revistas.udec.cl/index.php/cienciayenfermeria/article/download/13204/11398/34246]
  • Trust before content. The same overview names trust and a good relationship as conditions of care. In practice: slow down early sessions. [source: https://revistas.udec.cl/index.php/cienciayenfermeria/article/download/13204/11398/34246]
  • Parallel help-seeking is normal. Many Mapuche people use clinics for some problems and traditional healers for illnesses they see as spiritual. In practice: ask, never assume either path is exclusive. [source: https://revistas.udec.cl/index.php/cienciayenfermeria/article/download/13204/11398/34246]
  • Rights, not favours. Chilean patients in high-Indigenous areas have a legal right to culturally relevant public care. In practice: tell clients what PESPI or intercultural services exist locally. [source: https://www.dipres.gob.cl/597/articles-212527_doc_pdf1.pdf]
  • Language is care. Facilitators and Mapudungun interpreting are part of the official model. In practice: offer them, do not wait to be asked. [source: https://www.dipres.gob.cl/597/articles-212527_doc_pdf1.pdf] [source: https://www.minsal.cl/?p=4900]
  • The CFI supports, not replaces, diagnosis. Use it to inform judgement. [source: https://www.psychiatry.org/File Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
  • Avoid both errors. Do not pathologise culturally sanctioned trance or spirit experience; do not miss psychosis, depression, trauma or suicidality because a cultural label is present. [synthesis, using DSM-5-TR and ICD-11 exclusions in section 4]
  • Consent governs every link. Share information with a machi, facilitator or community only with the client's explicit consent. [synthesis]
  • Name the history. State stigma of machi, land conflict and racism shape distress and trust; acknowledge them. [source: https://utpress.utexas.edu/9780292782846/] [synthesis]
  • Stay in your lane on remedies. Give no advice on lawen (herbal medicines) or on starting, stopping or changing any medicine; route questions to the prescriber. [synthesis]
  • Respect gender diversity in machi roles. Bacigalupo documents gender-shifting in machi healing; do not read it as pathology. [source: https://utpress.utexas.edu/9780292782846/]

4. Intervention inventory

Everything below is the psychotherapist's own work. None of it is machi practice, and no step asks the therapist to diagnose, perform or advise on Mapuche healing. Example language is illustrative throughout.

4.1 Cultural self-examination

  • Purpose / when: Before the first session and whenever you feel certainty, curiosity that turns into fascination, or dismissal. The urban Santiago study argues that "intercultural" services often leave the biomedical side's power unexamined and that practice should be at least "interepistémicas". [source: https://intervencion.uahurtado.cl/index.php/intervencion/article/download/176/237]
  • Steps: (1) Write down what you assume about Mapuche people, machi and "shamanism", and where those ideas came from (media, conflict coverage, tourism, textbooks). (2) Note whether you think of your own model as knowledge and theirs as belief. (3) Identify what you do not know (language, territory, community, urban or rural life). (4) Decide what you will ask rather than assume. (5) Take it to supervision or consultation with a Mapuche colleague or facilitator if one is available. [synthesis]
  • Example language (to yourself or in supervision, illustrative): "What would I need to see to take this client's explanation as seriously as my own formulation?"
  • Watch for: romanticising machi as exotic; treating the client as a spokesperson for all Mapuche; assuming every Mapuche client consults a machi (many are Christian, urban or not involved). Working when you ask more and explain less, and the client corrects you freely. [synthesis] [source: https://revistas.udec.cl/index.php/cienciayenfermeria/article/download/13204/11398/34246]

4.2 Offering a facilitator or Mapudungun interpreter

  • Purpose / when: At first contact, for any client who speaks Mapudungun or wants Mapuche concepts handled accurately. Chilean services fund intercultural facilitators who speak the language and know the Indigenous health system; the 2024 regulation treats facilitation as intercultural dialogue, not automated translation. [source: https://www.dipres.gob.cl/597/articles-212527_doc_pdf1.pdf] [source: https://revistamedicadechile.cl/index.php/rmedica/article/download/10833/37936/133801]
  • Steps: (1) Ask the client's language preference. (2) Ask whether they want a facilitator present, explaining the role. (3) Check that the facilitator is acceptable (community ties can raise confidentiality worries). (4) Brief the facilitator beforehand on purpose and confidentiality; debrief afterwards on terms that did not translate. (5) Speak to the client, not the facilitator. [synthesis]
  • Example language (illustrative): "This service has a facilitator who speaks Mapudungun and knows Mapuche health. Some people like that, some prefer not. What would suit you?"
  • Watch for: the facilitator softening or reframing distress; the client holding back because the facilitator knows their family. Working when key concepts are rendered in the client's own words and checked back. [synthesis]

4.3 Core Cultural Formulation Interview

  • Purpose / when: In the first one to three sessions with any Mapuche client, and whenever cultural factors seem to shape the problem. The DSM-5-TR CFI has 16 questions in four domains: cultural definition of the problem (Q1–3); cultural perceptions of cause, context and support (Q4–10); cultural factors affecting self-coping and past help-seeking (Q11–13); and cultural factors affecting current help-seeking (Q14–16). APA says it is "designed to be used by any clinician providing services to any individual in any care setting" and that it informs, not replaces, diagnosis. [source: https://www.psychiatry.org/File Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] [source: https://www.psychiatry.org/File Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]
  • Steps: (1) Introduce it as wanting to understand the problem in the client's own way. (2) Work through the four domains in your own words, following the client's language (for example kutran or a Spanish term). (3) Under past help-seeking, ask explicitly about machi, lawentuchefe, family remedies, churches and clinics. (4) Under the clinician relationship (Q16), ask about discrimination and language. (5) Summarise back in the client's terms. Clinicians may reproduce the APA form for use with their own patients; modifying or translating it needs APA permission. [source: https://www.psychiatry.org/File Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] The DSM-5 field trial found it feasible, acceptable and useful, and later interviews took less time; a duration in minutes is [uncertain]. [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/]
  • Example language (illustrative): "People describe their troubles in different ways. How would you describe what is happening to you? What would your family or community call it?"
  • Watch for: short, guarded answers (trust not yet built); the client testing whether you will ridicule a spiritual explanation. Working when the client offers their own terms and causes unprompted. [synthesis]

4.4 Exploring the explanatory model

  • Purpose / when: When the client links distress to imbalance, harmful energy, spirit loss, envy, sorcery, broken obligations or the land. Use Kleinman's questions (Kleinman, Eisenberg and Good, 1978, Annals of Internal Medicine) and the CFI Explanatory Model module. [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf] [source: https://psychiatry.org/File Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
  • Steps: In your own words, ask (1) what they call it; (2) what caused it; (3) why it began when it did; (4) what it does to them and how it works; (5) how serious it is and how long it will last; (6) what treatment they think they need; (7) what problems it has caused; (8) what they fear most. Then (9) ask who in their world could best help, and (10) where your help fits beside that. [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf] [synthesis for 9–10]
  • Example language (illustrative): "You said this came after the trouble with your neighbours and that something was sent. Tell me how you understand it working on you."
  • Watch for: imposing Mapuche categories the client has not used (for example offering "wekufe" first); treating the model as a symptom. Working when you can state the problem, cause and hoped-for remedy in the client's words and they agree. [synthesis]

4.5 Asking about the machi and other Mapuche agents

  • Purpose / when: In every assessment with a Mapuche client and at review points, since many Mapuche people use clinics for some illnesses and traditional healers for those they see as spiritual. [source: https://revistas.udec.cl/index.php/cienciayenfermeria/article/download/13204/11398/34246] Use the CFI Spirituality, Religion and Moral Traditions and Coping and Help-Seeking modules. [source: https://psychiatry.org/File Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
  • Steps: (1) Normalise: say many people use more than one kind of help. (2) Ask whether they have seen, or want to see, a machi or another agent (lawentuchefe, bone-setter, family elder), and what they were told. (3) Ask how it went and whether it helped. (4) Ask whether they want you to know more or to keep the two separate. (5) Ask whether they take lawen or other remedies, solely so the prescriber can be informed with consent; do not advise on them. (6) Do not ask about ceremony details or what the machi did. [synthesis]
  • Example language (illustrative): "Some people I work with also see a machi or use lawen. Has that been part of your path? You decide how much you tell me."
  • Watch for: fear that disclosure will be judged or recorded against them; over-sharing ceremonial detail the client may later regret. Working when the client mentions machi consultation spontaneously in later sessions. [synthesis]

4.6 Cultural identity, territory and history

  • Purpose / when: When identity, land, migration to cities, language loss, discrimination or state violence appear in the story. Use the CFI Cultural Identity module (and the Immigrants and Refugees module where displacement is relevant). [source: https://psychiatry.org/File Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
  • Steps: (1) Ask how the client identifies (Mapuche, Pehuenche, other, mixed) and with which lof, territory or city. (2) Ask what being Mapuche means to them now. (3) Ask about experiences of racism in health services, school or work. (4) Ask about family history of land loss, displacement or political conflict, without pressing. (5) Link these to the presenting problem only in ways the client recognises. [synthesis] Chile's PESPI includes a human-rights reparation component for Indigenous victims in named court cases, which shows that state violence is officially acknowledged in health policy. [source: https://www.dipres.gob.cl/597/articles-212527_doc_pdf1.pdf]
  • Example language (illustrative): "Where is your family's land, and what does it mean to you to be there or away from it?"
  • Watch for: turning a political grievance into a symptom; assuming every client is affected by the conflict in La Araucanía. Working when the client names their own connections between history and distress. [synthesis]

4.7 Family and community informants

  • Purpose / when: When the client is very unwell, young, or when illness is understood as a family or community matter. The CFI Informant Version (17 questions) is used with a relative or friend. [source: https://psychiatry.org/File Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]
  • Steps: (1) Ask the client whom they want involved and get consent. (2) Interview the informant with the Informant Version in your own words. (3) Note where family and client models differ. (4) Ask the family what community support (lonko, elders, machi) they see as appropriate. (5) Feed differences back to the client privately first. [synthesis]
  • Example language (illustrative, to a relative): "How does your family understand what is happening to her, and who in the community would usually help?"
  • Watch for: family pressure toward or away from a machi against the client's wish; disclosure of secrets. Working when the client feels supported rather than overruled. [synthesis]

4.8 Distinguishing culturally normative experience from disorder

  • Purpose / when: When a client reports trance, spirit contact, possession, harmful energy, spirit loss or a felt call to a spiritual role. DSM-5-TR treats cultural concepts of distress as idioms, explanations and syndromes, and revised its examples to avoid stigmatising language. [source: https://www.psychiatry.org/File Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf] DSM-5 notes that identity disruption in dissociative identity disorder "may be described in some cultures as an experience of possession" but excludes disturbances that are "a normal part of a broadly accepted cultural or religious practice"; dissociative trance (other specified dissociative disorder) does not apply when trance is a normal part of accepted collective practice. DSM-5-TR keeps this in substance; exact wording [uncertain]. [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299] ICD-11 6B62 Trance disorder and 6B63 Possession trance disorder both require the state to be involuntary, unwanted and outside accepted cultural or religious practice, with significant distress or impairment. [source: https://www.findacode.com/icd-11/code-1807490186.html] [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] No DSM-5-TR cultural concept of distress is specific to Mapuche people; the DSM-5-TR culture note on beliefs that are not psychotic is [uncertain]. [source: https://www.unmc.edu/bhecn/_documents/dsm5tr_bw_6_slides_11_pages.pdf]
  • Steps: (1) Ask whether the experience happens inside a recognised community or ceremonial context, and whether it is wanted. (2) Ask how family and community view it (normal, a calling, an illness). (3) With consent, consult a facilitator or community member about whether it fits accepted experience. (4) Separately assess for features that suggest disorder: involuntary and unwanted episodes outside context, functional decline, sleep loss, disorganisation, thought disorder, hallucinations not shared or recognised by the community, mood episodes, substance use, trauma, medical causes. (5) Hold both: a client can have a spiritual understanding and also a treatable disorder. (6) Document the cultural framing and your reasoning. [synthesis] Accounts of a calling to become machi through illness are [uncertain: not verified]; if a client describes one, ask what the family and community make of it rather than interpreting it yourself. [synthesis]
  • Example language (illustrative): "In your family, how would people tell the difference between someone receiving something from the spirits and someone who is ill?"
  • Watch for: diagnosing psychosis on content alone; the opposite error of missing mania, psychosis or depression because a spiritual explanation is offered. Working when the client, the family and you share a formulation that names both cultural meaning and any clinical concern. [synthesis]

4.9 Risk assessment in culturally framed distress

  • Purpose / when: Whenever distress is severe, a client feels bewitched or pursued, spirit loss is feared, or a healing has not helped. [synthesis]
  • Steps: (1) Ask directly about suicidal thoughts, intent and plans using your usual standard, in the client's language and framing ("wanting to stop living" may be easier than clinical words). (2) Ask about fear of harm from others and any thoughts of harming the person blamed. (3) Ask about sleep, eating and physical illness that may be waiting for spiritual treatment. (4) Build a safety plan that includes family and community supports the client trusts, including a machi if they wish. (5) Do lethal-means counselling (safe storage and removal) as usual. [synthesis]
  • Example language (illustrative): "When people feel something harmful has been sent to them, sometimes they also feel they cannot go on. Has that happened to you?"
  • Watch for: risk masked by stoicism or distrust of services; family plans to wait for a ceremony while urgent medical care is needed. Working when the client agrees a plan they consider their own. [synthesis]

4.10 Collaboration and referral through intercultural channels

  • Purpose / when: When the client wants machi or other Mapuche care alongside therapy, or wants the two connected. In Chile, PESPI funds care by agentes de medicina indígena and uses referral and counter-referral protocols between Indigenous and biomedical medicine; intercultural facilitators help users navigate the network. [source: https://www.dipres.gob.cl/597/articles-212527_doc_pdf1.pdf] Community-run Makewe and Neuquén's Raguiñ Kien, where a community body selects the healers, are examples of community-held routes. [source: https://www.elciudadano.com/?p=1002844] [source: https://www.rionegro.com.ar/politica/designan-a-13-agentes-mapuche-para-el-hospital-intercultural-de-ruca-choroi-2421051/?amp=1] Some services still lack a protocol: a 2017 Cañete hospital seminar arose because users asked to be seen by a machi and teams had none, and the hospital was tasked with writing an intercultural mental-health protocol. [source: https://www.minsal.cl/?p=31490] Evidence from other regions: in Nigeria and Ghana, collaborative shared care between traditional and faith healers and primary care for psychosis (COSIMPO; Gureje et al., The Lancet, 2020) reduced symptoms more than usual care and reduced harmful practices [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306]; in a Ghanaian prayer camp (Ofori-Atta et al., Br J Psychiatry 212(1)), adding psychiatric medication reduced symptoms, but days in chains were not significantly reduced. [source: https://www.mentalhealthdataprizeafrica.aphrc.org/repository/paper/33405/joining-psychiatric-care-and-faith-healing-in-a-prayer-camp-in-ghana-randomised-trial] No Mapuche-specific outcome trial is cited here [uncertain: not verified].
  • Steps: (1) Confirm the client's wish; never suggest a machi to a client who has not raised Mapuche healing. (2) Find the local route: the service's PESPI or intercultural unit, facilitator, a community-run centre, or the client's own community. Do not locate or vet a machi yourself. (3) Agree in writing what may be shared, with whom, and for what purpose. (4) If contact happens, keep it to coordination: what the client wants from each, timing, risk, and how to reach each other. Do not ask about or record ceremonial content. (5) Agree how the client will tell you if anything feels unsafe. (6) Review together after any consultation. [synthesis]
  • Example language (illustrative): "If you would like a machi's help as well, the intercultural team here can tell you how that works locally. Would you like me to put you in touch with them? Nothing about our sessions goes to them unless you say so."
  • Watch for: a programme route the client distrusts as state-run (some Mapuche reject state "intercultural" labels) [source: https://intervencion.uahurtado.cl/index.php/intervencion/article/download/176/237]; long waits when demand outstrips supply, as a Petorca hospital reported [source: https://www.minsal.cl/?p=4900]; anyone outside community structures charging for "Mapuche" ceremonies. Working when the client experiences the two kinds of help as complementary, not competing. [synthesis]

4.11 Remedies, medicines and the prescriber

  • Purpose / when: When the client takes lawen or other remedies, or asks whether to stop psychiatric medicine for machi treatment. PESPI and Raguiñ Kien include people who gather and prepare medicines; Río Negro's pilot discusses plants alongside conventional treatment of chronic disease. [source: https://www.rionegro.com.ar/politica/designan-a-13-agentes-mapuche-para-el-hospital-intercultural-de-ruca-choroi-2421051/?amp=1] [source: https://www.noticiasnqn.com.ar/noticias/2026/08/21/348997-salud-rio-negro-busca-acercar-la-medicina-a-los-saberes-mapuches]
  • Steps: (1) Ask what the client takes, without evaluating it. (2) With consent, tell the prescriber that remedies are being used. (3) If asked whether to stop or change a medicine, say that is a decision for the client with the prescriber, and help them prepare the conversation. (4) Never recommend, source or describe preparation of any remedy. [synthesis]
  • Example language (illustrative): "That's a question for you and your doctor together. Would it help to plan what you want to ask, and to tell the doctor about the lawen too?"
  • Watch for: sudden stopping of medicine; fear that the prescriber will mock the remedy. Working when the prescriber knows and the client feels respected by both. [synthesis]

4.12 Integrating healing experiences

  • Purpose / when: After the client has received machi or community care, when they want to make sense of it in therapy. [synthesis]
  • Steps: (1) Invite them to say only what they wish. (2) Ask what changed for them, in body, relationships and outlook. (3) Ask what the machi or community asked of them afterwards (for example repairing a relationship) and how therapy can support it, without evaluating it. (4) Link changes to therapy goals in the client's words. (5) If the experience was distressing, treat it with the same care as any distressing experience. [synthesis]
  • Example language (illustrative): "What do you want to bring here from what happened with the machi, and what do you want to keep there?"
  • Watch for: the therapist interpreting or reframing the healing in psychological terms that displace the client's meaning; disappointment if it did not help. Working when the client draws on both without conflict. [synthesis]

4.13 Addressing stigma, racism and historical harm

  • Purpose / when: When distrust of services, discrimination, land conflict or the stigmatisation of Mapuche spirituality shapes the presentation. Bacigalupo reports state stigmatisation of machi; implementation research in Chile names an unequal relationship between the Mapuche people and the state. [source: https://utpress.utexas.edu/9780292782846/] [source: https://scielosp.org/pdf/rpsp/2016.v39n2/122-127]
  • Steps: (1) Ask directly about experiences of racism, including in health care. (2) Acknowledge them without defending institutions. (3) Distinguish realistic vigilance from symptoms. (4) Work on the effects (shame, anger, hypervigilance, grief) with your usual methods, adapted to the client's framing. (5) Support links with community and identity where the client wants. [synthesis]
  • Example language (illustrative): "Many Mapuche people have been treated badly in services like this one. Has that happened to you? I'd rather hear it than have it get in the way."
  • Watch for: the therapist's discomfort pushing the topic away; reducing the client to a victim. Working when trust and frankness increase. [synthesis]

4.14 When the client is a machi, or a relative of one

  • Purpose / when: Machi and their families may seek therapy for ordinary problems or for the strains of the role, including gender expectations and stigma described by Bacigalupo. [source: https://utpress.utexas.edu/9780292782846/]
  • Steps: (1) Treat the role as legitimate and not up for clinical evaluation. (2) Ask what they want from therapy and what is off-limits. (3) Do not ask about ritual knowledge. (4) Respect gender expression connected to the role without pathologising it. (5) Watch boundaries if community members also consult them. [synthesis]
  • Example language (illustrative): "What would you like this space to be for, and what belongs to your work as machi that we leave outside?"
  • Watch for: curiosity about their practice; dual relationships. Working when the client uses therapy for their own aims. [synthesis]

4.15 Safeguarding

  • Purpose / when: Whenever any healing practice, from any source, involves restraint, beating, starvation, sexual contact, coercion, accusations against a child, or delay of urgent medical care. These are not described as Mapuche practice in the cited sources; the duty applies to any setting. [synthesis] COSIMPO reported a fall in harmful practices with collaboration. [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306]
  • Steps: (1) Ask about safety neutrally whenever a client describes treatment. (2) If harm is present, follow your jurisdiction's reporting duties for children and adults at risk. (3) Arrange urgent medical care where needed. (4) Where safe and the client consents, involve the intercultural team or community authority rather than acting against the community as a whole. (5) Document facts, not cultural judgements. [synthesis]
  • Example language (illustrative): "Did anything during the treatment hurt you or happen without your agreement?"
  • Watch for: misreading legitimate practice as abuse, and abuse justified as tradition. Working when the person is safe and still able to use culturally meaningful help. [synthesis]

4.16 Documentation and confidentiality

  • Purpose / when: Every session. PESPI records Indigenous health provision in clinical statistics, and in Petorca a paramedic recorded machi consultations in clinical files. [source: https://www.dipres.gob.cl/597/articles-212527_doc_pdf1.pdf] [source: https://www.minsal.cl/?p=4900]
  • Steps: (1) Record the client's explanatory model in their words, marked as theirs. (2) Record that they consult Mapuche healers only with their agreement, and not what was done. (3) Do not record sacred or ceremonial detail. (4) Tell the client what is recorded and who can see it. [synthesis]
  • Example language (illustrative): "I'll note that you see a machi as part of your care, nothing more. Is that all right?"
  • Watch for: notes that read as dismissive ("believes he is bewitched"). Working when the client would be comfortable reading the record. [synthesis]

5. Handling problems

The cited sources describe service-level barriers but give no clinical guidance for these situations; the responses below are [synthesis] unless a source is cited.

  • Client is guarded or gives brief answers. Likely distrust of state services or fear of ridicule. Slow down, explain confidentiality, offer a facilitator, and say plainly that you will not judge spiritual explanations. Return to the CFI later. [synthesis] Trust is named as a condition of care. [source: https://revistas.udec.cl/index.php/cienciayenfermeria/article/download/13204/11398/34246]
  • Client asks the therapist to read, judge or explain their spiritual situation. Decline kindly: it is outside your role and belongs to the tradition. Ask who in their community could answer, and offer the intercultural route (4.10). [synthesis]
  • Client wants a machi but has no access, or the local programme has none. Acknowledge the gap; Chilean services report demand outstripping supply and missing protocols. [source: https://www.minsal.cl/?p=4900] [source: https://www.minsal.cl/?p=31490] Help the client ask their own community, family or a community-run centre; keep therapy going meanwhile. Do not suggest commercial or tourist ceremonies. [synthesis]
  • Client rejects state "intercultural" programmes. Respect it; some Mapuche voices reject the label. [source: https://intervencion.uahurtado.cl/index.php/intervencion/article/download/176/237] Let the client lead on community routes, and keep your own role clear. [synthesis]
  • Conflict between machi advice and clinical advice (for example stopping medication, avoiding hospital). Do not set the two against each other. Explore what the client understood; with consent, ask the intercultural team to help coordinate; refer medication questions to the prescriber; if there is acute risk, follow emergency procedures and explain why. [synthesis]
  • Overwhelm or acute distress, including fear of being harmed by sent energy. Prioritise safety and grounding in terms the client accepts; assess for psychosis, mania and suicidality; involve trusted family or community supports; arrange urgent care when needed. [synthesis]
  • Possible psychosis presented as spirit experience, or spirit experience presented to you as "madness" by others. Use 4.8: context, voluntariness, community view, functional change, and consultation with a cultural informant; revisit over time rather than deciding in one session. [synthesis] [source: https://www.findacode.com/icd-11/code-1807490186.html]
  • Non-adherence (missed sessions, not doing agreed tasks). Check whether the plan matches the explanatory model; tasks that ignore the client's account of cause seem pointless. Rebuild the plan from 4.4. Check for practical barriers: distance to rural services, travel to cities, cost, work. [synthesis]
  • Rupture after the therapist dismissed or over-interpreted a spiritual explanation. Name it, apologise specifically, ask what it felt like, and agree how you will handle such moments. [synthesis]
  • Family disagreement about machi versus clinical care. Hold separate and joint conversations; use the Informant Version to map positions; keep the client's own wish central. [synthesis] [source: https://psychiatry.org/File Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]
  • Therapist fascination or wish to learn the practice. Take it to supervision. The client is not a teacher of Mapuche spirituality for you, and machi knowledge is held by Mapuche communities. [synthesis] [source: https://intervencion.uahurtado.cl/index.php/intervencion/article/download/176/237]
  • Confidentiality in small communities. Facilitators and healers may know the client's family. Ask explicitly whom the client is comfortable with, and offer alternatives. [synthesis]
  • Signs of harmful or coercive treatment. Follow 4.15. [synthesis]
  • Political or land-conflict trauma. Acknowledge context, assess trauma symptoms with usual tools, and avoid taking public political positions in session; follow the client's framing. [synthesis]

Sources

Web sources:

Books and papers cited:

  • Bacigalupo AM (2007). Shamans of the Foye Tree: Gender, Power, and Healing among Chilean Mapuche. Austin: University of Texas Press.
  • Kleinman A, Eisenberg L, Good B (1978). Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine 88:251-258.
  • American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, 5th ed., text revision (DSM-5-TR).
← Previous · XI-113Kallawaya healers (Bolivia)Next · XI-115 →San Pedro (huachuma) ceremony