PERIPHERALIA

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A linear, cause-and-effect reasoning for many of the events, 
occurrences and illnesses seen in the technological world 
of the 21st century is instilled through Western medical 
education. Our logical reasoning becomes so ingrained 
that we may become automatically dismissive of mystical or 
mythical reasoning on behalf of our patients.

I have a patient with bipolar mood disorder, with psychotic 
features, and I asked her what she thought had caused her 
illness. She replied that it was due to “izilwane”. This literally 
mean “animals” in isiZulu, but in a medical context, it means 
“mythical creatures” as an explanation of her illness.

This is an example of what are called “familiars” or familiar 
spirits. These are supernatural beings who assist sorcerers 
in the practice of magic, and are concepts that have been 
present in most cultures for thousands of years.  They often 
appear in the form of an animal, or in human or humanoid 
form. They can be malevolent, if sent by a witch or sorcerer; 
or benign, such as the tokoloshe, who is in a humanoid form, 
and not necessarily sent by malevolent forces, but works 
on his own and is up to mischief. You will, of course, receive 
different explanations from different communities, with 
different indigenous belief systems, as to the behaviour of 
specific familiar spirits.

Izilwane is a generic term. More particular familiars would 
be creatures such as imikhovu, who are zombies from 
resurrected corpses, and izimpaka, loosely translated as cats 
of various kinds. There are also numerous other animals, such 
as baboons, hyenas and owls, that are specific to the culture 
of the area in which one is living and practising. For instance, 
I note that familiars are often tigers in India, and panthers 
in Central America. Vampires and werewolves in European 
mythology are kept alive nowadays by series such as Dracula 
and the Twilight Sagas.

The above patient was referring to izilwane, sent by a witch 
(umthakathi), but izilwane could also refer to any number of 
crawling creatures which are representatives of ancestors and 
deceased members of the family (amadlozi). Snakes come 
under this heading, rather than under the familiars of witches. 

Lizards are commonly seen as manifestations of amadlozi, 
and praying mantises manifestations of female amadlozi. 
Occasionally, frogs, toads, scorpions, crabs and chameleons 
play this role. Visits by animals representing ancestors are 

usually, but not always, benign. On the other hand, visits by 
familiars are invariably malignant, but other creatures, such 
as tokoloshes, as described, are generally bent on mischief 
more than anything else.

I sometimes ask my patients what they believe the cause 
of their illness to be, and whether or not they have seen a 
traditional healer for the illness. Many reply “No”, and explain 
that they do not believe in these forms of causation or 
traditional beliefs. This then helps me to proceed with the 
Western consultation. Others reply “Yes”, and I then ask them 
to explain what the traditional healer identified the cause of 
the illness to be.

One patient, who I was treating for an anxiety disorder, replied 
“Ngithwetsuliwe”, which loosely translated means “They have 
made me into a zombie”, from the verb, thwebula, meaning to 
bring under one’s control or hypnotise.  My Zulu interpreter 
explained that the witch kidnaps you, and brings you under 
his or her control. You have to follow the instructions of the 
witch and forget about your own existence.  

These explanations give me some insight into where the 
patient is coming from, and into the cultural beliefs behind 
their illness. It is a quick couple of connecting questions to 
a whole realm of sociological data and cultural information. 
You can then take one step back in the reasoning process, as 
the patient may believe that he or she has become vulnerable 
to witchcraft, mediated by third parties or spirits, because 
he or she has failed to perform certain rituals or violated 
taboos, thus causing ancestral displeasure. Therefore, certain 
sacrifices or ceremonies should be performed to appease 
these spirits.

I do not necessarily comment on the replies I receive, unless 
the information is obviously harmful, but accept them at face 
value, and I believe this acceptance helps rapport. For me, it is 
helpful that I know what healers and causational theories are 
important to the patient, so that I can adjust what Foucault 
called my “medical gaze”.  

I can then balance the izilwane with the high density 
lipoproteins.

Chris Ellis 
Family Physician, Pietermaritzburg, KwaZulu-Natal 
e-mail: cristobalellis@gmail.com

Izilwane, imikhovu and  
izimpaka – mythical creatures 

as explanations of illness