[Mental disease related to belief in being possessed by the "Zar" spirit]

The belief in being possessed by the "Zar" spirit is widespread in East and Central Africa, particularly in Sudan and Ethiopia. It also affects Jews living in Ethiopia, as well as those who have immigrated to Israel. According to this belief, being possessed by Zar is the cause of almost all somatic and mental disturbances. Zar exorcism, rituals, language and the clinical syndromes of 13 cases of Zar possession treated in our outpatient clinic are described. Of the 13, 8 were neurotic and the rest atypical psychotics, who except for 1, remitted quickly. Of the 13, 9 were married, 6 were males and 8 were 40 or older. All had a history of Zar possession while still in Ethiopia, and in the immediate families of 8 there were others with a history of Zar possession. 8 of the cases spoke in a peculiar "Zar language." In all cases the new episode of Zar possession appeared during the first 2 years of living in Israel. The differential diagnosis of DSM-III R categories in relation to Zar possession illness, and anthropological and sociopsychological implications of the illness in Israel as compared to Ethiopia are discussed. According to an accepted theory, Zar possession is found in the weaker strata of Amharic society. In Ethiopia, therefore, it was the women who were usually affected. In Israel, there has been a dramatic emancipation of the Ethiopian woman, and men were relegated to lower status. For these reasons, in Israel it is the men among the Ethiopian immigrants who are more susceptible to the condition. We find it important to combine both traditional and modern therapeutic modalities in treating Zar possession.