Irish fairy doctors and bean feasa

1. Introduction

Version followed: the tradition as historians and folklorists document it: W. B. Yeats's section "Witches, Fairy Doctors" in Fairy and Folk Tales of the Irish Peasantry, Lady Gregory's chapter "Seers and Healers" in Visions and Beliefs in the West of Ireland, First Series, Con Costello's Kildare account of Moll Anthony, Andrew Sneddon's 2022 history of Irish magical healing (1852–1922) and Julia Rosari Kingston's 2019 ethnography of Irish vernacular medicine. The therapist's own work follows the DSM-5-TR core Cultural Formulation Interview (CFI) and the APA supplementary modules.

What it is. "Fairy doctor" is the term Yeats used for healers whose power was held to come from the fairies together with "a something--a temperament--that is born with him or her"; he set them against witches, who were held to draw on evil spirits, and described fairy doctors as consulted for advice on spells affecting butter and milk, suspected changelings and the "fairy blast" (a swelling or paralysis attributed to a fairy stroke) [source: https://www.sacred-texts.com/neu/yeats/fip/fip43.htm]. The bean feasa (Irish, "wise woman") was a healer who, as the tradition held, contacted otherworld forces to cure physical and mental ailments; some nineteenth-century practitioners drew clients from wide areas [source: https://askaboutireland.ie/reading-room/history-heritage/folklore-of-ireland/folklore-in-ireland/healers-and-healing/magic-and-religious-cures/]. Historian Andrew Sneddon sorts Irish magical healers of 1852–1922 into well-informed amateurs (home remedies passed on orally), charmers (who healed free of charge) and paid cunning-folk who specialised in diagnosing and curing the effects of fairy and witchcraft attack on people and animals; healing of this kind was especially common among the rural poor, often used instead of doctors, and healers occasionally came before the lower courts when cures failed [source: https://pure.ulster.ac.uk/en/publications/gender-folklore-and-magical-healing-in-ireland-1852-1922/].

Named historical figures (as sources report them).

Biddy Early of Feakle, Co. Clare: the most famous bean feasa; died 1874; drew clients from all over Ireland; tradition held that she had a bottle given to her by the fairies [source: https://askaboutireland.ie/reading-room/history-heritage/folklore-of-ireland/folklore-in-ireland/healers-and-healing/magic-and-religious-cures/]. Lady Gregory's informants said her knowledge came from the fairies, that she had been "away" (taken by the fairies) for seven years, and that local priests opposed her; clients brought sick children and adults, people "touched" or "led astray", and lost or straying livestock [source: https://gutenberg.org/cache/epub/43973/pg43973-images.html]. Birth c. 1798, the name Bridget Ellen Connors, and an 1865 court appearance in Ennis under a witchcraft statute that ended for lack of evidence come from an encyclopaedia summary citing Meda Ryan (1978) and Edmund Lenihan (1987) [uncertain: secondary source only] [source: https://en.wikipedia.org/wiki/Biddy_Early].
Moll Anthony of the Red Hills, Co. Kildare (also called Mary Leeson; died about 1878): consulted for paralysis, fits, strokes and other illnesses in people and animals; said to have received her gift from the fairies; her herbal remedies came with strict conditions, and a broken condition was taken to explain failure [source: https://askaboutireland.ie/reading-room/history-heritage/folklore-of-ireland/folklore-folk-tales-and-c/moll-anthony-of-the-redhi]. Tradition records that she was refused Christian burial [source: https://askaboutireland.ie/reading-room/history-heritage/folklore-of-ireland/folklore-in-ireland/healers-and-healing/magic-and-religious-cures/]. Kildare schoolchildren were still recording stories of her in the 1930s Schools' Collection [source: https://duchas.ie/en/cbes/4769953/4762551].

Core idea of change, as the tradition held it. Illness, paralysis, wasting or strange behaviour could be attributed to the fairies (a "touch" or "stroke", being "away", or a changeling left in a person's place); a healer with a recognised otherworld connection identified the cause and gave a remedy with conditions, and a failed cure was explained by a broken condition or by the illness being beyond help [source: https://gutenberg.org/cache/epub/43973/pg43973-images.html] [source: https://askaboutireland.ie/reading-room/history-heritage/folklore-of-ireland/folklore-folk-tales-and-c/moll-anthony-of-the-redhi]. These are the tradition's own explanations, reported here neither as fact nor dismissed.

What remains today. This is mainly a historical tradition, not a therapy. Vernacular healing continues in twenty-first-century Ireland: plant-based cures, manipulative techniques such as bone-setting, and charms, prayers and rituals for conditions such as shingles, ringworm and haemorrhage, held by people who trace their cure through a line of transmission [source: https://cora.ucc.ie/handle/10468/7872]. A 2019 University of Wales Press volume on Irish charms includes recent fieldwork on a contemporary healer's methods [source: https://folklore.indiana.edu/research/publications/2019-charms-ireland.html]. A distinct paid "fairy doctor" role with a living community of practice is not documented in the current scholarship cited here [uncertain: not verified]. Present-day services sold as "fairy doctoring" or "bean feasa healing" are best treated as modern reconstructions unless a community and a line of transmission stand behind them [synthesis].

For the psychotherapist. You do not practise any of this. Your work is culturally responsive psychotherapy alongside it: understanding what fairy-related idioms, family stories and visits to people with "the cure" mean to the client; telling cultural idiom apart from illness; supporting any wish to combine help sources; and safeguarding where belief is used to justify harm or delay medical care. Change, in your work, comes from a shared understanding of the problem in the client's terms, less shame, accurate diagnosis and a plan the client can own [synthesis].

2. Framework

The tradition has no therapy phases. The framework below is for the psychotherapist's own work; APA sources govern the CFI parts and the rest is [synthesis].

Who holds authority and what stands behind the tradition.

Historically, authority came from community reputation, a claimed gift (from the fairies, from being "away", or from a dead relative, as informants told Lady Gregory) and inherited knowledge, not from any licensing body [source: https://gutenberg.org/cache/epub/43973/pg43973-images.html] [source: https://en.wikipedia.org/wiki/Biddy_Early].
Today, holders of a cure are recognised locally and through lineage or transmission; Kingston's ethnography discusses their legal status and their standing within their communities [source: https://cora.ucc.ie/handle/10468/7872]. There appears to be no statutory register or professional body for these healers [uncertain: not verified].
The Catholic Church historically opposed healers such as Biddy Early, and orthodox medicine disapproved of magical healers [source: https://gutenberg.org/cache/epub/43973/pg43973-images.html] [source: https://pure.ulster.ac.uk/en/publications/gender-folklore-and-magical-healing-in-ireland-1852-1922/]. A client's own priest, minister or faith community may be a relevant voice for them [synthesis].
The archive of the tradition is the National Folklore Collection, UCD, which holds the 1930s Schools' Collection (published on dúchas.ie, UNESCO Memory of the World badge 2017) [source: https://duchas.ie/en/cbes/4769953/4762551]. Folklore scholars at UCC and elsewhere interpret the material [source: https://ucc.ie/en/bealoideas/research/publications/books/bookofthecailleach]. An archive or a university is not an authority over anyone's healing practice [synthesis].

Phases of the therapist's work.

Engagement and cultural assessment (sessions 1–2). Goal: understand the problem in the client's terms. Format: individual, with the Informant Version if a family member's view matters. Use the 16-question core CFI in four domains: cultural definition of the problem; cultural perceptions of cause, context and support; cultural factors affecting self-coping and past help seeking; cultural factors affecting current help seeking [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]. APA gives no time for the CFI; the field trial found later interviews took less time [uncertain: no minute figure verified] [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/]. Move on when you and the client can name the problem in words you both accept and risk has been screened.
Formulation (sessions 2–4). Goal: an explanatory model, the role of fairy-related or other folk explanations, and a clinical judgement on normative idiom versus disorder. Add supplementary modules as needed; APA allows them at first evaluation, later or repeatedly [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]. Move on when a written formulation is shared with the client and any safeguarding or medical issues have a plan.
Treatment alongside other help (number of sessions set by the presenting problem). Goal: evidence-based treatment for any disorder, delivered in a way that respects the client's meaning frame and other sources of help (a person with "the cure", prayer, the GP). Review the combined plan every 4–6 sessions [synthesis].
Integration and review. Goal: help the client place heritage, family stories and experiences of folk healing in their own life story, and plan relapse prevention. Repeat CFI modules if the picture changes [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf].

3. Guiding principles

Write and speak for the client's tradition, not as part of it. Never offer, imitate or prescribe a cure, charm or fairy remedy; your role is psychotherapy [synthesis].
Attribute, do not adjudicate. Fairy agency, "the touch" and being "away" are described as the client and tradition hold them; you neither affirm them as fact nor dismiss them [synthesis].
Use the client's words. Adopt their terms ("touched", "the cure", "away with the fairies") in reflections once you know what they mean to them [synthesis].
Joke, idiom or belief? Find out. In modern Ireland and the diaspora, fairy language is often humour or idiom; ask before assuming belief or illness [synthesis].
The CFI supports judgement, not diagnosis by itself. APA states it is not meant to be the only basis for a diagnosis [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf].
Avoid both errors. Do not pathologise shared cultural belief, and do not let cultural explanation hide psychosis, delirium or physical illness; the 1895 death of Bridget Cleary, whose husband held that she was a changeling while she was ill with bronchitis, is the defining warning in Irish history [source: https://en.wikipedia.org/wiki/Murder_of_Bridget_Cleary] [uncertain: secondary source].
No advice on remedies or medicines. Do not comment on herbal cures or tell a client to start, stop or change medication; route medical questions to the GP or prescriber [synthesis].
Consent for any contact. Speak with a healer, family member or priest only when the client asks for it and has given written consent about what is shared [synthesis].
Name the history of contempt. Folk belief was mocked as backward and used politically in the nineteenth-century press; expect shame and check your own stereotypes [synthesis] [source: https://www.stfx.ca/media/4551/download].
Safeguarding overrides cultural deference. Any restraint, burning, forced dosing, deprivation or denial of medical care justified by a changeling or fairy explanation is a safeguarding matter, especially for children and disabled or ill adults [synthesis].
Do not steer clients to healers. Support a client's own choice to consult a person with a cure; do not recommend practitioners or reconstructions [synthesis].

4. Intervention inventory

Every item below is the psychotherapist's own work. None is a fairy doctor's or charmer's procedure, and no cure, charm, remedy or divination method is described. Example language is illustrative wording, not taken from any source.

4.1 Cultural humility and self-examination

Purpose / when: before and throughout work with clients of Irish or Irish-diaspora heritage who raise fairy belief, folk cures or family stories of healers; especially if you are Irish yourself and assume you already know what these mean [synthesis].
Steps: (1) Note your reactions to fairy talk (amusement, embarrassment, romanticism, "superstition"). (2) Recall that nineteenth-century newspapers used such belief to portray rural Irish people as primitive, and that clergy and doctors condemned healers [source: https://pure.ulster.ac.uk/en/publications/gender-folklore-and-magical-healing-in-ireland-1852-1922/] [uncertain: press framing from a student essay only] [source: https://www.stfx.ca/media/4551/download]. (3) Separate tourist or "Celtic" imagery from what the client actually reports. (4) Bring cases where you feel judgemental or fascinated to supervision [synthesis].
Example language (illustrative): "I grew up with some of these stories too, but I don't want to assume I know what they mean in your family. Can you tell me how they were talked about at home?"
Watch for: smiling at or exoticising the client's account; the client testing whether you will laugh. It is working when the client brings more detail over time, not less [synthesis].

4.2 Core Cultural Formulation Interview with folk-healing content

Purpose / when: first assessment of any client who mentions fairies, "the cure", charmers, being "touched" or a family history of consulting healers; also routine use, since APA describes the CFI as usable by any clinician in any setting [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf].
Steps: (1) Tell the client you will ask how they and the people around them understand the problem. (2) Work through the four domains in order: cultural definition of the problem (Q1–3); perceived causes, stressors, supports and cultural identity (Q4–10); self-coping, past help seeking and barriers (Q11–13); current help-seeking preferences and the clinician–client relationship (Q14–16) [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]. (3) Use the official APA form; clinicians may reproduce it for use with their own patients, but modifying or translating it needs APA permission [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]. (4) Where folk explanations appear, record them in the client's words and flag which supplementary module to add [synthesis].
Example language (illustrative): "Some people explain what's happening to them in medical terms, some in religious terms, some through things their family has always believed. How do you make sense of it?" "Have you, or has anyone in your family, gone to someone with a cure for this?"
Watch for: the client giving the "official" medical account first and the folk account only later; perceived condescension in Q16 (relationship). It is working when the client volunteers family explanations without apology [synthesis].

4.3 CFI Informant Version

Purpose / when: when a family member's interpretation (for example, that a relative is "not themselves", "away" or "changed") is central, or the client cannot give a full account [synthesis].
Steps: (1) Obtain the client's consent to involve the informant. (2) Use the APA Informant Version: 17 questions, starting with the informant's relationship to the patient, then the same four domains [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]. (3) Compare the informant's model with the client's and note conflicts, especially any belief that the person has been replaced or is not really themselves [synthesis].
Example language (illustrative): "When you say she hasn't been herself, what do you notice? What do you and the family think is behind it?"
Watch for: an informant's account that frames the ill person as not human or not really present; this needs immediate risk review (see 4.12). Working when the family can hold both their explanation and a plan for medical and psychological care [synthesis].

4.4 CFI supplementary modules

Purpose / when: to expand any CFI subtopic. APA lists 12 modules: Explanatory Model; Level of Functioning; Social Network; Psychosocial Stressors; Spirituality, Religion, and Moral Traditions; Cultural Identity; Coping and Help-Seeking; Patient–Clinician Relationship; School-Age Children and Adolescents; Older Adults; Immigrants and Refugees; Caregivers. They can be added to the core CFI or used alone, at first evaluation or repeatedly [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf].
Steps: (1) Choose modules from what the core CFI raised: Spirituality, Religion, and Moral Traditions where Catholic or Protestant practice and folk belief meet or clash; Coping and Help-Seeking where a cure, holy well or charmer has been used; Cultural Identity for diaspora clients; Older Adults where an older client learned the tradition in childhood; Caregivers where a carer holds the folk explanation. (2) Use one or two modules per session. (3) Summarise back and add findings to the formulation [synthesis].
Example language (illustrative): "You mentioned your grandmother took you to someone for a cure. Can we spend some time on how faith, cures and doctors fitted together in your family?"
Watch for: assessment fatigue; module use replacing rapport. Working when the formulation includes the client's own help-seeking map [synthesis].

4.5 Explanatory-model inquiry (Kleinman)

Purpose / when: to map the client's own model of the illness when it includes fairy agency, a "touch", bad luck, a curse or punishment.
Steps: Ask, in your own words, Kleinman's eight questions as paraphrased in a clinical handout: 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 they think they should get; what problems it has caused; what they fear most [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf]. The original paper is Kleinman, Eisenberg and Good (1978) in Annals of Internal Medicine [source: https://www.cambridge.org/core/product/F99D9D36838A8207D377730DEB445F7B/core-reader]. Then note where the client's model and yours overlap, and negotiate a plan using the overlap [synthesis].
Example language (illustrative): "What do you call this, in your own words?" "Why do you think it came on at that point?" "What frightens you most about it?"
Watch for: a model that excludes all medical care (see 4.11); a fear of being "taken" or of something being taken from the family, which may carry grief or guilt. Working when the client can describe both models without feeling caught between you and their family [synthesis].

4.6 Exploring fairy idioms as possible idioms of distress

Purpose / when: when the client or family uses phrases such as "touched", "away with the fairies", "astray", "changed" or speaks of a stroke or blast. DSM-5-TR defines cultural concepts of distress as including idioms, explanations or perceived causes, and syndromes [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf]. No Irish fairy idiom appears among the DSM-5-TR examples listed in a university-hosted summary (which names concepts such as ataque de nervios, khyâl cap, kufungisisa and susto) [source: https://www.unmc.edu/bhecn/_documents/dsm5tr_bw_6_slides_11_pages.pdf]; the exact DSM-5-TR list is [uncertain]. Treating these phrases as idioms or explanations is therefore [synthesis] by analogy.
Steps: (1) Ask whether the phrase is meant literally, half-seriously or as a figure of speech. (2) Ask what the phrase described when used about others in the family or locality. (3) Note the symptoms it covers (in Lady Gregory's collection, being "touched" was linked to sudden illness or paralysis, and "astray" to night-wandering) [source: https://gutenberg.org/cache/epub/43973/pg43973-images.html]. (4) Translate into a clinical description without discarding the client's term [synthesis].
Example language (illustrative): "When your mother said you were 'away with the fairies' that winter, was she joking, worried, or meaning something more?"
Watch for: literal belief newly arising in someone whose family uses the phrase only as a joke, which may signal psychosis; sudden-onset weakness described as "a touch", which needs urgent medical review for stroke [synthesis].

4.7 Asking about "the cure" and healers without judgement

Purpose / when: every assessment where the client is of rural Irish or diaspora background, because vernacular cures for skin conditions, shingles, ringworm and similar problems continue in twenty-first-century Ireland and are held through lines of transmission [source: https://cora.ucc.ie/handle/10468/7872].
Steps: (1) Ask as a normal part of help-seeking (CFI Q12). (2) Ask what the person with the cure did in general terms, whether anything was swallowed or applied, and what the client expected. (3) Ask how the client felt about it and whether their doctor knows. (4) Record it without evaluative language [synthesis]. Do not ask for or record the words of a charm; charmers hold these as given or inherited, and they are not yours to collect [synthesis] [source: https://pure.ulster.ac.uk/en/publications/gender-folklore-and-magical-healing-in-ireland-1852-1922/].
Example language (illustrative): "Lots of families have someone they go to for a cure. Has that been part of things for you?" "Was there anything you were given to take or put on?"
Watch for: concealment because of past ridicule by doctors; ingested or applied remedies alongside prescribed medicines, which must go to the GP or pharmacist. Working when disclosure is matter-of-fact [synthesis].

4.8 Distinguishing culturally shared belief from disorder

Purpose / when: when fairy or changeling beliefs come with distress, impairment, behavioural change or risk; to avoid both pathologising shared belief and missing illness.
Steps: (1) Establish whether the belief is shared by the client's family or community and held in the usual way, or is new, idiosyncratic, fixed and spreading [synthesis]. (2) Screen for delirium, infection, stroke, dementia and substance effects first when onset is sudden; Bridget Cleary was medically diagnosed with bronchitis before her family came to treat her as a changeling [source: https://en.wikipedia.org/wiki/Murder_of_Bridget_Cleary] [uncertain: secondary source]. (3) Assess for psychosis, including misidentification beliefs that a close person has been replaced, which a student analysis of the Cleary case links to Capgras syndrome [uncertain: speculative, student essay] [source: https://www.stfx.ca/media/4551/download]. (4) For possession-type or trance experiences, apply the DSM-5-TR exclusion for experiences that are a normal part of broadly accepted cultural or religious practice (as paraphrased in a university study guide citing APA 2022) [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299] and the ICD-11 codes 6B62 Trance disorder and 6B63 Possession trance disorder, both requiring the state to be involuntary and unwanted and outside accepted cultural or religious practice [source: https://www.findacode.com/icd-11/code-1807490186.html] [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574]. Possession by fairies is not a typical feature of the Irish historical accounts cited in this guide; these codes are relevant only if the presentation fits [synthesis]. (5) Consult a cultural broker or folklore scholar when unsure what is normal in the client's community (see 4.9).
Example language (illustrative): "Is this something others in your family believe in the same way, or is it something you've come to feel more recently?" "Has anyone else noticed what you've noticed about him?"
Watch for: a belief that a family member is not themselves, not human or must be driven out; this is a risk sign whatever its cultural roots. Working when you can state, with the client's input, which parts are shared belief and which are symptoms [synthesis].

4.9 Consulting cultural brokers and folklore resources

Purpose / when: when you need to know how a phrase, story or practice is understood in a particular locality or generation.
Steps: (1) With the client's consent and without identifying them, ask a colleague or community member from the same background, or consult published folklore. (2) Useful published resources include the National Folklore Collection's Schools' Collection on dúchas.ie, compiled by schoolchildren in the 1930s, which records local cures and healers by school and county [source: https://duchas.ie/en/cbes/4769953/4762551], and scholarship such as Ó Crualaoich's study of the wise-woman healer (Cork University Press) [source: https://ucc.ie/en/bealoideas/research/publications/books/bookofthecailleach]. (3) Use what you learn to ask better questions, not to tell the client what they believe [synthesis].
Example language (illustrative): "I've read a bit about how cures were talked about in that part of the country, but I'd rather hear how it was in your family."
Watch for: substituting archive material for the client's own voice; breaching confidentiality in a small community. Working when consultation sharpens your questions [synthesis].

4.10 Coexisting and, where wanted, collaborating with holders of a cure

Purpose / when: only when the client wishes to keep using a charmer or person with a cure alongside therapy, or asks you to be in contact [synthesis].
Steps: (1) Ask what the client wants: simply for you to know, or for some contact. (2) If contact is wanted, get written consent specifying what may be shared. (3) Limit contact to coordination (who is helping with what; warning signs that need a doctor) and never ask about or comment on the cure itself. (4) Agree that medical care and any prescribed treatment continue. (5) Document [synthesis]. There appears to be no formal Irish programme linking folk healers with mental-health services [uncertain: not verified]. Evidence from other settings shows both promise and limits: in Nigeria and Ghana, collaborative shared care between traditional and faith healers and primary-care workers for psychosis reduced symptoms more than usual care (Gureje et al., The Lancet 2020) [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306] [source: https://centreforglobalmentalhealth.org/node/839]; in a Ghanaian prayer camp, adding psychiatric medication lowered symptoms but did not significantly reduce days in chains (Ofori-Atta et al., Br J Psychiatry 212(1)) [source: https://www.mentalhealthdataprizeafrica.aphrc.org/repository/paper/33405/joining-psychiatric-care-and-faith-healing-in-a-prayer-camp-in-ghana-randomised-trial]. Neither concerns Irish healers.
Example language (illustrative): "It's your choice to keep going to him. Would it help if he and I knew a little about each other's part, or would you rather keep them separate?"
Watch for: pressure from you or the family in either direction; any advice from the healer to stop medication or avoid doctors, which you raise with the client and route to the prescriber. Working when the client experiences the two sources of help as compatible [synthesis].

4.11 Medical-care and remedy safety check

Purpose / when: whenever a remedy has been swallowed or applied, a doctor's treatment has been refused, or an illness is being explained only in fairy or cure terms. Historical accounts describe herbal remedies given with strict conditions, and in the Cleary case the husband said he had not been giving the doctor's medicine [source: https://askaboutireland.ie/reading-room/history-heritage/folklore-of-ireland/folklore-folk-tales-and-c/moll-anthony-of-the-redhi] [source: https://en.wikipedia.org/wiki/Murder_of_Bridget_Cleary] [uncertain: secondary source].
Steps: (1) Ask whether anything is being taken or applied and whether the GP or pharmacist knows. (2) Do not comment on the remedy's safety or advise stopping or starting anything. (3) Encourage the client to tell the prescriber, and with consent let the GP know a remedy is in use. (4) For sudden or severe physical symptoms, advise urgent medical assessment [synthesis].
Example language (illustrative): "I'm not the right person to say whether that's safe with your tablets. Would you be willing to mention it to your GP or pharmacist this week?"
Watch for: delay of urgent care; refusal of medicine justified by a healer's conditions. Working when the client tells all their helpers what they are using [synthesis].

4.12 Safeguarding where fairy or changeling explanations drive harm

Purpose / when: any report that a child, ill person, disabled person or older adult is seen as "not themselves", "changed" or a changeling, and is being restrained, burned, forced to take substances, deprived, isolated or denied medical care. In Irish tradition changelings were sickly or disabled children, or occasionally young women, believed to be fairies left in a person's place [uncertain: student essay summarising Bourke] [source: https://www.stfx.ca/media/4551/download]. In 1895 Bridget Cleary, ill with bronchitis, was forced to the fire, had urine thrown on her and was burned to death by her husband, who insisted she was a changeling; he was convicted of manslaughter and sentenced to 20 years' penal servitude, and relatives also received sentences [source: https://en.wikipedia.org/wiki/Murder_of_Bridget_Cleary] [uncertain: secondary source]. Angela Bourke's The Burning of Bridget Cleary (Penguin, 2001) is the standard historical study [source: https://en.wikipedia.org/wiki/Murder_of_Bridget_Cleary] [uncertain: not verified].
Steps: (1) Ask directly about what is being done to the person. (2) Follow your local safeguarding procedures: in Ireland, Tusla for children and HSE safeguarding teams for adults; elsewhere, the equivalent statutory bodies [uncertain: not verified]. (3) If there is immediate danger, contact emergency services. (4) Arrange urgent medical and psychiatric assessment of the person described as changed, and of the person holding the belief if it appears delusional. (5) Keep the cultural explanation in the record as context, not as mitigation [synthesis].
Example language (illustrative): "You've told me your family think she isn't really herself. I need to ask: has anyone done anything to try to bring the real her back?"
Watch for: minimising ("it's only old talk"); escalation around a crisis, bereavement or illness. Working when the person is safe and medically assessed [synthesis].

4.13 Working with family attributions

Purpose / when: when relatives explain a family member's disability, illness, dementia or behaviour change in fairy terms, or blame a past event (disturbing a fairy fort, a broken condition of a cure) [synthesis].
Steps: (1) Meet the family with the client's consent. (2) Elicit each person's explanation (Informant Version, 4.3). (3) Acknowledge the explanation as part of family heritage. (4) Introduce the clinical account as an additional frame that brings practical help. (5) Agree concrete care tasks every member can support [synthesis].
Example language (illustrative): "Your family has its own way of understanding this, and I'm not here to argue with it. What I can add is what we know helps people with these symptoms."
Watch for: blame and guilt about a broken condition or a missed visit to a healer; scapegoating of the ill person. Working when the family shifts from blame to care [synthesis].

4.14 Addressing shame, stigma and historical contempt

Purpose / when: when a client is embarrassed by family beliefs, was mocked for them, or feels torn between a modern identity and a rural or older family culture [synthesis].
Steps: (1) Normalise: vernacular healing has been widespread among the Irish rural poor and persists today [source: https://pure.ulster.ac.uk/en/publications/gender-folklore-and-magical-healing-in-ireland-1852-1922/] [source: https://cora.ucc.ie/handle/10468/7872]. (2) Explore where the shame came from (school, Church, doctors, migration). (3) Separate respect for heritage from agreement with every belief. (4) Use the CFI Cultural Identity module where identity conflict is central [synthesis].
Example language (illustrative): "It sounds as if you were taught to be embarrassed by your grandmother's cures. What do you make of them now?"
Watch for: the client performing scepticism to please you. Working when the client can talk about heritage with neither shame nor defensiveness [synthesis].

4.15 Integrating heritage and experiences of folk healing

Purpose / when: later in therapy, when a client wants to make sense of experiences with a healer, a family legend of a wise woman, or a childhood cure [synthesis].
Steps: (1) Invite the story in the client's words. (2) Explore what it meant then and now (comfort, fear, belonging, control). (3) Link to current strengths and values. (4) If the client wishes, they may look up their family's area in the Schools' Collection themselves [source: https://duchas.ie/en/cbes/4769953/4762551]. (5) Do not interpret the experience as either supernatural or merely psychological [synthesis].
Example language (illustrative): "When you think of being brought to her as a child, what stands out? What does that memory give you now?"
Watch for: distress or fear revived by stories of being "taken"; romanticising that hides real harm. Working when the experience sits coherently in the client's life story [synthesis].

4.16 Working with religious conflict

Purpose / when: when a client feels guilt or conflict because their Church opposed folk healers, or because a cure combines prayer and folk practice. Lady Gregory's informants reported priests warning people away from Biddy Early, and Moll Anthony was, by tradition, refused Christian burial [source: https://gutenberg.org/cache/epub/43973/pg43973-images.html] [source: https://askaboutireland.ie/reading-room/history-heritage/folklore-of-ireland/folklore-in-ireland/healers-and-healing/magic-and-religious-cures/].
Steps: (1) Use the CFI Spirituality, Religion, and Moral Traditions module. (2) Explore what the client's faith means to them now. (3) If the client wishes, support contact with their own priest, minister or chaplain; you do not rule on doctrine [synthesis].
Example language (illustrative): "It sounds like going for the cure felt like going against the Church. How do you hold those two things now?"
Watch for: scrupulosity or moral-injury themes; fear of punishment. Working when the client reaches their own position without coercion [synthesis].

5. Handling problems

The historical sources do not address psychotherapy; all guidance in this section is [synthesis] unless a source is given.

Client treats the topic as a joke and moves on. Accept the humour, then return once: "You laughed, but you brought it up. Is there a serious part to it?" If not, drop it; fairy idiom is often just idiom [synthesis].
Client expects you to mock them (or you catch yourself smiling). Name it: "Doctors haven't always taken this seriously. I want to understand it, not judge it." Repair any visible amusement at once and take it to supervision [synthesis].
Client asks whether you believe in fairies or in the cure. Answer honestly and briefly, without arguing: "My job isn't to decide that. It's to understand what it means for you and to make sure you get every kind of help you want." [synthesis]
Client asks you to recommend a healer or a cure. Decline kindly; you do not refer to folk healers or reconstructions. Explore what they hope a cure would give them and whether their GP and family can help them find what they want [synthesis].
Stuck: the explanatory models do not meet. Return to Kleinman's last question (what they fear most) and build the plan on shared goals (sleep, safety, getting back to work) rather than on agreement about cause [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf] [synthesis].
Non-adherence because a healer's conditions conflict with medical treatment. Do not argue with the condition; ask the client how they weigh it, ensure the prescriber knows, and agree what would signal the need for urgent care [synthesis]. Historical cures were often bound by strict conditions whose breach was blamed for failure [source: https://askaboutireland.ie/reading-room/history-heritage/folklore-of-ireland/folklore-folk-tales-and-c/moll-anthony-of-the-redhi].
Guilt after a "failed" cure. Explore self-blame for breaking a condition or not going sooner; reframe responsibility and grief [synthesis].
Overwhelm or fear (being "taken", being punished, a curse). Slow down, ground, check risk and sleep, and assess for anxiety or psychotic disorder. Do not offer counter-rituals or reassurance about the supernatural [synthesis].
New literal belief that someone is a changeling or has been replaced. Treat as an emergency until shown otherwise: check safety of the person described, arrange urgent psychiatric and medical assessment, follow safeguarding procedures (4.12). The Cleary case shows how fast such belief can escalate in a household during illness [source: https://en.wikipedia.org/wiki/Murder_of_Bridget_Cleary] [uncertain: secondary source].
Family pressure on the client to use or to stop using a healer. Support the client's own choice; involve the family only with consent and use the Informant Version or a family session (4.3, 4.13) [synthesis].
Rupture over safeguarding action. Explain that the action concerns harm, not the family's beliefs; acknowledge the hurt; offer a review session; keep the door open [synthesis].
Small-community confidentiality. In rural areas the healer, priest and family may know each other and you. Be explicit about what you will and will not share and with whom [synthesis].
Client uses a modern "fairy healing" or "bean feasa" service. Explore it like any help-seeking; note costs, claims, any advice to avoid medical care, and any exploitation; do not present it as the historical tradition [synthesis].
Diaspora clients. Use the Cultural Identity and, where relevant, Immigrants and Refugees modules; family beliefs may have changed, faded or hardened after migration [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] [synthesis].
Your own uncertainty about what is normal. Consult a cultural broker or folklore resource (4.9) and record the uncertainty in the formulation rather than resolving it by guesswork [synthesis].

Sources

Web sources

Books cited (details as given by the sources above)

Bourke A. The Burning of Bridget Cleary. Penguin, 2001 [uncertain: not verified].
Ryan M. Biddy Early: The Wise Woman of Clare. 1978; Mercier Press edition 1991 [uncertain: not verified].
Lenihan E. In Search of Biddy Early. Mercier Press, 1987 [uncertain: not verified].
Gregory A. Visions and Beliefs in the West of Ireland. 1920.
Fitzgerald W. Journal of the County Kildare Archaeological Society, vol. VIII, p. 79 (on Moll Anthony) [uncertain: not verified].
Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine 1978;88:251–258.

← Previous · XI-136Norse seiðr Next · XI-138 →Cornish pellars