Romanian Căluș

1. Introduction

Version followed: the Căluș as described in the UNESCO Representative List entry (proclaimed 2005, inscribed 2008) and the 2022 booklet of the National Commission of Romania for UNESCO, with Romanian and international ethnography (Kligman 1981; Iuga and Vlahbei 2022; Călinescu 2023; Săraru 2010; Alexa 2025) as attributed outside or scholarly context. The clinical inventory follows the DSM-5-TR Cultural Formulation Interview (CFI) and its supplementary modules.

What it is. The Căluș (Căluş) is a ritual dance performed around Rusalii (Pentecost, Whitsun) by all-male groups of dancers, the căluşari, to two violins and an accordion. It is typical of the Olt region and Oltenia in southern Romania and is also part of the heritage of the Vlachs of Bulgaria and Serbia. The groups go from house to house and through public spaces, and by tradition the căluşari were "thought to be endowed with magical healing powers", promising households health and prosperity. The UNESCO text says the ritual probably descends from ancient purification and fertility rites centred on the horse, and that the name comes from the wooden part of a horse's bridle. The Romanian UNESCO Commission calls it "a prophylactic and healing ritual". [source: https://ich.unesco.org/en/RL/calus-ritual-00090] [source: https://www.cnr-unesco.ro/uploads/media/PATRIMONIU_IMATERIAL_eng.pdf]

The affliction it is associated with. Romanian folk belief, as ethnographers report it, holds that the Iele (also called Rusalii), feminine mythological beings, are most active in the Whitsun period, and that people who break that period's work taboos, or who are out at night, may be struck ill by them. The condition is called being luat din Căluș (taken by the Căluș) or taken by the Rusalii/Iele. Scholars have glossed it in their own terms as "a neurological disorder" (Călinescu 2023) or as psychoneurotic conditions and "a kind of epilepsy" believed to be caused by these beings (Săraru 2010); these are outsiders' glosses, not the community's own category. The căluşari are described as the only ones able to heal it, through an ecstatic dance ritual that ethnographers say involves trance. [source: https://folklore.ee/folklore/vol87/iuga_vlahbei.pdf] [source: https://martor.muzeultaranuluiroman.ro/archive/martor-28-2023/10_calinescu/] [source: https://www.diacronia.ro/indexing/details/A5858/pdf]

What remains today. Several scholars report that the healing function has largely receded and that the dance now survives mainly as performance, festival and heritage emblem (Săraru 2010; Kligman's 1970s fieldwork found it was, for some, "a vivid memory of a healing and fertility ritual"). Others argue the ritual is still living: healings were recorded in Giurgița (Dolj) in 2008 and 2009, and a 2023 study examines current healing in Dolj County. Commercial and staged performance has grown since the communist period and since the UNESCO listing (Alexa 2025). [source: https://folklore.ee/folklore/vol87/iuga_vlahbei.pdf] [source: https://www.folklore.ee/ritual_year/RY/article/view/57]

What this guide is for. The Căluș is a community heritage tradition held by village căluşari groups and their leaders; a psychotherapist does not perform it. This guide covers the psychotherapist's own culturally responsive work with a client for whom the Căluș, the Iele and the Rusalii period carry meaning: a Romanian or Vlach client who explains distress as being luat din Căluș or struck by the Iele; a family member of such a person; or a căluşar himself. Change, from the therapist's side, comes from understanding the client's own explanatory model, distinguishing culturally meaningful experience from illness that needs other care, and supporting whatever combination of family, community, church, medical and psychological help the client chooses. [synthesis]

2. Framework

The Căluș is a heritage ritual, not a therapy model, so it has no clinical phases. The framework below is for the psychotherapist's own work alongside it. [synthesis, built on the CFI's stated uses: source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]

Who holds authority in the tradition.

The vătaf (master, leader) heads each group, sets the dance sequence and gives commands; the căluşari swear obedience to him. UNESCO says young men "used to be initiated into the ritual by a vataf", who inherited the charms (descântece) and steps from his predecessor. [source: https://ich.unesco.org/en/RL/calus-ritual-00090] [source: https://folklore.ee/folklore/vol87/iuga_vlahbei.pdf]
The masked Mute (Mutul) shares ritual authority with the vătaf in some groups, acting as his helper or opponent; the Romanian UNESCO booklet describes this shared authority. [source: https://www.cnr-unesco.ro/uploads/media/PATRIMONIU_IMATERIAL_eng.pdf] [source: https://folklore.ee/folklore/vol87/iuga_vlahbei.pdf]
Official heritage bodies: the National Commission for the Safeguarding of the Intangible Cultural Heritage, a specialist body of the Romanian Ministry of Culture, coordinates safeguarding and grants the title Tezaur Uman Viu (Living Human Treasure); vătafs of căluşari groups have received it (e.g. Dăbuleni, Dolj, 2024), nominated through county centres for the conservation and promotion of traditional culture. [source: https://tvrinfo.ro/?p=267731] [source: https://www.cnr-unesco.ro/uploads/media/PATRIMONIU_IMATERIAL_eng.pdf]
Scholarly documentation comes from Romanian ethnographic institutions (e.g. the Constantin Brăiloiu Institute of Ethnography and Folklore; the Museum of the Romanian Peasant's journal Martor). These are documenters, not ritual authorities. [source: https://www.folklore.ee/ritual_year/RY/article/view/57]
The relationship between the Căluș and the Romanian Orthodox Church: the ritual sits within the Orthodox calendar (after the Saturday of the Souls, around Pentecost), but the Church's current stance on Căluș healing is [uncertain: not verified]. [source: https://folklore.ee/folklore/vol87/iuga_vlahbei.pdf]
No formal programme exists, as far as published sources show, for clinical referral to căluşari, in Romania or abroad [uncertain: not verified].

Phases of the therapist's work [synthesis]

Phase	Goal	Typical format	Move on when
1. Engagement and cultural assessment	Hear the problem in the client's own words; run the core CFI; learn whether Căluș, Iele or Rusalii meanings are part of it	1–2 sessions (CFI within the first assessment); interpreter if needed	Client's own name for the problem, causal account, help-seeking history and expectations are recorded
2. Differential and safety	Separate culturally meaningful experience from conditions needing medical or psychiatric care (seizures, functional neurological symptoms, dissociative or psychotic disorders, depression); check safety	1–2 sessions plus medical referral where indicated; informant interview with consent	Medical red flags have been routed; risk is assessed; working formulation agreed
3. Shared formulation and plan	Combine the client's model with the clinical picture in language both accept; agree goals	1 session, repeated as needed	Client endorses the formulation and the plan's mix of help sources
4. Working alongside community help	Psychological treatment for the agreed target; respectful coordination with family, community or church help the client chooses	Usual course of the chosen evidence-based therapy	Goals met or reviewed
5. Integration and review	Make sense of any healing experience; revisit identity, heritage and migration themes; plan for the next Rusalii season if it is a recurring trigger	1–3 sessions; may recur seasonally	Client can name what helps and when to seek which kind of help

CFI modules can be used at first evaluation, later in care or repeatedly. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]

3. Guiding principles

You are alongside the tradition, not inside it. Practical meaning: never offer, imitate, stage or advise on Căluș healing, charms or dance; your work is assessment, formulation, psychotherapy, coordination. [synthesis]
Authority sits with the vătaf, the group and the community. Practical meaning: if a client wants Căluș-related help, it comes through their own village or family pathways; do not broker contact with performers or festival groups as healers. [source: https://ich.unesco.org/en/RL/calus-ritual-00090] [synthesis]
Attribute, neither affirm nor dismiss. Practical meaning: say "in your family's understanding, the Iele…" rather than stating that spirits did or did not cause the illness. [synthesis]
The client's own term is primary. Practical meaning: record luat din Căluș or the client's phrase verbatim, with its meaning to them, before any diagnostic term. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
Variation is the rule. Practical meaning: ethnographers report different practices between groups and villages, and between belief and performance; do not assume a Romanian client believes in, values or even knows of the healing aspect. [source: https://martor.muzeultaranuluiroman.ro/archive/martor-28-2023/10_calinescu/] [source: https://www.folklore.ee/ritual_year/RY/article/view/57]
Cultural meaning does not exclude illness, and illness does not cancel meaning. Practical meaning: always run the medical and psychiatric differential, especially for seizure-like, trance or paralytic symptoms, while keeping the client's explanation in the formulation. [synthesis; diagnostic exclusions: source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574]
Do not reproduce the tradition. Practical meaning: no charms, ritual steps or dance-healing procedures in notes, handouts or sessions; when a client recounts them, record only that they took part and what it meant. [synthesis]
Consent governs collaboration. Practical meaning: contact family, community figures or clergy only with the client's explicit, specific, documented consent. [synthesis]
Heritage, pride and loss matter clinically. Practical meaning: decline, commercialisation and migration can mean loss or pride for clients from căluşari villages; explore it rather than treating it as background. [source: https://folklore.ee/folklore/vol87/iuga_vlahbei.pdf] [synthesis]
Safety overrides cultural deference. Practical meaning: any delay of urgent medical care, harm to a person, or risk to a child is acted on through usual safeguarding routes, explained respectfully. [synthesis]

4. Intervention inventory

All interventions below are the psychotherapist's own. None of them performs, imitates or substitutes for Căluș healing. Example language is illustrative unless quoted and cited.

4.1 Cultural humility and self-examination

Purpose / when: before and throughout work with a client from a Romanian or Vlach background where Căluș, Iele or Rusalii meanings may arise; especially when the therapist shares the background (urban vs village, believer vs sceptic) or holds views about "superstition" or about Romanian folklore as national symbol. [synthesis]
Steps: (1) Note your own assumptions: is the Căluș to you a stage spectacle, a national emblem, a superstition, a sacred tradition? (2) Note any status gap (urban professional, migrant, village origin, Roma or Vlach identity, generation). (3) Read at least the UNESCO and Romanian UNESCO Commission descriptions so the client does not have to educate you from zero. (4) In supervision, review moments where you corrected, smiled at or over-romanticised the client's account. [synthesis] [source: https://ich.unesco.org/en/RL/calus-ritual-00090]
Example language (illustrative): "I know the Căluș mostly as something performed at festivals. I'd like to understand what it means in your family and village, which may be quite different."
Watch for: the client switching to a performative, folkloric register ("it's just an old custom") when they sense judgement; over-identification if you share the background. It is working when the client volunteers family meanings and doubts without prompting.

4.2 Core Cultural Formulation Interview (CFI)

Purpose / when: at initial assessment for any client, and specifically to bring out whether the client frames the problem as luat din Căluș, an Iele affliction, a Rusalii taboo breach or something else. The CFI has 16 questions 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. It supports clinical understanding and is not meant to be the only basis for diagnosis. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
Steps: (1) Use the official APA form (it may be reproduced by clinicians for use with their patients; translation or modification needs APA permission). (2) Ask about the problem in the client's words first; write their term verbatim. (3) Ask about causes as the client and their family and community see them. (4) Ask about stressors and supports, including the role of cultural identity (village, region, religion, migration). (5) Ask what the client has done to cope and whom they have consulted (family, priest, doctor, healer, căluşari). (6) Ask about barriers and preferences, and about the client–clinician relationship (language, prejudice). (7) Summarise back and check. Duration of the CFI is not fixed in the official forms; a field trial found later interviews took less time [uncertain: minutes not verified]. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf] [source: https://experts.umn.edu/en/publications/feasibility-acceptability-and-clinical-utility-of-the-cultural-fo/]
Example language (illustrative): "Sometimes people describe a problem differently to their family than to a doctor. How would your family at home describe what happened to you?" / "Is there anyone your family thought could help, outside doctors?"
Watch for: reluctance to name a folk explanation to a clinician (fear of being seen as backward); the explanation emerging only at the help-seeking questions. It is working when the client's own term and causal story are on record and the client agrees with your summary.

4.3 CFI supplementary modules and Informant Version

Purpose / when: to deepen specific areas when Căluș or Iele meanings matter. Relevant modules among the twelve: Explanatory Model; Spirituality, Religion and Moral Traditions; Cultural Identity; Coping and Help-Seeking; Social Network; Immigrants and Refugees (for diaspora clients); Older Adults; School-Age Children and Adolescents. The Informant Version (17 questions) is for a family member or friend. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf]
Steps: (1) Choose modules from what the core CFI raised (e.g. Spirituality module if Orthodox faith and folk belief coexist or conflict). (2) Use the Informant Version with consent when the client was in a trance-like or altered state they cannot fully recall, or when family hold the explanation more strongly than the client. (3) Record differences between client and informant accounts without adjudicating. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf] [synthesis for selection]
Example language (illustrative): to an informant, "When this happened, what did people in the family think was going on? Who did they think could help?"
Watch for: family pressure toward one explanation; the client deferring to elders in the room (consider separate interviews). It is working when you can state each person's model separately.

4.4 Exploring the explanatory model (Kleinman)

Purpose / when: to map the client's understanding in detail once luat din Căluș, the Iele or a Rusalii taboo has been named. Kleinman, Eisenberg and Good (1978) proposed eight questions; in paraphrase they cover: what the client calls the problem; what caused it; why it began when it did; what it does and how it works; how severe it is and how long it will last; what treatment the client thinks they should receive; the chief problems it has caused; what the client fears most about it. [source: https://tanenbaum.org/wp-content/uploads/2021/06/HANDOUT-Explanatory-Models-of-Illness.pdf] [source: https://www.cambridge.org/core/product/F99D9D36838A8207D377730DEB445F7B/core-reader]
Steps: (1) Ask the questions conversationally, in the client's own terms. (2) Pay special attention to timing (Whitsun period, a taboo breach such as working on a feast day, being out at night), since ethnographers report these as attributed causes. (3) Ask what the client expects from you versus from family, church or community. (4) Write a short paragraph in the client's words and read it back. [source: https://www.diacronia.ro/indexing/details/A5858/pdf] [synthesis]
Example language (illustrative): "You said it started around Rusalii. What do you and your family think made it start then?" / "What are you most afraid this might mean?"
Watch for: guilt or self-blame for a taboo breach; fear of recurrence each year; a model that blends biomedical and folk causes (common and acceptable). It is working when fears and expectations are explicit and can be addressed in the plan.

4.5 Placing the idiom within cultural concepts of distress

Purpose / when: for formulation and documentation. DSM-5-TR describes cultural concepts of distress as including idioms, explanations or perceived causes, and syndromes. Luat din Căluș is not among the named DSM-5-TR examples (which include, for instance, ataque de nervios, khyâl cap, kufungisisa, susto) [uncertain: full DSM-5-TR list not verified from a primary source]; it works locally as an explanation and perhaps as an idiom. [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-SectionIII.pdf] [source: https://www.unmc.edu/bhecn/_documents/dsm5tr_bw_6_slides_11_pages.pdf]
Steps: (1) Decide with the client whether the term names the experience (idiom), the cause (explanation), or a recognised pattern of signs (syndrome). (2) Document it in the cultural formulation section of your notes, not as a diagnosis. (3) Keep any DSM or ICD diagnosis separate and justified on its own criteria. [synthesis]
Example language (illustrative): "When you say you were 'taken', is that the name for what you felt, or your explanation of why it happened, or both?"
Watch for: using the folk term as a diagnostic label in reports; scholarly glosses ("neurological disorder", "a kind of epilepsy") being treated as clinical findings. It is working when the formulation keeps the client's meaning and the clinical description distinct but linked.

4.6 Asking about healer and community consultation without judgement

Purpose / when: at every assessment and review, to learn whether the client or family has sought help from căluşari, a vătaf, other folk healers (descântătoare), priests or monasteries, and what came of it. [synthesis]
Steps: (1) Normalise: many people use several sources of help. (2) Ask what was sought, what it meant, and whether it helped. (3) Ask whether anything was asked of them (payment, restrictions, stopping medicines). (4) Record without ritual detail. (5) Ask whether they want you to know about future consultations, and whether they would like you to coordinate. [synthesis]
Example language (illustrative): "Some families ask the căluşari or a priest for help with this kind of thing. Has anyone in your family done that? What was it like for you?"
Watch for: concealment (the client expects disapproval); signs that urgent medical care was delayed. It is working when the client discusses all help sources openly and you can plan around them.

4.7 Distinguishing normative experience from disorder

Purpose / when: whenever trance, collapse, seizure-like episodes, paralysis, altered identity or voices are described in connection with the Iele, the Rusalii period or Căluș healing; also for căluşari who describe trance during performance or healing. [synthesis]
Steps: (1) Establish context: did the altered state occur within a community-recognised ritual, voluntarily, and resolve within it? (2) Apply the diagnostic exclusions: DSM-5 dissociative identity disorder (possession form) and dissociative trance under other specified dissociative disorder exclude states that are a normal part of a broadly accepted cultural or religious practice; ICD-11 6B62 Trance disorder and 6B63 Possession trance disorder require the state to be involuntary and unwanted and not part of accepted cultural or religious practice, with distress or impairment. (3) Screen for seizures, syncope, functional neurological symptoms, psychosis, mood disorder, substance use and trauma. (4) Refer for medical and neurological assessment for any seizure-like or paralytic episode; scholarly glosses link this affliction with "a kind of epilepsy", so do not assume a cultural cause rules out a neurological one. (5) Consult a cultural broker or informant on what is locally normal. [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] [source: https://www.findacode.com/icd-11/code-1807490186.html] [source: https://umsystem.pressbooks.pub/aswbprep/?p=1299] [source: https://www.diacronia.ro/indexing/details/A5858/pdf] [synthesis for steps 3–5]
Example language (illustrative): "Some experiences are a recognised part of a tradition and some are a sign that the body or mind needs other care. Can we look at both together?"
Watch for: pathologising a căluşar's ritual trance; missing epilepsy, functional seizures or psychosis because a folk explanation was offered. It is working when you can state why the experience does or does not meet criteria, with the cultural context recorded.

4.8 Interpreters and cultural brokers

Purpose / when: when the client prefers Romanian (or another language, such as Vlach Romanian, Bulgarian or Serbian) for emotional or spiritual material, or when local meaning is unclear to you. [synthesis]
Steps: (1) Use a trained professional interpreter, not family, for assessment. (2) Brief the interpreter that folk terms (luat din Căluș, Iele, Rusalii) must be kept in the original, not translated as "possessed" or "epileptic". (3) Check the interpreter's own attitudes (urban–rural, religious) and confidentiality concerns in small diaspora communities. (4) For cultural meaning, consult with consent a cultural broker such as a Romanian-speaking clinician or an ethnographer familiar with the region; published ethnography (e.g. Martor, the Constantin Brăiloiu Institute) can orient you but does not speak for the client's village. (5) Debrief the interpreter afterwards. [synthesis] [source: https://www.folklore.ee/ritual_year/RY/article/view/57]
Example language (illustrative): "Please keep any words for spirits or illnesses in Romanian, and tell me afterwards if a word has no easy English equivalent."
Watch for: interpreter softening or editorialising ("she means she was nervous"); client fear the interpreter knows their community. It is working when the client's terms appear verbatim in notes with the client's own gloss.

4.9 Working with family and community

Purpose / when: when family hold the Căluș or Iele explanation, arranged or want to arrange community healing, or disagree with the client or with clinical care. [synthesis]
Steps: (1) Get the client's consent on who to involve and what to share. (2) Hear each family member's model (CFI Informant Version can structure this). (3) Find shared goals ("we all want her well and back at work"). (4) Negotiate a plan that keeps medical safety and respects family help-seeking. (5) Agree how disagreements will be handled. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Informant.pdf] [synthesis]
Example language (illustrative): "You and the doctors may explain this differently, and you both care about the same outcome. Can we write down what each of you thinks will help?"
Watch for: the client being overruled; family shame about either the illness or the folk explanation; pressure to stop medical treatment. It is working when the family supports the agreed plan and the client feels heard.

4.10 Collaboration and referral with community-sanctioned help, when the client wishes

Purpose / when: only when the client asks for community, folk or church help to be part of their care. Authority for Căluș healing rests with the vătaf and his group in the client's own community; you do not choose, recruit or vet a healer. [source: https://ich.unesco.org/en/RL/calus-ritual-00090] [synthesis]
Evidence context (other traditions, not Căluș): in Nigeria and Ghana, the COSIMPO cluster trial (Gureje et al., The Lancet, 2020) found collaborative shared care between traditional and faith healers and primary care workers reduced psychosis symptoms more than usual care, with fewer harmful practices; in a Ghanaian prayer camp (Ofori-Atta et al., Br J Psychiatry 212(1)), adding psychiatric medication to usual care reduced symptoms, but days in chains were not significantly reduced. These show collaboration can work and its limits; no comparable study of Căluș healing exists in published sources [uncertain: not verified]. [source: https://pubannotation.org/docs/sourcedb/PubMed/sourceid/32861306] [source: https://centreforglobalmentalhealth.org/node/839] [source: https://www.mentalhealthdataprizeafrica.aphrc.org/repository/paper/33405/joining-psychiatric-care-and-faith-healing-in-a-prayer-camp-in-ghana-randomised-trial]
Steps: (1) Clarify what the client wants (e.g. to return home at Rusalii to see the căluşari, a priest's blessing, family support) and why. (2) Keep the client as the link: the client or family arranges any community help through their own pathways. (3) Check medical safety (no stopping prescribed medicines, no delay of medical review); route medicine questions to the prescriber. (4) If the client wants you to speak with someone (priest, family elder), get specific written consent and share only what is agreed. (5) Afterwards, ask what happened and what it meant (see 4.11). (6) Do not refer clients to staged or festival groups as healers; the healing function belongs to the village tradition. [synthesis] [source: https://www.folklore.ee/ritual_year/RY/article/view/57]
Example language (illustrative): "If going home for Rusalii feels important to your recovery, let's plan around it so your treatment here continues safely."
Watch for: the client seeking your endorsement of efficacy (stay attributive); conflicts between church and folk views in the family; financial exploitation by anyone presenting as a healer. It is working when community help and clinical care run side by side without either being hidden.

4.11 Integrating a healing or ritual experience

Purpose / when: after a client has taken part in, witnessed or been the subject of Căluș healing, or after a căluşar has experienced trance in healing. [synthesis]
Steps: (1) Invite an account of the experience at the level of detail the client chooses; do not ask for or record ritual specifics. (2) Explore meaning: relief, fear, belonging, obligation, doubt. (3) Link it to current goals ("what does it mean for how you face this year?"). (4) Address any distress the experience itself caused (fear, shame, bodily after-effects) and route physical symptoms to a doctor. [synthesis]
Example language (illustrative): "What was it like for you, and what has stayed with you since?"
Watch for: intrusive memories or panic after a frightening altered state (consider trauma-focused assessment); conflict between the experience and the client's other beliefs. It is working when the experience is woven into the client's own story rather than avoided or feared.

4.12 Working with căluşari and their families as clients

Purpose / when: when the client is himself a căluşar, vătaf or Mute, or from a căluşari family. Sources describe obedience oaths to the vătaf, shortened performances because of work, travel to towns to raise money, stage self-censorship (the Mute excluded from stage), and growing commercial and festival work. [source: https://folklore.ee/folklore/vol87/iuga_vlahbei.pdf] [source: https://www.folklore.ee/ritual_year/RY/article/view/57]
Steps: (1) Ask about the role and what it means for identity, masculinity, family standing and income. (2) Explore stressors: group hierarchy and conflict, obligations at Rusalii vs work or migration, tension between healing tradition and staged performance, public recognition. (3) Ask about trance or altered states in a non-pathologising way, then screen as in 4.7. (4) Respect confidentiality of group matters; record only what is clinically needed. [synthesis]
Example language (illustrative): "Being a căluşar seems to carry a lot of responsibility. What does it ask of you, and what does it give you?"
Watch for: loss of role (injury, migration, group dissolving) presenting as depression; physical injury from vigorous dancing treated as purely spiritual. It is working when the client can name both what the role sustains and what it costs.

4.13 Migration, heritage loss and identity

Purpose / when: for diaspora clients (Romanian or Vlach) for whom Rusalii, the Iele or the Căluș evoke home, family, or conflict with a new setting. The CFI Immigrants and Refugees and Cultural Identity modules structure this. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
Steps: (1) Map connections to home community and practices. (2) Explore grief, guilt (e.g. not observing Rusalii restrictions abroad) and pride. (3) Identify heritage resources the client values (family, church, cultural associations). (4) Support the client's own choices about practice abroad. [synthesis]
Example language (illustrative): "What has it been like to spend Rusalii far from home?"
Watch for: guilt tied to taboo breaches; isolation. It is working when the client finds meaningful continuity with their heritage on their own terms.

4.14 Safeguarding and medical-delay checks

Purpose / when: whenever any help source (folk, church or other) involves risk: delay of urgent medical care (e.g. seizures, paralysis, high fever treated only as Iele affliction), stopping prescribed medicines, restraint, harm, exploitation, or risk to a child. No source links Căluș healing itself to such harms [uncertain: not verified]; the checks are standard practice. [synthesis]
Steps: (1) Ask directly and routinely about these risks. (2) Explain your duties at the start of therapy. (3) For medical urgency, arrange same-day medical review. (4) For harm to an adult at risk or a child, follow local safeguarding procedures, telling the client and family why. (5) Assess suicide and self-harm risk with standard practice where distress, shame or hopelessness is present. (6) Document factually, without ritual detail. [synthesis]
Example language (illustrative): "Whatever help your family arranges, I need to be sure the seizures are also checked by a doctor. Can we book that today?"
Watch for: reluctance to see a doctor framed as "doctors can't help with this"; children brought for healing instead of medical care. It is working when medical care runs alongside other help.

4.15 Seasonal planning around Rusalii

Purpose / when: when symptoms, fear or family pressure recur each Whitsun period, the time ethnographers associate with heightened Iele activity. [source: https://martor.muzeultaranuluiroman.ro/archive/martor-28-2023/10_calinescu/] [synthesis]
Steps: (1) Plot past episodes against the calendar with the client. (2) Agree early warning signs. (3) Plan supports for that period (family contact, extra sessions, medical review, the client's own religious or community observance). (4) Review after the season. [synthesis]
Example language (illustrative): "Rusalii is coming up in a few weeks. What would help you feel prepared this year?"
Watch for: anticipatory anxiety; avoidance spreading beyond the client's own beliefs. It is working when the season passes with fewer or shorter episodes and less fear.

4.16 Documentation and coding

Purpose / when: after assessment and at review. [synthesis]
Steps: (1) Record the cultural formulation (client's term, explanatory model, help seeking) separately from diagnoses. (2) Use DSM or ICD-11 codes only where criteria are met after applying cultural exclusions (e.g. ICD-11 6B62 or 6B63 only if involuntary, unwanted and outside accepted practice). (3) Avoid pejorative or dismissive terms; attribute beliefs. (4) Do not record ritual procedures, charms or the identity of community healers. [source: https://www.findacode.com/icd-11/code-1807490186.html] [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] [synthesis]
Example language (illustrative, in notes): "Client and family attribute episodes to being 'luat din Căluș' (taken by the Iele during Rusalii); client sought help from family and community; neurological review requested."
Watch for: notes later read by others as mocking or as endorsing. It is working when a reader from the client's community would recognise their account as fairly described.

5. Handling problems

The published sources on the Căluș are ethnographic and heritage texts; they do not address psychotherapy. All guidance in this section is [synthesis] unless a source is given.

Client minimises or hides the folk explanation ("it's just an old custom"). Response: return to it later via help-seeking questions (CFI domains 3–4); say plainly that you ask everyone about family and community explanations; never press. [synthesis] [source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
Client asks whether you believe in the Iele or the căluşari's power. Response: answer honestly and briefly that your role is to understand what it means to them and to help alongside whatever else helps; do not argue or endorse. Example (illustrative): "I don't hold the knowledge your community holds about this. What I can do is help with how it is affecting you now." [synthesis]
Client asks you to recommend or arrange Căluș healing. Response: explain that this sits with their own family and community and the vătaf of their village group; you will coordinate your care around whatever they choose; do not suggest festival or commercial groups as healers. [synthesis] [source: https://ich.unesco.org/en/RL/calus-ritual-00090]
Family or community help is used instead of urgent medical care. Response: name the medical risk clearly and respectfully; frame medical care as "as well as", not "instead of"; arrange review the same day if urgent; follow safeguarding procedures if an adult at risk or a child is endangered. [synthesis]
Client stops medicines after community or church advice. Response: do not advise on medicines; route urgently to the prescriber; explore the meaning of stopping without blame. [synthesis]
Stuck: the client and family attribute everything to the Iele and see no role for therapy. Response: find goals both models share (sleep, fear, functioning, family conflict); offer therapy for these; revisit at review. Accept that the client may decline. [synthesis]
Overwhelm when recalling a frightening trance or collapse. Response: slow down, ground in the present, limit detail, check for trauma symptoms, and consider trauma-focused treatment with standard safety and consent steps. [synthesis]
Rupture after a perceived dismissal (e.g. a doctor called it "superstition"). Response: acknowledge the hurt directly; separate yourself from the remark without disparaging colleagues; repair by asking what would make the service feel respectful. [synthesis] [CFI client–clinician relationship questions: source: https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-CulturalFormulationInterview.pdf]
Non-adherence clustered around Rusalii. Response: anticipate it (4.15); plan flexible sessions or telehealth if the client travels home; do not frame observance as resistance. [synthesis]
Over-romanticising by the therapist (treating the client as a bearer of national folklore). Response: keep the focus on the client's own experience; supervision. [synthesis] [context: the Căluș as national symbol, source: https://folklore.ee/folklore/vol87/iuga_vlahbei.pdf]
Diagnostic disagreement (team labels ritual trance as psychosis or possession trance disorder). Response: present the cultural formulation and the diagnostic exclusions for culturally accepted practice; request an informant interview and cultural consultation; re-examine whether the state was involuntary, unwanted and outside accepted practice. [source: https://pmc.ncbi.nlm.nih.gov/articles/PMC9199574] [source: https://www.findacode.com/icd-11/code-1807490186.html]
Opposite error: a real disorder masked by the cultural account (epilepsy, functional seizures, psychosis, depression). Response: complete the medical and psychiatric differential regardless of explanation; scholarly glosses of the affliction as "neurological" or "a kind of epilepsy" are a prompt for medical review, not a diagnosis. [source: https://www.diacronia.ro/indexing/details/A5858/pdf] [source: https://martor.muzeultaranuluiroman.ro/archive/martor-28-2023/10_calinescu/] [synthesis]
Conflict between Orthodox faith and folk belief in the client or family. Response: use the CFI Spirituality, Religion and Moral Traditions module; explore without taking sides; the client may wish to involve their priest. The Church's stance on Căluș healing is [uncertain: not verified]. [source: https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM5_Cultural-Formulation-Interview-Supplementary-Modules.pdf]
Confidentiality in a small diaspora or village network. Response: discuss explicitly who knows what; choose interpreters with this in mind; share nothing with community figures without specific consent. [synthesis]
A căluşar client injured or no longer able to dance. Response: address loss of role and identity; check for depression; link with medical and rehabilitation care. [synthesis]
Physical contact. The therapist does not touch the client as part of any of this work; any clinical touch follows usual professional rules (explicit consent, right to stop, never sexual). [synthesis]

Sources

Web sources:

Books and articles cited:

Kligman G (1981). Căluş: Symbolic Transformation in Romanian Ritual. Foreword by Mircea Eliade. Chicago: University of Chicago 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.
Works cited within the ethnographic sources above (Vuia 1935; Pop 1962; Oprişan 1969; Eliade 1973 and 1980; Vulcănescu 1985; Giurchescu 1992, 2008, 2009; Ghinoiu 2001, 2005) are named as those sources give them [uncertain: not verified directly].

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