“It’s most definitely about wairua”: a story of a fatal road accident, by Dr Himali McInnes
Kiri* and her partner are driving through a small North Island town on their way to catch up with whānau. It’s a spring day in September, the first week of the school holidays. The mighty Waikato River, overhung with cool numinous fog, curves to meet the road, then swings out and further away. Reeds and rushes line the bank, skeletal trees are just starting to burst with life, harakeke trail in the water.
Suddenly there’s a flash of colour to their left. A blur of yellow darts out from between the parked cars. Runs out onto the road.
It’s the most sickening sound Kiri has ever heard. That unmistakable sound of metal and soft flesh colliding. Her stomach twists. “Shit! Was that a kid?”
Kiri’s partner screeches to a stop. They both jump out of the car, and race to the front. Kiri is half praying, half trying not to scream. They see a small child spreadeagled on the damp tarmac.
He’s not moving. His yellow T-shirt has ridden up, exposing his tummy. His right leg, bent at a funny angle, pokes out of his denim shorts; the thigh bone looks odd, swollen.
Kiri kneels beside the boy. She’s not sure if he is alive or dead.
She learnt some basic first-responder training ages ago but she’s never had to use it in real life. Right now, she can’t remember a thing. Her brain is frozen with panic.
“Oh shit, oh shit. No, no, no!”
Kiri’s partner falls to his knees beside the child. “Is he alive? Is he breathing? I’ll call 111!” He punches the emergency number on his phone. “C’mon, little buddy, just open your eyes, c’mon!”
Someone on the pavement starts to scream. The screams bring other people running out of a nearby house. They start yelling when they see the boy. Several adults surround Kiri and her partner. An angry clot of words and hot breath. A young woman pushes Kiri away, cradles the boy’s head. The woman is sobbing in terror.
“What the hell happened?” yells an older man. He’s livid. His eyes pop. He’s practically spitting as he speaks.
“The kid just ran out, it was so quick, I couldn’t even …”
“You been drinking, buddy?”
“You were driving too fast, eh! Weren’t you? Eh?”
“Look, man, it was an accident, I swear!”
“If anything happens to my moko, I’m gonna fucken kill you, bro.”
More family members surround them. Someone jabs Kiri’s partner’s chest, causing him to stumble backwards. He looks at Kiri, frightened. His eyes flick towards their car. Where are the police? The ambulance? The situation is so heated, so volatile, Kiri is not sure what’s going to happen next. She backs away from the group, sits in the passenger seat, locks the door. Another car drives up and pulls over – more relatives have arrived. Kiri’s partner uses the distraction to slip back inside the car himself. He throws the car into reverse. The tyres squeal and the couple speed away. They are too scared to hang around.
They head straight to Kiri’s whānau in Auckland. She’s so upset she can’t speak at first, then she finally tells her family what happened. They urge Kiri and her partner to go to the police. The car is taken in for forensic examination, to check for damage and for DNA evidence from the victim. The couple are interviewed under caution. Kiri’s partner is breath-tested for alcohol. A serious crash unit investigator is dispatched to the scene to examine it and to interview any possible witnesses.
Over the next few weeks, Kiri hides at home. She’s a professional Māori woman in her thirties; nothing like this has ever happened to her before. She has nightmares, flashbacks. She hears the sickening thud of the child being crunched by metal.
It makes her sit up in bed in the middle of the night. Her heart ricochets inside her ribs, her mouth is dry, her palms sweaty.
She replays the scene over and over. The flash of yellow. The fog twisting like pale fingers over the road. The suddenness of it all.
Could they have done anything differently? Were they driving too fast?
The couple receive increasingly threatening messages on social media
The child’s family now know who Kiri and her partner are. New Zealanders often have just two degrees of separation, but in this part of the country, dotted with small communities, the connections are even more tight-knit. The couple start receiving messages on social media. They learn that the little boy has died in hospital of his injuries. The messages become increasingly unpleasant, threatening. They insinuate harm to Kiri and her family.
Kiri cloisters herself in her room. She barely comes out, even to eat meals. She is unable to attend work. She withdraws from her family. Her mood is persistently low, a suffocating fug of darkness that slithers into her mind and clouds her vision. She cries all day, finds it hard to sleep as it brings awful flashbacks.
Some things that Kiri has never experienced before start to happen. She smells blood, petrol, sticky tarmac, briny water. She feels something cold and prickly ‘walking’ along her arms. She hears voices muttering around her. Sometimes the voices are not clear in what they are saying, like a radio tuned to low static.
But to Kiri, they sound negative, and she is sure they are talking about her. At other times, the voices are clearer, and they are scathing. She sees bizarre figures, large and small, humanoid in appearance, scuttling around the edges of her room. Some of the figures she recognises as her own dead relatives; when the figures approach her, she hides under the bedcovers until they go away.
Her therapy is based on the best possible health outcomes for Māori using a wairua-based approach
Her worried family refer her to mental-health services. Her case is taken up by Whītiki Maurea, the Māori Mental Health and Drug & Alcohol Service in north-west Auckland. Whītiki Maurea weaves together Māori healing practices and Western clinical practice. Neither takes precedence. Therapy focuses on the patient’s wider whānau, and seeks the best possible health outcomes for Māori using a marae- and wairua- (spirit-) based approach. Kiri undergoes a cultural assessment, beginning with karakia, waiata, an acknowledgement of her whakapapa and a thorough mental-health assessment. In recognition of the partnership approach of this mental-health service, Kiri is assessed by two practitioners: Dr Andrew Howie, a very experienced Pākehā psychiatrist, and Piripi Daniels, a kaumātua with a wealth of traditional knowledge and societal connections. Piripi Daniels died in 2020. He was a great kauri of a man, who Andrew says taught him much about the fundamental importance of Māori approaches to spiritual and mental health, especially when dealing with Māori patients.
This story of patient Kiri and her distressing descent into mental illness is as much a testament to Piripi’s enduring legacy and knowledge as it is about Andrew’s recognition that there are “more things in heaven and earth” than are contained in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM‑5).
Andrew and Piripi sit with Kiri in an interview room. Kiri is dishevelled, distressed and disorganised. There are dark circles under her eyes. She’s lost weight in the four weeks since the accident. Her clothes hang loosely. She probably hasn’t showered or changed for a few days. There’s a rankness to her, the almost fetid smell of old sweat and fear. Her family have told the team this behaviour is completely out of character.
She’s normally neatly kept and punctual with her work and family commitments. They’re adamant she’s not taking drugs as they monitor when she gets up, when she eats, when she sleeps. Andrew asks Kiri to recount what happened. She does so haltingly. She stops at times, mid-sentence, lost in thought. She speaks of the panic attacks she’s been having, sometimes in the middle of the night. She speaks of the nightmares, the visitations by shadowy threatening figures, the voices that say horrible things about her. Her mood is labile. Her eyes bloom with fresh tears, then just as quickly she switches to anger, then fear. She glances sideways, looks over Andrew’s shoulder and cocks her head, frowning. She’s listening to something that Andrew can’t hear or see.
“It was clear to me,” Andrew says, “that Kiri was displaying symptoms of psychosis, and responding to auditory and visual hallucinations. I had started to formulate possible diagnoses as she spoke: perhaps post-traumatic stress disorder with dissociation, perhaps a brief psychotic episode with stressors, perhaps a panic disorder or a major depressive disorder. But about halfway through the interview, I noticed that Piripi had started to behave oddly as well. That threw me a bit. I’d never seen him like this before. I thought, gosh, what’s he doing?”
“I can see small creatures out of the periphery of my vision,” says the kaumatua. “I think this is a mate Māori issue”
The usually calm kaumātua is darting his eyes this way and that. He, too, looks over Andrew’s and Kiri’s shoulders as they speak and looks surprised, perplexed. Andrew stops to ask Piripi what is happening. “I can see small creatures out of the periphery of my vision, Andrew,” Piripi says. “I think this is a mate Māori issue. Do you mind if I take over in te reo?”
Mate Māori is the term for an illness that is thought to be psychosomatic, and often precipitated by transgressions of tapu or mākutu. Tapu has various meanings: sacred, prohibited, restricted, set apart, forbidden. Mākutu refers to sorcery or witchcraft.
Andrew’s vocabulary of te reo Māori extends to about 100 words, so he cannot fully follow the ensuing conversation between Piripi and Kiri. However, Kiri seems a lot more engaged than she did when speaking with Andrew. She is listening intently to Piripi. He even coaxes a small, timorous smile out of her.
Piripi says to Andrew, “My initial suspicions are right, I think. This is not a hinengaro [mind] or tinana [body] issue. It’s partly a whānau issue. It’s most definitely about wairua. I’d like to arrange a meeting between Kiri and her whānau and elders from her tribe. After that, we should try to meet with the child’s family and the elders from their tribe also.” Piripi closes the interview with a heartfelt karakia. He then takes over Kiri’s care, and Andrew hears that the proposed meetings have been organised.
A month later, Andrew has a consultation with a young, well-dressed woman. Kiri is smiling and personable, poised and articulate. She has good affect, good eye contact. She displays no symptoms of psychosis. She explains how Piripi said she needed to put right what had gone wrong through karakia, a meeting with the child’s whānau and a clear apology. Her symptoms resolved after she had addressed her transgression and the pain of the bereaved, once she had recognised her symptoms in the holistic context of Māori spirituality, and given space to make amends.
Kiri’s story was Andrew’s first encounter with mate Māori. He feels he could so easily have misdiagnosed her using Western phenomenology and given her a psychiatric label and drugs. It was a powerful reminder to him to step back and let someone else lead.
An edited extract (the chapter contains wider, more detailed discussion on Māori spirituality) from a superb collection of medical essays The Unexpected Patient by Dr Himali McInnes (HarperCollins, $36.99), available from bookstores operating in Level 2, also known as ABA (Anywhere But Auckland).
* Names have been changed.