THE
IMPACT OF ALLOPATHIC BIOMEDICINE ON TRADITIONAL HEALING SYSTEMS
The term “ethnomedicine” refers to
the comparative study of medical systems, focusing on beliefs and practices concerning
sickness and health in different human populations. It observes and describes
hygienic, preventive, and healing practices, taking temporal and spatial
references into account.
Typical ethnomedical topics include
causes of sickness, medical practitioners and their roles, and specific
treatments utilized. The explosion of ethnomedical literature has been
stimulated by an increased awareness of the consequences of the forced
displacement and/or acculturation of indigenous peoples, the recognition of
indigenous health concepts as a means of maintaining ethnic identities, and the
search for new medical treatments and technologies. In addition, Kleinman
(1995) found ethnographic studies an “appropriate means of representing
pluralism...and of drawing upon those aspects of health and suffering to resist
the positivism, the reductionism, and the naturalism that biomedicine and,
regrettably, the wider society privilege” (p. 195).
Puerto Rican Folk Healing
My interest in ethnomedicine was
stimulated by a visit to a public community mental health center in Cayey,
Koss (1979) conducted a research
study of this process, concluding that the folk healers were highly motivated
and committed to their work. She also noted that their approach to therapy was
more emotionally charged than that of Western-trained psychotherapists, and
that it utilized rituals and herbal remedies. Clients were urged to develop
themselves spiritually; sessions were focused on the meaning of life and the
individual’s connection to God and to the cosmos. The clients’ families often
were called in, and advice was freely given. The Western-trained
psychotherapists worked with the practical aspects of the case rather than the
spiritual dimensions of a client’s life.
Koss described a client who was seen
both by mental health professionals and folk healers. When brought to the center,
she was given medication for depression and visual hallucinations. The folk
healers “exorcised” eight malevolent spirits. Despite the seriousness of the
case at the outset, the client was discharged a week later and resumed her
classes at secretarial school. The two types of practitioners had worked
cooperatively, addressing themselves to various aspects of the client’s belief
system and behavior.
Koss was surprised to discover that
the mental health professionals often sought out folk healers themselves for
counseling. One psychologist consulted with a folk healer during divorce
proceedings and was given instructions on how to contact his spirit guides to
help him in court. With the help of the folk healers the psychologist worked
through his problems in forming close relationships and eventually married
again. He told Koss that the folk healing practices had been far more effective
in his case than any psychotherapy he had previously received.
Koss (Koss-Chiono, 1992) later
followed up clients who had received Western psychotherapeutic treatment in
Hallmarks of Effective Treatment
In
his exhaustive study of cross-cultural practices, Torrey (1986) concluded that
effective treatment inevitably contains one or more of four fundamental
hallmarks:
1.
A
shared world view that makes the diagnosis or naming process
possible;
2. Certain personal qualities of the
practitioner that appear to facilitate
the patient's recovery;
3. Positive patient expectations
that assist recovery;
4. A sense of mastery that empowers
the patient.
If
a traditional medical system yields treatment outcomes that its society deems
effective, it is worthy of consideration by Western allopathic biomedical
investigators, especially those who are aware of the fact that allopathic
biomedicine is the dominant health care paradigm for less than 20 percent of
the world’s population (Mahler, 1977). However, what is considered to be
“effective” varies from society to society (Krippner, 2002).
It is also important to note that
allopathic biomedicine places its emphasis upon “curing” (removing the symptoms
of an ailment and restoring a patient to health), while traditional medicine
focuses upon “healing” (attaining wholeness of body, mind, emotions, and/or
spirit). Some patients might be incapable of being “cured” because their
sickness is terminal. Yet those same
patients could be “healed” mentally, emotionally, and/or spiritually as a
result of the practitioner’s encouragement to review their life, finding
meaning in it, and becoming reconciled to death. Patients who have been
“cured,” on the other hand, may be taught procedures that will prevent a
relapse or recurrence of their symptoms. An emphasis upon prevention is a
standard aspect of traditional medicine, and is becoming an important part of
biomedicine as well (Krippner & Welch, 1992).
A differentiation can also be made
between “disease” and “illness.” From
either the biomedical or the ethnomedical point of view, one can conceptualize
“disease” as a mechanical difficulty of the body resulting from injury or
infection, or from an organism's imbalance with its environment. “Illness,”
however, is a broader term implying dysfunctional behavior, mood disorders, or
inappropriate thoughts and feelings.
These behaviors, moods, thoughts, and feelings can accompany an injury,
infection, or imbalance – or can exist without them. Thus, one may refer to a “diseased brain”
rather than an “ill brain,” but of “mental illness” rather than of “mental
disease.” Cassell (1979) goes so far as to claim that allopathic biomedicine
treats disease but not illness; “physicians are trained to practice a
technological medicine in which disease is their sole concern and in which
technology is their only weapon” (p. 18).
Every human population, in every era,
builds a specific worldview or “mythology” through its own culture. Specific
views of the body, health, and sickness stem from this model of the world.
Therefore, comparisons between allopathic biomedicine and indigenous
ethnomedicine can be made utilizing these models. In the social and behavioral
sciences, a “model” is an explicit or implicit explanatory structure that
underlies a set of organized group behaviors.
Their use in science attempts to improve understanding of the process they
represent. Models have been constructed
to describe human conflict, competition, and cooperation. Models have been proposed to illustrate such
topics as the etiology of mental illness, the spread of disease, the
interaction of personality dynamics and family interactions.
The
In
April 1995, the Office of Alternative Medicine (OAM) of the United States
National Institutes of Health held a conference on research methodology. The
charge of this conference was to evaluate research needs in the field of
complementary and alternative medicine (
The panel proposed a definition of
Complementary and alternative medicine (
The
second charge of the panel was to establish a list of parameters for obtaining
thorough descriptions of
1. Lexicon. What are the specialized terms in the system?
2. Taxonomy. What classes of health and sickness does the system
recognize
and address?
3. Epistemology. How was the body of knowledge derived?
4. Theories. What are the key mechanisms understood to be?
5. Goals for Interventions. What are the primary goals of the system?
6. Outcome Measures. What constitutes a successful intervention?
7. Social Organization. Who uses and who practices the system?
8. Specific Activities. What do the practitioners do? What do they use?
9. Responsibilities. What are the responsibilities of the
practitioners,
patients, families, and community members?
10. Scope. How extensive are the system’s applications?
11. Analysis of Benefits and Barriers. What are the risks and costs of
the
system?
12. Views of Suffering and Death. How does the system view suffering
and
death?
13. Comparison and Interaction with Dominant System. What does this
system
provide that the dominant system does not provide? How does this system
interact with the dominant system?
14.Evaluation. Are there
data available that demonstrate the
efficacy
of the healing system? What research methods are appropriate for investigating
the system?
For
illustrative purposes, I will apply the National Institutes of Health Criteria number
Traditional Balinese Shamanism
On
the
When
I saw this dance performed in 1985, the dancers seemed oblivious to the outside
world as they enacted the great battle between the forces of the witch and
those of humankind. It started with the lesser characters whom, when faced with
defeat, called upon the aid of higher forces which transformed them into more
powerful beings. Each of the succeeding transformations was met with mounting
tension on the faces of the crowd and was supported by the growing crescendo of
the gamelan orchestra. Children who were dozing suddenly woke up. The climax
finally came when the Barong, a mythical creature who frequently comes to the
aid of human beings, at last faces his arch-adversary, the malevolent witch
Rangda, and the dancers shift from their usual sense of identity to become
players in this cosmic drama.
Denny
Thong (1993), a psychiatrist who organized the first mental hospital on
At
that very moment, one of my staff was bringing to me another glass of the thick
Balinese coffee that I had been using to keep from falling asleep at that late
hour. Suddenly, without warning, he threw the glass over his shoulder, stood
upright as if in anger, and quivered with wide open eyes. Abruptly he proceeded
to turn and walk to a nearby papaya tree which he pulled out of the ground.
That seems to have been some sort of signal because afterwards many others in
the crowd, including a member of the orchestra, experienced the same radical
transformation. My first frightening impression was that utter chaos had broken
out. (p.79)
Overwhelmed
by this sudden and unexpected turn of events, Thong sat confused and bewildered
with no idea of where to look or what to do. Fortunately, the Balinese
themselves had no such problem. Restraining the disorderly behavior of the more
violent trance dancers, their attention focused once more on the stage and its
surroundings. The players still were dancing, still in an altered state of consciousness,
but one that was less intense. The gamelan played on but only with the
mesmerizing continuous deep rhythm of the large gongs. Thong's most striking
observation was that despite all the wailing and untamed antics, nobody was
hurt. He recalled,
This
led me to the conclusion that this was no true chaos; instead it was a wild but
nonetheless orderly form of behavior. It was only at this point that I turned
around to ask my Western companion, Christopher, a question about his feelings
concerning this primal scene. The result was my second shock of the night when
I saw Christopher sitting upright with the same dazed look in his eyes as the
dancers. At that moment...all the trance dancers gathered before the Barong who
began to lead a procession around the temple. Dear Christopher joined in as
well. (pp. 79-80)
It
took the efforts of a pemangku or
village priest to gently bring Christopher and the other people back to their
ordinary state of consciousness. With his assistants, and armed only with holy
water, the pemangku wandered through
the crowd sprinkling the entranced revelers; the sacred water quickly revived
them. Could this phenomenon be categorized as "mass hypnosis"? Such a
label would be less than accurate because there was no direct goal-orientation
of the entranced individuals.
In
Thong's (1993) opinion, the Balinese people’s repressed emotions find an outlet
in the dance and drama -- an outlet the culture has provided for them to
abreact, either vicariously or directly. Classical dance and drama in
In
addition, I personally have seen balians
(i.e., Balinese shamans) enter both transpersonal and other altered states
during healing and exorcism ceremonies. The balian
taksu is a healer with mediumship talent who alters consciousness to assist
in the diagnosis of the ill and unfortunate. Sometimes, the diagnosis is bebai in which an evil spirit has been
sent by a sorcerer. The victim's rival has paid the sorcerer to practice bebainan, or black magic, for purposes
of revenge or jealousy. Thong concluded that in the "altruistic trance
states”, a dancer responds to the needs of another person or a group of people.
This state is usually reached during or after the performance of a ritual and,
in
Shortly
after my visit to
This
experience led Thong to evaluate the mental health system he had help to
construct in
As a
result, Thong initiated a Family Ward, which consisted of four compounds, each
of which could house one patient and his or her family. In this way, the active
participation of the family would be encouraged. The compounds were built of
traditional materials, and each had its own entrance. During the day, patients
would engage in ordinary activities, such as farming, carpentry, and similar
enterprises. They could cook for themselves, using the kitchen and utensils
that were supplied. The staff would spend a good part of the day discussing
patient’s problems, answering their questions, and listening to them express
their feelings. The plan was to limit Family Ward admissions to first-time
patients and to keep them for a maximum of two weeks. The rationale was that
these patients were suffering from an acute psychotic reaction that would subside
quickly, and then would be manageable on an out-patient basis. If there was no
improvement, patients would be transferred to the regular ward. Patients and
their families would be taught how to administer their own medication.
Both
the patients and their families were allowed to utilize the services of balians and other traditional healers,
if they so chose. One local balian was
especially popular. He was a retired high school principal and his treatment
consisted of pressing a number of points on the skin, beginning at the neck.
With some, there was no reaction, while others writhed in pain. The balian concluded that these patients
were the victims of bebian and
administered the appropriate treatment. Thong remarked, “Astonishing enough…,
several patients whom he treated showed remarkable improvement after his
treatments” (Thong, 1993, p. 68).
At
the end of one year, Thong and his staff evaluated the results of the Family
Ward. Fourteen patients had been admitted, nine from
One
patient was a 19-year-old girl with no schooling who had suffered an acute
psychotic attack. She refused any food or drink unless it was given by a family
member. She reported hearing voices of deities who ordered her to fulfill
certain religious tasks. Her family shared her belief system and when she was
admitted, seven of her brothers insisted on joining her. After sixteen days,
and after the administration of anti-psychotic medication, she returned home
with her brothers. Apparently, the voices had stopped and she decided to take
an active role in her local temple. Thong (1993) wrote,
This
case reminds me of the priest of Batur temple whom I described earlier. If we
had admitted these patients into the main ward, thus branding them as mentally
ill, it would have had dire consequences. The status of the individual would
have suffered and the family would have endured a significant financial burden
because they would have had to conduct special ceremonies to cleanse the
patient of the spiritual pollution attributed to the main ward. (p. 69)
Soon,
Thong’s project aroused considerable controversy in the national capitol of
Andean Kallawaya Medicine
In 1996, I spent five days in
Kallawaya herbalists trace their
tradition back to the legendary
In ancient times, people saw no
division between themselves and their environment. However, rivers and valleys
created natural boundaries or ayllus,
the ecological and cultural units of Kallawaya society. Kallawaya healers were
once identified with certain ayllus,
referred to as Qollahuaya, “places of
the herbs.” The communities in the lower
slopes (3,200 to 3,500 meters above sea level) grow barley, beans, corn (or
maize), peas, and wheat. Those in the central communities cultivate oca (i.e., Oxalis crassicaulis) and many varieties
of potatoes on rotated fields that are 3,500 to 4,300 meters high. Those of the
highland communities (4,300 to 5,000 meters) herd alpacas, llamas, and sheep.
Traditionally, ayllu members from the
three levels exchange produce and provide each other with the necessary foods
to maintain a healthy and balanced subsistence.
Traditional Kallawaya follow three
injunctions: ama swa, do not steal; ama llulla, do not lie; ama khella, do not be slothful.
Kallawaya also believe in a principle of nature they refer to as the “boomerang
law”: if you harm others, malevolent acts will return to you. Living by these
precepts is felt to be fundamental in establishing and maintaining harmony
within the community. A life of moderation, peace, and harmony is in accord
with the Kallawaya maxims, and a dynamic equilibrium is needed to produce a
healthy balance.
The goal of the Kallawaya medical
model is to maintain and restore the harmonious relationship of community
members, the community as a whole, and the natural environment. The Kallawaya
practitioner needs to assure the availability of medicinal plants and
proficient healers who are conversant with health, sickness, the natural realm,
and the world of spirits. Prevention involves the practice of moderation in
daily life, and the maintenance of trust among members of the community.
Kallawaya healers mediate between
the ill person's body and the environment, attempting to restore the balance
that has been lost. However, restoration of this balance is dependent on a
number of factors--the sickness itself, its severity, and the cooperation of
patients and their families. The confidence and the faith of the patient are
key factors because herbal treatment is a slow process that requires a great
deal of patience. Belief is felt to activate the self-regulatory mechanisms
that are fundamental to recovery. In addition, considerable emphasis is placed
on prevention; proper nutrition is seen as essential to the maintenance of
health.
Kallawaya practitioners often travel
to parts of
In
The personnel involved among the
Kallawaya represent various skills and functions. Herbalarios collect plants; yerbateros
prepare plants; curanderos apply the
herbs and other medicines; yatiris
(also known as amautas) are spiritual
healers; partidas are midwives. Over
time, Kallawaya practitioners began to perform more than one function hence
many of these traditional divisions have become less rigid. Nevertheless, all
practitioners mediate between the environment and the patient and, in some
cases, the community-at-large.
A common folk method of diagnosis
utilizes a guinea pig. The procedure begins with tying the guinea pig to the
patient's stomach or kidney area. A coca leaf preparation is placed over the
head of the patient followed by a joint prayer affirming belief in the
procedure. The guinea pig is removed and cut open so that its internal organs
can be observed. Any anomaly of these internal organs is regarded as a
representation of the patient's sickness. A small lesion in the animal's lung
is most serious as it indicates a terminal condition on the part of the
patient. This procedure did not originate with the Kallawaya, but still is used
by some practitioners.
Another folk tradition that is taken
seriously by some Kallawaya healers involves examining the patient's side for
small scars that resemble puncture marks. These marks, in combination with
certain behavioral symptoms, indicate an invasive condition, marked by high
temperatures, brought on by sorcery or kharisiri.
The marks indicate that malevolent spirits have entered the patients' body,
usually near the liver, to steal their fatty tissue. These malevolent spirits
can take the form of human beings referred to as karikari; they live on fat and usually strike when their victims
are not fully aware, such as when they are intoxicated (Bastien, 1992, p. 71).
One practitioner told me that sorcery is quite rare and did not exist until the
Spanish conquest; it is often related to the malignancy of the invaders.
Some practitioners use patients'
dreams for diagnostic purposes because they represent the spirit communicating
with the body. A voyage may be postponed due to negative signs in a dream.
Nightmares may predict serious health problems. An important decision might be
made on the basis of a positive dream. One person's dreams might even be an
omen of things to come for the entire community.
The patient's behavior provides
important clues for diagnosis and treatment.
In general, a calm patient is healthy; crying and screaming may be signs
of susto or “soul loss.” The symptoms
of susto vary, but include
depression, anxiety, laziness, loss of appetite, shaking, fever, nausea,
hearing noises in the ears, and passing gas.
A practitioner’s treatment is highly
individualized but the importance of a balanced diet is generally emphasized. Practitioners advise their patients to “eat
food from the area and during its season”; some fruits may be eaten before they
are fully ripe for medicinal purposes.
The Kallawaya healers employ more
than one thousand medicinal plants, about one third of which have demonstrated
their effectiveness by allopathic biomedical standards, and another third of
which have been judged “likely” to be effective (Bastien, 1992, p. 47). These
plants are divided according to the three distinct “weathers” that Pachamama
(Mother Earth) and Tataente (Father Sun) have given to their ayllu, namely hot, mild, and cold.
Coca plays a major role in many of
the healing procedures because it is felt that the plant grows between the
world of human beings and the world of the spirits. A coca and quinine mixture
has been used to treat malaria--most notably, as Kallawaya healers tell the
story, during the digging of the
Kallawaya medicine generally is
accompanied by rituals involving prayers, amulets, and mesas--ceremonial fabrics on which objects are arranged, generally
in a left-to-right manner, that symbolizes the journey from sickness to health.
Llama fetuses are commonly used in the preparation of mesas because the llama is a sacred animal. Amulets are placed on
the mesa or worn around the patient's
neck, giving him or her confidence and spiritual power, especially when a
patient complains of some type of deprivation. Different amulets represent
health, love, wealth, or equilibrium with Pachamama and Tataente.
Mesas are often used to prevent sickness
or imbalance, often for the entire community; when they represent offerings to
the spirit world, they are burned after their utilization. The so-called Pachamama Mesa can be burned on any day
of the week, often for a wedding or when crops are planted. The Mesa Gloria or Mesa Blanca is composed of 12 pieces of cotton on a white
background and is burned on a Wednesday night in response to a thunderstorm.
Sets of four figurines are placed on the mesa
(e.g., four figures of horseshoes, houses, and llamas, four dice made of sugar,
four pieces of St. Nicholas bread).
The Awicha Mesa or Chulpas Mesa
is burned on Tuesdays or Fridays in honor of deceased members of the community
to console their spirits and is related to the chulpas, the preparation of corpses for traditional funerals.
However, it is believed that people who stroll through areas while funerals are
being arranged sometimes fall sick.
One practitioner itemized the
objects he uses for his mesas--coca
leaves, religious figurines, “gold” or “silver” bread (pan de oro or pan de plato),
alcohol, eggs, white flowers, wool, fat, and llama fetuses. If a llama fetus is
not available, he may use a pig or sheep fetus.
Herbal preparations usually are
ingested but occasionally are used in conjunction with a “steam box”; the naked
patient enters a receptacle that has been filled with steam created from the
medicinal mixture. The active ingredients of the herbs enter the pores of the
patient at the same time as the sweat cleanses the toxins.
I observed a patient in one of these
steam boxes in the
There is an armamentarium of
procedures that do not involve herbs, for example, healing songs and dances.
These songs are felt to be especially effective in treating insomnia. The
dances are frequently utilized to renew the patient's supply of energy. Susto is treated in a number of ways;
one practitioner mentioned asking Tataente “Am I allowed to heal this
condition?” then burning incense, praying with the Christian rosary, and making
offerings in the four directions of the compass.
The Kallawaya society attempts to
maintain a balanced environment that exists in harmony with nature. Because
prevention of sickness is an important element of the Kallawaya system, any
disequilibrium deserves immediate attention. In rare cases, the community has
the responsibility to expel members who endanger the balance. A more commonly
assumed social responsibility is to support patients by bringing them food,
money, music, and anything else that will maintain their faith and their
motivation to recover; this community process is referred to as ayni. A festive ceremony for offering
group assistance is referred to as a preste
and is frequently used to treat susto.
Ayni is especially important for
people with chronic problems, because it demonstrates community support.
These practitioners are not shamans,
even though several shamanic traditions exist in
In the 1950s and 1960s, Bolivian
pharmacists and physicians successfully curtailed the influence of Kallawaya
practitioners by public humiliation, restrictive laws (and imprisonment for
their violation), and denial of licenses (Bastien, 1992). Even though some
Kallawaya practitioners incorporated various aspects of biomedicine into their
procedures, physicians and politicians portrayed these healers, at best, as
members of an antiquated tradition and, at worst, as charlatans. The success of
Kallawaya treatment and the increasing surplus of allopathic physicians in
Mounting a counterattack, many
Kallawaya healers stereotyped physicians as kharisris,
mythic figures who steal fatty tissue, the source of force and energy in folk
tradition. As a result, however, those Kallawaya practitioners who had adopted
a few biomedical practices often lost patients.
In the 1980s, most Bolivian physicians
and nurses discontinued efforts at integrating ethnomedicine because their
superiors did not promote it (Bastien, 1992, p. 38). At the same time, there
was a sharp resurgence in Kallawaya practice as the value of their medicinal
plants was touted by biomedical research, and because Bolivian peasants could
not afford biomedical treatments (in 1984 the cost of a penicillin injection
was about $10.00
In
the 1990s, communication between physicians and herbalists in
Mexican-American Curanderismo
Frank and Frank (1991) contend that
three main factors are present in an effective healing process: (1) the
installation of hope through “naming” the problem and making the diagnosis in a
context understandable by the client; (2) emotional arousal, dynamic healing
techniques, and the creation of catharsis, hope, and confidence; (3) a feeling
of control and a sense of mastery gained by the client in regard to the
presenting problem. Because Mexican-American Curanderismo covers these three
bases, it is not surprising that its survival seems assured. Nevertheless,
formal investigations of the practitioners, their worldviews, and their
technologies seem necessary before globalization, industrialization, and
political opportunism erode the unique aspects of this singular system of
healing.
Curanderismo, or Mexican-American
folk healing, is a coherent, comprehensive system of healing that derives from
the synthesis of Mayan and Aztec teachings with
Diagnosis is made on the basis of
the history of the ailment, the symptoms, and retrospectively by the response
to treatment. Diagnosis may involve
natural, psychological, and/or spiritual procedures. On the natural level, a practitioner can
observe the patient and ask questions.
On the psychological level, a curandera
may claim that she can “see” her patient's “aura” or energy body; the size,
color, and shape of this “aura” can be an important diagnostic sign.
On the spiritual level, a “spirit
guide” often reveals the nature of a patient's problem in dreams. Initial
diagnoses often are carried out by the patients themselves or by family members
and neighbors. Etiology can also be natural, psychological, or spiritual. The role of bacteria and viruses is taken for
granted as a possible causal factor.
Another alleged natural cause of a patient's difficulty is empacho, indigestion due to a ball of
food being lodged in the intestine or food sticking to the wall of the
stomach. Psychological causes are felt
to be behind bilis, a malady caused
by anger or fear, envidia (caused by
jealousy), mal aire (by imbalances in
relationships or in personal qualities), and caida de mollera -- the perception that an infant's fontanel is too
low due to his or her mother's neglect.
Spiritual etiologies abound; embrujada or sorcery involves the
participation of demonic spirits while mal
puesto results from a hex. Sometimes
there is a combined etiology; empacho
can be brought about when a mother forces her child to eat too much or to
consume food that the child dislikes.
The patient's behavior is used to
help make a diagnosis; for example, if diarrhea, crying, vomiting, and sunken
eyes accompany a fallen fontanel, the diagnosis of caida de mollera is confirmed.
One form of envidia is mal ojo, which occurs when someone with
an “evil eye” stares at the victim because of envy or desire. Symptoms include fever, headaches, vomiting,
and drooping eyes. On the other hand,
gas, constipation, a bitter taste in the mouth, and a “dirty white tongue”
accompany bilis.
Specialists generally carry out
treatment. Herbal treatments are supervised by the herbolaria, medica, and herbalista while the señora prescribes home remedies. The
patient's “vibrating energy” may need to be modified by incantations or
manipulation. Suggestion, confession,
and persuasion are employed; the practitioner may increase patients'
self-esteem by getting them involved in group activities and church functions,
or asking them to visit a holy shrine. The magica
combines herbs with such spiritual practices as prayers, chants, sprinkling
holy water, burning incense, and lighting candles. Exorcisms are performed by
an espiritista who is adept at
enlisting the help of benevolent spirits and ridding the patient of malevolent
ones. The etiology must be accurately made in order to insure the proper type
of treatment, as well as to select the most appropriate practitioner.
There are important regional
differences in Curanderismo. For example, its model of health emphasizes
“balance” in relationships and behavior.
But a “balance” of emotional “humors” and the avoidance of an excess of
either “hot” or “cold” foods is important as well. An exception is found in southern
Prognosis is favorable if the
treatment regimen is closely followed.
However, failure to comply may lead to a worsening of the condition or,
in the case of such problems as caida de
mollera and mal puesto, to
premature death. Suicide can be the result of metaphysical sources or as a
failure to find a spiritual approach to life's problems.
The practitioners will vary
depending on location; a practitioner who is referred to as a curandera in San Diego, California, may
correspond to a señora in San
Antonio, Texas, a medica in Santa Fe,
New Mexico, and a parchera in parts
of Guatemala. Most practitioners of
Curanderismo are women, but the proportion varies geographically. Curanderas
typically are “called” to their profession by spiritual entities; they
apprentice themselves to a friend or relative until they are considered ready
to practice. Most of them are part-time
practitioners who do not charge a specific fee but are given a small offering
or gift. The setting is often the home of the practitioner and its function is
both diagnosis and treatment.
The
goal of the Curanderismo model is to assist the recovery of the patient,
restoring his or her “balance” within a social framework that preserves the
traditions of the family and the Mexican-American subculture. Suffering and infirmity are seen as an
inevitable part of life, and as part of God's plan to instruct human beings and
lead them to salvation. Sickness is not seen as a punishment from God but as a
challenge.
Hockmeyer
(1990) investigated a specific curandera,
Diana Velasquez, who had a staff position in a
The
cases dealt with by Velasquez were far from simple, ranging from a young woman
who had been continually sexually molested by her grandfather to a man
undergoing a personal identity crisis when his wife found a well-paying job.
She also had to cope with accusations by young “acculturated” members of the
Mexican-American community that she was “nothing but a witch.” Velasquez’ diagnostic categories resemble
those found in the U.S. Southwest, including brujo and embrujada, both
of which she treated with rituals to re-establish “balance.” She even
successfully treated a Western-trained psychotherapist who was suffering from
visual hallucinations during the day and insomnia at night, relying on her
customary rituals.
Ethnomedicine and Biomedicine
The World Health Organization (Mahler, 1977)
has defined health as “a complete state of physical, mental, and social well-being,
not merely an absence of disease or infirmity” (p. 3). The value of
ethnomedical practitioners and their incorporation into biomedical systems has
become widely heralded since their advocacy by the World Health Organization,
but the high cost of training folk healers, the reluctance of the medical
bureaucracy to accept them, and the decline of ethnomedicine in many parts of
the world have discouraged such incorporation. The objective of available
medical care for all people of the earth by the beginning of the 21st century
depends upon granting folk healers professional autonomy as well as to educate
them in abandoning worthless (and sometimes harmful) practices, and to teach
them and their communities about effective public health measures (Bastien,
1992, p.27). Many ethnomedical practitioners use adaptive strategies that
represent living and dynamic systems, subject to change in response to the
community and the environment.
However, it is important not to
romanticize folk healers and ethnomedicine. Lead content is very high in some
traditional medicines, including those used by certain ethnic groups in the
Ayurvedic medicine, a traditional
medicine widely used in
In some Mexican communities, two
remedies known as “Azarim” and “Grota” are commonly prescribed by folk healers
for empacho (intestinal sickness).
“Litargio” is also prescribed as a deodorant.
All three have an extremely high
lead content and are harmful even if used for short time periods (Smolinske,
2005).
Physicians
who treat diverse ethnic populations need to become aware of traditional
medicines often used in these communities. In addition, there is an increasing
use by the general
At the same time, if a Balinese
shaman, a Kallawaya healer, or a Mexican-American curandera can not help a patient, there may need to be a referral
to an allopathic physician, especially if surgery is needed; in La Paz we were
told it was a common practice for referrals to go in both directions as some
physicians would send patients to Kallawaya healers.
Most people who use these three
systems, as well as comparable systems in other parts of the developing world,
recognize the advantages of biomedicine. Yet they are often aware of how
biomedicine can be used as a political instrument to discriminate against
ethnic groups and socioeconomic classes, and to create dependency relations
with the industrialized countries who supply (and profit from) allopathic
medicines and implements. In this way, the contrast of ethnomedicine with that
of allopathic biomedicine enters what has been called the postmodern dialogue.
From a postmodern perspective, “official” medicine (i.e., biomedicine) can be
contrasted with “traditional” medicine (i.e., ethnomedicine), observing that
the latter has had to struggle for legitimacy against powerful forces.
Ethnomedical practitioners,
according to my informants, attempt to preserve their own way of thinking with
its emphasis on living in concord with the natural environment, on balance and
harmony, and on community support and spiritual direction. Such concepts generally are foreign to
allopathic biomedicine (Hufford, 1995).
Biomedical technology often
determines what is to be taken as authoritative knowledge and, in turn,
establishes a particular domain of power. Biomedicine typically extends this
privileged position to economics, politics, and class relationships.
Legislation, medical schools, licensing, and medicinal terminology all interact
to jealously guard the power of biomedicine. It is no wonder that ordinary
people frequently view biomedicine as serving powerful groups in their country
while they struggle for a vestige of power over their own lives (Bastien, 1992,
p. 17).
The celebrated ethnologist Claude Leví-Strauss
(1955) proposed that the kind of logic developed by indigenous people is as
rigorous and complete as that of modern science. It is not the quality of the intellectual
process that differs but the mode of expression and application. For example,
the cultural myths of pre-Columbian Mexican and Central American societies not
only were comprehensive guides to daily conduct but also provided an
explanation for the mysteries of the universe.
Each mythic episode can be interpreted in several ways according to the
context and the listener's understanding.
The symbols used are manipulated with such economy that each serves a
wide range of philosophical and religious ideas. Quetzalcoatl was the “feathered serpent” who
symbolized the transformation of matter into spirit, as well as the god of the
winds, the Lord of Dawn, the spirit of the sacred ocelot (a fierce jungle cat),
the last king of the Toltecs, and (following the Spanish conquest) Jesus
Christ.
These three ethnomedical models of
healing emphasize spiritual aspects of health and sickness, a dimension long
ignored by biomedicine. I use the term “spiritual” to describe those aspects of
human behavior and experience that reflect an alleged transcendent intelligence
or process that inspires devotion and directs behavior. The spiritual dimension
of life is evident to any person who becomes aware of a life meaning that
extends beyond the immediacy of everyday expediency and concerns. The
difference between religion and spirituality and can be described as a
distinction between adherence to the beliefs and practices of an organized
religious institution and a person’s relationship to an alleged transcendent
reality either with or without regard to a formal religion or creed (Krippner, 2002).
There are now dozens of studies
dealing with “spiritual health” in the English language literature (Krippner,
2002). Four major dimensions have been studied in these investigations: meaning
and purpose in life, intrinsic values, transcendent beliefs and experiences,
and community relationships. Some of the studies found lower levels of
depression among individuals who manifested one or more of these four
dimensions.
In several studies of African-Americans,
high rates of hypertension were observed; the social support given by churches
and communities have been suggested as antidotes to this condition (Krippner,
2002, p. 195). The link between physical health and spirituality or attendance
at religious services has been affirmed in several investigations; it is
especially apparent in reduced hospital stays, lower blood pressure, fewer
heart attacks, reduced stress levels, and enhanced immune functions. However,
there are exceptions to these generalizations. Some people feel abandoned by
God when they become sick; others refuse to take their children to a medical
practitioner for fear of contravening “God’s will.”
There are ecopsychologists who
believe that healing the planet is basically a shamanic journey; if so,
traditional medical systems can play a vital role in this endeavor. But while
herbal medicines, indigenous treatments, and shamanism are becoming faddish in
the West, indigenous systems are becoming increasingly endangered. It is crucial to learn what shamanism and
related systems of healing have to offer the postmodern world before archival
research in libraries replaces field research as the best available method for
investigating these healing systems.
Their longevity indicates that they have served many groups of people
quite well over the millennia. The question remains as to what they can offer a
world where allopathic biomedicine is not only revered but also powerful.
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The preparation of this paper was
supported by the Chair for the Study of Consciousness,