"Ngoma"
and the Household Production of Health
Health and Illness in African Worlds
Wednesday, 13 January 1999
Goals for the day
complete the big
picture
make links between our various
sources
give you a conceptual
framework
how to read Thornton
Strategies
questions from last time, 10
min.
think chronologically: how did we
get to 1990s Uganda?, 10 min.
conceptual framework, 20
min.
new clip, 10 min.
ngoma all the way back, 20
min.
conclusion: back to timeline, 10
min.
Questions from last
time
How does breakdancing relate to
healing?
How did the diaspora from Nigeria
and Kongo occur?
"spiritual or actual healing" in
the film?
How does the "actual healing"
take place (in relation to time)?
Scene with psychiatrist/healer:
were the boys possessed?
How many people actually believe
in the spiritual healers?
Why is there a contradiction
between: L’s views in the conversation with the rainmaker VS.
what Vaughan says about him accepting spiritual
healing?
What is the relationship between
the efficacy of the treatment and the continued belief and hope in
that treatment even if it does not work?
Where we have been
chronological
overview
Conceptual framework
Med Anthro Theory
101
just a few things to keep in mind
for "Health and Illness in African Worlds"
Medical anthropologists focus
on:
1. People’s life worlds and
experience of sickness and healing (phenomenology)
2. People’s ideas about
disease causation and diagnosis (systems of meaning)
3. The material conditions in
which their experiences and beliefs are situated (local disease
ecology)
The problem of
translation
Since they are often interested
in the medical beliefs and practices of people of cultures and
life worlds quite different than their own,
medical anthropologists are
routinely confronted with the problem of translating the
unfamiliar into familiar--that is, Western--terms and
concepts.
HOW can we
translate
without tearing the unfamiliar
out of context??
without subordinating the
unfamiliar to Western assumptions about
sickness
health
efficacy
autonomy
WE MUST BEGIN
by scrutinizing and challenging
tacit Western knowledge of sickness.
We must begin by making this
tacit knowledge explicit
challenge 3 common sense
assumptions
Begin by challenging ASSUMPTION
1
the taken-for-granted distinction
of BIOMEDICINE vs. TRADITIONAL MEDICINE
so-called "traditional" systems
are highly diverse, including within Africa
what do they share: only that
they are different from biomedicine
How to start then?
By asking: How do the
beliefs and practices of such-and-such medical system
ORIENT healers and patients to their
bodies?
Are all medical systems equally
interested in the body???
Think of a continuum of medical
systems
At one end is biomedicine, an
internalizing system
attention is directed to bodies,
the insides of bodies
At the other end are
"externalizing" systems
diagnostic and therapeutic ideas
and techniques direct attention AWAY FROM THE BODY
medical gaze looks
outwards:
scanning networks of people and
quasi-people
for morally significant
encounters and events involving the sick person or close
relatives
Film clip, 20 min.
Chokwe in Congo, near
Angola
4:48-24:38
Diagnostic goal in an
externalizing system
construct a useful etiology,
that is, a string of circumstances and events that
lead to the onset of suffering
or distress
identify the ultimate source
of illness
therapist’s goal is to
insert her/himself into the patient’s sickness
narrative
and once there, persuade or
coerce the pathogenic agents to stop afflicting the
patient
Biomedicine is an "internalizing"
system
diagnosis and therapy orient
patients and healers TOWARDS THE BODY
sickness coincides with the
limits of the body; goal of D and T are to get inside the body,
take control of its internal parts and processes
here we find theories of
pathophysiology, grammars that enable reading bodily
changes symptomatically
CHALLENGE our common sense
assumption # 2
"Since biomedicine can read
embodied symptoms, it is more empirical (based on experience) and
realistic than externalizing systems."
All systems are generally
empirical and realistic, that is capable of producing
self-vindicating outcomes--evidence that demonstrates their
efficacy.
Medical efficacy consists of two
different things:
"hoped-for results"
"expected results"
"Hoped-for results" are easy,
given that:
most medical problems are
either:
(1) transient or recurrent
symptoms that are perceived as discrete disorders
OR
(2) self-limiting diseases,
that is, episodes that end in either spontaneous remission or
death
A reputation for "hoped-for"
efficacy requires:
(1) intervention routine occurs
between onset and outcome
(2) remissions predominate over
unwanted outcomes
(3) superior alternative
interventions are absent or inaccessible
What about when efficacy equals
"expected results"?
But not hoped-for
results.
Possible to produce evidence that
affirms the line of reasoning that persuaded patients and
practitioners to select particular interventions.
Through the capacity of a system
to infuse sickness with meaning
Especially when medical practices
serve entrenched interests.
Challenge our common sense
assumption # 3
"In any community, an
individual’s behavior is congruent with a unitary set of
meanings concerning sickness, its causes, diagnosis, treatment,
etc."
Must distinguish
between:
(1) medical TRADITIONS,
such as biomedicine or ngoma cults of affliction
(2) medical SECTORS, the
form(s) that a tradition takes in a given community
(3) medical SYSTEM =
collection of traditions and sectors available to people living in
a given community = PATTERNS OF RESORT = (therapeutic
itineraries)
Wallman reading:
What are the patterns of resort
in Kampala, Uganda??
What traditions are at
play?
In what distinct
sectors--hospitals, pharmacies, homes-- are these
practiced?