Social science & medicine. Part B, Medical anthropology最新文献

According to humoral medical theory, food and body states may be classified as ‘hot’ or ‘cold’. During periods of physical vulnerability, behavioral and dietary precautions may be invoked for therapeutic and prophylactic purposes following the humoral medical principle of the treatment of opposites. Childbirth in particular affects humoral balance, and in confinement precautions are observed to replace heat lost during parturition and to protect the mother against cold and wind. Women in Asia and Latin America especially share several postpartum precautions, including physical confinement, restrictions on bathing, the prescription of hot and proscription of cold foods; for many women these precautions are supplemented with the direct application of heat, including by ‘mother roasting’, steaming. or smoking. The postpartum precautions, as detailed for Malay women, provide a framework for the management of birth and the ritual and social assumption of motherhood.

Significant differences in medical practice may be noted between Western-trained and indigenous healers in South African society, particularly in terms of the doctor-patient relationship, the preparation of case histories, diagnosis, and referral to other types of practitioners. A further distinction may be noted, within indigenous medicine, between the inyanga who is usually male and uses African medicines in a non-clairvoyant manner, and the isangoma who is female and uses medicines and techniques in a clairvoyant manner. The former observes and examines patients directly and ministers to the whole patient; the latter usually consults with a patient's family and relies on spiritual insights to interpret the causes and consequences of suffering. The networks of isangoma, spanning the Nguni-speaking societies of eastern South Africa, in particular among the Zulu, are given special attention here because of their role as ‘morality custodians’, maintaining a meaningful world view in a society beset with rapid changes and deep contradictions.

The anthropologist's discourse on medicine depends on a satisfactory understanding of medical knowledge. This means recognizing that: (a) an actor does not know all of his medical facts in the same way; (b) his medical knowledge is recursive: and (c) this knowledge needs to be viewed in terms of the processes by which it is produced rather than in terms of its structure. When processual and structural views of medical knowledge are compared, the latter are found to either bracket out important emotional and ideological determinants, or to trivialize them. Scientific processes for producing medical knowledge can be distinguished from non-scientific ones. But in both cases medical facts are socially constructed. This view of medical science is at odds with empiricist versions. The latter ignore the social determinants of scientific knowledge and, as a consequence of this position, legitimize a technology-centered and theory-centered view of non-Western medicine.

This essay calls into doubt the quest for ‘theoretical closure’ in the study of African systems of healing. The notion of ‘theoretical closure’ may be understood in two ways, one empirically derived and the other epistemological. The first is based on the assumption that ‘medical systems’ form a natural and discrete empirical domain, a view ultimately grounded in arbitrary or ethnocentric analytical criteria. The second sees such medical systems as parts of ahistorical and closed social systems. Both serve to render medical anthropology parochial in relation to the mainstream discipline and unable to seize the potential offered by the study of healing to illuminate important general problems, such as the articulation of thought and action, of individual experience and cultural form, and of structural order and historical process.

The study of healing in societies which have relatively recently been incorporated into world systems raises the urgent need to devise models which permit the examination of socio-cultural orders in time how they are both reproduced and transformed. This can no longer legitimately be viewed as the ‘opening’ of ‘closed’ systems: rather, it requires understanding how the dynamic processes of particular small-scale societies engage with encompassing politico-economic forces. Healing is crucially bound up with this, for its knowledge and practice give form to key conceptions and values in all cultures, and play upon the identity of physical and social being. The context of affliction is an important locus both for the reinforcement and the reformulation of socio-cultural categories.

The case of the Tswana of Southern Africa is employed to suggest how a focus upon healing systems in time is entailed in the study of wider processes of perpetuation and change. It is the interrelationship of these processes in particular socio-cultural and temporal contexts which is the key to understanding both systems of healing and systems in general.

Within a pluralist medical culture, there is (from the doctors' point of view) a hierarchy of medical systems, differing in their wealth or power and in the degree of their systematisation. In the case studied, traditional medicine is at the bottom of the hierarchy and is so un-systematised as scarcely to constitute a system, though it nourishes nonetheless. The lack of system is seen in the disunity of traditional doctors, in their lack of a single consistent theory and in the wide variation in meaning in the medical terminology in daily use. Because traditional medicine is not itself a system, the claim of Islamic and European medicine to be systems of universal validity is popularly denied; they are simply tacked on (along with their ‘new’ diseases) to the existing kaleidoscope of medical ideas. Patients, then, unlike doctors, recognise only a single, wide-ranging corpus of illnesses for which all the different healers between them should possess the cures. The patient is not interested in knowing the cures or the ideas; nor are doctors necessarily interested in all the causes. Indeed what is striking is how little either patient or doctor needs (or wants) to know. Consequently, in analysing the popular culture, the notion of ‘alternative systems’ is largely irrelevant.

The two medical traditions which make up Arabic medical science remain as separate but complementary elements of Morocco's present pluralistic system. Prophetic medicine is concerned with spirit aetiologies, and Galenic humoral medicine with environmental factors. At their interface, an ambiguous group of illnesses refers to either system for their explanation and treatment, and analysis of their ambiguity demonstrates a profound syncretism between the systems around the concept of illness from contamination by cold or spirits. The illnesses are mostly chronic organic impairment of the senses, locomotion and fertility for which there is little effective treatment, and the Moroccan response to them, by drawing explicit symbols from two areas of shared experience—environmental cold as a pathogenic agent of the ecological domain, and spirit encounter as a feature of the neurotic domain—into the implicit understanding of their symptoms and signs, relates the private experience of organic illness to shared social categories in a way that may have value from the biomedical viewpoint.

The first part of this paper presents data on the socio-medical system of an ethnically heterogeneous society collected during 16 months of fieldwork. Special attention is given to the Black Caribs (or Garifuna). The focus is on the possible functions of alternative therapeutic systems. The second half of the paper provides a semiotic framework for the analysis of illness episodes. It is concluded that the sign of disorder in this context has no single interpretant. Rather, there exist a variety of interpretants from which the therapist and patient may select. There are constraints on this process, but the process is enhanced where the patient (and the social group) are free to negotiate a ‘diagnosis’. Negotiation implies selecting from among a variety of potential meanings: it implies a dialogue in which one goal is an interpretation which is acceptable in cultural terms and which leads to a therapy which is perceived as ‘appropriate’. Negotiation may also mean the realignment of signs into new ‘syndromes’ which indicate different etiologies or therapies. The existence of alternative therapeutic systems facilitates this process by providing access to new codes governing interpretation. The confrontation with biomedicine and its largely intractable codes may require that the ensuing interpretation incorporate, account for, or partially assimilate the ‘diagnosis’ or interpretation of biomedical personnel. Nevertheless, a single sign may have multiple referents, each consistent with one of the various interpretations imposed by multiple therapeutic systems. These referents may exist simultaneously without inherent contradiction. But to achieve such a consensus may require the development of new models based on an articulation but not an identification of two or more codes.

Beginning with the description of a single instance of problematic illness, this paper moves toward the comprehension of Tabwa therapeutics by placing them in their most complete conceptual context. Decisions made regarding methods of treatment, the loci of therapy (both physical and social), and the means of assessing therapeutic effectiveness reflect an epistemology which includes the overlapping domains of physiology, diagnosis, divination and religious and magical practices; domains whose different contents are nevertheless tightly interwoven by a relatively small number of underlying principles. The articulation of these principles makes clear that Tabwa concepts of illness and transformation form a coherent whole within which both traditional and European medicines take their appropriate and complementary places.