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

A physician evaluating health status among rural Tanzanian children as well as working in a Lutheran hospital, evaluates use of traditional and hospital-based medical care in the Usambara Mountains. Most rural Tanzanians use both traditional and hospital-based services, even for one disease episode. Local attendance at the Maternal and Child Health Clinic (MCHC) is increasing. 82% of the eligible children of the village attend. Of those who are eligible but do not attend, most have a sibling who had attended the clinic. Poor relations between hospital-based and traditional practitioners increase villagers' discomfort at attending the hospital or clinic, including the MCHC. Relations can be bettered by:

(a) having both MCH aides and village women discuss problems at the village health committee; (b) encouraging traditional healers to participate fully on the committee and be trained to hold village health posts: (c) encouraging women to attend the clinic and eliminating the disparagement of traditional medicines in all clinics.

Mauritius is a polyethnic society that provides an ideal situation in which to study medical pluralism. The population of this Indian Ocean island predominantly consists of individuals of Indian African. French, and Chinese origin; Hinduism. Christianity, Islam, and Buddhism are all represented on the island. A wide variety of both secular and religious healing resources are encountered on Mauritius, many of which are associated with particular ethnic and/or religious traditions. However, except for a few of the religious specialists, most practitioners are consulted by individuals of diverse ethnic and religious backgrounds.

In this paper I examine the medical belief system and health-seeking behavior of Mauritians in order to delineate both the conceptual and behavioral mechanisms contributing to the maintenance of medical pluralism. Despite the heterogeneity of the population, lay individuals tend to hold similar beliefs about the causes of illness and to construct similar categories of illness. Mauritians believe that illness may result from a wide variety of factors and that no single healing tradition is capable of dealing with all of these. Therefore, the medical belief system and the distribution of medical knowledge require and promote the maintenance of diverse healing traditions. The decision-making process during quests for cure is structured in such a way that it allows patients to consult a variety of healing traditions for particular illness episodes and to utilize over their lifetimes a diversity of healing resources.

The medical belief system on Mauritius is a consistent, unified system that promotes the maintenance of ideologically diverse healing traditions and the acceptance of newly developed or newly introduced therapeutic resources. It is, thus, well adapted to the social history and social heterogeneity of the island. It does, however, exhibit some characteristics that are not usually reported in other less heterogeneous societies, and the question arises as to whether these correspond to the extent of medical pluralism and or ethnic heterogeneity in other sociocultural contexts.

Kindoki (Kongo ‘bewitchment’) has often been analyzed as a social phenomenon which provides an outlet for repressed hostility, frustration and anxiety; as an indicator of tense social relationships, as accusations are directed toward outside agents of the relationship; as a medium through which episodes dramatize or reinforce social norms. But the following questions need to be asked from a psychological viewpoint. Does kindoki reflect the individual's unconscious means of personality integration? When it is used in describing an existential condition, clinical data suggests that the individual is moving from dependency to self-affirmation and self-integration. I propose the following hypotheses which guide my therapeutic work with the bewitched. Beliefs in kindoki are a representation of unconscious strivings toward ego integrity. Use of kindoki symbolism expresses engagement in the process of individuation, of identity formation, and a means of affirmation in the context of social thought and social relationships. An individual's identity is located in the ego yet also in communal culture; kindoki symbolism established the separate identity of the two—social and individual—identities. It enables the individual to say ‘no’ to the group which is the dominant part of his personality structure. In the kindoki experience, the individual uses the ‘group ego’ against which to externalize his feelings and impulses so as to promote personal growth. Kindoki symbolism provides the context in which the individual discovers and actualizes himself. It is thus a unitary psycho-social phenomenon. The therapist dealing with bewitched patients should accordingly, in diagnosis, adopt an analytic approach and, in therapy, a psycho-synthetic approach so as to not only represent the wholeness of kindoki as a system of thought but also to facilitate the healing process.

Although some of these comments are about papers which appear in other sections of this publication, the author addresses general conference issues and in particular, the application of medical anthropology to medical practice.

The distinction between a priori and a posteriori causality is a necessary methodological pre-condition for the analysis of explanatory assertions about sickness. Part one, on a priori causality, will not undertake a somewhat absurd reconstruction of a Senoufo medical ‘taxonomy’, it will rather describe the formal types of connections, necessary or possible, between a symptom and the three elements of its causal configuration: cause, agent, and origin. It is to be emphasized that there is a great heterogeneity between the logic of a priori ‘codes’ and pragmatic a posteriori elaborations. What is the reason for such a heterogeneity?

The second section shows that Senoufo therapeutic behaviours and institutions function in a closed and autonomous manner in relation to the interpretive register: the introduction of new therapeutic alternatives (notably Islamic or biomédical) do not necessarily lead to a change in causal thought. Furthermore R. Horton's conception of cause switching in West African medical thought must be criticized because of the inadequacy of the related notion of ‘remedial prescription’ and his lack of distinction between cause, agent, and origin.

Finally, an effort is made to separate out the principle of coherence which accounts as much for the diversity of a priori explanatory models and observed divinatory and therapeutic practices, as for the closure of the etiological field in relation to external systems. The analysis of the complex institution of sãdoho leads to the conclusion that: (1) the sickness event is conceived as the reactivation of an earlier event; it is immediately reinserted and stored in the collective memory of the matrilineage: (2) the divinatory device has the function of feeding this memory with its proper constituent instances and recollections: (3) initiation to sãdoho, which reactualizes and transfers all previously registered and stored sickness etiologies upon a potential diviner of the matrilineage, illustrates the general conception of causality based on the principle of repetition. This permits an understanding of several (taits peculiar to the medical pluralism of the Senoufo.

The paper suggests that a danger which faces the integrated study of health and medicine in Africa is a failure to attend closely enough at this early stage to the differences in concepts and taxonomies originating in each contributing specialism. This is because the new division of the subject which accompanies an integrated perspective upon it no longer follows the division of labour which used to be, broadly, between disciplines. So as those stark but comforting contrasts blur, it is important to keep hold of a robust and usable conceptual apparatus if we are to avoid deep confusion. Therefore, preferring to risk oversimplification rather than precocious complication, each of the three contributing disciplines—medicine, anthropology and history—is examined and the burning questions of the moment in each are proposed. In this process, the contributions which each can make to the new alignment become obvious. Equally, the limitations upon the new alignment are exposed, and the paper ends with a note of caution.