Brown Ch 13 (Finkler)

Brown Ch 13 (Finkler) - shut Sacred Healing and Biomedicine...

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Unformatted text preview: shut Sacred Healing and Biomedicine Compared Kaja Finkler in the last selection, Foster outlined two general "ideal types ” of ethnomedical systems: personal istic and naturalis- tic. Although there are some problems with that typology, it is a valuable tool for cross~cultural comparison. The episte- mologies—the ways of knowing and explaining things—are radically different in these two kinds of medical systems. But does that matter to the patients who seek relief from their symptoms? Do epistemological differenccs aflect the quality of the interaction between healers and their patients? This selection provides a direct comparison of the the- ory and practice of healing for two medical systems— themselves. As you will see, there are several aspects of Spiritualist healing that are attractive to patients, and there are characteristics of the biomedical system that are discour- aging to patients. From the viewpoint of the patients' sub- jective experience, the contrast is very real. The National Institutes of Health—the central facility for funding biomedical research in the United States—mas recently set up an office of Alternative and Complementary Medicine to study the wide variety of medical systems in our own medically pluralistic system. Alternative medicine is very popular (and big business) and covers the gamut Spiritualism and biomedicino—within the single context of from New Age Spiritualism to homeopathy to massage ther- urban Mexico. Kaja Finkler has done extensive fieldwork, first studying a Spiritualist temple and then a biomedical hospital. She observed and took notes on thousands of in ter— actions between healers and patients; she did follow-up in- terviews with patients at their homes in barrios all around Mexico City. Her study of this biomedical system is ex‘ tremely interesting because its practice is rather difierent from the way biomedicine is practiced in the United States. Some of this difference is probably attributable to the fact that biomedicine was imported to Mexico from France, and French biomedicine is significantly dt'fl‘erent from biomedi- cine in Britain, Germany, and the United States (Payer 1988). Finlcler describes a clear case of medical pluralism. Patients do not seem to be bothered by the fundamental epis- temological diflerences between Spiritualism and biomedi- cine. They are pragmatic; they want relief from their pain. Many patients come to the Spiritualist temple after disap- pointing encounters or results at the hospital. Spiritualist healers cultivate their after they have been cured apy to macrobiotic diets. The demand for alternative medi- cine may stern, at least in part, from the characteristics of the social encounter between the healer and the patient. However, both biomedicine and alternative therapies seem to require belief as part of the care. As you read this selection, consider these questions: I Spiritualist healers seldom talk to or even have eye con- tact with their patients. Why is this? Why don’t their patients feel alienated? I Do the kinds of questions that biomedical practition- ers ask conflict with the cultural sensibilities of the Mexican patients? Why might the encounter feel uncomfortable? I In what ways does Foster’s naturalistic—personalistic typology fit the comparison ofbioniedicine and Spiritu- alism? Are there ways it doesn’t work? I What does the author mean when she claims that bio— medicine rel ies on the placebo efi’ect? INTRODUCTION In this article, I compare two systems of healing— Spirirualist and biomedicine—as practiccd in Mex- ico. The comparison addresses several dimensions, including the physical setting, etiological concepts, di- agnoses, the practitioner—patient relationship, recruit- ment into the healing role, and treatment repertoires. 118 as well as issues relevant to the patients’ perceptions of their bodies and their existences. My extensive 11-” search on Spiritualist healing transformed my under- standing of biomedical practice in Mexico and, mm my studies of biomedical practice in Mexico fuszhEd me with fresh insights into Spiritualist healing in we)? that I had not anticipated. While my specific tools 15- on Spiritualist healing in Mexico and biomedlflne" practiced there, the comparison illuminates broader ' a F"; :-. . Kw .i‘t-u issues relevant to sacred and biomedical treatment regimens crtiss-culhirally. As a participant and observer of both healing regimes and their patients, I noted similarities and dis- similarities betWeen secular and sacred healing that broaden the grasp of the two medical systems and re- sult in different impacts on patients. The comparison sheds light on the nature of medical regimes embed cled in dissimilar systems of knowledge and divergent experiences. in practical terms, the comparison brings into relief the strengths and weaknesses of both.‘ With its origins in the 19th century,2 Spiritualism (Espirituallsmo) in Mexico is both a dissident religious movement and a health care delivery system (Finkler 1981, 1933, 1985a, 1986a). Spiritualist temples, fre- quently headed by women, are widespread in Mexico and in the border states of the United States. Spiritual- ism provides its followers with a clearly defined cos- mology, ethics, and liturgical order, transmitted orally to its adherents through a medium in trance during weekly rituals consisting chiefly of sermons (Finkler 1983, 1985a). While Spiritualism incorporates an anti- Catholic stance (Finkler 1983), it is firmly rooted in Judeo-Christian teachings. As a healing system, Spiritualism ministers to hundreds of patients.3 The majority of thosa coming to Spiritualist temples for the first time seek treatment from the healers for self-assessed, nongrave ailments. During the period of my study, about 10 percent of first-time patients became temple regulars and partici- pants in the movement (Finkler 1985a). The French model of scientific medicine was intro»- duced into Mexico in the 19th century.‘1 At that time, French texts replaced the classical medieval ones upon which Spanish Colonial medicine was based, and Mexican physicians studied in France. Following World War II, the French influence waned, and the US. medical model came to dominate Mexican bio- medical practice and continues to do so (Finkler 199] }. However, while biomedicine has been transported from the United States to Mexico, it has also been cul- turally reshaped in its day-to-day practice.-a Even a synoptic view of Spiritualist healing re~ veals that Spiritualism and biomedicine diverge along many dimensions. Spiritualism is embedded in a sa- cred world while biomedicine is sanctioned by secular science. Using Kleinman’s typology (Kleinman 1978), biomedicine is a professional system staffed by pro- fessionals with many years of formal training and legitima ted by the state. Spiritualist healers are practi— tioners, lacking formal academics, academic prepara- tion, and state legitimation. And, although the two Systems of healing may have developed in Mexico during the same historical period, they are rooted Sacred Healing and Biomedicine C ornpared 119 in disparate realities and distinct epistemologies. Nevertheless, they become unified in day-to-day life by the people who resort to them, a phenomenon that has been recognized cross-culturally.“ Unlike academi- cians, who regard the two healing regimens as diamet- rically opposed and in competition, the people who seek treatment do not distinguish the profound episte- mological differences between sacred healing, such as Spiritualism, and biomedicine. in the search for the al- leviation of pain, pragmatism prevails,- people judge the treatments they are given by their effects. They look toward those who provide them with the best medicine for a given sickness episode. By and large, people the world over, including these in the United States and Mexico, have assumed at least two distinctive postures regarding alternative healing, of which Spiritualist healing is one variant. On the one hand, folk healers are romanticized and idealized, especially when they are compared to physicians. in this camp, folk healers are usually re— garded as enjoying an idyllic relationship with their patients. On the other hand, folk healers, including Spiritualists, are simply dismissed as quacks and char- latans, impeding the work of physicians. The argu- ment is made, usually by local physicians, that patients stubbornly cling to traditional healers and by the time they seek out physicians to treat them, they are too sick to benefit from medical care. Physicians, then, are constantly compared to folk healers? but such comparisons normally lack an empirical ground- ing in both systems of healing. The comparison pr ‘- sented in these pages emerges out of my research on Spiritualist and biomedical practice in Mexico (Finkler 1985a, 1991). During my initial research on Spiritualist healing, I found that patients seeking treatment from Spiritual- ist healers usually did so after unsuccessful treatment by several physicians. Generally, people were referred to the healers by friends, neighbors, or acquaintances (Finkler 1985a), people whose pains had been allevi- ated by Spiritualist ministrations. This finding led me to carry out my study of biomedical practice in Mexico and to question what propelled people to seek alterna- tive healing and why biomedical treatment failed to alleviate their non-life—threatening conditions. METHODS During two separate research periods, I studied Spiri- tualist and biomedical healing and their respective pa- tients.8 i spent two years in a Spiritualist temple in a rural region in Mexico where I investigated healers 120 Belief and Ethnomedical Systems and patients and also trained as a Spiritualist healer (Finkler l985a). Subsequently, I spent two years in a large urban hospital in Mexico City where I studied biomedical practice and patients' responses (Finkler I991). In the Spiritualist temple, 1 observed 1,212 healer- patient interactions, and in the hospital, 1 sat in on 800 medical consultations. Subsequently, 1 followed up on the patients in both studies" to assess their responses to treatment ateach research site. I studied the healing practices of 10 healers and 17 physicians. The patients at both research sites were from the lower echelons of Mexican society and had similar non-life-threatening complaints, including headaches, back pain, chest pain, abdominal pains, and general musculoskeletal discomfort. HEA LERS Mexican Spiritualist healers are primarily women.10 They are usually recruited as a result of having them- selves had an affliction unsuccessfully treated by physicians. Healers minister to the sick through spirit protectors who poSSess their bodies when they enter a trance. Mexican Spiritualists tame the spirits of the dead that roam the universe and harness them for the good of humankind, that is, for healing the sick- The spirits possess the bodies of the healers—individuals chosen to treat the afflicted. Spiritualist curers resort to a wide variety of healing techniques, including the usa- of an extensive pharmacopoeia, ritual cleansing, purgatives, massages, baths, spiritual surgeries, reli- gious ritual, pharmaceuticals,11 and, what I call "pas- sive catharsis,” when a patient experiences a sense of releaSe and relief without having said anything (Finkler 1985a). In general, Spiritualist healers do not provide the patient with a definitive diagnosis, and when they do, it usually consists of informing the person either that he or she possesses a gift (don) that requires cultivation or that the person is possessed by an obscure spirit that requires extrication. Normally, people whose illnesses were not readily alleviated by standard Spiritualist procedures were given these types of diag- noses. ln either instance, the patient is required to enter training to develop the gift for healing or to expel the evil spirit. A person who does so becomes what I call a regular, an adherent of Spiritualism, and can become a healer or another type of temple func- tionary. When a healer declares that the patient is pos- sessed of the gift of healing or by an evil spirit, it is a sure way of recruiting the patient into the ranks of Spiritualisrn. Spiritualist healers and those who be- come regulars are ordinary people whose lives be- come restructured by their participation in a commu- nity of persons immersed in weekly and monthly religious rituals and by new networks of associations. While Spiritualist healing and its practices may be alien to many readers, Mexican biomedical prac- tice, on first glance, will be familiar in its overall form. The 17 physicians I studied, We of whom were women, employ similar technological accoutrements (for example, stethoscopes, sphygmomanorneters, scales, X—ray machines) and the internatiOnal vocabu- lary of disease entities familiar to physicians the world over. The government hospital in which I carried out the study was poorly funded, and its impoverished state was reflected in the conditions under which the physicians performed their medical activities. They re- ceived patients in small cubicles firmished only with a desk and a cot, and they shared stethoscopes, blood pressure monitors, and other basic medical tools. The majority of the diagnoses physicians gave to patients were related to nonspecific etiologies, followed by conditions associated with infections and parasites as- sociated with digestive, genitourinary, and respiratory problems (Finkler 1991}. Before turning to the comparison between Spiritu~ alist and biomedical practices, I must emphasize that my discussion attends to the general similarities and dissimilarities between the two regimes. It must be kept in mind also that individual differences exist among Spiritualist healers and among physicians in the ways each type of practitioner exercises healing ac— tivities, including the advice a healer or a physician may give to patients concerning life’s problems.12 SIMILARITIES BETWEEN SPIRITUALISM AND BIOMEDICINE The disparities between Spiritualist and biomedical .I therapeutics and the ways in which patients perceive each of the two healing systems unquestionably out- weigh the similarities, but the similarities between {119' . two regimes are intriguing. For example, as biomedlr cine focuses on the body (Pellegrino and Thomasulfl 1981), so too Spiritualist healers address their miner trations to bodily discomforts. it is important to sum ' that patients sought, first and foremost. symptom 311“ via tion from Spiritualist healers in much the same “fall as they did from physicians. in fact, as I noted ' the overwhelming majority of first-time patients Ln 3 I. Spiritualist temple arrive with bodily pains of ' " " duration (Finkier i985a) and after having been ',. cessfully treated by physicians. - : Both physicians and Spiritualist healers adhere to a dualistic view of the body and its attendant distur- bances. Biomedicine has been criticized for its mind— bodv dualism (Engel 1977), but it is frequently overlooked that a similar dualism prevails in sacred healing such as Spiritualism. Spiritualists clearly and forcefully distinguish between the corporeal, or in their terminology “material,” and “spiritual” distur- banccs in much the same way that physicians distin- guish between organic and psychological sickness. This dualism is contrary to the more characteristic Mexican holistic concepts of the body and sickness in which sickness is normally regarded by both sexes as an extension of day-to-day adverse experience or emotional discharges, especially anger.13 Thus, both Spiritualist healers and physicians impose a mind body dualism on their patients. There are structural, if not conteXtual, similarities between Spiritualist healers and physicians in their encounters with patients. In both regimens, the patient takes the role of a passive recipient of the practi- tioner's ministrations, and in both regimens, the practitioners require their patients’ compliance.” to both settings, I witnessed practitioners reprimand- ing patients for not having folIOWed the prescribed treatments. As i noted previously, while academicians See profound epistemological differences between bio- medical practitioners and alternative healers, such as Spiritualists, from the patient’s perspective, biomedi- cine and Spiritualism accomplish similar ends. For ex- ample, in their desire to know what is wrong with them, patients expect to have their bodies examined and their “insides” seen. Both physicians and healers attempt to peer inside the patient’s body, the former with technological apparatus and the latter with the gate of the spirits. According to Spiritualist healers and their patients, the healing spirits penetrate the bodies of patients to ascertain their malady. The spiri— tual gaze exerted by the healers' spirits parallels patients’ expectations for technological management that enables physicians, in the words of one patient, "to look inside my body” to make a correct diagnosis. Ironically, while physicians must juggle available re- sources and struggle with the decision whether to use contemporary technology (Flnider 1991) to make their diagnoses, the spirits’ gaZe is routine and intrinsic to Spiritualistic healing. The spirits continuously pro- claim their omniscience, and patients are not even re- quired to say much, often to the patients’ relief. In this way. patients undergo what i have called "passive catharsis” (Finkler 1985a) when the healer tells the patient what the patient is experiencing, eliminat- Sacred Healing and Biomedicine Compared 121 ing the need for patients’ active verbalization of their discomfort. DIFFERENCES BETWEEN SPIRITUALIS‘T AND BIOMEDICAL PRACTICE The dissimilarities between the two regimes exist along several dimensions of contrast, including the physical setting, etiological beliefs, diagnosis and treat- ment repertoire, reorientation of the patient’s body, re- cruitment into practice, and most importantly the practitioner-patient relationship. The Physical Setting The physical setting of the healing encounter reflects broad prevailing themes in the respective societies in which each of the two healing regimes is embedded. Mexican Spiritualism evolved out of Mexican culture, and the spatial setting in which the healing takes place reflects Mexican cultural scnsibiiities. The physical context in which healers discharge their ministrations mirrors the Mexican culture’s concern with family and community and its lack of concern with privacy. Not unsurprisingly, in Spiritualist temples, the healing experience is communal. Healers sit in one room, re- ceiving patients separately. Consequently, there is a cacophony in Spiritualist healing rooms that imparts a Sense of a collective experience, very unlike the physi- cian-patient encounter that takes place in isolation in a cubicle, occasionally in the presence of onlookers such as students, nurses, and occasional visitors. The rela- tively private surroundings of biomedical consulta- tions reflect the individualist cast of biomedicine. As 1 noted earlier, biomedicine was transplanted into Mexico from Europe and the United States, and the spatial structure of the physician-patient encounter as we know it today and as it takes place in Mexico mim- ics Western industrialized society's emphasis on pri- vacy and individualism. This model conceives of the person as an autonomous unit, independent of and isolated from other individuals and from social and cultural contexts, as the patient is when he or she en- ters the physician’s cubicle for a consultation. Etiological Beliefs and Diagnoses The common pool of etiological beliefs” in Mexico contains notions about environmental assaults such as climate (cold, wet), inappropriate diet and lack of 122 Belief and Ethnomedical Systems vitamins, and hard work. Emotional discharges, asso- ciated with adverse life events, and day-to-day ex« perience are regarded as sickness producing. Most important. anger, usually associated with moral evalu- ations and conflicting social relations and frequently allied with nerves (ueroios), is a singularly important etiological explanation of a sickness episode. Susie, or sudden fright, is considered to produce various mal~ adies, but especially diabetes. Spiritualist healers sub- scribe to the ideas held by most Mexicans about sickness causality with one notable exception: belief in. witchcraft. If biomedical treatment fails, many people assume that the infirmity is produced by witchcraft. Patients seeking treatment from Spiritualist healers usually ar- rive at a Spiritualist temple believing that witchcraft has been worked on them. The Spiritualist healers I studied categorically deny this possibility. Spiritual- ists’ denial of the existence of witchcraft removes the blame for the patient’s disorder from a neighbor, rela— tive, or other person with whom the patient interacts. Spiritualists fix culpability squarely on impersonal spirits for which neither the patient nor his or her social circle can be blamed. By doing so, they re— store order in the person's disrupted social relations and thereby possibly avoid future anger resulting in illness. in day-to—day practice, Spiritualist healers, unlike physicians, are not concerned with etiological expla- nations. Such etiologies as they do offer, however, are relatively limited and unchanging compared with those of biomedicine. Spiritualist healers confer a co- herent system of explanation usually reduced to as- saults by evil spirits. For example, Spiritualists believe that afflictions that stubbome resist both biomedical and Spiritualist ministrations must have been caused by the intrusion of a recalcitrant spirit that requires taming in the service of healing and removal from the body. Mexican physicians combine biomedical and trad i- tional folk understandings to explain sickness.“ in the majority of cases that l studied, the physicians’ causal explanations included biomedical understandings of the breaking down of the bodily machine, invasion by pathogens, stress, and obesity, coupled with folk un» derstandings such as anger, nerves and fright and, to a lesser extent, environmental and social causes, or diet. The emphasis, however, is on the individual’s be» havior and never on impersonal spirits or witchcraft. Most important, unlike the Spiritualist healer, the physician may provide more than one explanation, or may change explanations, especially if he changes the diagnosis. Unlike physicians, Spiritualists draw on a limited diagnostic repertoire and eschew multiple diagnoses. There is usually consistency among different Spiritual- ist healers regarding etiology, as well as diagnosis and treatment.” In fact, Spiritualists rarely furnish pa- tients with a diagnosis, nor do patients expect to re- ceive one, becauSe they usually agree that the spirits are all knowing and know the patient’s affliction. On the other hand, patients do expect to be given a diag- nosis by physicians. In my studies, whether or not a patient received a diagnosis was an important vari- able influencing the perceived successful outcome of a physician’s treatment (Finkler 1991). Theoretically, at least, physicians made their diagnosis on the basis of patients’ presenting symptoms, medical hismry, and a physical examination. In my study of phySi- cians" clinical judgments, i found that, in the last analysis, diagnoses were based on physicians' stereo- typic epidemiological understandings of the patient population, individual physicians’ training and expe- rience, and moral values regarding, for example, sex- ual behavior. In other words, physicians often based diagnoses on understandings unrelated to patients’ symptomatic presentations and medical historir-st.is For example, the majority of the physicians in the study diagnosed parasitosis in their poor patients re- gardless of the presenting symptoms (Finkler 1991).19 When the initial diagnosis failed, physicians estab- lished diagnostic validity on the basis of symptom a1» leviation. A patient’s report of feeling better as a result of the drug the physician had prescribed validated the diagnosis for the physician. From the standpoint of good medical practice, a physician is required to test hypotheses and revise di- agnoses according to empirical observations and the patient's response to the prescribed treatment, but from the patient’s perspective, diagnostic revisions were distressing. For example, a physician would change the diagnosis if a patient’s complaints were not alleviated by the prescribed treatment. A modification of the diagnosis suggested to the patient that the doc- tor lacked the certainty and knowledge to cure the ill‘ ness. Moreover, when patients sought quick relief from pain by consulting various doctors, they often ended up with seVeral different diagnoses for the same symptoms. Patients who were given different di- agnoses by the same physician or by several phySI- clans (Finkler 1991; Helman 1985: Koran 1975) became confused and befuddled about the nature of their turbances and wondered which physician’s diagnosis was correct. Interestingly, patients would occasionally I ask Spiritualist healers to verify a physician’s diagml‘ sis as a way of making sense out of the diverse did? ‘ noses they had been given by other physicians. Adding to this confusion, physicians reorient-the' patient's view of his or her own body and the-mm!“ tiae of its functioning when they explore with W patient the nature of his or her bowel movements and excreta, or when they dwell on issues relating to the patient’s sexuality. Biomedical consultations fre- quently focused on matters related to sexuality, a sub- ject normally not broached by Spiritualist healers, except when women patients reported vaginal dis- charges or delayed menstruation. Whereas patients confronting Spiritualist healers discussed male—female relations in terms of rights and obligations, within the medical consultation physicians called attention to the individual’s sexuality in ways that Spiritualist healers never did. in the medical setting, marital relations be- came expressed in trequency of sexual intercourse or other issues concerning sexuality. The focus on an individual’s sexuality was inher- ent to the medical consultation when physicians ques- tioned women (Finkler 1994a) about the frequency of sexual intercourse, menstruation, contraceptive use, and number of births and abortions. in addition, women were required to change their concept of the shape of their bodies when physicians di- agnosed patients as obese and prescribed special diets. In the impoverished social classes, women are rarely concerned with their weight, and they adhere to a tradi- tional Mexican diet of tortillas, salsa, and beans out of economic necessity and cultural conunitment. Unlike Spiritualist healers, who never imposed an esthetic model of the body on their patients, physicians would frequently do so to the consternation of the patients.20 The Practitioner-Patient Encounter The doctor-patient encounter has become a central concern in the study of biomedical activities, given the widespread notion that the doctor-patient relationsz provides the key to good medical practice. In this re— gard, alternative healers, including Spiritualists, are often held up as examples to show what the physi- cian-patient relationship lacks. Numerous assertions have been made about folk healers“ personal ties to the patient. It is commonly held, for example, that the folk healer-patient relationship, in contrast to that of the doctor and patient, is based on shared etiological un- derstandings and congruent explanatory models and that traditional healers care more about and are more attentive to patients. Such attentiveness is often mea- sured in terms of healers’ having more eye contact with patients, more time with patients, and more em- pathy and compassion. It is also widely held that tra- ditional healers, unlike physicians, have a holistic view of the patient.21 Sacred Healing and Biomedic‘me Compared 123 My observations, however, are that Spiritualist healers, unlike physicians, lack eye contact with their patients and ostensibly fail to recognize the individual standing before them. They sit in trance with expres- sionless faces, eyes closed, holding or stroking the patient, who briefly murmurs a description of the dis- order. Being in the trance state precludes the healers’ displaying any kind of affect for their patients. By con- trast, during the medical consultations in the present study, the physician and patient sit facing each other; their physical contact is limited to the physician’s physical explorations by palpation and auscultation. Physicians’ affective expressions vary, however. Some constantly smile at the patient, while others maintain a serious demeanor. Furthermore, in the consultations, physicians spend about 21 minutes on average with a first-time patient (Finkler 1991), whereas the Spiritualist healer- patient interaction usually lasts less than half that time (Finlder 1985a).22 The affective content of the inter- action varies among both physicians and Spiritualist healers. Some Spiritualist healers and physicians are relatively brusque and indifferent to a patient’s suf» faring, while some Spiritualist healers console their patients by reminding them that God and the spirits know their pain and some physicians demonstrate concern for a patient’s suffering. The differing physical postwes of the physicians and Spiritualist healers, the time they each spend with their patients, and the requirement that patients reoris ent their view of their own bodies highlight the dra- maturgical nature of the physician-patient consultation in contrast to the Spiritualist healer~patient encounter. The patient’s major concern is that the healer or physician know his or her pain. When the patient con- fronts a Spiritualist healer, he or she need not tell the healer very much for the healer to know everything. In fact, the spirit constantly reminds the patient "I know everything.” In this way, the healer reassures the pa- tient and also establishes legitimacy in the healing role. The physician, though, must question the patient and anchor the condition and locate it in chronological time and in a specific part of the body in order to make an accurate diagnosis. While patients’ expectations of Spiritualist healers are that the spirits know everything, patients expect the physician to question them (Finkler 1991). In this way, they are assured that the physician will learn about their malady, a knowledge the spirit occupying the healer’s body already possesses. Most important. patients are also assured that the Spiritualist healer knows their pain because they know that Spiritualist healers too have suffered afflictions before becoming 124 Belief and Ethnomedical Systems healers. This brings us to the important difference of recruitment of healers and physicians. Recruitment into the Healing Role The different ways in whidi Spiritualist healers and physicians are recruited into their respective roles have different effects on patients. Whereas those we cruited into the medical profession are usually healthy individuals, as we saw earlier, those recruited into Spiritualist healing usually experienced an affliction themselves before becoming healers. As formerly sick people who have become health providers, Spiritualist healers are themselves examples of the potential for recovery through Spiritualist ministrations. impor- tantly, they convey to the patient that they have grasped the patient’s anguish through their personal experience. They experienced the pain in the past in the same way as the patient is experiencing it in the present. The doctor cannot provide the patient with experiential evidence, as Spiritualist healers proudly do, that his ministrations inducc a transformation from having been sick to healing others. The potential conversion of a patient to a health practitioner, or other functionary serving God and the spirit world, forms part of the Spiritualist therapeutic repertoire, a technique that the biomedical therapeutic kit lacks. Treatment Repertoires As noted earlier, Spiritualist healers’ diagnoses are rel- atively simple, but their treatment repertoires are rela- tively complex. By contrast, the physicians' diagnoses are complex, but the cure repertoire is limited. The physicians' treatments are chiefly medication or, in extreme cases, surgery. On the other hand, the Spiri- tualist healers treatment kit contains a large array of treatment options, which also involve a patient’s par- ticipation in various treatment activities. These in- clude the use of pharmaCeuticals or herbs and other botanicals that rural patients are often required to col- lect in the open fields, getting massages, taking baths that require preparation by the patient, and other ac- tivities (for example, placing crosses under the bed), as well as participation in Spiritualist rituals. These activ- ities, in effect, engage patients in their recovery. In keeping with this point, physicians take full responsi— bility for the patient’s successful cure, it not for their failure to heal, whereas Spiritualist healers assign re- sponsibility to patients for their cure by constantly re- minding them that they must have unrelenting faith in the Spiritualist God and His benevolence, further in- volving them in their own therapy. Furthermore, while the biomedical technological management for which patients clamor carries a heavy symbolic load and no doubt aids in perceived recovery, the cleansing that Spiritualist healers supply embodies powerful symbols that address the pro- found contradictions in which the patient’s illness may be embedded. Not surprisingly, of those patients who perceived themselves as recovered through Spiritualist healing, most attributed the recovery to the cleansing they had received (Finkler 1985a}. Whereas patients may have disagreed with the treat- ment course proposed by physicians, patients always agreed with the Spiritualist treatment, especially when it involved ritual cleansing, coupled with herbal remedies. With these cleansings, the healers symboli- cally removed evil that may have befallen the patient, and thereby resolved the disorder in the patient’s life, even if only temporarily. CONCLUSION To summarize the dissimilarities, perhaps the most crucial difference between biomedicine and sacred healing of the Spiritualist variety is this: healers re- solve contradictions for patients that physicians can- not because the biomedical script requires physicians to focus on discrete physical pains while the patient is experiencing a timeless and overbearing pain that is not necessarily localized in chronological time or con- fined to a specific part of the body. Moreover, physicians do not address the contra- dictions in which patients are enmeshed. To explain sickness, the biomedical model may blame impersonal pathogens that attack the body, explaining the sick- ness in generalized terms rather than in terms of the patient’s personal suffering. Or, it blames the patient, especially his or her poor habits {Mc Keown 1979). Biomedicine often requires patients to alter cus« tomary behavior such as diet, work, or drinking habits as well as to alter profound notions of their bodies. it does not, however, attempt to transform the circumr stances of a patient’s life in the way Spiritualists do for these who become regulars. Spiritualist healing can gradually transform the person’s existence by incor- porating him or her, and sometimes the entire family. into a religious community. Over the long term: Spiritualist healing provides new interpersonal net- works and also places the person in a new relationship l with God. In the latter instance, relationships with . other human beings become subsumed within the 111' I teraction with God. This process is further facilitated by Spiritualist insistence that witchcraft lacks all?” reality, that human beings cannot harm one another- ] ' 3v denying the existence of witchcraft and evil niachinated by other humans, Spiritualists facilitate smoother social interactions, militating against anger and future illness episodes. Spiritualist healing progressively reorders the ex- istence of those patients who eventually become regu- lars by incorporating them into a community of sufferers who Share a satisfying religious reality and symbolic meanings, by God appointing them to be- come functionaries in their movement, or by His hav- ing chosen them to become healers because they possess the gift. As I have emphasized elsewhere, Spiritualist healers do not produce miraculous cures. All transformations are achieved gradually, and some patients even experience great pain in the process (cf. Finkler 1985a). It is noteworthy, hoWever, that Spiritualist healing differentially reorders men's and women’s lives; it re- orders men’s lives to the ostensible advantage of women. Spiritualists preach against machismo in men. leading them to cease drinking heavily and womaniz- ing. The men tend to spend their leisure time with their wives and families rather than with their former friends or other women. By restructuring men's lives, Spiritualist-s promote smoother marital relationships (Finkler 1981), a change women recognize as salutary and healthful. As I explain elsewhere, adverse social relations, especially marital discord, can be as patho- genic as any virus, and women’s health in Mexico specifically is greatly influenced by their relations with their mates {Finkler 1994a}. In the measure that Spiritualist healers succeed in easing the marital rela- tionship, they are also promoting a woman’s health. While biomedicme attempts to refashion the pa tient"s view of his or her body, Spiritualism alters the person’s experience of his or her body. On an existen- tial level, healers embody a spirit through trance and, in so doing, experience their bodies in a new and sa- cred way. Uniformly, all healers and functionaries who entered trance to fulfill their healing roles reported that they have experienced a tingling effect in their bodies, a heightening of the senses, and a vision of extraordi- nary colors. Additionally, trancing may have physio— logical correlates that influence the healing process (Finkler 1985a). Clearly, biomedicine does not incorpo- rate trancing into its treatment repertoire, nor does it address the existential dilemmas, reinterpret them, give them new meanings, or change the social relation- ships in which the patient is embedded, including those betWeen husband and wife (Finkler 1981}. In the final analysis, Spiritualist healers, like physi- crans, fail to heal their patients when they fail to attend to the patient’s world, with its attendant contradictions Sacred Healing and Biomedicine Compared 125 and requisite transformations (Finkler1985a, 1991}. To succeed in resolving non-lifothreatening, subacute conditions, a heating system must address patients’ bodily ills and concurrently transform their perceived existence (Finkler 1991, 1994a). lmportantly, the process of transformation, in and of itself, alters the patients' lives and, in the proCess, their state of health.23 One final point merits consideration. This com- parison suggests that folk healers, such as Spiritual- ists, depend on their healing techniques rather than on their persona to effect a cure. Yet, as l noted at the out set of this discussion, great emphasis has been given to the relationship between the healer and patient in the same way as to the doctor-patient relationship in bio- medical practice (see also West 1984). In fact. the doctor-patient interaction has formed a focal point of study, and it has become axiomatic that the doctor- patient relationship is a determining factor in success- ful primary health care delivery and by extension in the healing process (cf. Brody 1992). It has been as— serted that a preper doctor-patient relationship, re— garded as crucial in biomedicine, produces a placebo effect (Brody 1988), and that treatment outcomes de- pend on it. It is widely assumed that the relationship between patient and sacred healer has a similar effect. My findings are (Finkler 1991) that only Certain as- pects of' the doctor-patient relationship tend to influ- ence the healing process in biomedical practice for patients with self-limiting conditions, revolving around the physician’s explanations of the patient’s Condition, the patient’s agreement with the physi- cian’s diagnosis, and whether or not patients partici- pated in the encounter,“ reemphasizing the role of patient participation in cures that, as l noted, are incor— porated in Spiritualist treatment techniques. My argument is that biomedical practice relies greatly on patient management during the therapeutic encounter because its healing techniques lack certain‘ ties; in Fox's words, "the development of scientific medicine, then, has both uncovered and created un- certainties and risk that were not previously known or experienced" (19:30:19). As i observed earlier, the physician’s therapeutic kit lacks certainty and means to resolve the contradictions by which the patient is encompassed, to deal with patients’ subjective experi- ences and the certainties of pain, or to reorder their lives. For this reason, treatment hinges not only on healing techniques, as it does in sacred healing, but also on the encounter itself, including the time it lasts, and the physician’s persona becomes part of the physician’s tool kit. Significantly, Spiritualists insist that there are no differences among individual healers. 1 26 Belief and Ethnomedical Systems I assert that this is became in Spiritualist healing, the healer-patient encounter is secondary to the healer’s techniques, in which the person of the healer is sub- merged. The treatment techniques involve the patient in the cure rather than the healer’s manner or person- ality itself and aid patients in restructuring the con- flicts in which they may be entangled. The emphasis on the role of the individual healer effecting the cure of the individual patient reflects Western industrialized society’s bias, wherein the per— son has become an atomistic unit. The fostering of the drama in the consultation is based on the model of the doctor-patient relationship that mirrors the prevailing ethos of the abstract, independent individual con— fronting a self-mterested, autonomous physician dur- ing the encounter. The individual in Mexico is not solitary; he or she is embedded in a family that encom- passes his or her life, and each looks to the physician for alleviation of pain. Spiritualist healing addresses issues of culpability, evil, and witchcraft, and reorders social relationships, especially those with one's mate (Finkler 1981), which biomedicine fails to do. Paradoxically, as a folk healing movement, Spiri- tualist beliefs exert little hegemonic force in Mexico on a national scale, but by transforming patients’ exis- tence through incorporation into a community of per- sons healed spiritually, they have created a religious movement comprising thousands of people. In so doing, Spiritualist ministrations have promoted, on an aggregate level, religious pluralism in Mexico. Spiritualism thereby contributes to advancing social change by mobilizing a sizable population and fo— menting a growing movement that hirrushes Mex- icans with new options for religious participation. While Spiritualist healing may change a couple’s day- to—day interaction, on an aggregate level the move- ment fails to restructure Mexican society in ways that could benefit its participants economically or politi- cally (Fin kler 1986a}. On the other hand, biomedicine, by treating individual bodies without transforming people's lives, fails to contribute to new social forms for the collectivity. It succeeds only in maintaining its hegemony as the major authorized provider of health care legitimated by the state. NOTES 1. There has been a surge of interest in alternative healing in the US. medical community, as evidenced by the fact that the National Institutes of Health have opened the Office of Alternative Medicine in 1993 to promote stud- 10. 11. ies of alternative medical practices and their efficacy (see also Eisenberg et al. 1993}. . The Spiritualist movement in Mexico was founded as a religious movement in 1861 by a recalcitrant priest named Roque Rojas, whose portrait hangs at the altar of every Spiritualist temple. (For a historical overview, see Finlder 1983, 1985a; also see Lagarriga 1991,- Ortiz Echaniz 1977, 1989.) Sylvia Edianiz Ortiz {personal communication] re- ported that in one Mexico City Spiritualist temple that she had studied for over 20 years, she counted as many as 5,000 patients in one day. In the rural area where I carried out my research on Mexican Spiritualist healing, I counted as many as 125 patients in a day (Finkler 1985a}. There are hundreds of Spiritualist temples in Mexico, as well as in certain parts of the United States (Finlder 1983, 1985a). in October 23, 1833. Valentin Gomez Farias instituted the Establecirruento de Ciencias Médicas and estab- lished French medicine in Mexico. (See Finkler 1991 for a discussion of the history of medicine in Mexico.) See chapters 5 through 8 in Finkler 1991 for the specific cultural influences on Mexican biomedical practice. This has often been discussed under the rubric of med- ical pluralism (see, for example, Bastien 1992; Cos- minsky 1983; Crandon—Malamud 1991; Janzen 1978]. See bibliographies in Finkler 19853, 1986b, 1986c. Also, see a formal economic analysis done by [mill-ran (1990). She compares the cost effectiveness of Spiritualist heal- ers and physicians, using the data reported in Finlder 1985a and 1991. l employed the same method in both studies. Because of space limitations, 1 refer the reader to Finlder 19853 and 1991 for a detailed description of the method. Therel discuss with great specificity sampling techniques and selection, recruitment of patients into the study, instru- ments used in each study, and interviewing techniques , at each research site. In both studies, patients were inter- viewed before they saw the healers and the physicians. and I observed the healer and physician consultations. . I followed up at their homes 125 patients in the rural re- gion seeking treatment from the Spiritualist temple and 205 patients in Mexico City who were initially inter- viewed at the hospital (see Flnlder 1985a, 1991}. The fact that the majority of the healers are recruited as a consequence of affliction and that they are also wow raises the important question of differential morbidity along gender lines. I initially addressed this issue In Finkler 1985b and more recently in Finkler 1994a where.- . 1 Explore in great detail and in new ways why mm“!- _ women experience sickness than men and I ofler a new- theory to explain the phenomenon. Many pharmaceuticals have now become part Of My“? medicine and have been incorporated into folk Frat-'9‘ tioners' pharmacopoeia, including Spiritualist healers-- These may include terramycin, Enterovioforma, Dram- amine, and others. Generally speaking, the phannacw" ticals prescribed by a spirit possessing the healer's , state. For reflect the healer's experiences in a waking example, the spirit of a woman healer who ha d worked 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. as. a nurse assistant tended to prescribe patent medi- cines, while others who lacked similar exposure pre- scribed only the standard massages, baths, and teas that are regarded as the most pure type of Spiritualist heal~ ing [see Finkler1985a.) See Finlder 1985a:chapter 7 and Finkler 199lzchapter 7 for a detailed discussion of the variations in practice among Spiritualist healers and among physicians re- spectively. See Pinkler 1985a and 1991 for discussion of etiological beliefs in Mexico. It could, of course, be argued that Spiritualists concretize a holistic view of the body when they literally incorporate the spirits into their bodies during possession trance; nevertheless, they profess a dualistic perspective as do physicians. It is possible that the Spiritualist healers' encounters with their patients mimic in a religious idiom biomedi- cine's secular practices, given their exposure as patients to biomedicine and its procedures. Spiritualist healers also wear white coats during healing sessions, as do physicians. See Finkler 1991 where l introduce and discuss the notion of a, cultural pool of etiological understandings, upon which men and women draw differentially when they are struck by a sickness (see Finkler 1994a). The exact nature of Mexican physicians' etiological ex- planations is highly complex. For a discussion of their beliefs and clinical judgment, see Finlder 1991:chapter 6. For a detailed comparison of agreements among Spiritualist healers and among healers and patients re- garding etiology and treatment, see Finkler 1984. For a similar finding on psychiatric practice in the United States, see Gaines 1979. it is common knowledge that parasitic infections are endemic across Mexico, although it is disputed to what degree people simply carry rather than experience parasitic disease, especially amebiasis [Gutierrez 1986). According to Gutierrez, "The fundamental problem consists of a tendency to erroneously diagnose amebia- sis in cases of diarrhea and dysentery due to the diffi» culty in practicing laboratory examinations" (1986:375}. in fact, some physicians would claim that a patient was obese when they lacked a diagnosis for a woman's con- dition. See Finkler 1994a, especially the case of Josefina who, like other women, was distressed by the physi— cian's suggestion that her body was abnormal. Also, see for example, the case of Nomi in Finkler 1991, where the physician prescribed a diet for the patient that was im- possible for her to follow because of economic con- straints and work routines. Numerous anthropologists have written on the impor- tance of the folk healer-patient relationship, including Clark 1973; Dobkln de Rios 1981; Fabrega and Silver 1973; Foster and Anderson 1978; Gould 1977; Kinzie 1976; Kleinman 1980; Landy 1977; Peters 1978. In fact, when the head of the temple noticed that a healer spent a relatively long time with a patient, she would reprimand the spirit that it was spending too much time with one patient. This usually occurred when there were many people waiting for a consulta- 127 Sacred Healing and Biomedicine Compared tion. During my initial study of Spiritualist healing, I counted as many as 125 patients seeking treatment from the healers in one day. On my subsequent visits, and as recently as the summer of 1993, 1 observed many more patients than the 125 I noted in my study in 1977~79; and the number of healers grew from 8 to 24, working two shifts, in this temple alone during a span of 1-1 years. 23. See Finkler 1994a for the case of Margarita. She provides an excellent example of how a woman changed from a sickly to a healthy individual in the process of becoming a Karate champion. Her case emphasizes that it is the process of transformation itself that heals. 24. Other variables include: the physician’s giving the pa- tient a diagnosis,- whether or not physicians explained to the patients what was wrong; whether or not patients agreed with the physician’s diagnosis; and whether or not patients posed questions to the physician, meaning they partidpated in the consultation (see Finkler 1991; for a multivariate analysis of these findings showing the types of patients most responsive to these aspects of the physician-patient encounter, see Finkler 1994b). REFERENCES Armstrong. David. 1983. The Political Anatomy of the Body. Cambridge: Cambridge University Press. Bastien, Joseph W. 1992. Drum and Stethoscope. Salt Lake City: University of Utah Press. Berger, Peter, et al. 1974. 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Brown Ch 13 (Finkler) - shut Sacred Healing and Biomedicine...

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