Cardea, E., & Krippner, S. (2010). Culture and hypnosis. In S. J. Lynn, J. W. Rhue, & I. Kirsch, (Eds.

), Handbook of clinical hypnosis (2nd ed.; pp. 743-771). Washington, DC: American Psychological Association.

CULTURE AND HYPNOSIS1

ETZEL CARDEA, Ph. D.* AND STANLEY KRIPPNER, Ph. D.** * Thorsen Professor in Psychology, Lund University, Sweden ** Alan Watts Professor of Psychology, Saybrook Graduate School and Research Center, USA

Corresponding author: Etzel Cardea, Ph. D.

Thorsen Professor Department of Psychology University of Lund P.O. Box 213 SE-221 00 Lund, Sweden Telephone number: (0)46 46 2228770 fax (department of psychology) 46 46 222 4209 email: Etzel.Cardena@psychology.lu.se webpage: http://www.psychology.lu.se/Personal/e_cardena/

The authors dedicate this chapter to the memory of David Bakan, Ph. D., the quintessential archetypal wise man, and thank Jeffrey Kirkwood and Devin Terhune, M. Sc., for their editorial assistance. Stanley Krippner expresses his gratittude to the Saybrook Graduate Schools Chair for the Study of Consciousness for supporting his participation in the preparation of this chapter.

HYPNOSIS AS A CULTURAL CONSTRUCT Culture has been defined as "the organized system of knowledge and beliefs that allows a group to structure its experiences and choose among alternatives" (Tseng, 1997, p. 4). Over the course of our lives we are immersed in a specific culture, yet it is often assumed that whereas biological factors are essential, cultural variables can be treated superficially or taken for granted. In fact, cultural concepts are multilayered and complex, and any notion of an easily definable culture is misleading. Instead, we have groups that can be more (e.g., tribal groups) or less (e.g., New York city inhabitants) homogeneous, more (e.g., the Hassidim) or less (e.g., metrosexual males) traditional, more (e.g., traditional Japanese) or less (e.g., (urban US citizens) communal and, in the case of immigrants, more or less acculturated to their new homeland. And even within a culture there are important socio-economic differences that may, for instance, make the experience of an inner-city African-American more similar to that of a denizen of a Brazilian favela than that of his/her wealthy suburb counterpart. Yet a lot of what passes for cross-cultural psychological research is mostly research on middle-class, formally educated groups that happen to live in different countries.

Another important consideration is that cultural analyses are often framed within etic (presumably universal) or emic (culturally relative) explanations and constructs. The former are typically based on Western rationality and are context-poor, whereas the latter tend to be more culturally and historically thick. Research shows that etic explanations are neither obvious nor easy to establish (e.g., van Duijl, Cardea, & de Jong, 2005). We will aim to maintain these considerations in mind as we discuss the cultural construct

known as hypnosis. It is worth mentioning that disregarding cultural variables may produce implausible conclusions such as accepting that individuals who show impressive hypnotic-like phenomena (e.g., analgesia) in the midst of a Thaipusam ritual are low hypnotizables because they scored below average on a Western created, but not validated in their culture, measure of hypnosis (Kok, 1989). In this chapter we focus on hypnotic and hypnotic-like phenomena in non-Western cultures, rather than comparing, hypnotizability evaluations in Western countries (e.g., Cardea, Kallio, Terhune, Buratti,& Lf, under review; Perry, Nadon, & Button, 1997).

Locke and Kelly (1985) provided a valuable framework for understanding how cultural variables undergird states of consciousness, whether or not the reader considers that hypnotic processes can effect an alternate state of consciousness. In their model, culture shapes an experience through a number of interrelated processes. They include ethnoepistemology (the basic metaphysical and epistemological axioms held by a culture, such as whether shamanic experiences refer to another reality or are just fantasy), its signs, symbols, and metaphors (e.g., indicators of special powers or attributes, such as a shaman holding a magical pouch or a physician having an M.D. degree from Harvard), predisposing factors (e.g., having been socialized by the media or rituals to have specific expectations about what may happen in hypnotic or vodou contexts), situational factors (e.g., the general context of a hypnosis experiment or a ritual), and the specific patterning of experiential, behavioral, and phenomenological changes (e.g., the hypnotic suggestions themselves or specific drumming beats in a vodou ceremony). This

framework will help us understand better in what ways mesmerism, hypnosis, and possibly related phenomena such as shamanism are similar or differ from one another.

The term hypnosis is often used to refer to a variety of structured, goal oriented procedures in which the suggestibility or motivation of an individual or a group is enhanced by another person, words, a mechanical device, a conducive environment, or by oneself. These procedures attempt to blur, focus, or amplify attention or mentation (e.g., imagination or intention), in order to produce suggested or spontaneous behaviors or experiences. In a simpler formulation, one of the great hypnosis researchers, T. X. Barber (1984) defined hypnosis as a procedure to disregard extraneous concerns and focus on specific suggestions to alter ones experience, behavior, and/or physiology. This mostly atheoretical formulation allows us to more easily look at the hidden cultural variables in hypnosis (Cardea, 1999).

It is common, although arguable, to state that what we now term hypnosis had its modern birth in the theory and practice of mesmerism, as first enunciated by Franz Anton Mesmer in the 18th Century, yet at the same time trace its historical roots back to tribal rites and shamanic practices (Brown & Fromm, 1986, p. 3). For example, Agogino (1965) stated that the history of hypnotism may be as old as the practice of shamanism (p. 31) and described hypnotic-like procedures used in the court of the pharaoh Khufu in 3766 B.C. He added that priests in the healing temples of Asclepius (beginning in the 4th century B.C.) induced their clients into temple sleep by hypnosis and auto-suggestion and that the ancient druids chanted over their clients until the desired effect was obtained.

Vogel (1970/1990) pointed out that herbs were used by native healers in pre-Columbian Central and South America to enhance verbal suggestion. How can we make sense of such disparate statements?

One way is, following Locke and Kellys model, to propose that although the specific patterning of experience in hypnosis (e.g., suggestion) has some historical parallels, the ethnoepistemology of hypnosis as a secular process involving a natural mechanism (in the case of Mesmer, a proposed animal magnetism; in the case of the Abb Faria and others, the use of psychosocial variables such as suggestions) may be traced to Mesmer. Nonetheless, even earlier discussants of what was then considered demonic possession pointed to suggestions and other psychosocial rather than metaphysical explanations (Duncan, 1634, in de Certeau, 2000). Laurence and Perry (1988) mention that Mesmerism was in fact heir to the exorcist practices of the time, although in his case couched in the scientific terms of the time (i.e., magnetism). The emotional and social displays during Mesmers healings, so different from the physically passive and isolated contemporary practice of hypnosis, were also likely influenced by other religious ecstatic movements in Europe (cf. Rosen, 1969). How the original theory and practices of Mesmerism were transformed into contemporary hypnosis would require a whole book, but the interested reader can consult excellent histories of hypnosis (e.g., Gauld, 1992; Laurence & Perry, 1988).

What we now call hypnosis is embedded in a network of implicit meanings and ontological assumptions about the nature of reality, what does or does not constitute

hypnosis (e.g., Hilgard, 1973), and so on. Too often authors commit the categorical fallacy (Kleinman, 1988) of using Western constructs such as hypnosis or trance and superimposing them on other cultures without first evaluating whether such constructs are valid or reliable in their new environment. Even though within our own specific culture there are disagreements as to the base nature of hypnosis, (Lynn & Rhue, 1991), some authors will use the term as a facile explanation for manifestations in other cultures, or conclude that clinical hypnosis is simply a cultural and historical adaptation of shamanism (Overton, 1998, p. 151), where it would be questionable to use it even as a descriptive term in other cultural contexts than the current Western one.

Trance is good example of a term that is often used as an explanatory term despite its being unclear even within our own cultural framework. Although the term is often assumed to connote some kind of etic category, perhaps of a biological predisposition to enter into a hypnotic state, Table 1 shows that there are multiple meanings of trance just within the English language This has not prevented authors in psychology and anthropology from using it as a foundational or even explanatory concept, despite its multivocality. Directly transferring such an ambiguous concept to other cultures disregards its semantic networks and intertextuality. Gergen (1985) observed that the terms in which the world is understood are social artifacts, products of historically situated interchanges among people (p. 267).

Considerable theory and research data suggest that the response to hypnosis involves various interpersonal, sociocultural, and cognitive factors (e.g., Shor, 1962; Woody,

Bowers, & Oakman, 1992). Among them are behaviors and experiences that reflect expectations and role enactments on the part of the hypnotized individuals or groups, who attend (often with questionable awareness) to their own personal needs and to the interpersonal or situational cues that shape their responses (Barber, 1969; Brown & Fromm, 1986, Spanos & Chaves, 1989). Other research data have emphasized the part that attention (whether it is diffuse, concentrated, or expansive) plays in hypnosis,by enhancing the salience of the suggested task or experience (Krippner & Bindler, 1974; Balthazard & Woody, 1992). Both of these bodies of hypnosis literature have underscored the interaction of several variables in hypnosis and can help better understand healing indigenous practices that involve either overt or covert suggestive and motivational dynamics.

To use the term hypnosis to describe exorcisms, the laying-on of hands, dream incubation, and the like does an injustice to the varieties of cultural experience and their historic roots. Hypnosis and the hypnotic state have been too often reified (Spanos & Chaves, 1991, p. 71), distracting serious investigators from ingenious uses of human imagination and motivation that are worthy of study in their own right. Nonetheless, a survey of the social science literature, as well as our observations in several traditional societies, suggests that there are frequently elements of native healing procedures that can be termed hypnotic-like. This is due, in part, to the fact that alterations in consciousness (i.e., observed or experienced changes in peoples patterns of perception, affect, or cognition, especially awareness, attention, and memory) are sanctioned and deliberately fostered by virtually all indigenous groups. For example, Bourguignon and

Evascu (1977) found that 89% of 488 sampled societies displayed socially-approved altered states of consciousness. The ubiquitous nature of hypnotic-like procedures in native healing is also the result of the ways in which human capacities, such as the abilities to strive toward a goal and imagine a suggested experience can be channeled and shaped differentially by social interactions (Murphy, 1947, Chapter 8).

Concepts of sickness and of healing are also socially constructed and modeled in various ways. The models found in traditional cultures frequently identify such etiological factors of sickness as soul loss, breach of taboo, or spirit possession, intrusion, or invasion, all of which are diagnosed, at least in part, by observable changes in the victims behavior as related to their mentation or mood (Frank & Frank, 1991, Chapter 5). Unlike infectious diseases and disabilities resulting from physical trauma, these conditions, including those with a physiological predisposition, are socially constructed. Similarly, the alterations in consciousness identified by Bourguignon and Evascu (1977) are shaped by historical and social forces within a culture. For example, there is no Western equivalent of wagumuma, a Japanese emotional disorder characterized by childish behavior, emotional outbursts, apathy, and negativity. Susto is a malaise, commonly referred to in several parts of Latin America, thought to be caused by a shock or fright and often connected with breaking a spiritual taboo. Conversely, some Western eating disorders can be considered culture-bound (Keel & Klump, 2003).

Cross-cultural studies of native healing have only started to take seriously the importance of understanding indigenous models of sickness and treatment, perhaps because of the

prevalence of behavioral, psychoanalytic, and medical models, none of which have been overly sympathetic to the explanations offered by traditional practitioners (Ward, 1989). In contrast, we may consider the proposition that Western knowledge is only one of several viable representations of nature (Gergen, 1985). Kleinman (1980) commented that the habitual, and frequently unproductive way researchers try to make sense of healing, especially indigenous healing, is by speculating about psychological and physiological mechanisms of therapeutic action. These are then applied to case material in an ethnocentric fashion that conforms particular instance to putative, etic principles. The latter are primarily derived from the concepts of biomedicine and individual psychology. By reducing healing to the language of biology, other human aspects (i.e., psychosocial and cultural significance) are eliminated leaving behind something that can be expressed in biomedical terms, but that disregards the language of experience, which is a major aspect of healing. (pp. 363-364).

An example of Kleinmans observation is the overly facile equation of the Eskimo pibbktoq (in which individuals tear off their clothes and wander aimlessly in inclement environments) with a hysterical disorder (Gussow, 1985). In much the same way, hsieh-ping, a Taiwanese condition marked by disorientation and auditory hallucinations, has been considered a depressive condition (Hughes, 1985). Ward (1989a) remarked that in both instances, it is prematurely assumed that Western classifications of mental disorders are universal, even though their manifestations may be shaped by culture. Gergen (1990) warned against using these terms as if they depict actual occurrences; the

vocabulary of the mental health professions serves to render the alien familiar, and thus less fearsome (p. 358).

The value of a truly cross-cultural approach is to understand the range of individual and social variation in the scientific search for an understanding of human capacities (PriceWilliams, 1975). Therefore, in this chapter we concentrate on the similarities and differences between hypnotic virtuosos and traditional shamans and describe the hypnotic-like aspects of native healing procedures using the definition of hypnosis already stated, while only incidentally making interpretive analyses of the procedures from the standpoint of Western science and therapy. Most illnesses in a society, as well as alleged changes in consciousness are socially constructed, at least in part. Because some native models of healing assume that practitioners, to be effective, must shift their attention and awareness (e.g., journeying to the upper world, traveling to the lower world, incorporating spirit guides, conversing with power animals, or retrieving a lost soul), the hypnosis literature can illuminate these processes and be illuminated by them.

CLINICAL AND FORENSIC APPLICATIONS Although not without its limitations (Cardea, 1995), Winkelman (1992) has proposed an important typology based on archival data from dozens of traditional societies, identifying four general groups of spiritual practitioners: shamans and shamanic healers, priests and priestesses, mediums and diviners, and malevolent practitioners (some culture may have more nuanced typologies, such as the 40 different types of Nhuatl healers in

10

ancient Mxico or the current variations of healers and shamans in the Sierra Mazateca; Miranda, 1997). With the exception of priests and priestesses, these practitioners purportedly cultivate the ability to regulate or shift their patterns of perception, affect, and cognition for benevolent (e.g., healing or divining) or malevolent (e-g., casting spells or hexing) purposes.

Shamanism and hypnosis

Hypnotic-like procedures are often apparent in the healing practices of native shamans. Shamans can be defined as socially sanctioned practitioners who claim to voluntarily regulate their states of consciousness so as to access information not ordinarily available, using it to facilitate appropriate behavior and healthy development-as well as to alleviate stress and sickness among members of their community or the community as a whole. In this chapter we include within the rubric of shamans both those who manifest the classical soul journey as well as those who can be possessed by the spirits in a controlled way (cf. Cardea, 1996). Among the shamans many roles, that of healer is the most common. The functions of shamans may differ in various locations, but all of them have been called on to predict and prevent afflictions or to diagnose and treat them when they occur. Shamanic healing procedures may be highly scripted in a manner similar to the way that hypnotic procedures are carefully sequenced and structured. The expectations of the shamans or hypnotists clients can enable them to decipher task demands, interpret relevant communications appropriately, and translate the practitioners suggestions into personalized perceptions and images. Shamans themselves display what Kirsch (1990), in discussing the hypnosis literature, called learned skills; their

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introduction to hypnotic-like experiences during their initiation and training generalizes to later sessions, and they can ultimately engage in journeying or invite spirits to possess them virtually at will. For instance, Japanese shamans of the Tohoku region believe that they can contact the Buddhist goddess Kannon, who assists with their diagnosis, producing visual or auditory imagery that the shaman experiences and reports. This is an example of the translation that characterizes both hypnotic sessions and shamanic imagination. Achterberg (1985) studied these shamanic translations and considers dreams, visions, and similar processes a venerable source of vital information about human health and sickness. So ubiquitous is their process of gleaning pertinent information from fantasy-based symbols and metaphors that Krippner (1987) suggested that shamans, as a group, might be considered fantasy prone.

A systematic comparison between shamans and hypnotic virtuosos reveals both similarities and differences (Cardea, 1996): * The proposed typology of high hypnotizables as either fantasy prone or dissociator virtuosos (Barrett, 1990) is similar to that of classical shamans and mediums (Eliade, 1964; Winkelman, 1992). * Hypnotizability shows a genetic contribution (Morgan, 1973), and family incidence has been found among various types of healers (Campos Navarro, 1997; Eliade, 1964). * The developmental paths for high hypnotizability of either punishment (or trauma) or encouragement of fantasy (J. Hilgard, 1979) have a parallel in the described

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common history of illness and training of imagination among shamans (Halifax, 1980; Noll, 1983). * Hypnotic virtuosos often have a propensity for the arts and for cognitive flexibility (J. Hilgard, 1979), as do shamans (Cardea & Beard, 1996; Shweder, 1972). * Many but not all (e.g., mention of plants and animals) of the phenomena reported in shamanism such as kaleidoscopes and out-of-body experiences (Lewis Williams & Pearce, 2005) are also mentioned spontaneously by hypnotic virtuosos (Cardea, 2005). * Hypnosis and shamanism been associated with reputed psi events (Angoff & Barth, 1973; Stanford, 1992).

There are, however, important sociocultural differences. Whereas hypnosis typically occurs within a one-on-one clinical or research individual setting and has a secular ethnoepistemology, shamanism usually occurs in a social, ritual context of service, embedded within a metaphysical framework (Cardea, 1996).

With respect to inductions, Furst (1977) has described procedures by which North American Native Americans sought alternative states of consciousness: psychoactive plants, animal secretions, fasting, thirsting, self-mutilation, exposure to the elements, sweat lodges, sleeplessness, incessant dancing, bleeding, plunging into ice-cold pools, and different kinds of rhythmic activity, self-hypnosis, meditation, chanting, and drumming (p. 70; compare with Ludwigs 1966 general taxonomy of ways to induce an altered state). Furst used non-Indian concepts (e.g., self-hypnosis, trance, and

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meditation) that may not be directly comparable with the original experiences, and went on to describe the use of ecstatic trance to determine the experients relationship with the unseen forces of the universe. `Analogous hypnotic practices are the various nondirective, permissive procedures in which hypnotized clients use their own fantasy and imagery to work toward the desired goals (e.g., Kroger, 1977, Chapter 14).

The Nanaimo Indians of Vancouver Island expect their shamans to fall unconscious during a ceremony in order to incorporate the tutelary spirits necessary for healing to occur (Jilek, 1982, p. 30). Alaskan Eskimo shamans claim to journey to the spirit world during a ceremony conducted in a darkened igloo, while they, stripped naked, sing and beat drums (Rogers, 1982, p. 124). Rogers claimed that the shamans use of rhythmic drumming and monophonic chanting induces self-hypnosis (apparently because of their goal-directed nature) while also placing the client in a hypnotic trance in which the suggestions of recovery and cure are given (p. 143). Although drumming is a common feature in shamanism, Rouget (1985) offered a devastating critique to the theory that a simple acoustic driving of the brain by drumbeats can explain the alterations of consciousness observed.

In discussing the Ammassalik Eskimos of eastern Greenland, Kalweit (1988) observed that their continuous rubbing of stones against each other may be seen as a simple way of inducing a trance. . . . The monotony, loneliness, and repetitive rhythmic movement join with the desire to encounter a helping spirit. This combination is so powerful that it erases all mundane thoughts and distracting associations (p. 100; cf. T. X. Barbers

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definition mentioned earlier). Belo (1960) observed similarities between the behavior of Balinese mediums and hypnotized participants. Although there was no trained observer of hypnosis on Belos field trips, a hypnotic practitioner observed several of her films and claimed to notice similarities between hypnotic trance and mediumistic trance. Likewise, M. Bowers (1961) proposed similarities between vodou practices and hypnosis, and there is experimental evidence that physical movement, characteristic of vodou and other religious rituals, does not prevent Western hypnotic virtuosos from experiencing substantial alterations of consciousness similar, but not identical, to those produced by a quiescent procedure (Cardea, 2005).

Kirschs (1990) discussion of the role of expectancies in hypnosis and psychotherapy is relevant to each of these cases. Hypnosis, like many culturally based rituals, serves to shape and bolster relevant expectancies that reorganize consciousness and produce behavioral changes related to the goals of hypnotic subjects and shamanic clients. For example, the ideomotor behavior that often characterizes hypnosis (e.g., arms becoming heavier or lighter, or fingers moving to denote positive or negative responses) resembles the postures, gestures, collapsing motions, and rhythmic movements that occur during many native rituals. In both instances, the participants claim that the movements occur involuntarily. Kirsch suspects that expectancy plays a major role, but admitted that these responses are experienced as occurring automatically, without volition (p. 198). Also, the drumming and many other ritual aspects help maintain a continuous focus of attention, as compared with the usual shifting of attentional foci (cf. Cardea & Spiegel, 1991).

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Navajo Healing Procedures Rogers (1982) divided native healing procedures into several categories (p. 112): nullification of sorcery (e.g., charms and dances), removal of objects (e.g., sucking and shamanic surgery), exorcism of harmful entities (e.g., fighting the entity or making the entity uncomfortable), retrieval of lost souls (e.g., by soul catchers or by shamanic journeying), eliciting confession and penance (e.g., to the shaman or to the community), transfer of illness (e.g., to an object or a scapegoat), suggestion and persuasion (e.g., reasoning, use of ritual), and shock (e.g., a sudden change of temperature or a precipitous physical assault). In all of these procedures, hypnotic-like techniques using symbols, metaphors, stories, and rituals, especially those involving group participation, can play an important role.

Despite attempts at acculturation, most Navajo men and women still believe in their traditional cultural myths and participate in the corresponding rituals (Adair, Deuschle, & Barnett, 1988). In the Navajo concept of illness, the universe is an interrelated whole in which powers of both good and evil exist in a balanced and orderly relationship. When this relationship is disturbed, disharmony occurs, producing illness. Its cause, therefore, is basically metaphysical; illness takes place when the individual or group is out of harmony with the natural and supernatural worlds (Topper, 1987).

When someone knowingly or accidentally breaches taboos or offends dangerous powers, the natural order of the universe is ruptured and causes contamination or infection

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that must be redressed (Sandner, 1979). When the family has determined that treatment is necessary, a hataali, or singing shaman, is called in, frequently accompanied by an herbalist and/or a diagnostician (both of whom are of lower status). The herbalists gather plants and make medicines, some of which are used directly and some of which are used ceremonially by the hataali. The diagnosticians are usually women and listen to the spirits for a statement of the problem. This procedure resembles self-hypnosis in that it is a self-administered procedure that regulates ones attention and is goal-oriented in nature. Other diagnostic procedures that resemble self-hypnosis include hand trembling, star gazing, candle gazing, and crystal gazing, all of which involve the focusing of attention (e.g., on the perception of the mirror images), with the purpose of facilitating insight into the nature of the problem.

Navajo hataali use a number of therapeutic procedures, most notably one or more of the ten basic chantways, complex patterns of activities centered around cultural myths in which heroes or heroines once journeyed to spiritual realms to acquire special knowledge. The symptoms for which a given chant is prescribed are based on connections with the specific chant myth. For example, Hail Way is prescribed for muscular tiredness and soreness because the hero, Rain Boy, suffered from these symptoms when he was attacked by his enemies, whereas Big Star Way protects the client against the powerful influences of the stars and the dangers of the night. It takes several years to learn major chants, some of which consist of hundreds of songs. Hosteen Klah, a famous Navajo hataali who died in 1937, knew more chants than any other healer of his era, one of which took 9 days to complete. The effectiveness of the chant is thought

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to be the result of its accurate performance because it evokes healing power from the spirits. For instance, the Night Chant uses 24 sequences containing a total of 324 songs; its hero is Dawn Boy, who enters the presence of the gods at a sacred canyon. His song, which must be sung perfectly by the hataali to be successful, appeals to the deities for assistance. One can observe the resemblance of the storytelling aspect of the chant to the use of narrative teaching stories in Ericksonian hypnotic procedures (e.g., Erickson, Rossi, & Rossi, 1976). These stories are highly scripted and reflect the societys perspective on human nature (Lynn & Rhue, 1991). Like Milton Ericksons teaching stories, no formal induction procedures are used in chants. However, there is an emphasis on the correctness of the procedures; as a result, the hataali is in an extremely vigilant frame of mind. The ability to master the elements of a chantway has been compared with memorizing a Wagnerian opera (Kluckholn & Leighton, 1962, p. 309). An ability to remember the cultural myths used in the chantway is mandatory if a hataali is to serve as an educator who can pass traditions and tribal wisdom on to the younger generation (Dixon, 1908).

The absence of a formal induction does not prevent the client from becoming receptive and motivated to follow the implicit and explicit suggestion of the ritual, just as most, if not all, hypnotic phenomena can be evoked without hypnotic induction (Kirsch, 1990). Contributing to this procedure is the multimodal approach that characterizes chants, as well as their repetitive nature and the mythic content of the words, which are easily deciphered by those clients well-versed in tribal mythology. Sandner (1979) described how the various sensory modalities are combined: the visual images of the sand paintings

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and the body painting, the audible recitation of prayers and songs, the touch of the prayer sticks and the hands of the medicine man, the taste of the ceremonial musk and herbal medicines, and the smell of the chant incense-all combine to convey the power of the chant to the patient. A hataali usually displays a highly developed dramatic sense in carrying out the chant but generally avoids the clever sleight of hand effects used by many other cultural healing practitioners to demonstrate their abilities to the community. The chant is considered by Sandner to facilitate suggestibility and shifts in attention through repetitive singing and the use of culture-specific mythic themes. These activities prepare participants for a healing session that may involve symbols and metaphors acted out by performers, enacted in purification rites, or executed in sand paintings composed of sand, corn meal, charcoal, and flowers, but destroyed once the healing session is over. Some paintings, such as those used in Blessing Way, are crafted from ingredients that have not touched the ground (e.g., corn meal, flower petals, and charcoal). Once again, the client may translate the symbols and metaphors, while maintaining a continuous focus of attention.

There are five steps in the typical chantway ceremony: preparation (in which the client is purified); presentation of the client to the healing spirits; summoning of these spirits to the place of the ceremony; identification of the clients with a positive mythic theme; transformation of the clients into a condition where ordinary and mythic time and space merge; and release from the mythic world and return to the everyday world where past transgressions are confessed, where new learning is assimilated, and where life changes are brought to fruition. These steps resemble Kirschs (1990, p. 163) three phases of the

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use of hypnosis in psychotherapy: preparation, induction, and application. The clients purification and presentation are analogous to preparation, the evocation of the spirits resembles induction, and the identification and transformation represent clinical application. And throughout all of these procedures there is the assumption that the healee transits into a special, sacred space, in a not dissimilar way to attending a Western therapists office.

Hypnotic-like procedures affect the mentation of both the hataali and the client during the chant. Sandner (1979) pointed out that the hataalis performance empowers the client by creating a mythic reality through the use of chants, dances, and songs (often accompanied by drums and rattles); masked dancers; purifications (e.g., sweats, emetics, herbal infusions, ritual bathings, and sexual abstinence); and sand paintings. Campbell (1990) described the colors of the typical sand painting as those associated with each of the four directions and a dark center: the abysmal dark out of which all things come and back to which they go. When appearances emerge in the painting, they break into pairs of opposites In the context of this mythic reality, especially as made visible in the designs created in sand by the hataali, the client is taken into sacred time and is able to bring a total attentiveness to the healing ceremony. This resembles the focusing of attention characteristic of many hypnotic procedures, and the presence of culturally significant symbols may maximize clients imagination and motivation, empowering their self-healing capacities through identification with symbols held to have therapeutic consequences. This provides the credible rationale that Kirsch (1990) has found to enhance treatment effectiveness (see also Torrey, 1986). The clients follow a specific

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regimen for the next four days to protect members of the community from their newly acquired powers. The role of the community is important in another way: The chants are attended by large numbers of people, and many of them may be asked to participate. This type of participation appears to increase the clients sense of personal power, magnify their imagination as they attend to the chants, and provide social reinforcement and increased motivation. The mentation of the practitioner, the client, and the community may all be affected by the ceremony. Not only do clients believe that they derive energy from the sand painting by sitting on it, but the hataali is (P. 30) and clients claim to feel the power emanating from the sand painting (Sandner, 1979). This resembles the enhancement of imagination common to several hypnotic procedures, and is probably further augmented by the repetitive chanting.

Toppers (1987) study of Navajo hataali indicated that they also raise their clients expectations through the example they set of stability and competence. Politically, they are authoritative and powerful; this embellishes their symbolic value as transference figures in the psychoanalytic sense, representing a nearly omniscient and omnipotent nurturative grandparental object (p. 221; for a similar analysis to the hypnotic situation see Shor, 1961). Frank and Frank (1991) put it more directly: The personal qualities that predispose patients to a favorable therapeutic response are similar to those that heighten susceptibility to methods of healing in non-industrialized societies, religious revivals, experimental manipulations of attitudes, and administration of a placebo (p. 184). Also, in his modern classic, Ellenberger (1970, p. 12) suggests three sine-qua-non essentials of healing: the healers faith in his or her own abilities, the patients faith in the healer, and

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communal acknowledgement of the disease, the healing method, and the healer. Suggestion and expectancy are bolstered through reinforcement of the clients belief in the power of the chant and its symbols, a tight structuring of the ceremonial performance, repetition (especially in chants, songs, and prayers), physical exhaustion, the dramatization of a significant event in Navajo mythology, and, on rare occasions, the use of psychotropic herbal substances (e.g., datura) to evoke a physical effect that convinces the client of the power of the ritual.

As important as the impact of the chant and prayers on the hataalis consciousness may be, Sandner (1979) insisted that the Navajo practitioner relies on knowledge, not trance phenomena or magical effects. The chant work is a restrained and dignified procedure, and for the most part the medicine man represents for the patient a stable, dependable leader who is a helper and guide until the work is ended (p. 258). In other words, two crucial factors in the clients treatment appear to be the personal qualities of the hataali and the expectancies of the client; shifts in attending may be more useful in intensifying the abilities of the practitioner and the receptivity of the client than in providing any type of innate therapeutic effectiveness. However, the hypnotic-like procedures strengthen the support by family and community members as well as the clients identification with figures and activities in Navajo cultural myths, both of which are powerful elements in the attempted healing.

Even though Navajo shamans use hypnotic-like procedures, they do not believe the chantway or the healing prayers to induce an alteration in ordinary consciousness. To

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deliberately enter an altered state, or to claim that they were in such a condition, would be considered undignified by the Navajo healers. Nevertheless, the lengthy chants, songs, and prayers are so repetitive and monotonous that an outside observer might justifiably claim that they serve as consciousness-altering procedures. Furthermore, this example demonstrates how each culture constructs the notion of altered states differently; the spectrum of altered states is constricted and narrow among the Navajo, in contrast with the complexities of construction found in many Eastern traditions. Tibetan Buddhism, for example, contains five classes of meditation, each of which includes four levels that may incorporate dozens of specific potential alterations with a variety of outcomes (i.e., ways in which consciousness is reorganized following a meditative procedure; Brown, 1977). At best, the hataali appear to modify their attentional states rather than to "alter" all of their subsystems of consciousness, or their consciousness as a totality (cf. Tart, 1975). Attention determines what enters someone's awareness. When attention is selective, there is an aroused internal state that makes some stimuli more relevant than others and thus more likely to attract one's attention. A trait that is more characteristic of shamans than an "alternative state of consciousness" might be the unique attention that shamans give to the relations among human beings, their own bodies, and the natural world, and their willingness to share the resulting knowledge with others (Krippner 2002, 2005).

Afro-Brazilian and Afro-Caribbean healing procedures

Various early West African cultures considered that an individual was closely connected with nature, the community, and his or her communal group. Each person was expected to play his or her part in a web of kinship relations and community networks. Strained or

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broken social relations were held to be the major cause of sickness; a harmonious relationship with ones community, as well as with ones ancestors, was important for health. At the same time, an ordered relationship with the forces of nature, as personified by the lwas, orixas, or deities, was essential for maintaining the wellbeing of the individual, the family, and the community. West Africans knew that disease often had natural causes, but they believed that these factors were exacerbated by discordant relationships between people and their social and natural milieu. Long before Western medicine recognized the fact, Africas traditional healers took the position that ecology and interpersonal relations affected peoples health (Raboteau, 1986).

West African healing practitioners felt that they gained access to supernatural power in three ways: by making offerings to the spirits, by foretelling the future with the help of a spirit, and by incorporating a spirit (or even an ancestor), who then diagnosed illnesses, prescribed cures, and provided the community with warnings or blessings. The medium, or person through whom the spirits spoke and moved, performed this task voluntarily, claiming that such procedures as dancing, singing, or drumming were needed to surrender their minds and bodies to the discarnate entities (Desmangles & Cardea, 1996; Krippner, 1989), although it is a simplification to assume that spirit possession involves only one type of consciousness alteration (Cardea, 1989). The slaves brought these practices to Brazil and the Caribbean with them; despite colonial and ecclesiastical repression, the customs survived over the centuries and eventually formed the basis for a number of Afro-Brazilian and Caribbean religions. Books by a French spiritualist, Alan Kardec, were brought to Brazil, translated into Portuguese, became the basis for a related

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movement (i.e., Kardecism). There were followers of Mesmer in this group, but Kardec proposed that spirits, rather than Mesmers invisible fluids, were the active agent in altering consciousness, removing symptoms, and restoring equilibrium (Richeport, 1992).

Contemporary shamans in Brazil, Haiti, and other countries still teach apprentices how to sing, drum, and dance in order to incorporate the various deities, ancestors, and spirit guides. They also teach their followers about the special herbs, teas, and lotions needed to restore health, and about the charms and rituals needed to prevent illness (McGregor, 1962). The ceremonies of the various Afro-Brazilian groups (e.g., Candombl, Umbanda, Batuque, Caboclo, Quimbanda, and Xang) differ, but all share three beliefs: Humans have a spiritual body (that generally reincarnates after physical death), discarnate spirits are in constant contact with the physical world, and humans can learn how to incorporate spirits for the purpose of healing. After interviewing 40 spiritistic healing practitioners in Brazil, Krippner (1989) identified five methods of receiving the call to become a medium: (a) coming from a family having a history of mediumship, (b) being called by spirits in ones visions and dreams, (c) succumbing to a malady or spiritual crisis from which one recovers to serve others, (d) having a revelation while reading Afro-Brazilian spiritistic literature or attending spiritistic worship services, or (e) working as a volunteer in a spiritistic healing center and becoming inspired by the daily examples of compassion. If the call is rejected, severe illness or misfortune may result; as one candombl medium told Krippner, Once the orixa calls, there is no other path to take (p. 193). In a similar fashion, a vodou oungan (vodou priest) told Cardea that he had rejected his call until he

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had an episode of amnesia and he found a machete wound in his leg, at which point he no longer resisted

Once the apprentices begin to receive instruction in mediumship, such experiences as spirit incorporation, automatic writing, out-of-body travel, and recall of past lives lose their bizarre quality and seem to occur quite naturally (Cardea, 1991). Socialization processes provide role models and the support of peers. A number of cues (songs, chants, music, etc.) facilitate spirit incorporation, and a process of social construction teaches control and appropriate role taking, and provides communal support. Richeport (1992) observed many similarities between these mediumistic behaviors and those of many hypnotized subjects (e.g., dissociation and frequent amnesia for the experience).

The traits most admired in mediums resemble those traits that facilitate ordinary social interactions. If a spirit seems to be taking control of the medium too quickly, the other mediums may sing a song that will slow down the process of incorporation (Rouget, 1985). Leacock and Leacock (1972) observed that the Brazilian mediums in their study usually behaved in ways that were basically rational, communicated effectively with other people, and demonstrated few symptoms of hysteria or psychosis. They engaged in intensive training and, as mediums, pursued hard work that often put them at risk with seriously ill individuals. These are not likely to be the favorite pastimes of fragile personalities or malingerers. In fact, contrary to earlier proposal, usually without any actual data to support them, that practitioners of classical shamanism or spirit possession were psychotic or at least hysterical, recent empirical studies have found that their

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psychological health is as good if not better than that of their referent groups (Cardea Van Duijl, Weiner, & Terhune, in press; Van Ommeren, Komproe et al., 2004).

A fairly consistent similarity among mediums is their supposed inability to recall the events of the incorporation after the spirits have departed. However, Spanos (1989) has pointed out that this amnesic quality could just as easily be explained as an achievement; each failure to remember adds legitimacy to a subjects self-presentation as truly unable to remember, hence as deeply in trance (p. 101). And there is evidence that indigenous practitioners acknowledge different levels of possession depth, some of which do not involve amnesia (Frigerio, 1989), in a similar way to the different kinds of mediumship in the West (Cardea et al., in press). Thus, the interpretation of hypnotic phenomena as goal-directed action is helpful for understanding mediumship as an activity that meets role demands because mediums guide and report their behavior and experience according to these demands. It may be not be that they lose control over the behavior as they incorporate a spirit, but rather that they engage in an efficacious enactment of a role that they are eager to maintain.

An alternative point of view maintains that the mediums actually do lose control over their behavior, entering a trance or dissociative state that allow hidden parts of their minds to manifest as secondary personalities or spirits. Krippner (1989) discussed these issues and suggested that both the role-playing and dissociative paradigms describe merely the mechanisms by which a medium actually incorporates the orixa, discarnate entity, or spirit. It is the incorporation itself and the subsequent behavior of the

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spirit that represent the crux of mediumship. Because the possibility of spirit incorporation is hardly open to demonstration at the present time, one can only acknowledge this argument and focus on other aspects of these phenomena.

Another important consideration is that spiritistic ceremonies enable clients and mediums to arrive at a shared world-view in which an ailment can be discussed and treated (Torrey, 1986). In some spiritistic traditions, there are mediums who specialize in diagnosis, mediums who specialize in healing by a laying-on of hands, mediums who specialize in distant healing, and mediums who specialize in intercessory prayer. Treatment may also consist of removing a low spirit from a clients energy field, integrating ones past lives with the present incarnation, the assignment of prayers or service-oriented projects, or referral to another healer.

All of these procedures contain the possibility of enhancing clients sense of mastery, increasing their self-healing capacities, and replacing their demoralization with empowerment (Frank & Frank, 1991; Torrey, 1986). The mediums are not the only ones who appear to manifest hypnotic-like effects. Their clients also demonstrate apparent shifts in consciousness, especially while undergoing crude surgeries without the benefit of anesthetics; however, Greenfield (1992) observed that the Brazilian mediums make no direct effort to alter their clients awareness. Greenfield, who attributed the benefits of these sessions to the clients alterations of consciousness, has observed that no one is consciously aware of hypnotizing. . . patients . . . , and unlike the mediums, patients participate in no ritual during which they may be seen to enter a trance state (p. 23).

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However, there are a number of cultural procedures that Greenfield found to be hypnoticlike in nature. One of them is the relationship of client to healer, characterized by trust and resembling that between hypnotist and client (p. 23) in that these clients act positively in response to what the medium tells them. Another procedure is a context that allows the clients to become totally absorbed in the intervention, a healing ritual that galvanizes the clients attention and distracts them from feeling pain. Greenfield added that the spiritistic aspects of Brazilian culture foster fantasy proneness because large numbers of people believe that supernatural entities help (or hinder) them in their daily lives (p. 24). In support of Greenfields speculations, Biswas, See, Kogon, and Spiegel (2000) found that individuals consulting a faith-healer in Nepal were significantly more hypnotizable than those consulting Western medicine or ayurvedic practitioners, and that their level of hypnotizability was positively correlated with their assessment of the faith healers efficacy.

CASE AND FORENSIC MATERIAL

A murder case in Puerto Rico and a Haitian oungan Some years ago the first author was hired by the Puerto Rican post office police to help solve a murder/robbery with the help of hypnotic interviews. After explaining that there was no guarantee that any of the information obtained would be valid, he followed the ASCH forensic interview guidelines (Hammon, Garver et al., 1995) with a couple of witnesses. The first one, a university student, had no problem with the procedure. The second one, though, a peasant, illiterate woman with no formal education, responded in exactly the opposite way to his suggestions. So for instance, when he mentioned that she

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could allow her eyes to start closing, she would open them even more. Although, this was done in the presence of a police officer, she obviously did not trust a strange man to help lead her experience, and understandably so because there was nothing in her background to have trained her to just sit down and follow his instructions, and probably if she had ever heard about hypnosis it had been in the context of sensationalistic TV shows.

The second example concerns an interview with an intellectually sophisticated Haitian oungan who did not respond at all to a previous attempt a Western clinician to hypnotize him. He explained that suggestions of relaxation were very trivial compared with his frequent experience of interaction with the lwas (spirits; see Cardea, 1991). Both examples illustrate that sociocultural context and explanation, besides cognitive and biological predispositions, mediate hypnotic experience.

Graywolf A former resident of a Native American community, Graywolf is a shamanic healer whom the second author visited several times in Oregon. Born as Fred Swinney, Graywolf holds a masters degree in counseling. He integrated shamanic procedures into his practice and his life-style after a number of transformative dreams and visions. Taking the position that dysfunctional behavior is underscored by dysfunctional images of oneself and ones world, Graywolf attempts to assist his clients in identifying and transforming those models that have permeated cognitive, affective, and physical functioning. Janis was a client of Graywolf whose behavior manifested an excessive need for approval yet had been punctuated, of late, by unexpected and uncontrollable bursts of

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rage. One of Graywolfs procedures was hypnotic-like in that it utilized imaginative guided imagery to reach the upper world, to reach the lower world, or to journey back into a recalled dream. In an upper world session, Janis discovered herself as a deserted child and gained insight into an important source of her need for approval. In a lower world session, Janis began swaying and dipping like a snake. Convinced that she had discovered her power animal, Janis repeated these movements daily, noticing that her angry outbursts began to diminish. Finding ways to restore self-esteem to her child, and express her power animal in her daily behavior, Janis was delighted to observe an end to her outbursts.

On one occasion, Graywolf guided Janis back into a dream in which she shot her husband because he had not given her an expensive present. By imagining herself moving into the rage, she discovered a dark tunnel at the end of which was a red-faced baby crying desperately. In her fantasy, Janis picked up the baby, held it, and dried its tears. Later, she realized that the baby was herself at a younger age, experiencing a lack of attention that still upset her. The dream was an exaggerated account of her claims on her husbands care and affection; no matter how much he gave her, it was never enough to assuage the needs of the red-faced baby and the deserted child.

Janis understood that her dysfunctional image of being nice had begun to break down and that the uncontrolled bursts of rage had signified its demise. By reveling in the image and movements of the snake, rather than in her angry outbursts, she was able to enjoy a part of her that was not necessarily nice or approved but that was needed for her very

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survival. Graywolf worked with Janis, exploring the feelings accompanying the snakelike body movements to determine what new self-images they anticipated. Accepting her repressed sensuality, self-protection, and authenticity was possible because of her almost instant attraction to her power animal. Janis associated her newly discovered selfacceptance and self-esteem with a newly discovered enjoyment of life. In this instance, Graywolfs procedures mirrored the findings of Frank and Frank (1991) that effective treatment procedures involve an emotionally charged, confiding relationship with a helping person in a healing setting; a conceptual scheme or myth that provides a plausible explanation for the clients symptoms and a ritual for resolving them; and a ritual that requires the active participation of both client and helper and that is believed by both to be the means of combating the patients demoralization. With the help of Graywolf, Janis engaged in rituals that renewed her understanding, confidence, and enjoyment of herself and her life.

RESEARCH AND APPRAISAL Torrey (1986) surveyed indigenous psychotherapists, concluding, on the basis of anecdotal reports, that many of them are effective psychotherapists and produce therapeutic change in their clients (p. 205). The sources of that effectiveness are the four basic components of psychotherapy: a shared world-view, personal qualities of the healer, client expectations, and a process that enhances the clients learning and mastery (p. 207). Frank and Frank (1991) had a very similar conclusion after their classical study of the universal components of healing, and Jilek (1982) found support for the effectiveness of traditional healers in the Northwest. Strupp (1972) added, The modern

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psychotherapist . . . relies to a large extent on the same psychological mechanisms used by the faith healer, shaman, physician, priest, and others, and the results, as reflected by the evidence of therapeutic outcomes, appear to be substantially similar (p. 277).

A review of anomalous healing events and experiences (Actherberg & Krippner, 2000) is beyond the scope of this chapter but it is worth mentioning that some studies support indigenous healing practices. For example, the Journal of the American Medical Association (JAMA) published a report of an apparently successful treatment of systemic lupus erythematosus (SLE) by a native healer (Kirkpatrick, 1981). In early 1977, a 28year-old Philippine-American woman was diagnosed as having this disease, one that is notably resistant to treatment. After a year of unsuccessful medical attention, the patient returned to the remote Filipino village of her birth, contacting a local healer who then claimed to remove a curse that had supposedly been placed on her by a previous suitor. Within 3 weeks, she returned to face her skeptical physicians. She declined further medication, appeared to be in good health, and 23 months later gave birth to a healthy girl. The physician who authored the report concluded, It is unlikely that this patients SLE burned out. . . . But by what mechanism did the machinations of an Asian medicine man cure active lupus nephritis, change myxedema into euthyroidism, and allow precipitous withdrawal from corticosteroid treatment without symptoms of adrenal insufficiency? (Kirkpatrick, 1981, p. 137).

Kleinman (1980) conducted a follow-up study of 19 clients treated by Taiwanese tangkis, or shamans, at a healing shrine. All clients were visited at their homes 2 months after

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their initial visit to the tang-ki. Interviews could not be held with 7 clients, but of the 12 interviewed, 10 (83%) reported at least partially effective treatment. Six (50%) regarded themselves as completely cured, and 2 (17%) were treatment failures. The evaluations of family members were also considered, and the mother of one of the failures felt that the treatment would have been successful had her daughter continued for a longer period of time. The father of the other failure implied that his daughters condition had worsened after treatment. Even though the sample was small, Kleinman noted that there are virtually no other follow-up studies of indigenous practice. Even so, these findings are in line with our findings from studies of other indigenous healers and our impressions from observation of large numbers of patients treated by [the] tang-ki. . . . Even with these cautions in mind the results are striking (p. 320).

Kim (1973), a psychiatrist, conducted a follow-up study of individuals treated by a shaman in South Korea. He noted that temporary symptom relief was obtained in the four cases he diagnosed as suffering from psychoneuroses. However, of the eight cases he diagnosed as schizophrenic, six deteriorated following the shamanic ceremonies.

Spiritualist healers in a rural community in Mexico were investigated by Finkler (1985), who found that their treatments were most effective for nonpathogenic diarrheas, simple gynecological disorders, psychosomatic problems, and mild psychiatric disorders. The former two ailments were treated with teas, enemas, and douches; the latter two by symbolic manipulations and ministrations. However, Finkler found that in most cases, by the patients own accounts, spiritual practitioners failed to heal. Little change was noted

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in the case of serious physiological symptoms caused by physical or mental illness, probably because the living conditions had not changed. The underlying factors instrumental in producing the disease expressed in physiological or somaticized symptoms continue, including the unceasing flow of untreated sewage waters in the irrigation canals and the unremitting presence of disease vectors in the open garbage pits. Concomitantly, and equally to the point, violent deaths due to alcoholism and violence will continue, given the extant socio-structural conditions. Finkler also reported that in 50% of the cases, clients of the spiritualist healers claimed that they did not feel sick, yet still reported symptoms. Of the 108 clients in the study, he judged 30% to have had successful treatments, 35% unsuccessful treatments, and the others inconclusive or unclassifiable results. Campos Navarro (1997) conducted an in-depth field study with Mexican indigenous healers and supported their efficacy for some types of malaise along the same lines described by Finkler.

Katz (1982, 1984) carried out a 22-month field study among Fijian healers, recording data on 500 clients in one community who sought help during the course of a year. He noted that in 5% of the interactions, more than one type of healer was consulted. Overall, nearly 79% of the client/healer contacts were with the local nurse and 13% with the traditional healer. However, the latter saw each of his clients more times, so that the actual time spent in the respective healing efforts was about equal. The most frequent complaints were various aches and pains (35%). The nurse saw most of the cuts and wounds, whereas the traditional healer handled all of the requests for help against

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misfortune. However, Katz noted considerable overlap because of the ways in which clients conceptualized the problems and their etiology.

Additional research projects are needed to follow up the leads provided by these studies, and long-term follow-ups are needed to determine the stability of any improvement. Expectation and excitement can produce dramatic short-term effects but may not demonstrate staying power. The hypnotic-like aspects of native healing are possibilities for fruitful investigation. Scales are now available to measure absorption, imagination, suggestibility, and other human capacities that might be related to long-term improvement. Most of these scales are amenable to modification and adaptation to nonWestern populations. Various instruments to evaluate variations of consciousness (Pekala & Cardea, 2000) are promising candidates for cross-cultural studies, as are the imagery scales developed by Achterberg and Lawlis (1984), which have been used in the prognosis of life-threatening illnesses. These imagery scales are especially suitable for cross-cultural research because they simply ask patients to draw images representing their disease, the treatment they are receiving for the disease, and their bodys self-healing capacities. In one study, Achterberg and Lawliss psychological and imagery measures predicted a diseases progress more accurately than the patients blood chemistry (p. 3).

Qualitative analyses of the experiences of both practitioners and their clients have also been an underdeveloped area. Krippner (1990) used questionnaires to study perceived long-term effects following visits to Filipino and Brazilian folk healers, finding such variables as willingness to change ones behavior to significantly correlate with

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reported beneficial modifications in health. Cooperstein (1992) interviewed 10 prominent alternative healers in the United States, finding that their procedures involved the selfregulation of their attention, physiology, and cognition, thus inducing altered awareness and reorganizing the healers construction of cultural and personal realities (p. 99). Cooperstein concluded that the concept that most closely represented his data was the shamanic capacity to transcend the personal self, to enter into multiform identifications, to access and synthesize alternative perspectives and realities, and to find solutions and acquire extraordinary abilities used to aid the community (p. 121). Indeed, the shamans role and that of the alternative healer are both socially constructed, as are their operating procedures and their patients predispositions to respond to the treatment. It is important not only to study the effects of the hypnotic-like procedures found in native healing, but to accurately describe them and to understand them within their own framework.

CONCLUSION Although some critics continue to heap scorn on native healers (cf. Campos Navarro, 1997) the positive contributions of native healers are finally being given serious attention. In 1980, Nigerian legislators passed a law that integrated traditional healers into the staterun national medical health service. In Zimbabwe, the government has encouraged the ngungus to set up their own 8,000-member professional association (Seligmann, 1981). In Swaziland, traditional healers have been accorded equal professional standing with Western-oriented medical practitioners. In 1977, the United Malay National Organization, Malaysias dominant political party, decided to promote the use of bomohs in the treatment of drug addicts.

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The professionalization of shamanic and other traditional healers may suggest their similarity to practitioners of Western medicine; nevertheless, the differences cannot be ignored. Rogers (1982) has contrasted the Western and native models of healing, noting that in Western medicine, healing procedures are usually private, often secretive. Social reinforcement is rare. . . . The cause and treatment of illness are usually regarded as secular. . . . Treatment may extend over a period of months or years. In native healing, however, healing procedures are often public: many relatives and friends may attend the rite. Social reinforcement is normally an important element. The shaman speaks for the spirits or the spirits speak through him [or her]. Symbolism and symbolic manipulation are vital elements. (p. 169; see also Cardea, 1994). Rogers also presented three basic principles that underlie the native approach to healing: The essence of power is such that it can be controlled through incantations, formulas, and rituals; the universe is controlled by a mysterious power that can be directed through the meticulous avoidance of certain acts and through the zealous observance of strict obligations toward persons, places, and objects; the affairs of humankind are influenced by spirits, ghosts, and other entities whose actions, nonetheless, worldview-which fosters the efficacy of hypnotic-like procedures-varies from locale to locale but is remarkably consistent across indigenous cultures.

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Ceremonial activities produce shifts of attention for both the healer and the client, and the cultures rules and regulations produce a structure through which the clients motivations may operate to empower them and stimulate their self-healing aptitudes. Western practitioners of hypnosis employ the human capacities that have been used by native practitioners in their hypnotic-like procedures. These include the capacity for imaginative suggestibility, the ability to shift attentional style, the potential for intention and motivation, and the capability for self-healing made possible by neurotransmitters, internal repair systems, and other components of mind-body interaction. Hypnosis and hypnotic-like activity are complex and interactive and hence take different forms in different cultures. Yet, as with other forms of therapy, the mask. . . crafted by the groups culture will also fit a majority of its members (Kakar, 1982, p. 278). When in Malaysia, a World Federation of Mental Health workshop suggested collaboration between the universitys department of psychiatry and the traditional bomoh practitioners. The psychiatrists objected, claiming that such a move would only confirm the prejudice held by other departments in the medical school against psychiatry as unscientific (Carstairs, 1973). Despite similar complaints in Mxico, there have been encouraging events such as having indigenous healers talk to physicians and university professors (Campos Navarro, 1997). By investigating ways in which different societies have constructed diagnostic categories and remedial procedures, therapists and physicians can explore novel and vital changes in their own procedures, hypnotic or otherwise, that have become obdurate and rigid. It is also the case that many underprivileged groups throughout the globe do not have the financial or geographical access to Western-trained practitioners and/or the latter may not understand their clients world-view, one of the

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cornerstones of therapeutic interaction. Western medicine and psychotherapy have their roots in traditional practices and need to explore avenues of potential cooperation with native practitioners, whose healing methods may contain wise insights and practical applications. However, it is also dangerous to go to the other extreme and romanticize the potential efficacy of traditional healing methods, as there may be some unscrupulous or incompetent practitioners, but the same can be said of practitioners of hypnosis or any other forms of psychotherapy or medicine.

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