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Political activity may be defined as the manipulation of power differentials amongst conscious beings. Power may be defined as the ability to make someone else do your will, it is not a stable thing. Many forms and sources of power and always changing and moving. By Matthew Bluck Student ID : 08596042
Discuss the political aspects of cultural constructions of sickness and healing.
Sickness as experienced by an individual or a group of individuals is understood as an “ unwanted condition within themselves” (Hann 1995 : 6) and the definition of the experience is culturally constructed (Hann 1995 : 6) which involves culturally specific ideas of what constitutes the mind, body, soul, connection to the world and social relations. Thus the diagnosis of sickness and how it is redressed via healing (Brown 1995 : 37) will involve the salient discourses associated with the medical domain present within the culture (Dutta and Zoller 2008 : 31). The discourses present within the culture will feature specific ideas of relations between the various roles individuals play in the experience of sickness and healing and thus the performance of various forms of power through these relations.
Power can be defined as “ the ability to influence others while resisting their attempts to influence” (Vaughan & Hogg 1995 : 123) and the French and Raven 1965 model of social power has sought to identify power as having six social bases which are described as,
1. Reward, the perceived ability to give positive consequences or remove negative consequences 2. Coercive power, the perceived ability to inflict harm 3. Legitimate power, based on the perception of the individual having the right to impose prescribed behaviour. 4. Referent power, a source of influence based on identification, individual attractiveness or achieved respect 5. Expert Power, power based on the perception of possessing distinctive knowledge, ability or skills 6. Informational Power, power based on the ability to control information needed by others.
Figure 1 : Forms of social power and their bases (Vaughan & Hogg 1995 : 123)
To function as healers the individuals involved in the healing process are making authority claims (Murphy et al 2008 : 275) that are supported by the manipulation of power differentials, such as the social bases of power described by the French and Raven 1965 model, examples of this can be found in Don Handelman’s The Development of a Washo Shaman (Handelman 1977) and Levi-Strauss’s The Sorcerer and his Magic (Levi-Strauss 1967). In these two articles the shaman’s claim to authority are composed of expert power by his ability and experience in healing, informational power by access to knowledge controlled by a group and referent power through their personal qualities such as charisma. Reward and coercive power are associated with their ability to heal and harm, shamans are traditionally feared in some contexts as described by Handelman (Handelman 1997 : 437) and Levi-Strauss (Levi-Strauss 1967 : 178) due to their ability to invoke the supernatural. The forms of power described by the French and Raven 1965 model are capable of being discussed consciously by the individuals engaged in the discourse, they can be invoked by the participants as “conscious intentional” strategies (Wilce 1997 : 366) thus is part of their discursive consciousness (Giddens 1979 : 5, 73 & 203). As healers the individuals involved in the process of healing are involved in the creation and maintenance of meaning, making sense of suffering and finding ways for individuals to continue (Kirkmeyer 2006 : 583) and in doing this the individuals are providing a cluster of statements that define and simultaneously constrain the ways in which the sickness gets talked about. Thus they facilitate the reproduction of a particular discourse, the cultural construction of sickness and its modes of healing that will define the experience of sickness and healing. In the French and Raven 1965 model this influence would be described as a component of a legitimate form of social power and inherent within discourses are the social structures within which they are constituted.
The cultural constructions of sickness can be classified using terminology developed by Kleinman, Eisenberg and Good (1978) (Hann 1995 : 28) into Disease accounts, Illness accounts and Disorder accounts and the performance of healing is part of these accounts. Disease accounts focus on the body of the patient as the source of sickness and bodily interventions are used as the principle means to heal (Hann 1995 : 28) this is the predominant mode of discourse in western biomedicine (Wilce 1997 : 336). Illness accounts consider not only the body but also the person and their social
environment as a source of sickness thus consider the experience of unwanted changes in states of being and in social function. Healing in this context tends to require attention to persons and their environments, the Ndembu studied by Victor Turner explain sickness as caused by sorcery and thus their diviners heal by finding the social cause for the malign intention (Turner 1968 : 175) and the Kalahari Ju|’hoansi hunter gathers use a healing dance to heal the social causes of sickness (Katz et al 1997 : 17) . A current illness account in western medicine is the belief in sickness due to stress induced by the social environment (Hann 1995 : 28). Disorder accounts regard the source and locus of sickness as in the universe at large, as well as in the patients person or body, an example of this would be the theory component of traditional chinese medicine (Hann 1995 : 28). Although the descriptions of the healing dances of the Ju|’hoansi feature sickness as part of the body and the idea of drawing out the sickness from the patient into the healer and expelling, its cause is understood as originating from social causes, such as conflict and imbalances of power (Katz et al 1997 : 48).
In the discourse of western biomedicine infectious diseases are caused by non-sentient agents and it can be argued that in modern western society the medical domain is significantly differentiated from other cultural domains such as religion, politics and the rest of social life. Disease is caused by pathological processes (Weiss & Lonnquist 2006 : 30) and patients are treated as individuals, this is consistent with the disease processes and expectations of the patients themselves. Sicknesses as unwanted conditions have pathological features such as the disturbance in the capacity for independence (Hann 1995 : 4) and the ability to engage in productive work (Waitzkin 1986 : 135). The capacity for interdependence is also part of the western medical discourse in the context of behavioural functioning in psychology and psychiatry (Hubert 2002 : 128) but is not a normal component of the medical domain, that is something that belongs to the patients own personal lives. The comparative increased importance in the value of interdependence is present as a diagnostic feature for the Ju|’hoansi .
The Ju|’hoansi are described by Richard Katz in Healing Makes Our Hearts Happy (Katz et al 1997 : 12) as existing in egalitarian power structures and possess communal values that encourage the sharing of resources. Ju|’hoansi women are
honoured for providing the majority of the diet and population densities were low, 37 square kilometres per person, which is required for the long term survival of hunter gatherer bands. The traditional territories of Ju|’hoansi hunter gatherer bands are called n!ore, plural n!oresi, and a n!ore is the required territory to support a Ju|’hoansi hunter gatherer band through the seasonal cycles of a year (Katz et al 1997 : 15). Group relations between n!oresi are established through intermarriage and extended land use rights and the co-operative reciprocal interactions allow access to essential resources in a often changing environment (Katz et al 1997 : 16). Much of the Ju|’hoansi institutions and social practices can be seen as social technologies that allow them to resolve conflict that could potentially compromise their ability to acquire basic necessities available through social networks in times of need (Katz et al 1997 : 16). It is a common subsistence strategy for the Ju|’hoansi to share resources of their territories as local surpluses occur seasonally, reciprocity provides stability, thus for the Ju|’hoansi “ ownership is the ability to share” (Katz et al 1997 : 17). The institution of the healing dance is the dominant traditional method for treating sickness and is used for medical, psychological and political disturbances. During the healing dance Ju’hoansi healers make body contact by touching with hands, use vibrating hand motions, hugging and engage in a performance that conveys the idea of the sickness being an entity residing inside the patients body. Performance and symbols are important representations of expert and legitimate power, functional utilitarian objects acquire a multiplicity of meanings that provide cues for the various actors in the situation. A comparable script would be patients in a clinic, surrounded by posters of medical information, plastic moulds of parts of human anatomy, the functional paraphernalia of a medical clinic that also conveys the cultural awe of biomedicine (Weiss & Lonnquist 2006 : 30) .
The Ju|’hoansi dance is described by Richard Katz as away of resolving conflict and tension within the community, the dance brings people of the camps together in communal activity that serves in actuality and as a metaphor (Katz et al 1997 : 138) for their contribution to the group life of the community (see figure 2). A practical example of group healing process taking place in a Ju|’hoansi dance is described by Richard Katz. It involved a dispute between two women with accusations of stinginess and bad manners and initially the two women sat at opposite end of two lines of people attending the dance (Katz et al 1997 : 105). Eventually they sit next
two each other and the lines form into a circle and the camp moves on with the dance with a more pleasant change of mood.
Figure 2. Ju|’hoansi healing dance includes men, women, young and old (Katz et al 1997 : Preface 16)
Healing in the context of the Ju|’hoansi dance can be understood as the resolution of conflict and the prevention of conflict within the community by maintaining relationships and mitigating imbalances of power. The legal institutions present in western society are specialised into culturally specified domains and possess legitimate authority to resolve disputes which is representative of the more hierarchical power structures present in western society. Healing in western societies tends to feature adjustment of the individual to the situation or adjustment within the institutional context (Waitzkin 1986 : 135). An example of this is the illness account of stress, it is treated in a manner consistent with a disease account, an individual takes steps to relieve it within themselves. The Ju|’hoansi discourse on sickness and healing is composed of an illness account that is strongly centred on the experience of community, the sick person is understood as being sick due to tension in the
community (Katz et al 1997 : 48). There is no legal component with a legitimate authority to impose a resolution, the people have to derive a resolution themselves and resources are looked after and shared through their relationships.
Part of the explanations given by Richard Katz for the sustainability of the egalitarianism of the Ju|’hoansi are the nature of their tool kits and skill bases, in essence each individual of their community posses similar tool kits and skill bases as part of a nomadic hunter and gather band ( Katz et al 1997 : 13). Many young Ju|’hoansi seek to learn the difficult task of healing, half the men and one third of the women are successful (Katz et al 1997 : 25) which suggests that healing can be considered as a part of the tool kit. Traditionally learning in the Ju|’hoansi is by doing (Katz et al 1997 : 74), the learning of how to do healing involves mimesis (Pinto 2004 : 350), they learn the institutionalised power relationships, which for the Ju|’hoansi are comparatively egalitarian (Katz et al 1997 : 25). Some healers are understood as being better than others and this does suggest a political dimension as authority claims based on expert power are dependant on what the community will accept as true (Murphy 2008 : 278).
For the Ju|’hoansi their healers are stewards of the social group and in the traditional discourse associated with the Ju|’hoansi healers, they are able to enter into an advanced state of consciousness described as !aia and function as conduits of a spiritual healing power termed N|om (Katz et al 1997 : 133). The Ju|’hoansi idea of N|om is used in the context of things of power, such as medicine or the vapour trail of a jet (Katz et al 1997 : 18) and is located in people or a song , it is locatable by its effects and actions. Ju|’hoansi healers are understood as being able to see and sense N|om, which allows them to engage in a diagnostic function. In the discourse associated with a Ju|’hoansi healing dance a healer can see sickness and remove it, concentrating it in the top of the spine and expel it with a particular shriek (Katz et al 1997 : 142) and argue with the gods on the outcome for the patient. In this context the Ju|’hoansi healers have access to reward, expert, legitimate and referent social bases of power for the purpose of creating connectedness and community, Richard Katz has translated this as “ opening their hearts” to access N|om (Katz et al 1997 : 141). This connectedness can suggest a different reformulation of power as not the ability to influence others but as a set of relations where the person in the community performs
power to achieve productive goals (Mills 2003 : 36), this is foucaults idea of power relations and is an attempt to move away from Marxist concepts of power as “competitive and dominating” (Mills 2003 : 36) and concentrated in institutions in society. Given Ju|’hoansi societies traditional absence of institutions, value of extreme tolerance and what outsiders have called rugged individualism this idea of power through a system of relations may be more salient approach than describing power as the ability to influence. The function of the Ju|’hoansi healing dance may not be just to resolve imbalances of power, but to maintain the relations of power as well and in this way has a political function as it does involve the manipulation of power differentials by maintaining relations. There are issues with this idea, Robert Katz in Healing Makes Our Hearts Happy (Katz et al 1997 : 12) has not actively shown examples of competitive aspects and ingroup-outgroup dynamics in the Ju|’hoansi healing dance, it can be argued that this would be due to the practice of extreme tolerance, egalitarian value system and community maintaining practices of the Ju|’hoansi healing dance but the point made is that these are addressing particular issues so what happens when the healing dance fails?
The concept of No|m has a pragmatic utility in that it describes insights different from Victor Turners description of diviners use of analytical symbols in Ndembu Divination and its Symbolism that features seeing sickness in individuals and transcendental consciousness that is described as a journey to gods village (Katz et al 1997 : 99), because they possess an insight into the conflicts of interests and share the values of their communities (Giddens 1979 : 109) their experience is understood as true by the community.
Part of this insight has lead to healers taking up leadership roles in contact with Herero & Tswana pastoralists and Botswana and Nambian government institutions including schools, medical clinics and capitalist economies. The healers to provide meaning have to respond to the changing cultural situations, these feature contact and desire with products of capitalist economies which included sugar, tobacco and alcohol (Katz et al 1997 : 40) and through medical clinics exposure to western biomedical discourse with its attendant power structures, for the Ju|’hoansi the cultural authority of western biomedicine is registered with an impression of its institutional permanence (Katz et al 1997 : 85). This gives a potential answer to the
question what happens when the healing dance fails? As the Ju|’hoansi are exposed to western economies, education and alcohol there is a perception of the healing dances being less effective, the dances become shorter in duration and the sense of community is decreased. At present there are less cross camp dances ( Katz et al 1997 : 103) and the dances are more focused on curing specific illnesses than with fostering community. This could be in part to the western biomedicine but there has always been a recognition of selfishness and hoarding as negative aspects of the values of sacrifice and sharing (Katz et al 1997 : 138).
Western biomedical discourse is orientated towards the individual with attendant values of a competitive autonomy and different standards of truth. Thus western biomedical discourse would undermine the expert power basis for the Ju|’hoansi healers ability to engage in the manipulation of power differentials within their community. For something to constitute knowledge it must be recognised as truth by the community (Murphy et al 2008 : 278).
Thus the cultural construction of healing and sickness is consistent with the predominant values of a culture, sickness as unwanted states will involve the impairment of attributes that are valued by the individual and the community and as such is related to the social structures in which they are constituted. Ideas of healing and sickness can constitute part of a greater set of statements concerning power relationships and thus constitutes part of a discourse. For healers it is necessary to establish their knowledge as true in their community and this is achieved by utilising the various basis of social power. The French and Raven 1965 model of social power represents an approach to categorise forms of social power but invariably there are more sophisticated approaches. The discourse associated with the Ju|’hoansi healing dance features an illness account that has a significant community focus on healing and suggests another political aspect to healing. The Ju|’hoansi healing dance can be described as facilitating the formation and maintenance of power relations that can achieve productive goals consistent with the values of the community (Mills 2003 : 36). This approach can apply to western biomedicine as well, although medical discourse focuses on the individual as a disease account, one of the goals of western biomedicine is to maintain the functioning of an individual in society (Waitzkin 1986 : 136).
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