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Elements of Charismatic Persuasion and Healing

Author(s): Thomas J. Csordas


Source: Medical Anthropology Quarterly, New Series, Vol. 2, No. 2 (Jun., 1988), pp. 121-142
Published by: Blackwell Publishing on behalf of the American Anthropological Association
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THOMAS J. CSORDAS

Departmentof Social Medicine and HealthPolicy


HarvardMedical School

Elements of Charismatic
Persuasion and Healing
Therapeuticefficacyin religious healing is typicallyanalyzedby extrapolatingfrom ritualprocedure to expectedeffect, withoutspecifyingconditionsfor success orfailure in termsof the concrete experienceof participants. Takingsuch experientialdata as primary in therapeuticprocess should allow for definitionof minimalconditionsof therapeuticefficacy, including incremental change and inconclusive results. Two
cases of CatholicPentecostalritualhealing are discussed, withemphasis
on participants' reports of therapeuticprocess. The analyticfocus includes the orientationof participantswithinthe healing system, their experience of the sacred, the negotiation of possibilities, and the actualization of change. Alongside the anthropologicalquestionof how meaning shapes the illness experience, I pose the clinical question:how may
religious encountersinfluencean illness career? Considerationof these
questionssuggests thatdetailed experientialanalysis of therapeuticprocess can lead to a more balanced and pragmatic conceptualizationof
healingthanis available in studiesthatemphasizeeitherritualor clinical
dimensionsof healing.

he problemof efficacy appearsrepeatedlyat the center of debate aboutreligious healingpractices.Althoughotherreviewershave chosen to treatthe
diverse and voluminousliteratureon this problem(cf. Bourguignon1976;
Dow 1986; Moerman 1979), my purposehere is to develop an approachthat is
sensitive to incrementaland inconclusive effects that define the lowest threshold
of efficacy. It is by now commonplaceto observe that efficacy is contingenton
the natureof the problems addressedby different forms of healing, how those
problemsaredefinedin culturalpractice,andwhatcounts in culturaltermsas their
successfulresolution.Given these observations,however, we are left with a lack
of analyticspecificity to the concept.
A firststep is to be awareof which of threeaspects, implicit in most discussions of healing practice, is the focus of analysis. The first is procedure, or who
does what to whom with respect to medicines administered,prayersrecited, objects manipulated,alteredstatesof consciousness inducedor evoked. The second
aspectof healing practiceis what we may call process, referringto the natureof
participants'experience with respect to encounterswith the sacred, episodes of
insight, or changes in thought, emotion, attitude, meaning, behavior. Third is
outcome, or the final disposition of participantsboth with respect to their ex121

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pressedlevel of satisfactionwith healing, and to change (positive or negative) in


symptoms,pathology, or functioning.
Of these threeelements, therapeuticprocedurehas been treatedexhaustively
in many empirical studies and comparativeworks (Frank 1973 [1961]; Prince
1980). Therapeuticoutcome has only recentlybegun to be treatedsystematically
by anthropologists(Finkler 1985; Kleinmanand Sung 1979; Kleinmanand Gale
1982). However, therapeuticprocess as definedherehas been virtuallyneglected,
andrelegatedto the statusof a "black box." This neglect may originatein a failure to distinguishbetween prototypicalcases for ritualanalysis, such as rites of
passage (Turner1969) and ritualhealing. What is typically called process in anthropologicalstudies of such rites conforms more to what we are calling procedure. Following this convention, studies of religious healing have been based on
descriptionsof healing ritualsand interviewswith ritualspecialists, and have includedlittle explicit attentionto the phenomenologyof the transformativeprocess
as lived by participants.'Moreover, while most studies acknowledge that ritual
healing is religious, participants'experience of the sacred is seldom explicitly
documented,with the result thatit is often difficult to determinethe contribution
of the religious dimensionof religious healing (Csordas 1987a).
Moreover, whereas the condition for efficacy in rites of passage is social
consensusabouta biological inevitability(puberty,death)or a social fait accompli (marriage),efficacy in a situationof affliction is not so straightforwarda matter. Rites of passagefail only underextraordinarycircumstances,while the results
of ritualhealing are immensely variablein any circumstance.Yet ritualhealing
is often describedin such a way that its results must be seen as inevitable and
definitive:it is either invariablysuccessful (Kleinmanand Sung 1979) or fails to
do what it claims (Pattison, Lapins, and Doerr 1973). Given this situation, analysis has not been able to define satisfactoryempiricalconditionsof efficacy that
can also accountfor muchhealing thatmay be partial,incremental,and inconclusive. I suggest that these conditions may be found in the experientialdimension
of ritualhealing.
A fruitfulanalysis of therapeuticprocess can begin with the common ethnographicobservationthat a primaryeffect of religious healing is to alter the
meaningof an illness for the sufferer(Bourguignon1976). Frank(1973 [1961])
pointedthe directiontowardunderstandingthis change by defining healing as a
form of persuasionthat alters a person's "assumptive world." Compatiblewith
Frank's insight is the work in interpretiveanthropologythat analyzes ritual as
performance(Csordas 1983; Kapferer 1979, 1983; Schieffelin 1985; Tambiah
1977, 1985). This work raises issues of subjectiveexperience among ritualparticipants,impactsof utteranceand action carriedout within specific ritualgenres,
and performativetransformationof context as well as of meaning. However,
while interpretivescholarshiphas been able to highlight changes in assumptive
worlds, it is generally more attunedto issues of language and rhetoricthan to
eitherclinical issues or to the concrete experienceof participants.The analysis I
shall presentattemptsto balance interpretiveand clinical interests, while staying
as close as possible to experientialdata.
Catholic Pentecostalism and Charismatic Healing
The healing system examined here is that of the Catholic CharismaticRenewal, a movementwithin the Roman Catholic Church.The movement is char-

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acterized by its integrationof Pentecostal elements into Catholicism. Among


these areBaptismin the Spirit(an experienceof being infusedwith the power and
blessing of God throughHis Holy Spirit), speaking in tongues or glossalalia (a
kind of pseudolanguagelacking a semantic component and used primarilyas a
form of prayerwhich expresses praise to God), and the healing ministry(prayer
accompaniedby the laying on of hands for the relief of physical, emotional, or
demonic illness). Since its beginning in 1967, this movementhas spreadinto the
general Catholic populationand includes members from working, middle, and
professionalclasses (Csordas 1980; McGuire 1982).
CatholicPentecostalsareorganizedeitherin "prayergroups" affiliatedwith
particularparishesor in more highly structuredintentionalorganizationsknown
as "covenant communities." The principalritual event is the prayer meeting,
characterizedby the coordinateduse of severalgenres of rituallanguage(Csordas
1987b). Initiationseminarsintroducenew membersto the "life in the Spirit" and
integratethem into prayergroupactivities.
CatholicPentecostalsparticipatein the late 20th-centuryshift among Christians from emphasison sufferingand self-mortificationas an imitationof Christ,
to emphasison the possibility and benefit of divine healing as practicedby Jesus
in the gospels (Favazza 1982). The processes of healing and spiritualgrowthare
linked, because illness is typically regardedas an obstacle to spiritualgrowth.
Healingis thereforeconsiderednecessaryfor all personsin the processof spiritual
growth,and spiritualgrowthis in turnconducive to good health. The healing system is holistic in that it aims in principle to integrateall aspects of the person,
conceived as a tripartitecomposite of body, mind, and spirit.
The tripartiteconcept of the person is the basis for three distinct but interrelatedtypes of healing:physical healing of bodily illness, inner healing of emotional illness and distress, and deliverance from the adverseeffects of demons or
evil spirits (Csordas 1983). Physical healing is the simplest in form, in which
laying on of handsand, in some instances, anointingwith blessed oil accompany
prayer. Healing ministerspray for relief from illness, success of medical treatment, lesseningof side effects frommedication,or release from sufferingthrough
death. Inner healing may be aimed at removing the effects of a particularlife
trauma,or it may be a review and reinterpretationof an individual's entire life
history in light of the "healing presence of Jesus." Supplicantsare frequently
exhortedto forgive othersfor past wrongs. Vivid imageryoften accompaniesinner healing, either as a revelation of some repressedexperience or as a confirmation that healing is taking place. In deliverance, a supplicantis relieved of
oppressionby evil spirits. Demons in this instancetypicallydo not have complete
controlover a person in such a way as to requirethe formalChurchrite of exorcism, but are neverthelessregardedas having a detrimentaleffect on the person's
life and spiritualgrowth. Evil spiritsidentifiedor "discerned" by eitherthe healing ministeror the supplicantare dispatchedby a "prayerof command" in the
nameof Jesus Christ. While healing ministerstend to specialize, most recognize
the necessity at times of using all threeforms in varyingcombinations.
Charismaticritualhealing occurs in a varietyof settings. Large group-healing services originatedat the periodic conferences in which movement participantsassembleon a nationalor regionalbasis bothto show theirstrengthandunity
andto worshipandteach. In the decade fromthe late 1970s to the late 1980s these

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conferencesessions evolved into the publichealing service, in which healingministers of some reputationattractCatholics who may not otherwise participatein
the CharismaticRenewal. Healingprayersor petitionsfor self andothersmay also
occur in a segment of smaller weekly prayermeetings. Following these prayer
meetings,prayerfor individualsupplicantsmay be conductedin a separate"healing room" by a specially chosen team of healing ministersfrom withinthe group.
Moreintensivegrouphealing also occurs in smallerday-long or weekendretreats
and "days of renewal." Private sessions may be arrangedwith an experienced
healingministeror healingteam. Some of those who practicein the privatesetting
also have professionaltrainingin counselingor psychotherapyand integratethese
practiceswith ritualhealing. In addition,privatehealingprayersometimesoccurs
over the telephone. Finally, healing prayerfor oneself or othersmay be practiced
in the solitudeof privatedevotion.
Methods
The discussion presentedhere is based on a largerstudy of therapeuticprocess in Catholic Pentecostal ritual healing. Of the 75 healing ministers interviewed in the first phase of the research, six were recruitedto participatein an
intensive phase, in which their private healing sessions were observed and recorded. Healerrecruitmentwas based on willingness to participate,a reputation
within the movement as experienced and reliable, and an adequatecase load.
Healingministersparticipatedin recruitmentof subjects, making initial contacts
to determinetheirwillingness to participate.Both to protectindividualswho may
have been particularlyvulnerableand to enhancehealer-researcherrapport,healing ministerswere given discretionin determiningwhich individualsto exclude.
For each personrecruited,up to five healing sessions were recordedon cassette tape with the researcherpresent.2Duringa subsequentinterview, each participantwas asked to identify the most importantor meaningfulevent within the
session. These events were played back, and commentarieswere elicited for each
person, using an adaptedform of the InterpersonalProcess Recall (IPR) method
developed by psychotherapyprocess researchers(Elliott 1984, 1986). An additional backgroundinterview covered basic life history and medical/psychiatric
history,natureandlevel of involvementin the CharismaticRenewal, andattitudes
and expectationsof religious healing. In orderto confirmpresenceor absence of
psychiatricdisorder,this interviewincludedan adaptedand shortenedform of the
Scheduleof Affective Disordersand Schizophrenia(SADS).
Both individualswhose cases are presentedhere were followed from beginning to end of their involvement with one of the participatinghealing ministers.
They representprecisely the kind of incrementaland inconclusive process that I
suggestedabove as characterizingthe lowest limits of therapeuticefficacy in ritual
healing, and it is for that reason they were chosen as the focus of this analysis.
Before discussing them, however, I shall introducethe healer with whom I followed these cases.
A Minister of Charismatic Healing
FatherFelix, an experiencedCharismatichealing minister, is a 60-year-old
Catholicpriest, ordainedas a memberof a religious order in 1952. He holds a

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Doctorateof Ministrieswith concentrationsin psychology andcounseling andhas


been an assistantsupervisorof a programfor priestsin ClinicalPastoralEducation
(CPE). In 1975, as partof an assignmentas directorof pastoralcare at a Catholic
medicalcenter, he was askedby the executive administratorto coordinatea Charismatichealingministrywithinthe hospital. Althoughhe hadbeen awareof Charismaticprayergroups, he had previously taken no interest;thus his involvement
in Catholic Pentecostalismbegan with his consent to become active in Charismatichealing. Since then he has remainedactive in the healing ministry, leading
public healing services and workshopsand conductingprivatehealing sessions.
Catholic Pentecostalsbelieve that the power to heal stems from "spiritual
gifts" ("charisms" in theological terms) grantedby God. As FatherFelix continuedto work as both a counselor and healing minister, he asked God for "the
gift of discernmentto be able to know what to pray for. Because a lot of people
are coming in. There's a lot of stuff that's unconscious;they can't get in touch
with it." Discernment-divinely heightened intuition-is understoodas a divinely inspiredabilityto understandpeople, problems, and situations.FatherFelix recountstwo incidents in which he felt the grantingof this charismwas confirmed.In the first, while prayingwith a parishpriest, he spoke about problems
that were so uniquely relevantto the priest's situationthat the latterthoughthis
parishionershad already spoken to FatherFelix about them beforehand. In the
second, he discernedthathe should ask someone else in the healing groupto lead
a vocal prayerwhile he prayedsilently with his hand on a priest's back. During
the prayerhis hand became extremely hot. This heat was also perceived by the
supplicant,who latermentionedthat he had cancer in his back at the spot where
FatherFelix had "discerned" thathe shouldplace his hand. For FatherFelix, the
fortuitousplacementof his hand was a manifestationof discernment,while the
heat was a sign that healing was takingplace. Since then, FatherFelix has relied
stronglyon this gift in his healing practice.
FatherFelix holds privatehealing encountersin one of the counselingrooms
at the monasterywhere he resides. The session begins with a period of light talk
or counseling, duringwhich the priest typically inquiresaboutchanges that may
have occurredsince the previous session. He then places a straight-backedchair
in the centerof the small room, asks the supplicantto be seatedthere, and anoints
the person's foreheadwith holy oil. He standsbehind the person with one hand
on her head and anotheron her shoulder, prayingsilently for approximatelyfive
minutes. During this period he often receives "discernment" about the person
andthe problem.Afterwardshe asks the person aboutany experiences she might
have had duringthe prayer. After this second brief period of conversationand
counseling, the session ends, seldom having lasted more than a half hour.
FatherFelix stronglybelieves in the necessity of "getting to the source" of
a problemin orderto heal it. Fromhis experience, two importantsourcesof people's problemsare evil spirits and previous generations. To eliminate the influence of evil spirits he uses deliveranceprayer, and to eliminate that of previous
generationshe uses the mass for healing of ancestry.Each of these will be briefly
described.
In the Catholic Pentecostalhealing system, evil spiritstypically are named
afteremotions or behavioralpatterns;Anxiety, Depression, Lust, and Rebellion
are all common spirit names. FatherFelix agrees with most other Catholic Pen-

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tecostalhealersinterviewedthatspiritsattackindividualsat theirmost vulnerable


points, whetherthese be the propensityfor committinga particulartype of sin or
the lasting effects of traumaticexperience. No one can be completely possessed
by Satanunless he makes a conscious decision or pact; all other spiritualafflictions are in the form of oppressionor harassmentin a particulardomain of life
experience. FatherFelix also allows for humansources of negative emotions in
the absence of demonic influence, however, and it is a matterfor discernment
whethera personplaguedby depressionor lust is in fact underattackby the spirit
of Depressionor Lust. Among the most common spiritsin his experienceis Fearof-Being-Found-Out,which causes such thoughts as "if only people knew the
things I did or I think, I'd have no friends." Anothervery common spiritis Devaluation,akin to Self-Hatred,which causes "low self-image and self-esteem."
FatherFelix's typicalmode of deliveranceis to praysilently as follows: "By
the power of the Word of God, Jesus Christ, and by the power of the Sword of
the Spirit I sever forever all negative spiritual,emotional, psychic, or physical
negativeinfluencesthatarebotheringmy sister [or brother]."'Following this general prayerhe specifically addresseswhateverevil spiritsmay be present:"You,
darkbinding forces, I commandyou in the name of Jesus Christto be separate
one from the other, to be without communicationand to be renderedpowerless.
You have no more power over this person. He [or she] belongs to Jesus Christ."
He then silently commandsindividualdemons by name, as their presence is revealed to him throughdiscernment.He does not necessarily inform supplicants
thatthere are evil spirits involved, but instead waits for a sign in their speech or
behaviorthatconfirmshis discernment.Yet in withholdingthis divinely inspired
knowledge, he sometimes tells the supplicantthat he has discerned things that
may hurtif told. In this way he establishes a role both of wise protectorand empoweredhealerwho is in directcontactwith the sacred.
In additionto privatehealing sessions, FatherFelix often says a "healingof-ancestrymass" in the home of the supplicant.Beforehand,he asks the person
to preparea family tree going back as many generationsas possible, noting any
importantevents or healthproblems, such as suicide, alcoholism, mentalillness,
or abortion.He then "prays over" the genealogy for discernmentabout the individualsrepresented.The principleenacted in this ritual is that illnesses or adverse effects of traumaticexperiencescan be passed "throughthe blood line" to
successive generations.Partof a person's healingcan includethe healing through
prayerof individualforebearswho died withouthaving been healed. In some respects this practiceis akin to prayingfor the souls of the dead, but it goes a step
fartherin actuallytrying to heal the dead. When this is accomplished, the chain
of negative influenceis "severed," and the person is freed of the affliction.
This is a brief descriptionof the Charismatichealing ministryas practiced
by a single person. While it is well within the bounds of Catholic Pentecostal
healing practice as delimited by the researchdescribed above, several contextualizing remarksare in order. First, while it is quite common for priests and
membersof religious ordersto practiceritualhealing, many Charismatichealing
ministersare laypersons. Second, while some healing ministershave had professional trainingin counselingor psychology, most have had none. With respectto
procedure,FatherFelix makes less use of guided imagerythan do many Charismatichealingministers,althoughhe encouragesspontaneousmentalimagery.On

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the otherhand, he makes greatuse of deliverance, which many healing ministers


avoid because of the perceived dangerof dealing with powerful evil spirits. Finally, performingthe mass for healing of ancestryin supplicants'homes appears
to be a practiceunique to FatherFelix, and provides him with an opportunityto
observe family dynamics in a way that is typically reportedonly of healers in
small-scaletraditionalsocieties.
Two Cases of Charismatic Ritual Healing
Case I
Margo is a 27-year-old woman, thirdyoungest of nine children, who lives
with herparents,threeof her sisters, andone sister's three-year-olddaughter.She
is concurrentlyundertreatmentwith a psychiatrist(psychopharmacologist)and in
therapywith a psychologist, but she has been frustratedby the failure of both
medicationand therapy.The diagnosticportionof her interviewconfirmedpanic
disorderand major depression as her principalproblems.3She and her mother
both reportthatone of her sisters, who lives at home, suffers from schizophrenic
illness.
Margo'sillness began in 1985, two yearsbefore recourseto the healing minister. She had droppedout of nursing school after doing less well than she had
hoped, and had returnedto full-time work as a hospital administrativeassistant.
She felt overworkedand preoccupiedby this stressfuljob. At the same time she
felt that she was "losing" most of her previous friends as they got married,so
that her social life had become "flat." After six months she "burnedout" and
took a transferto a lower-status,less stressfuljob. Her firstpanic attackoccurred
two monthsafterthe transfer.
Difficulties of family life appearto have contributedto the problem. She
regardsher parents'marriageas very poor, characterizedby frequentloud arguments. She describes her fatheras critical, cruel, and authoritarian,to the point
of physically abusive discipline when his childrenwere young. She is very close
to her motherand older sister, but feels a need to distanceherself from emotional
overinvolvementand establish an independentlife. She reportsdeveloping, one
year priorto the onset of her illness, overt hostility and hatredfor a previously
close sisterwho had "ruinedher own life" and moved back into the family home
afterhaving had a baby with a man she did not marry.An additionalfactorin her
distressappearsto be the accidentaldeath of a brothersome years earlier. Given
this constellationof patternsand events, a majorareaof intense anxiety for her is
relationshipswith men. Throughpsychotherapyshe has come to associate this
anxietywith a lack of opportunityto develop a sense of trustfor others.
Margo is a practicing Catholic, and was involved in Charismaticprayer
groupsfor a period of months several years priorto her illness, but for no clear
reasonshe ceased attending. Since the onset of her illness, however, Margo has
frequentlyattendedpublic healing services and is on the mailing lists of two influentialCharismatichealing ministers. At these services she often experiences
"resting in the spirit," a form of motor dissociation in which a person, at the
touchof the healingminister,falls in a peaceful, relaxing, andrejuvenatingswoon
as the "power of the Holy Spirit" overcomes her. Yet Margohad been disturbed
in one of these services when the healer declaredthat she was being healed. On

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inquiry,the healerexplainedthather "gift of discernment' revealedthatthe healing processhad alreadystarted.Margoreportedbeing confusedandbaffled, since
"if the healing has alreadystarted,personallyI don't feel any different."
Margocalled FatherFelix to ask for help, and he advised that she attendhis
public healing service. At thatevent she requestedprayerfor severe depression,
and the priest instructedhis assistantsto pray for expulsion of a "spirit of Darkness." He then suggested that she come to him for privatehealing sessions. At
the initial session he recounted previous situations of successful healing, and
statedthathe felt she could be healedquickly. He "corrected"heridea thatprayer
wouldbe moresuccessful if she madeher mindblankwhile he prayed,explaining
that she should expect spontaneousmental imagery to emerge from her unconscious duringthe course of prayerand thatGod did not need her assistancefor the
prayerto be successful. He also "corrected" her view that she should cease
weekly psychotherapywhile undergoingritualhealing.
Duringthe second session, Margo told FatherFelix of a disturbingexperience she had had repeatedlyfor several monthsprior to the onset of her illness.
As she was driftingoff to sleep, she "could feel anotherpresence in my room. I
could feel someone actuallysit down on the end of my bed." She had never mentioned this to her psychiatristor psychologist, for fear that they would think her
crazy. FatherFelix agreed that she was right not to have told them, but that he
himself was quite familiarwith such experiences:it was an evil spirit. This confirmedwhat she had suspected, and reassuredher that it was a phenomenonwith
which FatherFelix could deal.4
Duringthe periodof silent prayer,perhapsin responseto FatherFelix's advice to allow thoughtsto come to her mind, Margoexperienceda series of ideas
"coming from all directions." Three issues emerged:the difficulties she experienced in her past administrativejob, whetheror not to change doctors (she had
been told that everythinghad been tried yet nothing seemed to help), and a disappointingrelationshipwith an older man. The lattersituationwas one in which
the man, who lived in a differentcity, had courtedher for a period of time until
she discoveredthathe was married.She cared for him, but was very angry, and
felt conflict abouther desire to be with him in spite of a conviction that it would
be morallywrongto do so. None of these issues was subsequentlydiscussedwith
the healer. FatherFelix simply told Margo to make note of what came into her
mindduringprayerbecause "it would be important"for her.
A final event thatunfoldedover two sessions had to do with the priest's advice thatone can verballyaddressnegative emotions and commandthem to leave
in the nameof JesusChrist.This event was explicitly identifiedas most significant
by Margoin a subsequentinterview. She interpretedthe advice to mean that the
problemis "all in the way thatyou're thinking." InvokingGod indicatesthatHe
does not want her to feel as she does, and if she has the strengthand faith to say
"leave" in His name, the negativeemotionsof anxietyanddepressionshouldgo.
Duringthe following session, FatherFelix discoveredthatthis techniquehad
not been successful in achieving the goal of changingher attitude.The following
key exchangetook place:
M: I had thoughtslike, you know, I'm slowly going to wither away. Almost
like having some form of cancer. It doesn't leave me. It hauntsme. It never
leaves me. It won't go away. I can't get rid of it. I don't know how to get

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rid of it. It's driving me crazy. It's driven me crazy. It's overtakenmy
whole life. And I...
FF: What did I tell you last time? I guess you forgot. About taking authority
over these things within yourself. You take authorityin the name of Jesus
Christ,andyou commandthem to just get the heck out. They have to obey.
M: I have said thatto myself at differenttimes. Like this whole past week while
I was at mass. I had the tremorsand the shakes real bad. You know, the
fears aroundotherpeople being there, whatever. And I kept saying that to
myself over and over again.
FF: Whatdid you say?
M: I kept saying, you know, "In the name of Christ, leave me, leave me."
Tryingto force the way thatI thoughtinto anotherdirection,morepositive.
And ...
FF: Let me clue you in to something. If you say, for instance, "In the name of
Jesus," right?There's an evil spiritthatcalls itself "Jesus" . . . but it's a
false Jesus. You've got to rememberthat. Some people get caught upit's like conjuringup a spirit, and they're confrontingthe evil spirit [that]
calls himself "Jesus." So I always use the name "Jesus Christ" or "Jesus
of Nazareth," you know? That Jesus. Oh, yeah, hundredsof [Spanishspeaking]people call themselves Jesus.
In this interaction (identified as significant by Margo herself), the directive
to specify the name Jesus Christ was more than a move by the healer to cover the
technique's lack of success. For the failure to command one's emotions indicates
in the logic of the healing system that more than one's emotions are involved. A
powerful force must be standing in the way, blocking the path to healing. In a
follow-up interview, Margo acknowledged surprise at learning both the subtlety
of the religious technique and the demonic cause of her problem. She recalled
Father Felix's original invocation of the "spirit of Darkness" during her first public healing service. She intimated that she had always "thought [about her problem] along those lines" and that the idea of evil forces being involved "struck
home." With respect to how this interaction helped her, she responded that it was
"to give me courage and more strength, and more faith. Faith-wise, to know that
this is not of God. And how prayer can build your faith. It can build your
strength."
In addition to having a home mass for healing of ancestry, Margo attended
a total of three private sessions with Father Felix. Instead of going to her fourth
session, she kept an appointment with her psychopharmacologist, who decided
that since no other treatment had worked, she should be admitted for electroconvulsive therapy (ECT). She indicated that she would have resumed the sessions
after discharge, but this was precluded by Father Felix's departure for a long
sabbatical.
Case 2
Ralph is a 25-year-old man who has finished high school and spent a short
period in college. He now lives with his parents and brother, a year his junior,
and is under medical and psychiatric treatment for a variety of problems. The
diagnostic portion of our interview confirmed a complex situation revolving

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arounda primarydiagnosis of paranoidschizophreniaoriginatingfrom serious


drug abuse; obsessive-compulsive disorderwith onset at age 14; probabledysthymic disorder(a mild form of clinical depression);symptomsof agoraphobia,
panicdisorder,and simple phobia(fearof heights);epilepsy relatedto a probable
brainlesion; and asthma.5
In 1983, approximatelyfour years before Charismatichealing, Ralph had
had a majorpsychiatrichospitalizationfollowing a drug overdose. His inpatient
experience was traumaticand appearsto have been the occasion on which his
principalcomplaintbegan: extreme "nervousness" in social situationsfor fear
people are thinkingnegatively about him, in particularthat they are thinkinghe
mightbe homosexual.6Since the adventof these fears, he has been unableto hold
a job and finds it nearly intolerableto be in a group of people. Another major
source of distress is his brother,who in the past has also been underpsychiatric
care. He cannottoleratehis brother,who is highly abusiveto theirparents,so the
two have takenturnsliving with theirgrandfatherin a nearbytown. Ralphappears
to have a close relationshipwith his father, but he feels that his motheris critical
and habituallymakes him feel guilty even in small daily events. His primary
pleasurecomes fromlisteningto recordedmusic andfromwritingpoetryin a style
thathe considerssimilarto that of Kerouacand Ginsberg, though he finds it extremely difficult to write creatively under the influence of his antipsychotic
medication.
Ralph'sreligiousbackgroundincludesexposureto the CharismaticRenewal
when he was 16, when he attendeda prayergroup for about a month with his
mother.Duringthis time he had the experienceof "Baptism in the Holy Spirit"
andbecamefamilarwith speakingin tongues andotherCharismaticpractices.He
currentlyclaims not to believe in God, but even so, admitsthat religious themes
consistentlyemerge in his poetry. The encounterwith FatherFelix was initiated
by Ralph'smother,who thoughtthat, as a psychologist, he could best advise the
family about a psychiatrist'srecommendationthat Ralph submit to electroconvulsive therapy(ECT). FatherFelix respondedthat if Ralphsaw him on a regular
basis he would not need ECT. Ralph enteredthe situationexpecting counseling
for his mainproblemof social nervousness,andonly when the sessions began did
he realizethey consisted primarilyof healing prayer.
Hopes were raised after the first session, during which Ralph experienced
warmthemanatingfrom the priest's hands and the sensationof purplerings expandingconcentricallyin his visual field while his eyes were closed. FatherFelix
interpretedthe vision in termsof Catholic liturgicalsymbolism, in which purple
representsdeath. He concludedthatsomethingnegative within Ralphwas dying.
More importantfor Ralph, the sense of a benign presence accompaniedhim for
two days afterthis initial session. This experienceencouragedhim to attendmass
with his grandfather,where he felt his eyes rotatingupwardin theirsockets (nystagmus). One of Ralph's greatestfears is that this occasional phenomenonwill
occurin public, and its occurrenceduringthe mass promptedhim to feel betrayed
by God. In subsequentsessions he again experiencedheat and color, but the sensations progressivelydeclined in intensity. In addition, althoughhe had prayed
silently along with FatherFelix duringthe first few sessions, he ceased this participationin the final ones.

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Ralph'spost-session interviewsreveal his perceptionof the therapeuticprocess as unsatisfactory.Two types of comments indicate that the healer at times
either overinterpretedor misunderstoodRalph's experience in ways that weakened the rhetoricalimpactof the healing.
One of FatherFelix's overinterpretationsoccurred when he was trying to
convince Ralphthatby dwelling on his nervousnesshe would perpetuateit, just
as someone who repeatsto himself "don't thinkaboutthe color green" is in fact
thinkingaboutgreen. Duringthe period of prayerwith laying on of handswhich
followed this conversation, Ralph saw the color green in addition to his usual
purple. FatherFelix attributedsignificanceto this, pointing out that green is the
color of hope in liturgicalsymbolism. Ralph rejectedthe interpretation,attributing his vision of green to the suggestion plantedby the previous advice, rather
thanto divine inspiration.In anotherexample, FatherFelix asked if he could invite two women fromthe local Charismaticprayergroupto help him in the healing
prayerin orderto expose Ralphto female influence, which he felt was inadequate
in his client's life, andapparentlyalso in responseto Ralph'sfearof being thought
a homosexual. Ralph's response to this therapeuticmove was to list a variety of
women he knew, rejectingthe idea thathis exposureto female presencewas deficient. Finally, FatherFelix attemptedto portrayas positive Ralph's uncharacteristicattendanceat mass and visit to a restaurantwith his grandfather.Ralph's
responsewas that he had attendedmass only once, and that going to a restaurant
never made him as nervousas did being in a groupof people.
In additionto these overinterpretations,FatherFelix appearsto have misunderstoodRalphon a numberof occasions. In a segment duringwhich the two
discussed whether Ralph's nervousness would prevent him from attending a
party,FatherFelix statedthathe thoughtmingling with people would be just the
thingRalphneeded. In responseto Ralph's statementthathe was too nervous, the
healer said that if you think nervous, you'll be nervous. Ralph objected, "No,
I'm not thinkingnervous, I am nervous!" In the follow-up interview, he stated
specificallythathe felt misunderstood,and that with paranoiaone cannot simply
tell oneself to do something. In anothersegment Ralphmentionedthathis father
encouragedhim to "be like him" and not care what others think. FatherFelix
interpretedthis as an expression of the father's insecurity, indicatingthat he did
not feel in control of his life and really did care about others' opinions. In the
follow-up interview, Ralph took exception to this, arguing that his father had
madethis statementonly once or twice, in the context of encouragingRalph, and
wasn't guilty of "denial." He felt thatFatherFelix's basic point aboutpeople in
general was correct, but that he was inaccuratein attributingsuch denial to his
father.Finally, in a session when Ralphstatedthatno changes had occurredsince
the previous session, FatherFelix turnedto the researcherand asked if in fact I
could not observe any changes. Ralph interpretedthis attemptto solicit impressions of observablebehavioralchange as an outrightcontradictionof his reportof
no internalexperienceof change. He statedthatthis made him angry, althoughit
"didn't have anythingto do with the praying" as a form of treatment.
In spite of this apparentwillingness to separatethe religious effects of the
prayerfrom the perceivedmissteps of the healing minister, successive overinterpretationsand misunderstandingsappearto have underminedthe therapeuticprocess. Ralph terminatedhis involvement after five sessions and a healing-of-

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ancestrymass. Subsequently,FatherFelix met in severalsessions with the father,


prayingostensiblyfor the second son with the fatheras "proxy."'In private,however, he admittedhe was simultaneouslyprayingfor the fatherhimself, who he
felt hadan overly criticaland negativemanner.The priestfelt thatthe man's manner was somewhatamelioratedthroughhealing, and the family also reportedthat
theirsecond son had become less wrathfuland abusive. However, the fathersoon
terminatedhis sessions with FatherFelix as well.
In an interview two months following his termination,Ralph described interactionswith a new psychiatrist,who was skepticalof the diagnosisof paranoid
schizophreniaand who had successfully hypnotizedRalph into not feeling nervous on a recentdatewith a woman.7He tendedto discountthe apparentsimilarity
between the peaceful feeling of being prayed over with eyes closed and being
placed in light tranceand was hopeful abouthis new course of treatment.
Incremental Change, Inconclusive Success
Muchof the literatureon religious healing implies thatritualnecessarilyand
definitively accomplishes, at least in its own terms, what it sets out to do. Far
from being definitive, the effects of healing in the two cases presentedhere are
incrementalandinconclusive. Both areclose to whatwe could call limitingcases,
beyond which the relevance of any idea of efficacy becomes questionable.Even
so, the case descriptionsindicatethatthe healing experiencewas more satisfying
for Margothanfor Ralph, since he rejectedthe processand she wished to continue
it. This contrastin behaviorsuggests the need for an interpretiveapproachsensitive to subtlebut importantmodulationsof meaningand experience in the therapeuticprocess. In an earlieranalysis based on retrospectiveaccountsof Charismatichealing, I proposedthattherapeuticprocess in ritualhealing be analyzedin
terms of participants'predispositions, their experience of empowerment, and
theirexperienceof transformation(Csordas1983). Following cases prospectively
has allowed a reformulationof these elements in more precise terms. Thus, we
will examine the two cases in light of these elements of therapeuticprocess.
Disposition of Participants

The term "disposition" is fortuitiousin that it has the dual meaning of a


prevailingmood or tendencyand of the act of disposingor arrangingin an orderly
way. In otherwords, underthis headingwe are looking not only at psychological
states, such as expectancy or "faith to be healed," but at the disposition of persons withinthe healing process vis-a-vis social networksand symbolic resources.
While neitherclient was very active in the Charismaticmovement, Margo
was more familiarwith religious healing throughattendanceat prayermeetings
and public healing services and had no questions aboutbasic religious belief. In
addition,her motherwas orientedtowardCharismaticspiritualityand subscribed
to the leading Catholic Pentecostalmagazine. In spite of strong disappointment
at a healing service in which she was told that her healing had already begun,
Margo'spositive dispositionwithinthe process was expressedin her gratitudefor
havingbeen singled out for one-on-one healing sessions with FatherFelix and in
her openness to his instructions.She acceptedhis injunctionsboth to be open to
spontaneousimages from her unconscious duringprayerand to conceive of her

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anxiety and depressionas "diminishing" from day to day. Her positive disposition was enhanced by the reassurancethat an apparitionat her bedside, about
which she had never told her secular therapist,was not a sign of mental illness
but a frequentand fully understandablemanifestationof an evil force. Finally, in
one session she took the initiativeof askingthe priestif he had spiritually"picked
up" or "discerned' anythingparticularabout her problemwhile he prayedover
her. This anticipationof divine empowermentin fact caughtFatherFelix by surprise, but he was able to summarizeseveral "fears" about which he had been
"led" to pray, thus reinforcingMargo's alreadystrongdisposition.
Ralph, in contrast, enteredthe process with ambivalence:he expressed agnosticism but acknowledgeda preoccupationwith religion that emerged both in
his poetryand even occasionally in prayingby repeatingthe name "Jesus." Like
Margo, he had been exposed to the practices of the CharismaticRenewal, althoughhe had not been involved for at least eight years and then only briefly. In
addition,he had enteredhealing underthe assumptionthat his sessions with Father Felix would consist not of prayerbut of counseling. Nevertheless, his disposition duringthe process was favorableenough that he prayedalong with the
priestduringthe first several sessions. Yet this level of participationdiminished,
with the final resultthathe discountedthe healing process as cultlike.
Experience of the Sacred

The humancapacityto attendto the world as sacred,other, andpowerfulhas


been documentedrepeatedlyby phenomenologistsof religion(Eliade 1958, 1959;
van der Leeuw 1938). Each healing system attendsto the humancondition differently,elaboratinga repertoireof ritualelements thatconstitutelegitimatemanifestationsof divine power. Withina particularhealing system, we areconcerned
with individualvariationin experienceof the sacredthatmay influencethe course
of therapeuticprocess.
Margo's experiences of concrete empowermentincluded periodic "resting
in the Spirit" at otherhealing services before enteringthe series of sessions with
FatherFelix. With the priest, instructionto be open to unconscious materialresulted in the spontaneousexperience of three significantaspects of her problem,
"rushingat her from all directions." Both the motordissociationof restingin the
Spiritand the spontaneousimagery are examples of concrete, embodied experience of the sacred. Ralph's experience of progressively diminishing empowerment began with a distinct experience of abandonmentby the transcendentpresence thathad initially been evoked in the healing prayer.The significanceof this
event nevercame to FatherFelix's attentionduringthe sessions; hence, he did not
have the opportunityof dealing with it in the contextof CatholicPentecostalbelief
and practice.In short, this experienceof the sacredwas not incorporatedinto the
therapeuticprocessfor Ralph, andthe intensityof his experienceof power as presence, heat, andcolor progressivelydiminished.It is also possible thatthe priest's
attemptto attributesymbolic meaningto the emergenceof greenin Ralph's visual
field furtherunderminedthe evocation of the sacred, since Ralph himself attributed the experienceto the power of suggestion ratherthanto divine power.
The most strikingdifference between the two cases is that Margo's experiences had more sacredcontentthatpertainedimmediatelyto her situation,as op-

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posed to Ralph's vague sense of divine presence, heat, and color that received
only minimalinterpretationby the healing minister. The observermight surmise
thatthe healercould have workedwith this experienceeitherby interpretingit as
a mystical companionwho could protectthe young man from pathologicalnervousness in social situationsor by using it as an experientialwedge into Ralph's
agnosticism,therebyfacilitatinggreaterdispositiontowardhealing. FatherFelix
might also have taken the occasion to induce behavioraland attitudinaltransformationthroughhis statedpriorityof getting to the "root" of Ralph's problems.
Instead, any potential content of Ralph's experience remainedunelaboratedas
insight, interpretation,or direction. It is unclear whetherthis did not occur because the healer was unawareof Ralph's experience of "presence" or because
such a strategywould be unacceptable.
Margo's experiences of empowermentwere substantiallydifferent, rich in
biographicalmeaning(suddenemergence of thoughtsaboutherjob, doctor, and
formerboyfriend). For her, the experience was a moment not of abstractbut of
concretetranscendence.As pointed out by Kapferer, "A ritual fixed in a transcendentmoment is empoweredto act on contexts external to the performance
and to transformthem in accordancewith the rearrangementor reorderingwhich
the transcendentmoment of the rite expresses" (1979:17). Unless the concrete
rhetoricwithin such momentsis identified,the phrase"in accordancewith" posits no morethanan abstracthomology between elementsof ritualandelementsof
a distressedlife. The concrete experience of the sacred is not an experience of
"the supernatural"but a transformedway of attendingto the humanworld. For
Margobut not for Ralph, the link between transcendenceand the reorderingof
life was forged in the biographicalcontentof her transcendentmoment.
Negotiation of Possibilities

A principaltaskof therapeuticpersuasionandhealingis to createalternatives


by changing the "assumptive world" (Frank 1973) of the afflicted. Different
healing systems may conceive the alternativesas new pathways, as a means of
becoming unstuck, or of overcoming obstacles, as a way out of trouble, or in
termsof a variety of other metaphors.They may use ritualor pragmaticmeans
and may encourageactivity or passivity, but the possibilities must be perceived
as real and realistic.
The firstpossibilityelaboratedfor Margoconcernedherattitudetowardmedical treatment.She was persuadedthat insteadof cooperatingwith the effects of
prescribedmedicationthrougha positive attitude,she hadbeen expecting them to
fail, and so they had. An extension of this line of thinkingwas her mother'sconjecturethatthe doctor's unexpecteddecision to try ECT may have been an effect
of the healing prayer.8
The second possibility was elaboratedthroughMargo's new understanding
of the role of evil spirits, placing "spiritualpower" alongside "illness" as a way
to make sense of a frustratinglife situation. This alternativewas providedalong
with the reassurancethat an unsettlingapparitionwas not a sign of insanity but
the manifestationof an evil spirit. She was laterpersuadedthat the techniqueof
"commandingher emotions" was not only a way to invoke divine power but also
a way to instill some sense of control over emotions she experiencedas uncom-

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fortableand alien. The attributionof the technique's ineffectiveness to interference by an evil spirit not only "raised the stakes" to a cosmological level, but
confirmedher feeling that anxiety and depressionwere alien to her naturalstate.
The story for Ralph can be summedup more briefly. There were simply no
possibilitiesgeneratedfor him in the healingprocess. As with Margo, FatherFelix
offered methods-relaxation, developing a positive attitude, attending social
events-but Ralphnever perceivedthem as realistic.
Actualizationof Change
Whatcounts as change, as well as the degree to which thatchange is seen as
significantby participants,cannotbe taken for grantedin comparativestudies of
therapeuticprocess. This insight is all the more importantfor this discussion,
where no definitive outcome exists and where our concern is to define minimal
elementsof efficacy.
The principalevidence for incrementalchange in Margo's healing is her reportof a decision to shareher troubleswith a youngersister-in-law.While a reason for this decision did not explicitly emerge in follow-up interviews, it can be
suggestedthat the healer's discourse on "Fear-of-Being-Found-Out"may have
plantedthe idea of seeking supportfrom othersratherthan attemptingto hide her
difficultiesfrom them. Attributingher formerbehaviorto a fear that is not only
negativebut may also representthe activity of an evil spiritis in this instancethe
key featureof the rhetoricof transformation.Whereasthe desire to hide her distresshadled to increasingsocial withdrawal,its linkageto the idea of an evil spirit
now motivated Margo to make her distress itself the occasion for social
engagement.
Failureto actualizechange in Ralph's healing is evident in his explicit rejection of whateverFatherFelix offered as evidence of therapeuticchange. Attending mass with his grandfatherwas discounted because it only happenedonce,
going to a restaurantwith his grandfatherwas not significantbecause he customarilydid such things withoutconsequence anyway, and anotherperson's opinion
aboutwhetherhe had changed was discountedboth because he had no indication
fromothersthatthis was so and especially because what matteredto him was that
he felt no different.When the researcherasked whetherhis recentlack of trouble
with uncontrolledeye movement was a possible result of healing prayer, Ralph
did not rejectthe possibility outrightbut greeted it with ambivalence,precluding
its classificationas an experienceof transformation.The healer's perceptionof a
positive change in Ralph's fatherdoubtless had minimal effect, since fatherand
son alreadyhad a close relationship.Similarly, the parents' reportof change in
his brotherhadminimaleffect, since strainedrelationsbetweenbrotherspersisted
to the point where they were unableto live in the same house.
In sum, the therapeuticprocess for Margo was characterizedby an initially
positive disposition;experiences of divine power with discrete, intelligible content; the elaboration of viable possibilities; and significant, if incremental,
changes. Ralph exhibited ambivalent disposition, diminishing empowerment,
nonrecognitionof possibilities, and rejectionof change, with a strongperception
of being misunderstoodby the healing minister.In these terms, healing was more
successful for Margothan for Ralph, and the analysis thus sheds light on the dif-

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ferentmodes in which the two terminatedtheir sessions. Ralph left the religious
healingprocess to find apparentlygreatersatisfactionfrom a psychiatrist/hypnotist, with no sense of continuityfrom his Charismatichealing encounter.Margo,
who was initially demoralizedaboutpsychiatryand psychotherapy,left the healing processto try an additionalinpatientpsychiatrictreatmentandprobablywould
have continued religious healing if the priest had not left the area for an extended

period.
Discussion
While moving in the rightdirection, this analysis still does not establishthe
significance of these transformationsin comparison to what clinical thinking
would call a cure. Whatis strikingin the examples presentedis their incremental
character,with no guaranteethatthey will be permanentlyintegratedinto the person's life. The incrementaland open-ended process of religious healing may
prove to be an essential characteristicthat requires some religious cures to be
"symbiotic" (Crapanzano1973): perhapsthere is no therapeuticoutcome, only
therapeuticprocess. CatholicPentecostalhealing can include the symbioticgoal,
encouragingsupplicantsto incorporatereligiousmeaningandinhabita religiously
defined community. Yet in the socioculturalsetting of late 20th-centuryNorth
America, we may readily discern factors that contributeto the fragmentaryand
inconclusivenatureof the healing process which do not pertainin the traditional
societies from which the bulk of ethnographicknowledge comes.
First, consider FatherFelix's attempt to draw the families of Margo and
Ralph into the healing process throughthe healing-of-ancestrymass. If there is
anythingunique about FatherFelix's healing practice in comparisonto that of
otherCatholicPentecostalhealingministers,it is his practiceof enteringthe home
and mobilizing family supportthroughparticipationin this event. Most Charismatichealing is based on the model of the individualencounter,and it is not unknownfor a womanto be in the healingprocess to the displeasureof her husband.
Even when the healertakes the initiativein mobilizing social support,his authority is not such thathe can intervenein the way sometimesdescribedfor traditional
healers. Margo's father was pointedly absent from her ancestry mass, as was
Ralph's brotherfrom his. Ralph's fatherparticipatedenthusiasticallyin several
privatesessions of his own with the priest, but he discontinuedthem withoutresolution, simply failing to make anotherappointment.Thus social support,often
cited as one of the hallmarksof ritualhealing, is by no means automatic.Support
from the family and supportfrom the community of religious believers are not
identicalor necessarily even compatible. Supportfrom either may be less emphatic than might be expected from the cases commonly reportedin the ethnographicliterature.
Consider, in addition, the ease with which people may enter and leave the
healing process in these examples. In cross-cultural perspective, this kind of mo-

bility among healing resourcesseems to be a function of both the numberof resources available and the exclusivity of each healing form. Finkler (1985) observed a distinction among Mexican Spiritualists between those who were devotees and those who made casual or periodic use of Spiritualist healing; Crapanzano

(1973) noted a similardistinctionbetween Hamadshadevotees who experienced

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a symbioticcure and otherswho received a "one-shot" exorcistic cure. As Catholic Pentecostalismhas developed over the past two decades, its healing forms
have become moreaccessible to those with only a marginalexposureto the movement.9Like Ralph and Margo, they are less likely to become involved in a total
"symbioticcure" and will more likely experiencethe kinds of incrementaltransformationsdocumentedhere. Thus, little understandingwill result if researchis
directedtowarddefinitivetherapeuticoutcome, ratherthantowardthe ambiguities
and partialsuccesses (and failures)embeddedin therapeuticprocess.
Furthermore,if their diagnoses are correct, Ralph suffers from a serious
schizophrenicillness characteristicallyassociatedwith psychotherapeuticfailure,
while Margo's problemsof depressionand panic typically respondwell to a varietyof psychotherapeuticinterventions.Researchin traditionalsocieties is often
complicatedby the fact that the anthropologistdoes not have comparablediagnostic information;on the other hand, researchin contemporarysociety can be
complicatedby the fact that the informantdoes have this information.Ralph's
rejectionof FatherFelix's comment, "If you think nervous, you'll be nervous, '
was based on his conceptionthat clinical paranoiacannot simply be banishedby
a changeof attitude.In contrast,Margo's willingness to tell abouther experience
of an apparitiononly to the priestand not to her psychotherapistwas based on her
concernthat she might receive a diagnosis thatto her was worse thandepression
and panic disorder.
One might say thatthe religious healingencountersof both supplicantswere
conditionedby previous encounters with mental health professionals, in terms
both of knowledge about their conditions and, especially for Margo, of insights
gained from previouspsychotherapy.This interpretationwould representethnographicmyopia, however. More accuratefor both Margo and Ralph, religious
healing was an interludein a history of encounterswith the mental health establishment. Herein lies both the clinical and anthropologicalsignificance of these
cases: anthropologically,in terms of how the interactionof both religious and
clinical meaningsshapethe illness experience;and clinically, in termsof how the
religious encountermay influence the trajectoryof the illness. How did Ralph's
previous hospitalizationand interactionwith mental health professionals affect
the encounterwith FatherFelix, and how did the experience with FatherFelix
influenceRalph'ssubsequentencounterwith the psychiatristusing hypnotherapy?
Margowas seeing both a psychiatristand a psychologist before meeting Father
Felix, who suggestedthatshe switch to a Christianpsychotherapistwhile she continuedwith healingprayer.In the end she appearedcommittedto both psychiatric
treatmentandreligioushealing. But were these independentcommitmentsor did,
for example, religious healing influenceMargo's willingness to submitto ECT?
The clinicianshouldfindthis kind of informationvaluable,but it is not likely
to be volunteeredby the patient. Like Ralphand Margo, both of whom refusedto
permitme to contact their physicians, many of those who have recourseto religious healing undoubtedlybelieve they are betteroff not informingtheir physicians unless or until some dramaticchange occurs for which they want medical
documentationof a miraculoushealing. Medical prejudice-real or perceived
againstreligious conviction may create a criticalblind spot in the clinical picture
of the large numberof people who find religious healing congenial.

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In concluding,we shouldallow a finalwordto FatherFelix, who was himself


disappointedthat more noticeable and quicker results had not been achieved in
eithercase. He attributedthe difficultywith Ralphboth to the supplicant'sresistanceandto his own failureto includemore of a counselingcomponentalongside
healingprayer.He also saw Margo's mainproblemas a negative family environment and her inabilityto achieve independencefrom it.
Conclusion: Therapeutic Process and the Theory of Healing
The methodadoptedin this study of examiningdisposition, religious experience, possibility, and incrementalchange as elements of therapeuticprocess
contrastswith studiesthatemphasizethe global role of psychologicalmechanisms
such as suggestion, catharsis,placebo effect, or regressionin service of the ego
(Calestro1972; Sargant 1973; Scheff 1979; Torrey 1972). These studies tend to
discouragedetailedanalysisof therapeuticprocess in the experienceof individual
persons, since if healing can be accountedfor by a nonspecific mechanism, all
thatneed be specifiedis how thatmechanismis triggered.Even when more specificity is given, as in Scheff's (1979) proposalthat a mechanismof distancingis
essential to the mechanismof catharsis, analysis tends to discount the natureof
distressand the differentialeffects of healing across individuals. We cannotdefinitivelysay, for example, thatthe techniqueof commandingher emotions constituteddistancingfor Margo, and even if we can, the effect may have been more
cognitive than cathartic.A similar point applies to invocation of "altered states
of consciousness" in explaining the effects of healing. 0 These states cannot be
treatedlike mechanisms such as catharsisor suggestion. Their naturemust be
defined in culturalas well as psychophysiologicalterms, and their place within
healing systems must be specified.
In stayingclose to the experientialdata, this methodalso contrastswith other
more globally stated conceptions of the healing process. For example, Dow
(1986) describes the healing process as one in which symbols from the mythic
realmare "particularized"in meaningfor an individualsupplicant.The symbols
are then "manipulated"by a healer to mediate or "transact"between the hierarchicallevels of society and self. In addition, emotions are "attached" to the
symbols to transactbetween levels of self and soma. In the case of Margo it is
certainlypossible to label the spiritof Darknessas a transactionalsymbol to which
the healerattachesthe emotion of depression;it could just as easily be described
as a qualitypredicatedby the healer on an inchoate pronoun(Fernandez1974),
or as a managementof meaningby the healer, who is acting as a spiritualbroker
defining the conditions of the supplicant's participationin the religious group
(Kapferer 1976). In short, a model is needed that can specify conditions for
change, criteriafor a job well done by the healer, and culturalrepertoiresof significantpatientexperience.
While Dow states that the healer "persuades" the patient that the mythic
symbols are relevantto his or her condition, he does not explain how such persuasion occurs and creates a disposition to be healed. Elements of religious experiencearejudged by Dow to be "therapeuticpreludes," the purposeof which
is to establish a therapeuticrelationshipbased on paradox;transcendence(Kapferer 1979) and experience of the sacred (Csordas 1987a) play no part. Finally,

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the relationship among social, self, and somatic levels is characterized as analogous to that of a "thermostat," such that "it is possible to affect processes in the
self and unconscious-somatic systems through the manipulation of symbolic parameters at the social level" (Dow 1986:63). The thermostat analogy is entirely
too mechanistic. What is needed at this stage in the development of a theory of
healing is specification of how therapeutic process effects transformation in existential states.
An approach grounded in participants' own experience and perceptions of
change may arrive at a more pragmatic conceptualization of healing as a cultural
process. This should be a goal not only on a conceptual, theoretical level but also
on the level of interaction between medical and sacred aspects of complex health
care systems, as illustrated by the two cases analyzed here. Having chosen a type
of religious healing that is formally and experientially different from psychotherapy, yet sufficiently similar for systematic comparison, I suggest the possibility
of a theory of the healing process that will not only include other, more seemingly
exotic forms but also permit a rethinking of healing in cosmopolitan biomedicine.
NOTES
Acknowledgments.Thanksare due to ArthurKleinman, Byron Good, Janis Jenkins,
RobertElliott, and Nancy Wood for valuable comments and criticisms offered in the developmentof this article. The researchwas supportedby NIMH grant#5R01 MH 4047302.
Correspondencemay be addressedto the authorat the Departmentof Social Medicine
and HealthPolicy, HarvardMedical School, 25 ShattuckStreet, Boston, MA 02115.
'A notableexception to this tendencyis the discussion in Good et al. (1982) of transference and countertransferencein a collaborationbetween traditionalhealers and mental
healthprofessionals.
were contactedpriorto the firstsession observedfor purposesof explain2Participants
ing the study, obtaininginformedconsent, and initiatingrapport,so that the researcher's
presencewould not be perceivedas disruptive.Healing ministerswere presentedwith the
optionof recordingsessions withoutthe researcher'spresence, but all invariablydeclined.
Althoughseveral participantswere somewhatnervous in early sessions, rapportwas successfully achieved, and none chose to terminateinvolvement with the project. Except for
rareoccasions, one of which is reportedhere, the researcherwas not drawninto the proceedings in any way. The importanceof this method is that it allows observationof nonverbalbehaviorin the healing sessions and adds to informant-researcher
rapport.
The researcherwith access to the intimacyof the healing session is, however, no mere
fly on the wall. Indeed, inevitably some topics discussed in researchinterviews are recycled back into the healing process. The act of listening to the tapes of the sessions raises
thoughtsand emotions thatmay otherwiseremainunexamined.These issues of reflexivity
are too large for adequatediscussion here and will be addressedin futurereports.
3Hermedicationsat the time of the study, a tranquilizer(Clonipan) and an antidepressant(Nardil), appearto confirmthis diagnosis.
4FatherFelix never explored the possible experientialconnectionbetween the frightening presenceand the earlierdeathof Margo's brother,since the occurrenceof thatevent
neveremergedin the sessions.
5Accordingto Ralph and his parents, various physicians disagreed over whetherhe
was in fact diagnosableas paranoidschizophrenicandwhetherhe in fact had a brainlesion,
but his primarymedicationsincludedan antipsychotic(Mellaril), an anticonvulsant(Tegretol), and an antidepressant(Elavil).

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ANTHROPOLOGY
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6Itis more thanlikely thatthis delusion of referencewith fear of homosexualityis the


basis for the diagnosishe reportsfor himself, but it is also the case thathe exhibits no other
typicalsymptomsof schizophrenia.He mentionsthe term "grandiosity"with referenceto
his self-conception as a potentially great poet but admits that anotherpoet has literally
complimentedhim at that level. In any case, adolescent grandiosityabout the statureof
one's poetrycannotbe consideredpathological;chances are thathis use of the term "grandiosity" is based on an interpretationby a mentalhealthprofessional.
7Ralphbroughtup the fact thatotherdoctorshadwarnedhim againsthypnosisfor fear
he might develop the idea that the doctor was controllinghis mind, but he denied having
any such delusions.
8However,it is uncertainto what extent Margo sharedthis attitudewith her mother.
Ironically,as a psychologist FatherFelix was opposed to the use of ECT.
9Personalcommunicationfrom movementleadersindicatesthat since its inceptionin
1967, 10 million North AmericanCatholics have been exposed to the movement, along
with 20 million Catholics in other parts of the world. Active participationat the time of
this writing, however, is estimatedat 162,500. This remainsa substantialnumber,especially when placed alongside the largernumberof ProtestantCharismaticsand Pentecostals.
'?Forthis reason, despite the preliminarynatureof their analyses, the works of Noll
(1983), Peters(1981), and Petersand Price-Williams(1980) on shamanismare important
steps towardunderstandingalteredstatesas loci for personaltransformation,as social rites
of passage, and as the simultaneousactivationof physiological and symbolic processes.
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Crapanzano,Victor
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