Transcultural Psychiatry: Anthropology Coming To Our Senses: Appreciating The Sensorial in Medical

Transcultural Psychiatry
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Coming to Our Senses: Appreciating the Sensorial in Medical

Anthropology
Mark Nichter
TRANSCULT PSYCHIATRY 2008; 45; 163
DOI: 10.1177/1363461508089764
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transcultural
psychiatry
June
2008
ARTICLE
Coming to Our Senses: Appreciating the Sensorial

in Medical Anthropology
MARK NICHTER
University of Arizona
Abstract This article supports the call for the sensorially engaged anthro-
pological study of healing modalities, popular health culture, dietary prac-
tices, drug foods and pharmaceuticals, and idioms of distress. Six concepts
are of central importance to sensorial anthropology: embodiment, the
mindful body, mimesis, local biology, somatic idioms of distress, and ‘the
work of culture’. Fieldwork in South and Southeast Asia and North America
illustrates how cultural interpretations associate bodily sensations with
passions (strong emotions) and anxiety states, and bodily communication
about social relations. Lay interpretations of bodily sensations inform and
are informed by local understanding of ethnophysiology, health, illness, and
the way medicines act in the body. Bodily states are manipulated by the
ingestion of substances ranging from drug foods (e.g., sources of caffeine,
nicotine, dietary supplements) to pharmaceuticals that stimulate or suppress
sensations concordant with cultural values, work demands, and health
concerns. Social relations are articulated at the site of the body through
somatic modes of attention that index bodily ways of knowing learned
through socialization, bodily memories, and the ability to relate to how
another is likely to be feeling in a particular context. Sensorial anthropology
can contribute to the study of transformative healing and trajectories of
healthcare seeking and patterns of referral in pluralistic healthcare arenas.
Key words body memory • healing • sensorial anthropology • somatic
idioms of distress • trauma
Vol 45(2): 163–197 DOI: 10.1177/1363461508089764 www.sagepublications.com

Copyright © 2008 McGill University
163
Transcultural Psychiatry 45(2)
Sensorial Anthropology: Six Central Concepts

Anthropologists have coined the term sensorial anthropology to describe the
study of cultural responses to the perceptual output of sense modalities
(e.g., touch, taste, smell, sight, and sound) as well as sensations such as
dizziness, shortness of breath, chest and heart pain, indigestion, states of
hot and cold, and shifts in ‘energy’ that conjoin mental and/or emotional
states with a physical condition (Hinton & Hinton, 2002). Included in the
purview of sensorial anthropology are the study of sensations that evoke
and are triggered by embodied memories, and the study of how the spaces
and places in which bodies are situated predispose perceptions of sensation
that are associated with feelings of fear and vulnerability, well-being and
protection.
Six inter-related concepts employed within medical anthropology are
particularly useful to sensorial anthropology: embodiment (Bourdieu,
1977; Csordas, 1990, 1993; Merleau-Ponty, 1964), the mindful body
(Scheper-Hughes & Lock, 1987), mimesis (Bourdieu, 1977; Lyon, 2002),
local biology (Lock, 1993, 2005; Lock & Kaufert, 2001), somatic idioms of
distress (Mark Nichter, 1981), and the ‘work of culture’ (Hollan, 1994;
Obeyesekere, 1985, 1990). Embodiment refers to one’s lived experience of
one’s body as well as one’s experience of life mediated through the body as
this is influenced by its physical, psychological, social, political, economic,
and cultural environments. As noted by Kirmayer (2003), ‘the essential
insight of embodiment is that the body has a life of its own and that social
worlds become inscribed on, or sedimented in, bodily physiology, habitus,
and experience’ (p. 285). Csordas (1990: 12) adds that embodiment
involves one’s ‘perceptual experience and mode of presence and engage-
ment in the world.’ Embodiment is prereflexive, but not precultural
(Csordas, 1990). It is influenced by one’s ongoing socialization (class and
caste, position and habitus) as reflected in such things as taste preferences
and diet, aesthetics and style, body projects, and so on (Appadurai, 1981;
Bourdieu, 1984; Khare, 1992; Pinard, 1991; Prasad, 2006).
Embodiment is a dynamic process and a form of contextual and histori-
cal engagement that results in one’s memories becoming embedded
in associational fields composed of images as well as sensations. Within
these associational fields, experiences of the past, present, and future influ-
ence one another.1 Given that perceptions are transformed (objectified)
into objects and words, they come to symbolize, symbols in turn can evoke
experiences, memories, and sensations (Merleau-Ponty, 1962). We inhabit
embodied spaces rich in symbols and cues that trigger this two-way
process (Basso, 1996; Cartwright, 2007; Casey, 1996, 1997; Low, 2003).
The mindful body is the nexus of one’s phenomenological, social, and
body politic.2 Within one’s mindful body the sensorial, the cognitive, and
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Nichter: Coming to Our Senses
the emotional dimensions of our being in the world are coextensive and
exist in dynamic relationship. Mimesis refers to the process whereby social
and visceral correspondences come to mirror each other as copies or
resonances through such processes as iconic association.3 Relevant to the
study of sensations, the process of mimesis contributes to bodily memory
in terms of both what Bourdieu (1977, 1990) has described as durable
bodily dispositions associated with habitus (associated with familiar sen-
sational states) and the bodily memory of traumatic events. Traumatic
events become embodied through ontological resonances within a
semantic network that Kleinman (Kleinman & Becker, 1998; Kleinman &
Kleinman, 1985) has termed their sociosomatic reticulum – a concept akin
to semantic illness networks (Good, 1977). Hagengimana and Hinton (in
press) have called for a study of trauma-somatics that examines why
trauma results in particular sets of symptoms in different cultures. This
entails a consideration of the extent to which experiences of trauma are
associated with bodily processes as locally understood and experienced, as
well as social and cultural values, and organizational principles. Import-
ant to note, an appreciation of mimesis and the sociosomatic reticulum
leads one to view somatization as a normal bodily mode of experiencing
personal, social, and political distress, not a more primitive or less-
adaptive substitution for verbal articulation (Kleinman, 1995; Mark
Nichter, 1981).
Mimesis also provides us with a good platform from which to examine
the appeal of drug foods, pharmaceuticals, and recreational drugs in as
much as they (a) produce bodily states in step with social and work-related
routines and desired states, (b) are useful in dealing with negative affect
and states such as boredom, and (c) provide psychosocial and psychologi-
cal release. As noted by Lyon (2002), mimesis speaks to the interlocking of
bodily, sociocultural, and psychological processes, as well as bodily agency
when it comes to understanding why particular substances associated with
different sensational states are favored.
The concept of local biologies (Lock, 1993, 2005) acknowledges the
importance of the biological body as an active agent and the dynamic
inter-relationship between culture and biology such that biological differ-
ence can influence individual experience as well as cultural interpretations
of that experience (Lock, 1993). Lock bases most of her writing on local
biology on research carried out on the sensorial experience of menopause
in Japan in comparison with women’s experience of menopause in the
USA. Many other domains of health-related experience are worth explor-
ing in terms of local biologies, such as the impact of different staple diets
on the bodies and lived sensorial experience of different populations
across the life course and at times of illness and distress. Local biologies
need to be examined in relation to ‘local phenomenologies,’ which
165
Halliburton (2002) describes as ‘constituted by both local analytic theories

of experience and lived experience itself and assumes these influence one
another to some degree’ (p. 1126).
Somatic idioms of distress refer to the ways in which visceral responses
to distress communicate angst to significant others. Somatic sensations
resonate within one’s social universe whether consciously acknowledged
or not. Somatic distress can also constitute an expression of collective ills
(Frankenberg, 1986) when experienced as a form of somatic response to
forms of oppression.4 In some cases, this visceral expression can serve as
a form of protest, a ‘weapon of the weak’ (Scott, 1985), albeit a protest
easily medicalized (Frankenberg, 1986; Scheper-Hughes, 1991). Attentive-
ness to visceral expressions of distress can also serve as an idiom of
concern at the site of the body.
The ‘work of culture’ (Obeyesekere, 1985, 1990) refers to the process
whereby distressful states, perceived risk and motives, negative affects, and
sensations are transformed into publicly accepted sets of meanings and
symbols that can be manipulated, or dealt with in some culturally salient
manner. Importantly, Obeyesekere notes that ‘where subjective experience
is often articulated through the medium of cultural symbols, cultural
symbols are only ever imbued with significance once they are internalized
and integrated into the context of an individual’s emotional and motiv-
ational concerns’ (see Throop, 2003, p. 112). Obeyesekere further observes
that personal experience is ‘organized in the context of cultural images to
the extent that cultural templates may actually help to shape the individ-
ual’s experience of reality’ (Throop, 2003, p. 114). Healthcare seeking in
pluralistic healthcare arenas may well involve the matching of personal
experience and ‘personal symbols’ to healthcare modalities that ‘make
sense’ and resonate in visceral as well as cognitive ways.5
Sensorial anthropology explores how sensations are experienced
phenomenologically, interpreted culturally, and responded to socially. This
entails examining which sensations are treated as important/relatively
unimportant in particular sociocultural contexts by both the primary party
experiencing them and significant others. It requires an appreciation of
those sensations deemed normative and to be expected, positive, and
culturally valued (e.g., age markers); and negative and devalued, yet salient.
It also demands investigation of the social relations of sensorial experience
recognizing that the sensorial is not just experienced individually, but
‘dividually’.
I use the term ‘dividual’ as a heuristic to emphasize that one’s experi-
ence of sensations is often dynamic and transactional.6 In cultures where
social enmeshment fosters close interpersonal as well as intrapersonal
bodily monitoring, one’s experience of sensations is rarely solitary. This
may be the case even if one adopts a stoic posture and does not verbally
166
articulate what one is feeling. Sensations resonate within one’s social

network among those attentive to fluctuations in each other’s somatic
state. The ‘work of culture’ is often described as involving the symbolic
transformation of painful affects through ritual or narrative. It also
involves bodily feedback on appropriate ways to handle or deal with sen-
sorial states in culturally appropriate ways. An example might be the
visceral as well as verbal feedback a woman receives from other women
about how to handle the pain of childbirth. Another example might
involve the feedback one receives on how to handle sensations associated
with performing a particular occupational task, or handling a traumatic
event.
Ayurveda as a Formative Experience: Participant

Observation at the Site of the Body
Thirty years ago I arrived in south India with the ambitious plan of
studying the popular health culture of a south Indian community and how
the local population made use of diverse healing traditions within their
pluralistic healthcare arena. One of the first healing traditions I was drawn
to was Ayurvedic medicine. I had read about Ayurveda in preparation for
my fieldwork and had a passing familiarity with its basic principles. At least
that is what I thought until I encountered an Ayurvedic practitioner who
eventually became one of my key informants and teachers.
Ishwara came from a family of Ayurvedic practitioners and in addition
to learning at home from his elders, attended a renowned college of inte-
grated Ayurvedic medicine in Madras. There he studied both Ayurveda
and the biosciences in the 1940s. When I first met him, Ishwara was
lukewarm about teaching me Ayurveda. While he was willing to discuss
Ayurvedic principles with me, he made it clear that learning Ayurveda
required far more than the study of books. It required an understanding
of cosmology and ecology as well as knowledge of my own body gained
through adhering to a dietary regimen. He had heard from a relative who
had visited the USA that Americans had no routine diet and ate when and
whatever they pleased. ‘Without a routine diet,’ he asked, ‘how could I
know my body and its constitution?’ Without knowing my body and its
constitution how would I in turn be able to evaluate the properties of
foods and medicines? And how could I diagnose my own humoral im-
balances let alone those of others? ‘Your body’, he said, ‘must be your first
teacher. You must learn to use your senses and not just your mind.’
Gradually, I won Ishwara’s trust and he began to teach me, but not in
the way I had imagined. To an observer, he was a scholar whose house was
stacked with books on Ayurveda and other Vedic sciences, textbooks on
physics, chemistry, and botany, and books on agriculture ranging from the
167
mundane to the teachings of Rudolf Steiner on planting according to the

phases of the moon.
I do not exactly remember what I said to Ishwara about anthropology
that caught his attention, but I do remember his fascination with the
notion of participant observation. This ‘participant observation,’ he said,
‘is a method used by our rishis to gain knowledge by observing how differ-
ent ways of living (diet, work, play, etc.) affected their bodies, desires, and
mind’. ‘This participant observation,’ he joked, ‘does not sound very
British, and yet you say are a student at a British university.’
Ishwara had been a keen observer of the British and had much to say
about their rule in India. He admired the British who colonized India as
great collectors and organizers of information. Their district gazetteers
contained detailed maps and census data as well as neatly catalogued in-
formation on subjects ranging from the districts’ flora and fauna to its
archeological and pilgrimage sites, its history to its caste distribution, hier-
archy, and language dialects. ‘This is how the British ruled India,’ Ishwara
noted, namely, through knowledge, the creation of maps, rules and
measures, and a bureaucracy that came to administer many areas of Indian
civic life. ‘But,’ he paused, ‘the British never truly settled in this place. They
were great explorers and clever administrators, but they did not become
one with the land, and they did not adapt to the diet of this place. And do
you know why?’ he asked me one day as we were eating roasted jackfruit
during a heavy rain. Within a moment, he provided the response: ‘because
this would render them less British.’ With a gleam in his eye, Ishwara noted
that the British collected information on almost every subject except one.
They did not collect recipes or compile cookbooks. ‘Because they did not
adopt our diet,’ Ishwara sighed, ‘they never truly understood our system
of medicine.’
I had no idea whether Ishwara’s observations about the diet of
colonial officials in India were accurate, but I did get the gist of his
message as it pertained to me.7 Ishwara was asking me if I was ready to
alter my diet and in doing so adapt to local biology (Lock, 1993), an
experience that would provide me with a profound personal transform-
ation in the name of ‘participant observation.’ I later came to understand
why my embodying, not just ‘learning,’ Ayurvedic principles, was so
important to him.
Late one afternoon, after talking to me about the relationship between
the microcosm and macrocosm, Ishwara’s favorite subject, he asked me a
rhetorical question: ‘What do you think about the way the Indian govern-
ment treated Ayurveda?’ During this conversation it became clear to me
that Ishwara saw Ayurveda’s decline in prestige as a direct outcome of the
Indian elite adopting British ideas about Ayurveda being less scientific
than bioscience. ‘The reason the British did not respect Ayurveda more,’
168
Ishwara emphasized, ‘was because they did not appreciate Ayurveda’s keen
observations of bodily processes expressed in humoral terms. How could
they, without experiencing the body as we know it?’ As Ishwara saw it, it
was essential to Ayurveda’s future that its empirical base be validated. I got
the impression that Ishwara saw me not just as a graduate student, but as
a representative of the west.8 It was important to him that I learn about
the flow of bodily humors at the site of my own body so that I would
experience the teachings of Ayurveda as empirically grounded.9
‘If you really want to understand Ayurveda as a participant observer,’
Ishwara stated, ‘the place to begin is your stomach.’ Like many of the
Ayurvedic scholars I met, Ishwara often spoke using analogies. In this case,
he likened my adapting to the staple diet of South Kanara to a plant
learning to adapt to the soil of a new place. But his comparison of parboiled
(double boiled) rice to the soil of South Kanara was meant as far more than
an analogy. Ishwara encouraged me to literally take in the essence of the
land through the consumption of locally grown rice, vegetables, fruits, and
herbs, the water from local wells, and the milk of local cows. He saw this
internalization and embodiment of place as something essential for my
transformation (transplantation).10
Ishwara emphasized that Ayurveda must be understood and practiced
in relation to time, place, climate, local food, and the type of work differ-
ent kinds of people perform. ‘Ayurveda is an applied science,’ he often
repeated. ‘The wisdom of the ages needs to be applied to meet the
conditions of the present. You cannot assume that medicines that work
well with one person or population in south India will work equally
as well as in north India or North America because the way of life is differ-
ent and people’s staple diet and climate are different. You must learn to
adjust your practice according to the principles you are being taught. And
you must be able to read the body to adjust well. Otherwise,’ he warned,
‘you will become a “catalogue practitioner” prescribing out of the cata-
logues of medicine companies that list medicines for different sets of
symptoms.’
As an Ayurvedic vaidya (practitioner), Ishwara assumed that my bodily
transformation would not be easy and would result in discomfort for
some time. However, it was a necessary first step to both my becoming
habituated to place, and attentive to bodily sensations that I would learn
to read as signs of humoral change. To make a long story short, my first
months learning about Ayurveda involved my own digestive system.
Understand digestion, Ishwara told me over and over again, and you will
be able to understand Ayurveda. And so my wife Mimi and I adopted a
simple south Indian Brahmin vegetarian diet for two years. We came not
only to relish it, but found within Brahmanic folk dietetics the application
of Ayurvedic science in everyday life. Our local biologies and sense of taste
169
did alter and we were able to understand and participate in a daily

running commentary on foods and bodily sensations in a visceral way –
a way described by Schechner (2001) as involving ‘snout to belly to bowel
rasaesthetics.’
Ishwara watched me practice social anthropology with both interest and
some amusement. When I arrived in India, folk dietetics was one of the first
subjects I decided to study as early interviews led me to believe that the
most basic form of self-care involved dietary change – more commonly
food restrictions than food proscriptions. Initially, I attempted to catalogue
the properties of foods based on their hot/cold and humoral qualities
following procedures already used by anthropologists in Latin America and
India (B. Beck, 1969) in the 1970s. I attempted to investigate both con-
sensus and intracultural variation in the classification of foods and local
perceptions of their effect on the body (Mark Nichter, 1986). This led me
to discuss what sensations different people felt after eating different types
of foods.
Ishwara considered my surveying of individuals about their impressions
of food qualities to be superficial, although he believed that asking what
sensations they experienced after eating particular foods was a good
diagnostic indicator of their constitutions. ‘You are lumping the experi-
ences of different kinds of people together, and counting similarities and
differences by caste,’ he observed, ‘but what does that tell you?’ He believed
that in order to understand responses to foods one must examine more
than an individual’s caste, although food differences among castes were
clearly important to consider. He encouraged me to think further in terms
of informants’ body constitution and humoral disposition, their state of
health, season, and occupation.11 ‘Your anthropology skims the surface
of the sea and does not take into account its currents, the wind, or tide,’
he stated. ‘To understand the sea you must sail the sea and to understand
the qualities of food you must use your own senses and consume foods
alone or only with rice (a staple baseline diet) and see their effect on your
constitution.’
Ishwara was keen that I personalize this learning experience. He empha-
sized that it was essential for me to learn to trust my body and read
sensations as signs of interaction between the properties of substances and
the state of my body. ‘It is for this knowledge,’ Ishwara stated, ‘that patients
consult Ayurvedic vaidya and ask what foods they should or should not
eat when they are ill. They already have a general idea of what they should
or should not eat during illness, but they look to us for more specific
advice based on our expert assessment of their state of humoral imbalance
and how this will be affected by foods and medicines. We speak from the
knowledge of experience, knowledge grounded in our own experience as
well as that learned from those we have observed closely in our practice.
170
Our patients’ bodies teach us about the flow of humors (dosha) if we are
attentive.’
And so I spent months eating foods and sampling medicinal plants and
reporting to Ishwara what sensations I felt after consuming them. Ishwara
often baited me. He would not tell me the name of a plant until I had
tasted it and commented on the sensations I felt after consuming it. He
pushed me further and asked me to learn about my body constitution by
examining why I desired certain tastes and why I had an aversion to other
tastes when healthy or when ill.
Trying to read my body’s hungers (desires) was the most difficult chal-
lenge I faced. I was presented with a basic dilemma: was my body desiring
some taste because that is what was needed to achieve balance (the way an
animal knows to eat a particular plant when ill), or was it my illness (bodily
imbalance) that produced a desire as a sign of imbalance? Ishwara repeated
his father’s favorite saying to me often: ‘Disease is a hunger and medicine
a food for that hunger. Appetite is necessary for life,’ he often remarked,
‘but uncontrolled appetites, physical as well as all forms of desire and
greed are the root causes of most hunger.’ This was a principle Ishwara saw
as basic to understanding not only Ayurveda, but also other healing
modalities such as exorcism and sorcery. The physical and mental
attributes of hungers, Ishwara emphasized, were mirror images of each
other. This enabled vaidya to refer patients to exorcists (mantravaidya)
with diagnoses that involved a form of code switching, humoral states, and
types of sensations corresponding to the attributes of particular types of
spirits and celestial bodies.
Gradually, I learned about common humoral disorders and how
they could manifest as different sets of symptoms. Each time my wife or
I became ill – or even experienced physical changes such as cracks on
the soles of our feet or at the sides of our lips (and so on), we were told
this was a good opportunity to learn about bodily imbalances. I also
observed vaidya–patient interactions at the homes and clinics of several
other practitioners and took notes on what questions they asked patients
about their body. These questions typically addressed sensations they
experienced related to taste, indigestion, hot and cold feelings in differ-
ent parts of the body, sleep, defecation, tingling sensations in the hands
and feet, feelings of heaviness, lack of strength, lightheadedness, dizziness,
and so on.
Over time, I came to better understand why such questions were being
asked and I learned to use my own senses to diagnose aspects of an indi-
vidual’s constitution and humoral imbalance. I learned to touch a person’s
skin to see if it was oily or dry – signs of wind (i.e., vata) or phlegm (kapha)
humoral predominance – and to distinguish different pulse rhythms
(although I never became good at this). All of these empirical observations
171
enable vaidya to discern patterns of sensations as signs and symptoms of

humoral predominance and imbalance. Ayurvedic vaidya gather sensorial
data and then filter it through a humoral knowledge grid that yields
patterns of associations that suggest diagnostic possibilities.
Practitioners of ‘experience near’ ethnomedical traditions like Ayurveda
learn to be attentive to the body sensations of their patients as well as to
use their own body as an instrument of diagnosis.12 Learning Ayurveda
requires vaidya to know and ‘calibrate’ their own bodies through routine
bodily regimens involving diet and lifestyle. I have presented my own
experience as a foreign novice engaged in participant observation that
required me to adopt (adapt to) the local biology of my informants in
order to understand both the way illnesses were being thought about (and
diagnosed) by experts, and how sensations were being responded to by a
lay population exposed to Ayurvedic ideas in a very diluted way. This
experience changed the way I do ethnography, for it led me to be far more
attentive to the sensorial.
Popular Health Culture: Being Attentive

to the Sensorial
Learning how those in other cultures understand their bodies entails an
understanding of ethnophysiology. Beyond knowledge of ‘parts and organs’
are local perceptions of ‘bodily processes’ often understood in terms of
analogical frames of reference involving: (a) cosmology and principles that
are assumed to pervade the macrocosm and microcosm, rendering the
body–land–universe coextensive; (b) ecological relationships observed in
nature (e.g., sun/wind/rain inter-relationships), symbiotic relationships
assumed to exist between man and other species of life, and knowledge
gleaned from studying plant and animal behavior; (c) flows and blockages
(fluid, wind, energy – hydraulics and pneumatics); and (d) processes
of transformation (e.g., digestion viewed in terms of cooking, churning),
organization (e.g., mechanical systems), and communication (e.g., com-
puter models driving ideas about immune responses). Analogical and
metaphorical understanding of bodily processes influences local biology
and bodily experiences. As pointed out by many anthropologists, popular
ideas about bodily processes, illness etiology, and pathology may also be
coextensive with dominant ideologies in society at a particular point in
time.13 In such cases, ethnophysiology is biopolitical to the extent that
it naturalizes perceptions of the ‘order of things’ and contributes to
governmentality.
Bodily sensations experienced when one is healthy or ill are commonly
interpreted in relation to bodily processes and how they are thought to be
impeded. Let me cite a few examples of how sensations inform and are
172
informed by notions of bodily processes as well as cultural health

concerns. My first example involves digestion, a process that in south India
is associated with a process of both cooking and churning, the flowing in
of food, and the flowing out of wastes.
Hunger, digestion, and defecation are the most basic parameters of
health and well-being for the vast majority of the Indian population. Rural
agriculturalists can literally tell the time of day by their hunger cycles and
taking untimely meals is considered a serious impediment to health,
rendering one vulnerable to a host of problems. In many ways, one’s
digestive cycle is like an internal clock calibrated to sensations associated
with food-transit time (hunger, defecation patterns) and activity patterns.
One of the most common discussions I had with informants in India was
about their digestive tracts, foods, and their effect on the body. Common
signs of ill health associated with digestion included the inability to eat as
much as one was accustomed to, burning sensations in the stomach or
upon defecation, low energy and lack of strength, abdominal pain while
working or bending, lack of taste or a lingering bitter or sour taste in the
mouth, gas, and the feeling that one needs to defecate but could not do
so. These signs prompted actions that varied from fasting and shifts in
what one would or would not eat to the taking of medicines to increase
digestive capacity (there are many home remedies and Ayurvedic medi-
cines for this), purge the body of wastes, or purify the blood of wastes now
circulating within the body. In some cases, infected wounds were thought
to be evidence that the blood was impure, especially if the pus that exuded
had a noxious odor. Many different types of bodily sensations and psycho-
logical states (lethargy, dullness, lack of interest) led people to think
that their digestion or the flow of wastes out of the body was not correct.
These sensations were taken seriously and guided the most basic forms of
self-care.
In the case of young children, bodily sensations associated with the
movement of worms in the body proved to be very important. In south-
western Karnataka state, India, the term givana da hulla (worms of life)
refers to worms one inherits from one’s mother via the breast milk. These
worms are thought to both churn foods in the stomach (much as earth-
worms churn soil) and consume waste in the stomach bag (much as snails
might clean the inside of a fish tank). A limited number of worms are
considered necessary for life, but too many are thought to cause problems.
For this reason, home-care practices are undertaken to control both the
number and activity of worms in the gut, lest worms migrate and cause
mischief – evident when worms are seen exuding from a child’s anus or
nose.
It is beyond the scope of this article to examine cultural notions of
worms and their symbiotic relationship with humans in great depth (see
173
Geissler, 1998 for a good case study in Kenya). The point I want to make
here is that many bodily sensations experienced by babies and young
children that are expressed nonverbally are linked by mothers to worm
activity because of notions of ethnophysiology that guide subjunctive
‘what if ’ thinking. For example, there is a tendency for mothers to think
that worms are responsible for a baby or young child crying. It is imagined
that the worms are hungry and restless and are demanding food. When
the worms are not fed it is perceived that they begin to eat at the flesh of
the child. And if a baby vomits up breast milk or does not take to the
breast, it is the worms that may be rejecting the mother’s milk. In such
cases, a mother may be encouraged to feed the child rice water (or glucose
solution). Breast milk will be introduced gradually so the worms can
become accustomed to it.
I once asked Ishwara about mothers’ perceptions of worm activity, and
his answer integrated Ayurvedic principles with local notions of ethno-
physiology. He noted that if one’s body humors were in balance, their body
did not accumulate wastes (Sanskrit: mala) and worm problems would not
occur. However, when digestion was not correct, wastes accumulated and
worms multiplied and sometimes migrated. Ishwara did not discount
mothers’ perceptions of worm activity, but he perceived worm activity to
be a sign of a more fundamental humoral imbalance that would not
simply be rectified by calming worms. He was attentive to mother’s obser-
vations of worm activity, but his reading of worm activity as a vaidya
differed markedly.
When children do not yet have a vocabulary to express the sensations
they feel, it is mothers who have to interpret what is troubling a child using
their ‘common sense’ as well as their own senses. Mothers monitor the
health of their children through touch, smell, sight, and sound. This
became clear to me while conducting research related to respiratory
disease in both India and the Philippines. I was commonly told by mothers
that they knew when their children were becoming ill by changes in how
they sucked breast milk (felt by mothers at the site of the breast when the
breast became engorged with milk due to poor sucking), the sound of their
breathing, the movement of their stomach and chest when breathing was
labored, the amount and smell of their sweat, their urine color and stool
consistency, their gaze, and their activity level. In coastal Karnataka, Indian
mothers spoke of their children having ‘inside fever’ (Kannada: ole jwara),
discernible to their touch at different parts of the body, although not
necessarily registered by a thermometer in the usual locations temperature
is taken. In some cases, internal fever was associated with other heat-
related symptoms such as skin rashes that were noted along with other
body sensations like a child’s thirst or even the cracking of the child’s feet
(a place heat was thought to escape).
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In the Philippines, when a child suffered from labored breathing or a

deep cough, I observed that many mothers became concerned about pilay
hangin. This is a condition that can occur when a child falls or is held too
tightly, resulting in bodily dislocations that can impede breathing and
cause or complicate respiratory illness (Mark Nichter & Nichter, 1994).
Most mothers do not feel that they have the ability or sensitivity to
diagnose pilay and take their children to native practitioners for diagnosis.
These practitioners are thought to have heightened sensitivity that allows
them to be able to touch the child’s back and identify dislocations, which
are then treated by massage and herbal preparations. Filipino mothers
often suspected that their child’s illness was climate induced, but still
checked for pilay. In addition to the sound of a child’s labored breathing,
bodily movements and other sensations mothers observed as unusual
raised an alarm that the problem might not simply be associated with the
lungs. They wanted to check for pilay as a ‘just in case’ precaution before
they spent money on a doctor’s visit or allopathic medicines as bodily
dislocations were thought to render doctors’ treatments ineffective
(Mark Nichter & Nichter, 1994).
A sense of vulnerability and local perceptions of illness as latent or
cumulative can lead people to be hypervigilant to bodily sensations. Let
me cite two examples. When HIV first received press in India in the early
1990s, I encountered several men who tested seronegative for HIV in
Kerala and Karnataka state, yet suffered from AIDS-related phobia
(Chandra & Ravi, 1995; Jacob & John, 1989). Similar to men whom I had
studied during the 1970s who had experienced semen-loss (dhat)
syndrome, many of these men suffered from anxiety and guilt associated
with having had sex with a prostitute.14 In some cases, this event had
occurred recently, while in other cases the event had occurred several years
before. During interviews with these men, a wide range of sensations was
reported as perceived signs of HIV. These included feelings of weakness,
inability to concentrate or control one’s emotions, loss of appetite, feeling
of heat inside the body (inside fever), paresthesia in the hands or feet,
tingling or burning sensation in the genitals when they urinated, skin
rashes, palpitations, or a racing heartbeat, and in one case an increased
sensitivity to the smell of menstrual blood. Many of these symptoms have
been reported globally as biological signs of anxiety, but some had particu-
lar cultural salience. They fit a cultural pattern of symptoms that were
all thought to manifest as a result of uncontrolled heat in the body. One
informant described HIV to me as a heat-related disorder that manifested
internally first and then gradually worked its way to the surface, resulting
in skin rashes and then open sores, heat-related indigestion, diarrhea and
weight loss, and tuberculosis.15 Every time he experienced heat-related
sensations, he was sure that his HIV was about to manifest. He interpreted
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an HIV diagnostic-test message asking people to come in for an AIDS test

three months after risky sex to mean that seeds of AIDS could lie dormant
in the body for months, if not years, before growing large enough to be
seen. He kept returning to the clinic to check for AIDS when he felt heat-
related sensations, fearing this was an indication that the seeds of the
disease had now germinated.
In some cases, men may attempt to hasten or trigger the symptoms of
an illness they believe is latent in their body due to the feeling of bodily
sensations like heat or tingling sensations. An example of this was in
Thailand: while working on a sexually transmitted infection (STI) study,
I ran across men who were concerned about transmitting an STI to
their wives following a sexual encounter with another woman. Many of
these men were working far from home as migrant laborers. Several
of these men had become hypervigilant near the time they were due to
travel home. They worried about burning sensations they experienced
while urinating and monitored the pressure of their urine stream, as well
as the color and smell of their urine. In only one case did a man go to a
clinic and ask for a diagnostic test (the test was for HIV although he had
sex within the past month). Some of the other men immediately took
‘combination medicines’ (Thai: yaa chud) following the experience of
unsual bodily sensations. Packets of yaa chud medicines are sold at drug
shops (although illegal) and often contain a combination of antibiotics
and diuretics. Other men attempted to hasten the manifestation of latent
illness so they could see if they were ill. A variety of food thought to trigger
symptoms (fermented fish paste dishes, specific fruits and vegtables) was
eaten and the person then waited to see what would happen. If symptoms
or unsual sensations manifested or were exacerbated, they sought
treatment.
Sensorial Anthropology and the Study of

Pharmaceutical Practice
Bodily sensations experienced after taking medications influence
whether medications are considered effective/ineffective or compatable/
incompatabile. Notions about ethnophysiology, illness etiology, and how
a medication is thought to act in the body influence whether sensations
experienced after taking a medicine are judged in a positive or negative
light (Etkin, 1992; Mark Nichter, 1989; Mark Nichter & Nichter, 1996).
For example, in India I have encountered people who have experienced
diarrhea, a burning sensation, or colored urine after taking a medicine and
viewed this as an anticipated part of the healing process associated with
the removal of toxins or heat from the body. I have documented other
people in the same community negatively evaluating these sensations as
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well as such sensations as a bad taste in the mouth, dry mouth, light
sensitivity, and so on. Cultural interpretations of medications are an
important issue to consider when trying to understand both non-
adherence and a population’s propensity to complain or not complain
about the sensations they feel as side effects of medication.
In some instances, sensations that one might think of as negative side
effects are valued. For example, I have been told by many people in India
that the experience of a burning sensation felt in the body following taking
a medicine is a measure of the medicine’s strength. Other anthropologists
have made similar observations. For example, in Malawi, women in-
frequently complain about the side effects of chloroquine because they feel
these symptoms indicate the drug is working (Helitzer-Allen, 1989). This
is a case of a side effect being interpreted as a demonstration of efficacy.
Van der Geest (1982) has reported that the side effects of a medicine are
valued in a region in Ghana where spurious drugs are commonly found
in the market. In many regions of the world, informants feel they know
they were taking the ‘real drug’ by its tell-tale signs in the body. Other social
scientists have corroborated this ‘proof ’ function of side effects in markets
that are ever more polluted by poor quality and bogus drugs (Cockburn,
Newton, Kyeremateng Agyarko, Akunyili, & White, 2005).16
Cultural perceptions of compatibility also play an important role in how
people determine the suitability of particular types of medication for their
personal use. Compatibility – the fit between medication and the bodily
constitution of an individual – is used to explain why a medication proves
efficacious for one person and not another, given a similar type of
complaint. Described most extensively in research in the Philippines as a
concept guiding pharmaceutical use (Hardon, 1987, 1991, 1994; Tan, 1994,
1996), I have encountered variations of the concept in Indonesia and
Thailand, and Craig (2002) has described the importance of the concept
in Vietnam. The perception of a medicine being compatible is important
for at least four reasons: (a) people may use a drug deemed compatible as
self-treatment for a wide variety of complaints; (b) drug effectiveness may
be misjudged after a short time if expectations of a drug are unmet, leading
the user to think the medicine is incompatible; (c) side effects may be seen
as a sign of drug’s incompatibility;17 and (d) noncompliance with medi-
cation prescribed may be justified on the basis of a medicine not being
compatible (Mark Nichter, 2002).
Little research has been conducted on how medicines are evaluated in
respect to compatibility. My own research suggests this to be determined
as much by how sensations associated with medicine use are interpreted as
by immediate relief from symptoms, especially when there is a concern that
the medicine will impact on important bodily functions (such as digestion
and defecation) and one’s capacity to work. A cultural consideration of
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popular and unpopular regimens used to treat a particular illness needs to

take stock of local perceptions of sensations associated with taking specific
drugs.18
Sensorially engaged research also needs to explore two other areas of
pharmaceutical experience. In what contexts and to what extent do
sensations related to the progression of an illness become conflated with
the sensations caused by the medications used to treat or manage the
illness? In the case of an asymptomatic condition like hypertension, I have
come across patients in North America who have conflated the side effects
of medications (and warnings about side effects on labels) with the
condition itself. In some cases, people become hypervigilant about these
sensations, interpreting them as an escalation or flare-up of the condition.
A second area of research called for is a sensorially engaged ethno-
graphic assessment of the pharmaceutical management of emotional
and psychological states, and the production of neurochemical selves
(Chatterjee, 2004; Martin, 2006; Rose, 2003). How do medicated states of
being affect the experience of different types and ranges of sensation,
attentiveness, and perceptions of what social and work environments are
tolerable? Also begging consideration is how the cultural interpretation
and salience of particular emotional states influence the popularity of
pharmaceuticals such as antidepressants (Kirmayer, 2002).
Sensorial Anthropology and the Study of Tobacco,

Drug Foods, and Dietary Supplements
A sensorial approach to ethnography also provides valuable insights into
the use of drug foods such as tobacco, caffeinated beverages, dietary
supplements, and so on. Mimi Nichter and I have paid close attention to
the sensorial in our research on tobacco use in South and Southeast Asia
and the USA, and areca nut use in India (Mark Nichter for the Project
QTI Group, 2006; Mimi Nichter, Nichter, & Van Sickle, 2004). In the
Philippines and Indonesia, people overtly describe searching for brands of
cigarettes that are compatible with their body, believing that the right
cigarette will not harm their body and even be a useful form of self-
medication. Their evaluation of compatibility is based on the presence of
positive sensations such as relaxation or reducing ‘stres,’ as well as the
absence of negative sensations – smoking not affecting their appetite or
causing unpleasant sensation in the throat or lungs. In Indonesia,
cigarettes are specifically smoked to reduce unpleasant thoughts and
bodily sensations associated with stress (Mark Nichter for the Project QTI
Group, 2006; Mark Nichter, Nichter, Padmawati, Thresia, & the Project
QTI Group, forthcoming). Cigarettes are explicitly marketed as a good
means to do so with advertisements portraying stressful situations in life
178
(from problems with a girlfriend or a boss to worries about the cost of

living or unemployment), with the invitation to just smoke and enjoy
(Mimi Nichter, 2006). Control of the emotions among Javanese men is
culturally condoned and cigarettes are positioned as a substance that will
assist one to manage negative affect as well as to engage in positive social
interactions.
In the USA, we have studied smoking initiation among youth and found
differences in the way sensations of early smoking episodes are experi-
enced (Acosta et al., 2008). For some youth the common experience of
dizziness following one’s first few cigarettes was experienced negatively,
whereas for others the experience was talked about in more positive terms
such as ‘a high’ or ‘a buzz’. Do such different responses help predict who
goes on to become a routine or heavy smoker?
Another area of tobacco use we have been examining among college
students is ‘party smoking.’ Beyond issues of social identity, affiliation, and
peer influence we are investigating other forms of utility associated with
smoking. Some students smoke to moderate the effects of alcohol (Mimi
Nichter et al., 2006). While some smokers boost a high from alcohol by
smoking, others speak of regulating a high by smoking and putting them
back in a steadier bodily state, when they feel they are getting too drunk
(or intoxicated from another drug).
In India, our research on betel nut (areca nut) use taught us to look at
not just positive and negative sensations, but also states where lack of
sensation is marked. One of the most common reasons people cited for
chewing areca nut was to reduce the experience of tastelessness in the
mouth (Tulu/Kannada language: chappe). Curiously, this sensation of
chappe was described both at times of hunger and after finishing a meal.
In other contexts chappe is complained about by those with negative affect
and one vaidya described the state to me as having no taste for life – a
condition caused by poor digestion. Other reasons areca and tobacco are
consumed are to warm the body when working in the rain, or to give a
work boost, as areca has a mild stimulant effect.
Sensorial anthropological research has much to contribute to studies of
the social utility and popularity of other drug foods ranging from those
having a stimulant to a sedative effect, especially at specific junctures of
history among particular groups of people. Anthropologists and historians
have documented the significant role that drug foods such as sugar, tea,
coffee, tobacco, and alcohol played in the expansion of the world market
system during the fifteenth and sixteenth centuries (Bradburd &
Jankowiak, 2003; Jankowiak & Bradburd, 1996; Mintz, 1996; Schivelbusch,
1992). To increase production in an emerging capitalist economy, the use
of stimulants was fostered to enhance physical performance by increasing
endurance, concentration, and the intensity of physical work. Drug foods
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were also used for the relief of physical pain associated with hard labor
and to suppress negative emotional states, allowing colonial workers to
‘tune out the wretchedness of life’ in conditions that might have otherwise
been intolerable (Bradburd & Jankowiak, 2003).
In present-day society, drug foods and dietary supplements are
also being used to keep people in step with the production process
(E. P. Thompson, 1967), the dictates of a fast-paced hyperstimulated
society (a condition that Vuckovic, 1999, 2000 has described as ‘time
famine’), and the boredom and restlessness experienced as a side effect of
a hyperstimulated state (Stromberg, Nichter, & Nichter, 2007). We need
sensorial ethnographies of how people use drug foods and drugs
(vitamins, dietary supplements, stimulants, sleeping medications, and so
on) to help them cope with the demands of the world in which they live.
Recently, Jennifer Thompson and I have been investigating not only
when and why people use dietary supplements, but how they determine
how much of a herbal supplement to use based on the sensations they
feel in their bodies, perceptions of bodily constitution, and sensitivity
to medicines (Mark Nichter & Thompson, 2006; J. J. Thompson &
Nichter, 2007).
Sensorial Anthropology and the Study of Somatic

Idioms of Distress and Concern
As one gains perspective into how visceral states and sensorial experience
are interpreted in different cultural contexts, somatic modes of attention
and inattention became more apparent. Csordas (1993) has spoken of
somatic states of attention as culturally elaborated ways of attending to
and with one’s body in surroundings that include the embodied presence
of others. The individual body is coextensive with that of other agents
inhabiting the same social environment. Their biorhythms and consump-
tion patterns, tastes, and desires are known by significant others. For this
reason, research on idioms of distress calls for close examination of both
somatic states of attention and mimesis, where the bodily states resonate
with affective states. In south India, common ways of experiencing and
expressing distress at the site of the body include shifts in food consump-
tion recognized by family members as well as physical complaints such as
the sensations of having a ball or mass (Kannada: gulma) in the stomach,
making it difficult to eat or digest food, a phenomenon associated with
both humoral imbalance (Ayurvedic diagnosis of ama) as well as sorcery.
Other complaints take on social salience when expressed verbally or
nonverbally through the act of taking medications or the seeking of prac-
titioners. Common complaints include constipation (blockage in flows),
burning sensations (uncontrolled heat), dizziness (imbalance), the feeling
180
of toxicity (Kananada: nanju), tastelessness, dullness, lack of strength,

semen loss, menstrual complaints and complaints of white discharge
(leucorrhea), nerve troubles (Kannada: nara dosha), and more recently
‘BP’ or ‘pressure.’ BP is becoming increasingly common as a medical diag-
nosis and many pharmaceutical products have appeared on the market to
address this ‘complaint.’ Local understanding of BP associates the
complaint with too much thinking (cascades of negative thoughts and
circular thinking), mental worries, and negative affective states, as well as
inappropriate diet, poor blood quality, and heat in the body. All of the
aforementioned complaints speak to ‘break down,’ ‘imbalance,’ ‘powerless-
ness,’ and ‘blockage’ in social as well as bodily processes. And as Kirmayer
and Young (1998) have noted, these somatic states may be indicative of
any combination of seven things: an index of a disease or disorder, a
symbolic expression of intrapsychic conflict, an indication of specific
psychopathology, a culturally salient idiom of distress, a metaphor for
experience, an act of positioning within a local world, or a form of social
commentary or protest.19
I have argued earlier (Mark Nichter, 1981) that in order to understand
how and when idioms of distress available in particular cultural contexts
(from the somatic to sorcery or spirit possession) are engaged, it is import-
ant to know what feedback is received from significant others. It is also
important to study how practitioners interpret and treat manifestations of
distress while engaging in ‘the work of culture.’ In the case of indigestion,
a common idiom of distress that I have written about at some length
(Mark Nichter, 2001), Ayurvedic vaidya treat humoral imbalance as the
root cause of many problems we would tend to see as psychological or
psychosomatic, believing that once balance is achieved and rhythms re-
established in the body/mind, then social solutions may be possible to
discern or act upon. Beyond treating a patient’s humoral state and reinstat-
ing bodily rhythms, Ayurvedic treatment may have a variety of social
impacts. It could be argued that in some cases this treatment medicalizes
what is essentially a psychosocial problem by focusing on an individual’s
humoral imbalance instead of family dynamics, provides the patient some
form of secondary gain by directing attention to them by family members,
provides the patient with a way of focusing on themselves or thinking
about their problems in a new way, or provides them with an ally or strong
protector (more common in the case of exorcists – mantravaidi) who looks
after their well-being and is attentive to their concerns, needs, and fears.
The act of receiving Ayurveda treatment at home or in a clinic may also
provide an aesthetically pleasing sensual environment associated with
positive memories and sensations triggered by smells, tastes, visual cues
(images of deities, etc.) and being touched (Farquhar, 1994; Halliburton,
2003). A positive placebo response may be triggered by associations with
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past treatment experiences encoded as positively charged embodied

memories associated with particular affective and sensory states.
Sensations associated with the smell of a herbal decoction boiling may
evoke associations not only with a particular medicine, but with the
experience of being cared for by a particular healing modality or a particu-
lar person (practitioner, significant other, etc.). The way of administering
medications (or treatment) and the performing of particular types of
rituals in conjunction with giving medication may evoke further positive
sensations and constitute an idiom of concern. Just as trauma is embodied
and triggered by cues (objects, symbols, spaces, times, etc.), so too positive
memories and affective and sensorial states are embodied and may be
evoked by healing modalities.
Two recent trends that influence somatic idioms of distress and concern
are worth highlighting. The first is the current propensity to mask and
medicalize sensations that once served as somatic idioms of distress. I
began noticing this trend in India in the late 1970s during the heyday of
India’s family planning campaigns. When women who had received family
planning operations at sterilization camps experienced feelings of distress
and complained about bodily sensations associated with weakness, dizzi-
ness, and heat in the body, they were given diazepam by doctors who did
not know how to manage these vague sets of sensations. Over the past 15
years I have witnessed more and more households taking family members
complaining of culturally salient somatic symptoms to doctors (general
practitioners), where they are given pharmaceutical fixes in the form of an
ever-increasing array of psychoactive drugs. I have also observed the rising
use of drugs like diazepam (under the brand name Calmpose) by the
general public purchased over the counter – although a scheduled drug –
especially in urban areas. Pharmaceutical fixes for psychosocial problems
are becoming more widely accepted. Ecks (2005) has noted that present-
day advertising for anti-depressant medication in India portrays people
(especially the urban middle class) as unmarked by depressive illness as a
result of taking pharmaceuticals that allow the afflicted individual to re-
enter social life, rendering them de-marginalized (Ecks, 2005). These drugs
are depicted as both blocking negative sensational states and enhancing
social interaction. The popularity of such drugs as technical fixes for
psychosocial, emotional, and mental health problems is also being fostered
by the psychiatry profession, which is predisposed to offer medicines to
patients as a prestigious first line of treatment now in keeping with patient
expectations (Nunley, 1996).
The commercial Ayurvedic drug industry has also responded with
products specifically designed for states of negative affect associated with
both life cycle events for women and sensations associated with negative
affect. Some mantravaidi I have followed over the years have also begun
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incorporating psychoactive drugs in the sacred ash (bhasma) or turmeric

powder preparations they give to patients to ingest during ritual cures.20
What impact does this pharmaceuticalization of negative sensational states
associated with social problems have on somatic idioms of distress, healing
modalities, and self-care? This is an important area for future research.
A second trend in India is the rising popularity of diagnostic tests
(scans) as a measure of quality of care by patients. Getting a ‘scan’ is also
being used as both an idiom of concern by family members who want to
demonstrate that they are doing everything possible to address a health
problem, and as an idiom of distress by patients. Testing technology (CT
scans, MRIs, sonograms, etc.) is readily available to the public and increas-
ingly more affordable in urban areas to even the lower middle class. It is
a profitable enterprise for practitioners and testing centers alike, who in
some cases offer walk-in services to patients without a referral or to
patients referred by indigenous practitioners (Mark Nichter & Van Sickle,
2002). This has opened up a new space for the expression of distress and
concern.
Sensations associated with anxiety states are often the focus of a scan.
And receiving a scan is enough to legitimate the afflicted’s sense of angst
to family members and for them to be seen as ‘at risk’, if not ill, with a
specific diagnosis. In many cases, the afflicted are still treated by prac-
titioners after receiving negative test results and told that tests may have
to be repeated in the future, or that their case is not serious, but needs to
be watched. After being told this, some patients become hypervigilant and
associate all manner of sensations with heart problems, pressure, nerves,
and so on.
A related trend, beginning in the late 1980s, has been for families to
directly take (without a referral) those afflicted with sensations associated
with anxiety states to neurologists and neurosurgeons to first rule out
nerve disorders and to get tested. One popular neurosurgeon I interviewed
in the city of Mangalore in 1990 estimated that more than one-third of his
first-time patients fell into this category. He was able to refer some of these
patients to psychiatrists, but many wanted to be treated directly with
medications after some form of test was administered. They wished to
receive treatment for nerve-related problems, not mental problems, which
are stigmatized.
We know little about how social response and interpretation of
sensations commonly associated with states of depression, anxiety, and so
forth are changing in cultural contexts exposed to new types of medi-
cation, forms of medical technology, and healing modalities, and the
advertising that accompanies their introduction. In North America, how
does the growing presence of complementary and alternative healing
modalities and forms of diagnosis influence how bodily sensations are
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talked about, framed, and responded to by different segments of the

population?
Sensorial Anthropology and the Study of

Transformative Healing and Trajectories
of Healthcare Seeking
There are many things we know little about related to healing modalities
and the management and release of sensations associated with patho-
logical states, negative affective states, and embodied memories. How do
healing modalities attend to deeply embedded and re-emergent sensations
associated with embodied traumatic events lodged in particular spaces of
the body (Casey, 1987) and triggered by environmental and cultural
cues, psychological states such as fear, sadness, anger, and feelings of
vulnerability? Strong emotional states and states of anxiety are often
re-experienced as a cascade of embodied sensations associated with
evocative memories, triggered by particular spaces, times, breaches in
social relations, states of uncertainty and threats to the future (the
hallmark of anxiety) or sudden shocks (of any type). What sensations
commonly accompany these states, which ones become amplified or are
dwelled upon because of their particular cultural or personal valence? And
how do different healing modalities release painful sensations through
forms of body work, energetic healing, ritual, prayer, the use of pharma-
copoeia (adopting different therapeutic strategies), and so on?
I have recently joined a team of multidisciplinary researchers attempt-
ing to look at the process of whole-person healing interventions in the
USA associated with complementary and alternative medicine treatment
(Ritenbaugh, Verhoef, Fleishman, Boon, & Leis, 2003). The focus of the
group is to better understand trajectories of change from states of stuck-
ness (chronic unhealthy repetitive patterns often marked by negative states
of sensation such as chronic pain) to the process of transformation
through which healing takes place and well-being of body–mind–spirit
and social relations emerges (Koithan et al., 2007). The group is attentive
to shifts in sensational states associated with movement in this process,
which range from the way in which one experiences the sensations of pain
or levels of energy to shifts in the acuity of one’s senses, such as changes
in taste or one’s ability to touch or feel touch. Under investigation are both
shifts in sensational states as makers, turning points, or resonances of
other associated changes and how different healing modalities catalyze if
not directly effect such changes.
Sensorially engaged anthropology can also contribute to the study of
how healing modalities treating negative states of affect and associated
bodily sensations function over time, providing us insights into trajectories
184
of care. Of key importance, although little studied by anthropologists, is

how long the effectiveness of treatments and the reframing of distressful
experiences last before they need to be recharged, and when healing leads
to long-lasting if not permanent transformation and release of negative
bodily memories.21 Victor Turner’s research into the meaning of symbols
in ritual is relevant to processual studies of healing as ‘works of culture.’
Turner pointed out that symbols are inherently unstable and that in
order to maintain their salience they must routinely be recharged by
performative acts that produce resonance between a symbol’s two poles:
one pole evoking cognitive representations related to some social and moral
order and the other pole sensory, evoking visceral states and embodied
feelings.22
A related issue demanding consideration is how sets of practitioners
work together or engage in referral to deal with different aspects of a
patient’s illness experience and process of healing. When I was first
conducting fieldwork in south India in the 1970s, it was common for well-
established Ayurvedic vaidya, astrologers, and exorcists to refer patients to
one another. An Ayurvedic vaidya would deal with negatively experienced
bodily sensations, humoral imbalances, and the re-establishment of
healthy bodily rhythms. An exorcist or astrologer (many had combined
practices) offered patients protection when they felt a heightened sense of
vulnerablity and experienced states of anxiety associated with spirits or
sorcery (acts of a strong enemy) through acts of propitiating and appeas-
ing offending spirits, emplacing them, or imprisoning them through ritual
acts (Tarabout, 2000). Ayurvedic vaidya, astrologers (jyothisni), and
mantravaidi recognized that excessive passions – anger, desire, grief –
disrupted the body/mind of the afflicted, and each did their part to reduce
feelings of vulnerability, enhance the person’s strength, and reestablish
balance. Today such referral patterns still exist, but appear to be becoming
less common in the area of south India where I have been conducting
long-term fieldwork.
We know little about patterns of referral in North America between
biomedical practitioners and complementary and alternative medicine
practitioners at a time when complementary and alternative medicine is
being used or experimented with by a significant percentage of the popu-
lation, and more and more practitioners are becoming interested in inte-
grated medicine (Institute of Medicine, 2005). When and to whom are
these biomedical practitioners referring patients who complain of illness
experiences and sets of sensations (such as manifestations of chronic pain)
for which a biomedical diagnosis and treatment is problematic? How are
such bodily states being managed in the short- and long-term by comp-
lementary and alternative medicine practitioners? Does management
involve behavior or life style change beyond being directed at symptoms?
185
Conclusion
In this article I have highlighted ways in which sensorially engaged
anthropology can contribute to the study of ethnomedicine and medical
anthropological studies of popular health culture, pharmaceutical practice,
drug food and substance use, idioms of distress and concern, transforma-
tive healing, and healthcare seeking. The meanings and experience of bodily
sensations are biosocial and need to be studied in the context of social
change. We are living at a time when thresholds of tolerance to discomfort
are decreasing (Barsky, 1988; Barsky & Borus, 1995) and the number and
variety of pharmaceutical fixes for all manner of symptoms of malaise are
increasing. Manifestations of chronic pain are becoming more prevalent in
North America (Csordas & Clark, 1992), and advancements in risk assess-
ment and profiling (and a robust risk-assessment industry) are leading to
shifts in risk subjectivities (Lupton, 1999). More and more people today are
adopting risk roles as one feature of biomedicalization (Clark, Mamo,
Fishman, Shim, & Fosket, 2003) and in the course of doing so are giving
new meaning to bodily sensations they now associate with the warning
signs of diseases. Environmental risk and perceptions of such risk are also
influencing individuals’ interpretations of somatic experience and intuitive
toxicology (Kraus, Malmfors, & Slovic, 1992; MacGregor & Fleming,
1996).23 This is also a time of increased medicalization of suffering
(Misbach & Stam, 2006) and the pharmaceutical management of emotional
states, in part driven by the pharmaceutical industry, and simultaneously a
time when more and more biomedically trained doctors are willing to refer
patients to practitioners of complementary and alternative medicine for
states of ill health they are unable to diagnose and treat effectively. It is
a time when complementary and alternative medicine modalities are
flourishing and an increasing number of people are willing to try these
modalities to promote health, as well as attend to negative sensations
associated with emotional states, embodied memories, the stress of living
in a fast-paced high-pressure world, environmental and occupational
health problems, and so on. A next generation of sensorial anthropology
will need to be attentive to these and other trends such as heightened
sensation-seeking among youth, given a faster pace of life and technology
that enables round-the-clock access to sources of stimulation, social
engagement, and enthrallment.24 We will have much to learn from an
anthropology that comes to its senses.
Notes
1. Casey (1987) draws a distinction between body memory and memory of the
body. Both are involved in linking the past to the present and future. Body
186
memory is ‘intrinsic to the body, to its own ways of remembering: how we

remember in and by and through the body . . . the way the body itself, in its
sinews and on its surface, remembers its own activity’ (Casey, 1987, p. 147).
Body memory occurs when one experiences sensations in the present similar
to those they have experienced in the past, such that memories, fears, etc.
influence the present experience. In memory of the body, the body is the
object of recollection in the mind. Memory of the body involves how indi-
viduals remember and narrate bodily events. At issue is the extent to which
changes in memory of the body may affect changes in body memory such as
the release of traumatic bodily memories and their associated sensations.
2. Three perspectives from which the body may be viewed are: (a) as a phenom-
enally experienced individual body-self; (b) as a social body, a natural symbol
for thinking about relationships among nature, society, and culture; and (c)
as a body politic, an artifact of social and political control (Scheper-Hughes
& Lock, 1987).
3. I find it more useful to think of mimesis in terms of resonance between
mind–emotions–body than mind–body mirroring. Mimesis is one way of
understanding both the metaphoric (similarity) and metonymic (contiguity)
contexture and interlinking of cognitive, affective, and bodily experience. See
Kirmayer (1992, 1993) on how metaphor links bodily, persona, and social
experience and the need to study metaphor in relation to praxis and not just
cognition. My use of the term resonance draws upon the phenomena of
‘string resonance’ (sympathetic vibration) in music and applies it to the
body–mind continuum. I view mimesis as one means through which humans
organize experiences across domains through iconic relations, homologies,
and perceptions of common processes often elaborated in healing systems
and ritual.
4. Sickness, in these contexts, can be read as ‘bodily idioms for registering
protest and for negotiating power relations’ (Scheper-Hughes, 1991, p. 56).
5. Personal symbols according to Obeyesekere (1981) are: ‘cultural symbols
whose primary significance and meaning lie in the personal life and experi-
ence of individuals’ (p. 44). In a culture replete with symbols like south India
with its complex local and pan-Indian cosmology and pluralist healthcare
arena, different people assign different levels of significance to various
symbols depending on the degree to which they have been rendered personal
and internalized. Personal ties to symbols may be cognitive, emotional,
sensorial, or affiliational (associated with social formations of the living and
deceased) with the most powerful symbols producing an embodied as well
as a cognitive response. As Halliburton (2004) has noted, pluralistic health-
care systems afford the afflicted a greater pool of resources to draw upon and
a greater opportunity to find a fit between patient and modality. This may
influence outcome studies for mental health in societies with fewer and
greater variety of healing modalities.
6. Marriott (1990) has argued that in India a nonwestern sense of the self as
‘dividual’ contrasts with the western notion of individuality and autonomy
as the foundational aspects of identity. Western conceptions of self or
187
‘personhood’ tend to be bounded, stable, enduring, and impermeable.

Dividuality is a transactional conceptualization of selfhood based on the idea
of a permeable self and dynamic interchange within one’s environment that
alters one’s very being. I use the term here as a useful heuristic and am not
endorsing broad application of Marriott’s rather Brahmanic (textual)
interpretation of perceptions of self in India.
7. The relationship between diet and the domestication of imperialism in
British India is actually quite complex (see Appadurai, 1988; Procida, 2003;
Zlotnick, 1996).
8. For a similar observation on how the ethnographer is addressed as a repre-
sentative of the ‘west’ at some points of an interview see Trawick (1992).
9. See Engler (2003) on struggles to claim legitimacy for Ayurveda through the
valorization of empirical observations.
10. See Zimmerman (1987) for a discussion of the biogeographic and topo-
logical aspects of Ayurvedic medicine and the ways in which bodily consti-
tution and local ecology interact such that one takes on qualities of one’s
environment. Zimmerman notes how the plants and animals of particular
places concentrate the essences of that place, and how these essences are in
turn passed on to humans through the processes of eating and subsequent
humoral transformation (cooking). To some extent one’s identity is environ-
mentally constituted (Brennan, 2002).
11. On the importance of constitution and disposition in Ayurveda see Singh
(2007).
12. I am not claiming that the only way healers come to know the experiential
state of their clients is through the use of their bodies. Indeed, some healing
traditions call for a healer to dissociate themselves from their own bodies in
order to feel the presence/consciousness/spirit of those who are the subjects
of divination. Moreover, what constitutes the boundaries of the body varies
by healing tradition and may well include a sense of being that extends
beyond the skin. Some mantravaidi, for example, accord significance to the
direction from which the afflicted individual approaches their house,
the time of consultation, qualities of the earth taken from the house of the
afflicted, social interactions between members of the party representing
the afflicted, and so on.
13. See, for example, Sivin (1995) and Unschuld (1985) on the relationship
between Confucianism and Chinese medicine or Martin (1987, 1990, 1994)
on how biomedicine and popular health culture in North America reflect
both Fordist and flexible accumulation as well as gender ideology.
14. Dhat syndrome (Bhatia & Malik, 1991; Edwards, 1983; Mark Nichter, 1981;
Ranjith & Mohan, 2006) is often associated with masturbation as well as with
having visited a prostitute and typically involves complaints of weakness,
inability to concentrate, having a penis that hangs to the right or left, and fear
of impotence, as well as inability to maintain an erection with a woman. I did
not come across anyone suffering from pseudo-AIDS who associated this
disease with masturbation and only one who associated it with homo-
sexuality. I came across several men who suffered from this syndrome after
188
having ‘mixed’ (had intercourse) with women while working in the gulf as
migrant workers.
15. Tuberculosis is thought to be predisposed, if not caused, by many things in
India (Mark Nichter, 2008) including excessive states of bodily heat associ-
ated with excessive sex, alcohol consumption, or smoking.
16. Drug counterfeiting has reached epidemic proportions and constitutes a
major challenge for global health. The World Health Organization (WHO)
estimates that at least 10% of the global drugs market consist of counterfeits
(Kelesidis, Kelesidis, Rafailidis, & Falagas, 2007; Newton et al., 2006; WHO,
2006). A study conducted in WHO’s Southeast Asia Region in 2001 revealed
that 38% of 104 antimalarial drugs on sale in pharmacies did not contain any
active ingredients (Aldhous, 2005).
17. A drug’s negative side effects may go unreported in a population if people
feel the medicine has not worked for them due to incompatibility. The
perception is that the drug might be compatible for others. In a similar vein,
drug resistance is often thought about in individual rather than population-
based terms.
18. For example, in a study of people’s evaluations of leprosy-treatment regimens
in Thailand, Boonmongkon (1995) found that patients viewed multidrug
therapy positively, reporting that they experienced a sensation of lightness,
which is locally associated with good health. By contrast, a mono-drug
therapy was considered by many people to produce an unhealthy feeling of
heaviness.
19. Disciplines like epidemiology need to take the cultural meaning of symptom
and sensation states seriously when developing syndromic management
plans. See, for example, Trollope-Kumar’s (2001) review of the research on
the meaning of leucorrhea among South Asian women. This review validates
observations I made about this bodily state being used as an idiom of distress
(Mark Nichter, 1981).
20. Prior to their use of modern drugs, some exorcists used herbal drugs that
have psychoactive pharmaceutical properties like Rauwolfia serpentina.
21. My use of the term ‘reframing’ does not specifically relate to cognitive
reframing. As noted by Kirmayer (2003), healing does not necessarily reframe
‘meaning’ in a cognitive sense, it can also reframe ‘experience’ on a sensorial,
emotional, and bodily level.
22. Although outside the scope of this article, the study of how ritual works
clearly requires an assessment of the sensorial experience of ritual and how
associative states are experienced by the mindful bodies of participants in
sociosomatic terms that translate social experiences into embodied responses
(Kirmayer, 1993, 2004; Kleinman & Becker, 1998). For example, sensory states
associated with particular types of spirit possession in the area of south-
western India where I have conducted fieldwork (Tulunadu) are induced
through the distinctive smell of areca nut inflorescence (singara). Although
the symbol of areca inflorescence is cognitively evocative and polysemous, it
is the distinct smell of singara that is a potent trigger of associations in ritual
contexts further marked by the smell, sight, and sound of other ritual items.
189
23. Kraus et al. (1992) describe humans as ‘intuitive toxicologists relying on their
senses of sight, taste, and smell to detect harmful or unsafe food, water, and
air.’ In our current risk society (U. Beck, 1992, 1996; Giddens, 1990) people
living in industrialized countries increasingly feel vulnerable to risks from
technology, and doubt that government regulations and agencies protect
them adequately from chemical risks due to the political and economic power
of corporate interest groups. In such a climate, argue MacGregor and Fleming
(1996), somatic sensations associated with psychological states ranging from
stress to depression may be attributed to environmental pollutants, and
apprehension about occupational and environmental risks may make people
hypersensitive to sensory cues associated with a range of experiences.
24. There is a need to study not just the desire for particular sensations, but the
seeking of sensations as arousal, and boredom as a state of nonarousal and
nonengagement and how this is responded to by youth (Stromberg et al.,
2007).
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Mark Nichter, PhD (University of Edinburgh, 1977) and MPH (Johns Hopkins
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Public Health at the University of Arizona, Tucson. He coordinates the graduate
medical anthropology training program in the Department of Anthropology. His
interests include the anthropology of the body, health and illness; risk and harm
reduction; global health; clinically applied anthropology; political ecology; the
process of healing and ethnomedicine. He has conducted significant ethnographic
fieldwork in South and South East Asia as well as the USA and has been a social
science advisor for the International Network of Clinical Epidemiology for over
two decades. He is currently involved in research on tobacco in the USA,
Indonesia and India. Among his publications stand the following books: Global
Health: Why Cultural Perceptions, Social Representations, and Biopolitics Matter
(2008); with Margaret Lock (eds., 2002) New Horizons in Medical Anthropology;
with Mimi Nichter (1996) Anthropology and International Health: Asian Case
Studies; and Anthropological Approaches to the Study of Ethnomedicine (ed., 1992).
Professor Nichter has published over 70 articles and book chapters related to
medical anthropology. Address: Haury Building, University of Arizona, Tucson,
AZ 85721, USA. [E-mail: Mnichter@u.arizona.edu]
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Transcultural Psychiatry: Anthropology Coming To Our Senses: Appreciating The Sensorial in Medical

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Transcultural Psychiatry

Coming to Our Senses: Appreciating the Sensorial in Medical

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Citations (this article cites 75 articles hosted on the

Coming to Our Senses: Appreciating the Sensorial

Vol 45(2): 163–197 DOI: 10.1177/1363461508089764 www.sagepublications.com

Sensorial Anthropology: Six Central Concepts

Halliburton (2002) describes as ‘constituted by both local analytic theories

articulate what one is feeling. Sensations resonate within one’s social

Ayurveda as a Formative Experience: Participant

mundane to the teachings of Rudolf Steiner on planting according to the

did alter and we were able to understand and participate in a daily

enable vaidya to discern patterns of sensations as signs and symptoms of

Popular Health Culture: Being Attentive

informed by notions of bodily processes as well as cultural health

In the Philippines, when a child suffered from labored breathing or a

an HIV diagnostic-test message asking people to come in for an AIDS test

Sensorial Anthropology and the Study of

popular and unpopular regimens used to treat a particular illness needs to

Sensorial Anthropology and the Study of Tobacco,

(from problems with a girlfriend or a boss to worries about the cost of

Sensorial Anthropology and the Study of Somatic

of toxicity (Kananada: nanju), tastelessness, dullness, lack of strength,

past treatment experiences encoded as positively charged embodied

incorporating psychoactive drugs in the sacred ash (bhasma) or turmeric

talked about, framed, and responded to by different segments of the

Sensorial Anthropology and the Study of

of care. Of key importance, although little studied by anthropologists, is

memory is ‘intrinsic to the body, to its own ways of remembering: how we

‘personhood’ tend to be bounded, stable, enduring, and impermeable.

Farquhar, J. (1994). Eating Chinese medicine. Cultural Anthropology, 9(4),

labor performance: A cross-cultural perspective. Current Anthropology, 37(4),

systems research: A discipline for studying complementary and alternative

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